A tale of two systems

A decade or so ago I spent a year consulting to a Big 3 automaker in Detroit. I was surprised by the level of complacency I observed toward quality and styling. (Shouldn’t a company that’s made cars for 100 years be able to build a reliable engine and transmission?)  I came to believe that one of the root causes was that the Big 3 compared themselves to one another rather than to the best in the world.

Something similar is going on in health care. It seems like every couple of weeks I read an article about how terrible the Canadian health care system is, inevitably by someone who is trying to preserve the status quo in the US system. Today’s example, ‘Too Old’ for Hip Surgery in the Wall Street Journal is a case in point. It starts in the usual way:

President Obama and Congressional Democrats are inching the U.S. toward government-run health insurance…. Before proceeding further, here’s a suggestion: Look at Canada’s experience.

The article then details a number of ugly anecdotes:

  • Someone whose MRI was delayed by the waiting list and then found out they had a brain tumor when they came across to the US and paid out of pocket
  • Someone who saved their vision by going to the Mayo Clinic
  • Someone told they were ‘too old’ to enjoy the benefits of Birmingham hip resurfacing at the age of 57 –and then denied the right to pay for it out of pocket in Alberta

These anecdotes are pretty bad, whether or not they are representative of the system as a whole. I also have my horror stories about the Canadian system involving, for example, the death of my friend.

But is Canada bashing really the right approach to health care policy? I’d say no. After all, there are plenty of horrible anecdotes (and statistics) about the US system, including its high cost, tendency toward overtreatment, and the large and growing number of uninsured. We could just as easily sit in Canada and cast stones at the US system, explaining how not to reform. But what’s the point?
Canada has perhaps the second worst health care system in the rich world, and although per capita spending is only about half the US rate, it’s still one of the more expensive countries for health care.

If we’re going to criticize government involvement in health care, let’s pick on a higher-rated system such as France’s. And maybe we should also adjust for the level of spending. What if the US adopted the Canadian system but continued spending 2x per capita what Canadians spend?

On the other hand, why not consider a top-rated system like Singapore’s, where costs are low, a private medical sector exists, and quality and accountability are high?

February 9, 2009

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