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Schooling Yglesias on Canadian Health care numbers

The Center for American Regress [yeah, i stole that from paul krugman] Progress has basically been the Third Way In Exile, waiting for the return of [the corporate wing of] the Democratic party. Unfortunately they are also corrupting the minds of our otherwise intelligent youth [how could you not like this definition of democracy?] and today they've got Matt Yglesias spouting half-truths about Canada's Medicare [and ours] in an attempt to refute the wingnut talking point that Obama is bringing us the dreaded socialized medicine! rationiiiing!

The way Canadian healthcare works is basically that if you want to see a doctor, you go see a doctor and the government pays the bill. This is a “single-payer” system (with the government as the single payer) and it in no way resembles what Obama has proposed. But it is what they do in Canada [all true]. A system like this can either cost a ton of money (sort of like our Medicare [not quite true]) or else you can control the costs by giving the program an explicit budget and then rationing access to care. And in Canada, they essentially have opted for the latter route. Sometimes a person wants treatment but the government won’t pay [mostly not true either].

Fortunately, some actual Canadians showed up in comments to set him straight on health care in Canada. They're anecdata, but well worth reading, and maybe forwarding to some of your scaredy-cat acquaintances. This one for instance:

5. Den Valdron Says:
May 27th, 2009 at 11:54 am

Well, I know a man who was diagnosed with third stage lymphatic cancer in Canada, living in a remote rural town. His Cancer was at a stage where they gave him a month to live, untreated. Fortunately for him, treatment started that very week. A day or two later, he had to go to the dentist to have his bad teeth out. Another day or two later he was in a medical urban center, getting his work ups. Chemotherapy followed almost immediately. It turns out he wasn’t covered under the normal programs, so family members were ready to take out second mortgages on their house to pay for his meds. But the faceless and uncaring bureaucrats couldn’t stand to see a senior citizen fall through the cracks so they went out and found the money in the system.

That person was my Dad. It’s been five years now, and no sign of the cancer coming back.

I know a woman in Canada who broke her ankle in a fall. Ambulance techs came, got her to the hospital. She had X-rays and palliative care that night. In the morning, they operated and put her shattered ankle back together, then six weeks of physio. Eventually, years later, she wanted all the pins and screws and bolts taken out, so she went back, and had it done.

That person was my wife. She walks, runs and plays just fine, thank you.

I know another woman who had several strokes. I wasn’t happy about the way the treatment that the emergency room people gave her, but I looked into it, and in stroke cases, it wouldn’t have made a difference. She received as much care and had as much quality of life as could be provided. In the ensuing years she had more minor strokes, developed epilepsy and had a couple of minor heart attacks. She was overweight, in poor health. She was scheduled for surgery, but her chances were considered poor, given the combination of obesity, poor health, epilepsy and prior strokes and heart disease it didn’t look good. Because of this, she was put down the waiting list. She died, before surgery got to her.

That was my mother in law.

I know a woman in Canada who was diagnosed with cancer. Her health was poor. The cancer spread like wildfire. They gave her six months. She was dead in one. The hospital, the nurses, everyone did their best. The nurses set up a cot beside her bed so that family could be with her day and night.

That was my mother.

I’ve lived in Canada, in several provinces. I’ve also lived in the United States in several states.

There’s no comparison between Canadian and American healthcare. It’s a horrorshow south of the 49th parallel.

Now to take on that fable that our Medicare is expensive, off-the-charts out-of-control scary expensive.

Yes, we spend a lot on people in Medicare. Guess what, they're old. Guess who else is covered by Medicare: people on dialysis waiting to see if they win the kidney transplant lottery before they die. Medicare is, for all practical purposes, our national high risk pool. It's how we pay for the expensive people, people who are falling apart, but nonetheless people who we'd really like to keep around a little longer, so the kids can get to have a few years with Grandma and Grandpa, for instance.

We could just put them all out on ice floes and save tons of $$$$$.

So, anyway, I went looking to see if other countries, countries who spend way less on health care overall, spend oodles on their old folks or not.

Everybody collects their data differently, and presents it differently, and names it differently, and... suffice to say I found Reinhardt's graph [the 2nd one] at the above link right off the bat, but had trouble tracking down some more numbers.

Here is a bit of back of the envelope arithmetic comparing our spending [2002, US dollars] to Canada's spending [2000-01, CDN] by age group. I did some fuzzy math to make the age categories sorta match up, and I'm not correcting for USD/CDN exchange rates or purchasing power parity or anything fancy, just some simple ratios to get an idea of what to look for next.

In a perfect world, one following Uwe's chart, the ratio between what we spend on any age group to what Canada spends on that age group should be the same, without my having to correct for any currency differences. Our Medicare only covers ages 65 and older [for purposes of this demonstration], whereas Canada's Medicare covers everyone in their country for all their lives, so I've chosen over-65 as my baseline comparison group.

over-65
US: $13,218 per person
Canada: $10,834 per person
ratio US/Canada: 1.22

Ok, our Medicare [for purposes of this discussion] pays 1.22 times more for our old folks than Canada's Medicare does for their old folks. Not a bad thing, and it goes to show that you can solve the dreaded waiting times problem by throwing money at it. Paul Krugman gives us an example:

On the other hand, it’s true that Americans get hip replacements faster than Canadians. But there’s a funny thing about that example, which is used constantly as an argument for the superiority of private health insurance over a government-run system: the large majority of hip replacements in the United States are paid for by, um, Medicare.

That’s right: the hip-replacement gap is actually a comparison of two government health insurance systems. American Medicare has shorter waits than Canadian Medicare (yes, that’s what they call their system) because it has more lavish funding — end of story. The alleged virtues of private insurance have nothing to do with it.

Yay, us!

So now, sticking with comparing Medicares to Medicares, what about subgroups of the old folks?

65-74
US: $9562
Canada: $6624
ratio US/Canada: 1.44

Hmmm, that's higher than 1.22, could be all those extra hip replacements. Or maybe they're just catching up on all those ailments that developed while they were uninsured and waiting to get old enough to qualify for Medicare.

75-84
US: $14578
Canada: $12535
ratio US/Canada: 1.16

85+
US: $23985
Canada: $27135
ratio US/Canada: 0.88

Obviously we don't love Grandma and Grandpa enough, we're spending relatively less on our old folks than Canada is spending on theirs. What about the youngsters?

0-18 [US], 0-14 [Canada]
US: $2385
Canada: $1437
ratio US/Canada: 1.60

Why does Canada hate their kidz?! Big caveat, I didn't try very hard to match up this age group. On to the working age adults, those who have that employer-sponsored private health insurance that we don't want to disrupt.

19-44 [US] 15-44 [Canada]
US: $3094
Canada: $1899
ratio US/Canada: 1.63

45-54
US: $4487
Canada: $2508
ratio US/Canada: 1.79

55-64
US: $6533
Canada: $3621
ratio US/Canada: 1.80

All of which suggests [need more data!] that our excess spending isn't going to caring for the old folks, that's fer shure. Instead, it's being spent on those age groups most likely to be covered by that all-important employer-sponsored private health insurance.

But that's ok, because Medicare is teh suxxor and private health insurance is teh awesum! Not.

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