Join 3,523 readers in helping fund MetaFilter (Hide)


Closer to the heart
July 3, 2007 2:42 AM   Subscribe

"In 2003, Americans spent an estimated US$5,635 per capita on health care, while Canadians spent US$3,003... Canada’s single-payer system, which relies on not-for-profit delivery, achieves health outcomes that are at least equal to those in the United States at two-thirds the cost." What do wealthy, educated Americans living in Canada think?
posted by Blazecock Pileon (137 comments total) 5 users marked this as a favorite

 
Well, as an educated (not wealthy, heh) American who will by the middle of this month be living in Canada, and who is generally healthy but who has a spouse with problems, I'll be reading this article with intense interest later after I get to work. I did read the abstract though, and it doesn't surprise me -- if you've got good insurance in the US it's a swell place to get specialists, etc. But my co-pays are killing me, the spouse needs mostly drug therapy, and where I'm going the drugs are tons cheaper. So I think I'm going to be better off in Canada.

Thanks for the links!
posted by the dief at 3:30 AM on July 3, 2007


Oh, and one thing I pretty fervently believe is that the health system in the US is going to get a lot worse before it gets better re: at least costs. I think by the time I reach retirement age -- in my mid 30s now -- America will have socialized medicine. But getting to that point is going to be extremely painful.
posted by the dief at 3:33 AM on July 3, 2007


It's worth noting that the study was conducted in Calgary, Alberta, so it can be fairly safely assumed that these wealthy, educated Americans are employed in the oil industry, and probably Texan.
posted by Flashman at 3:33 AM on July 3, 2007 [3 favorites]


are
posted by Flashman at 3:34 AM on July 3, 2007


The features of the US system rated most positively were timeliness and quality; those rated most highly in the Canadian system were equity and cost-efficiency.
posted by caddis at 3:44 AM on July 3, 2007


The men who hold high places must be the ones who start...

Yeah, good luck with that.
posted by Eideteker at 4:18 AM on July 3, 2007 [1 favorite]


Double-ish, but thanks for the second link.
posted by BrotherCaine at 4:28 AM on July 3, 2007


Pre-summary of future thread:

1) The US needs to get universal healthcare.

2) Universal healthcare is godless communism.
posted by DU at 4:30 AM on July 3, 2007 [4 favorites]


My general impression from talking to nurse practitioners (in the US) is that Canada achieves a lot of it's efficiencies by triaging across the whole system rather than just in ER. So if you are already circling the drain you are maybe not going to be first in line for the expensive treatments / dialysis / organ transplants, etc... great for 80-90%, sucks if you are the 10%. However, I could stand to be educated a little more on public health issues. Also, if you are dying, maybe painkillers are better than going for the expensive high-tech miracle.
posted by BrotherCaine at 4:33 AM on July 3, 2007


Maybe they should try talking to Americans in Canada making less than 50K a year. Or, less than 30K a year.
posted by Hildegarde at 4:51 AM on July 3, 2007


I wonder how much the Canadian system suffers just from Canada's proximity to the US? Are well-off Canadians crossing the border to undergo expensive procedures in the US frequently enough to undermine their own system?
posted by mullacc at 4:55 AM on July 3, 2007


1) The US needs to get universal healthcare.

2) Universal healthcare is godless communism.


Or maybe pity that because it IS godless communism, the US will never get universal healthcare and the public will never enjoy the benefits.

great for 80-90%, sucks if you are the 10%.

That's a good way of putting it. For routine medicine the quality of care here in Sweden is as good as anywhere and maybe even a bit better. But if I had some strange funky disease, or suffered some very bad injuries (i.e. found myself in the 10%) I would no doubt prefer to be treated in the U.S. where the high-end medical treatment is unparalleled.

From a basic public health policy point of view - the greatest good to the most people - universal healthcare makes a lot of sense, but that 10% argument is hard to avoid in America.
posted by three blind mice at 4:58 AM on July 3, 2007


Speaking of socialized medicine....
posted by the dief at 4:59 AM on July 3, 2007


As much as I hate to say it, I honestly don't believe the US will ever move to a true universal, single-payer system. Not as long as there is an insurance industry, anyway.

What we'll probably end up with is some sort of Frankenstein's monster based on something akin to the Massachusetts scheme where everyone will be required to have insurance and the government will throw-in some cash to help the traditional folks at the margins...the poor and the elderly. This will be a boon to the rapidly-growing private insurance market, as employers continue to drop/limit their group plans and transfer the cost/responsibility to their employees.

My gut says that almost nothing will be done to help the people in the middle...the ones who are being broken by medical/insurance costs.

In the end, the insurers will be allowed to, pretty much, continue business-as-usual, perhaps with a few legislated "controls" thrown-in to make it look like something has actually changed.
posted by Thorzdad at 5:04 AM on July 3, 2007


My general impression from talking to nurse practitioners (in the US) ... great for 80-90%, sucks if you are the 10%.

That may be the anecdotal evidence of American nurses you know, but the linked research (a study of studies) indicates that they are wrong. It says that the care is generally the same for everyone above or below the 49th parallel, just cheaper in Canada: "Canada’s single-payer system, which relies on not-for-profit delivery, achieves health outcomes that are at least equal to those in the United States at two-thirds the cost." They don't say anything like "Unless, of course, you have X, Y, or Z, in which case you are significantly better off in the US." In fact, they assert that "[t]hese results are incompatible with the hypothesis that American patients receive consistently better care than Canadians. Americans are not, therefore, getting value for money; the 89% higher per-capita expenditures on health care in the United States does not buy superior outcomes for the sick."
posted by pracowity at 5:21 AM on July 3, 2007 [1 favorite]


Are well-off Canadians crossing the border to undergo expensive procedures in the US frequently enough to undermine their own system?

How would this undermine the Canadian system, since it is already paid for? It might undermine private care, but then there's not as much demand for it in the first place, so there might not be much market pressure here anyway.
posted by Blazecock Pileon at 5:22 AM on July 3, 2007


Americans living in Canada generally rated the US health care system as being better than the Canadian system.
Wealthy Americans, who were the focus of the survey, favored the American system. I would expect so- in America, the health care system is easily accessible to the wealthy. I would be more interested in hearing what middle class Americans living in Canada had to say about it.
posted by jiiota at 5:22 AM on July 3, 2007 [3 favorites]


One factor that could help Canadian health care outcomes? Being right next to the United States.

Consider this scenario: the poor in Canada get better treatment (because the poor in America are uninsured), but it's still not very good. The rich would get exactly the same treatment, and would thus have worse outcomes than the rich in America, but instead, they fly across the border to go to the Mayo Clinic and go to Buffalo to get MRIs and so forth.

I'm not writing a study and have no data, so far be it from me to suggest that this is actually what's going on, but a cursory 8:30AM read-through of Guyatt et al. suggests that they don't explicitly address this variable, nor is it clear if cross-border health expenditures contribute to the per-capita spending figure.

I'm a big fan of the Canadian single-payer system, but people do go to the States when they can afford it and have a serious illness, and this could be a confound in the study's results.
posted by goingonit at 5:31 AM on July 3, 2007


In other words, what mullacc said.
posted by goingonit at 5:32 AM on July 3, 2007


My brother (doc here in Calgary) laid out in simple terms how the American system is much better for wealthy Americans. A CEO-type he had as a new patient said that his former employer in the US had paid for a full body MRI every month. Here, there's no facility to even attempt to do that sort of thing and certainly not part of corporate health care structures. As with everything in the US, it's better if you're rich.
posted by jimmythefish at 5:36 AM on July 3, 2007


> Wealthy

That might not mean what you think it means. You're in the economic lower-middle class -- at best -- without at least a six-digit annual income. The wealthy, some stratum above that, will buy whatever health care they need out of pocket regardless of where they live. The study itself refers to groups as 'low-income' and 'high-income' but I haven't read it closely enough to see if they clarify those brackets.

Incidentally, the US dollar is only worth CN$1.0573 as of this morning.
posted by ardgedee at 5:42 AM on July 3, 2007


I could tell long stories, but I can't be fucked right now.

The sound-bite version: both of my parents would be dead from entirely unrelated things in the last few years (one accident, one emergent health problem), despite the fact that they had not a couple of thin goddamn dimes to rub together at the time, if it not were for the fact that if you're in need in Canada, regardless of your financial status, you get help. Or they did, at least, in spectacular fashion.

I'm expat and haven't seen a doctor in Canada in decades, but it is part of what it means to be Canadian that if you are sick or hurt, you get medical assistance, rich or poor or whatever.

There are problems, of course. There always are. But I'll fly back and skullfuck the Prime Minister who dismantles Tommy's legacy.
posted by stavrosthewonderchicken at 5:47 AM on July 3, 2007 [6 favorites]


To some extent, the world leeches off the American system. The US is the undisputed leader in medical innovation:
This innovation-rich environment stems from the money spent on American health care and also from the richer and more competitive American universities. The American government could use its size, or use the law, to bargain down health care prices, as many European governments have done. In the short run, this would save money but in the longer run it would cost lives.

Medical innovations improve health and life expectancy in all wealthy countries, not just in the United States. That is one reason American citizens do not live longer. Furthermore, the lucrative United States health care market enhances research and development abroad and not just at home.
It's similar to poor countries breaking patents on expensive drugs: the drugs become cheaper for the patients, but without the patent system, the drugs might not exist at all.

Maybe it would've been wonderful for the US to have had socialized healthcare since the 1970s, but then maybe things like MRI would never have been invented. Any attempt to fix the US system (which is indeed broken) must be careful not to upset the environment of innovation that is keeping all the rest of the world's healthcare systems going.
posted by hoverboards don't work on water at 5:56 AM on July 3, 2007 [2 favorites]


Some quick maths reveals that the USA spends $44 per person per year on pornography. This is also a staggering figure. That's a whole lot of baby batter going to waste. Perhaps you could combine the porn and medical industries with sexy nurses* who perform all the normal tasks but whilst wearing really revealing clothes and stuff. Oh, and humping people. A lot. There's your placebo effect.


*of all sexual denominations of course. Cater to the needs of the audience and all that.
posted by longbaugh at 6:08 AM on July 3, 2007


(above not counting residents of Utah and therefore subject to change)
posted by longbaugh at 6:09 AM on July 3, 2007


Any attempt to fix the US system (which is indeed broken) must be careful not to upset the environment of innovation that is keeping all the rest of the world's healthcare systems going.
Then again, without having to focus exclusively on profit, perhaps we'd actually get the industry (especially pharma) to increase their efforts toward a wide range of serious maladies that go largely ignored because they effect a smaller, less profitable, portion of the population.
You know...more rare diseases and fewer boner pills.

All the great innovation is well and good, and, rightly, should be applauded. But so much of it is still relegated to the wealthier classes who can either a) pay for it out-of-pocket, or b)can afford the insurance to pay for it.
posted by Thorzdad at 6:24 AM on July 3, 2007 [1 favorite]


Maybe they should try talking to Americans in Canada making less than 50K a year. Or, less than 30K a year.
posted by Hildegarde at 7:51 AM on July 3 [+] [!]

Wealthy Americans, who were the focus of the survey, favored the American system. I would expect so- in America, the health care system is easily accessible to the wealthy. I would be more interested in hearing what middle class Americans living in Canada had to say about it.
posted by jiiota at 8:22 AM on July 3 [1 favorite +] [!]


That would hardly be interesting. There is no real dispute about the superiority of the Canadian system when it comes to access. The argument is always about quality - "gee, universal access is nice and all, but I have access and I don't want lesser quality care." Facts and perceptions in this area are far more interesting in this debate. The perception of higher quality in the US has long kept a Canadian system at bay. Although the study focused on wealth, the real issue is those with health benefits versus those without. You don't have to be wealthy to have them in the US, but you probably do need to have a job that provides them. In that vein, I am constantly amazed by people who would eschew the benefits of one job in favor of a different job with a few thousand per year higher salary but which lacks health benefits.
posted by caddis at 6:31 AM on July 3, 2007


As with everything in the US, it's better if you're rich.

If you're rich, you can go to any country you choose and get a monthly MRI by a masseuse wearing nothing but a smile. But did this CEO's full-body MRI every month save his life or just waste everyone's time and money. How often do you need a full body MRI? Why not every day?

Any attempt to fix the US system must be careful to limit the over-testing and excessive ass-covering that helps to drive costs.

To some extent, the world leeches off the American system.

And to some extent, the American system leeches off the world. It's not like the rest of the world isn't paying for the products American corporations are selling. The MRI manufacturers love to sell them abroad, and patients all over the rest of the world are financing those foreign MRI purchases directly or through taxes. Maybe there wouldn't be those innovations if there weren't a world market for the products. It's all one big weird financial system with people buying and selling the right to live or die a few days more. You might as well write that, to some extent, the American system profits from the world's medical problems.
posted by pracowity at 6:34 AM on July 3, 2007 [3 favorites]


Canada is Awesome. Happy belated Canada day to all.

And I'm sure people would still be making MRIs and Laser Guns if America had socialized medical care for all. Does no innovation or research take place anywhere else in the world?
posted by chunking express at 6:35 AM on July 3, 2007


Well, I'm a middle-class American living in Canada, and the system here has been working just fine for me. Of course, I don't have any major medical conditions, so perhaps I'm not the best qualified to compare the two systems, but having seen my mom incur some serious debt after Blue Cross denied coverage for my brother's colectomy, I'm really quite happy that such things won't happen here.

An previously unmentioned perk of the Canadian system, at least in Ontario, is that if a particular treatment is not available in the country, and your doc determines that it's necessary, the province will pay to have you treated abroad. A friend of mine was able to attend a treatment program for eating disorders in the US, which would have cost untold thousands of dollars ordinarily, since it was thought that she would have a better outcome there.

In sum: A+++ GREAT SELLER WOULD DO BIZ AGAIN, THX
posted by greatgefilte at 6:45 AM on July 3, 2007 [2 favorites]


The US is the undisputed leader in medical innovation

As long as you don't need insulin, antibody-coated stents, or cancer-killing viruses.
posted by greatgefilte at 6:51 AM on July 3, 2007 [6 favorites]


if a particular treatment is not available in the country, and your doc determines that it's necessary, the province will pay to have you treated abroad.

Verifying this. When my stepdad got his skull crushed, and was too large tough scary cowboy and claustrophobically freaked-out to be pushed into an MRI tunnel, they flew him down to Seattle, which was the nearest available open-air MRI available, at no charge. In fact, Medicare/Worker's Comp paid for the travel and the hotel in Vancouver for my mom on the way down from Northern BC (let alone the helicopter/jet evac and everything else).
posted by stavrosthewonderchicken at 6:53 AM on July 3, 2007 [1 favorite]


Maybe they should try talking to Americans in Canada making less than 50K a year. Or, less than 30K a year.

How many people living in the US making less than 30k had any health insurance to compare with the Canadian system? One in five? Less than that? It might be an interesting survey, but that overall lack of coverage in the lower income levels is telling enough.
posted by peeedro at 7:00 AM on July 3, 2007 [1 favorite]


To some extent, the world leeches off the American system.
*reaches across 49th parallel with Canadarm, claws back Canadian-discovered insulin*
This reminds me of those who say "Canada can easily afford to be a peaceful nation - they've got the good ol' USA to protect them." Grrrr.
posted by fish tick at 7:00 AM on July 3, 2007 [2 favorites]


1. No one knows if the Canadian system would scale to the size of the american system and maintain its benefits.
2. The USA already has socialized healthcare, in the form of the VA. Godless communism: only for those who defend it with guns. Miniature american flags for everyone else!
posted by blue_beetle at 7:12 AM on July 3, 2007


In the producer-consumer relationship, the producer is not the one that's the "leech." And I don't think anyone defines leader as meaning better than everyone else at every single thing. Is the US the undisputed leader? I don't know, but we're high on the list of countries being asked for drug patent forgiveness.
posted by erikharmon at 7:16 AM on July 3, 2007


With so much innovation in the U.S. coming from a socialized military and space program, I don't see how socialized healthcare in the U.S. would be any different. Much of the innovation is done by University research and grants, anyway; at least I don't believe any innovation is being done by the insurance companies that rake in billions by denying their customers' legitimate claims.
posted by disgruntled at 7:19 AM on July 3, 2007 [1 favorite]


Jilota, they already knew what middle and low income people would say. What was interesting was that 45% of high income favored American health care compared to 40% favoring Canadian. That's a very minimal difference, and probably means Canadian health care is preferred my a majority once you factor in low and middle income groups.

Pracowity, reread what I said. My anecdote does not contradict the findings of the study, and I actually read the whole article (when it was linked before). Triaging so that those who are very very high mortality risk are last in line for treatment will get you better results on average which is what this study measures. So basically what I'm saying by my sucks to be the 10% anecdote is that people who are dying quickly will die slightly faster in Canada than the US. This will have no effect on studies that have a 6 month follow up window however, because they'll probably be dead in either case. At the same time, the medical resources that are saved will boost the chances for all other classes of patients. Way better from a public health perspective, but if you are rich or over-insured, and want to prolong your suffering, the US system is a better choice. Note that I have no data on this besides some offhand comments by NPs who've worked with Canadian nurses.
posted by BrotherCaine at 7:29 AM on July 3, 2007


disgruntled, it's hard to say what an untried system would be like, but to compare existing systems, there is a clear and large innovation gap between the US and everyone else. Maybe you could preserve that lead and have socialized healthcare, but I haven't seen much discussion on how to do that. It would be unwise to deny healthcare to the future for the sake of making it cheaper in the present (again, cf. drug patents).
posted by hoverboards don't work on water at 7:29 AM on July 3, 2007


preferred *by* a majority
posted by BrotherCaine at 7:31 AM on July 3, 2007


Two good articles

Has Canada Got the Cure?

"the United States has been the unwitting control subject in a 30-year, worldwide experiment comparing the merits of private versus public health care funding. For the people living in the United States, the results of this experiment with privately funded health care have been grim."

Health Care: It's What Ails Us

"universal health care is in place throughout the industrialized world. In most cases, doctors and hospitals operate as private businesses. But government pays the bills, which reduces paperwork costs to a fraction of the American level. It also cuts out expensive insurance corporations and HMO's, with their multimillion-dollar CEO compensation packages, and billions in profit. Small wonder "single payer" systems can cover their entire populations at half the per capita cost."
posted by phoque at 7:34 AM on July 3, 2007 [1 favorite]


2. The USA already has socialized healthcare, in the form of the VA.
And the Medicare system as well.

That's what I don't get about adoption of publicly funded healthcare in the US - it's already exists, specifically treats the sickest age sector (over 65 elderly), and does it for 10-20% less than private insurance. Same country, same doctors, same procedures, same drugs, worse treatment population, similar outcomes, and Medicare is still cheaper than private insurance? How is that not a compelling argument?
posted by junesix at 7:37 AM on July 3, 2007 [1 favorite]


Wealthy Americans, who were the focus of the survey, favored the American system. I would expect so...

They must be Bill-Gates-level rich, or something. I -- Canadian -- lived in the States for a few years in some top income percentile with supposedly great insurance, and it sucked.

There didn't seem to be anything I could say to a GP that didn't get me a referral to a specialist. The GPs -- I switched a few times -- were useless. There was a $25 'co-pay' on my drugs, and -- this really pissed me off -- I could only go to two shit pharmacies for them.

Going through yet another hassle with the prescriptions, I told the pharmacist 'I'm on (Big Insurer A), but I could be on (Big Insurer B). Should I switch, given all these problems?' Heavens, no; Big Insurer B was 'the reason they had a security guard,' it being, apparently, that frustrating to people.

I suppose it might've been nice if I'd been severely ill. But the one person I know here who's gone abroad in search of better health care went to Japan, not the States, and I wouldn't want to give birth in the US, either.

Not to say the Canadian system hasn't developed frustrations of its own in the last five-plus years. But I'd rather be a Canadian than a rich American, myself.

A lot of this should be painfully obvious, anyway. Even keeping interaction to the basics, that US health care generated huge wads of paperwork in my house. Here, I have a little plastic card in my wallet and that's the end of it. Not hard to figure out which is working better on that end.
posted by kmennie at 7:43 AM on July 3, 2007 [1 favorite]


...it's already exists, specifically treats the sickest age sector (over 65 elderly), and does it for 10-20% less than private insurance. Same country, same doctors, same procedures, same drugs, worse treatment population, similar outcomes, and Medicare is still cheaper than private insurance? How is that not a compelling argument?

Because the groups these programs treat are outside the market already. They are, comparatively, a very small piece of the pie. The big profits are in the vast middle. Working families and individuals. That's where the battle needs to be focused, and you can bet the insurance industry simply won't allow it.
posted by Thorzdad at 7:44 AM on July 3, 2007


As an American living in Canada (and staying, thanks), the thing that sticks in my mind about Canadians re: this is that they don't talk about health care in the same breath they talk about employment. These things are unrelated here, like "what car do you drive" and "how's the weather". Something to talk about, but not really related.

In Canada, the single mothers who clean houses for a living, the starving artists, the students who eat ramen, the check-out clerks at Wal-Mart, the homeless people who beg for spare change -- everyone -- is covered.

Wheras, of course, in the States, no discussion about health care can possibly be separated from a discussion about "health insurance" and its brother "a job."

It's amazingly liberating.
posted by seanmpuckett at 7:59 AM on July 3, 2007 [5 favorites]


Hoverboards... Any attempt to fix the US system (which is indeed broken) must be careful not to upset the environment of innovation that is keeping all the rest of the world's healthcare systems going.

I think it's a red herring to suggest that fixing the US system would result in less money going to medical research. The point of a socialized or single pay program isn't to starve doctors, or to squelch innovation, it's to cut the non-medical, life-sucking leeches out of the loop. Take the gold that paves the floor the the insurance companies' executive washrooms today, and (after washing it) put some of it back in the pocket of the patient, and some in the research hospitals. Job done.
posted by deCadmus at 8:00 AM on July 3, 2007 [1 favorite]


That's what I don't get about adoption of publicly funded healthcare in the US - it's already exists

My mom's on medicare/medi-cal now, and it's a fucking joke. There's only one dermatologist in the entire Central Valley taking medi-cal patients.

And as for the US being head Rent Seeker wrt pharmacology patents, BFD, Mr Galt.

AFAICT the private profit motive is not necessary to drive medical innovation.

And I say this as someone who has the bestest medical plan available here in the Bay Area, home of the best doctors and best facilities.

Last month I walked out the pharmacy with a $150/mo non-formulary (to treat rosacea) scrip for free, since my corporate HR negotiated one heckuva a deal with Blue Cross.

Medicine is a high-quality profession that attracts a surfeit of quality professional people and should be a bedrock social service of our system, not the corrupted den of rent-seekers it has become.

I find my mission statement wrt my left-libertarianism: the state has a compelling interest in people becoming and remaining productive members of society informative here.
posted by Heywood Mogroot at 8:03 AM on July 3, 2007 [1 favorite]


Insurance companies and large hospitals spend billions on software to fight each other over payment.

Often they use the same software.

Made by a Bush cousin. I can't back that up yet, but I read it in a WSJ article a few months ago.


My point is that there's too much profit around health care to make socialized medicine politically viable. Staggering billions of "health care dollars" have nothing to do with health care, and instead have everything to do with corporate profit.

The insurance industry is ruining health care in the US.
posted by yesster at 8:06 AM on July 3, 2007 [1 favorite]


one more thing -

Implementing socialized medicine would be the biggest boon to entrepreneurialism that the US has ever seen.

(which is of course another reason that it is less likely to actually happen)
posted by yesster at 8:09 AM on July 3, 2007


I think the innovation question is a bit of a red herring, for a few reasons. For example, many Canadian innovations are bought by Americans and the patents are held in the US, meaning that a straight comparison of patents does not indicate whether the research was done under a public or private health care system.

A public interest in health care can be good for innovation. In Canada, the main governmental granting agency for medical research has a specific mandate to fund research that helps bridge the gap between an interesting idea and a commercial application, granting researchers the time and money to develop ideas that the private sector is not willing to risk their capital one. (These are called Proof of Concept grants.)
posted by carmen at 8:11 AM on July 3, 2007 [1 favorite]


One thing I've never understood about the debate over socialized medicine in the USA is why big business doesn't get behind it.

Think about a company like GM, which has about 280,000 employees (worldwide, not sure about the USA). If each one of those people is being insured at a (wild-ass guess) cost of $3000/yr, that means they're spending the better part of (pinky to lip) one billion dollars a year on medical insurance. GM should love the idea of socialized medicine. I'm surprised there isn't a massive industry coalition with a lavishly funded lobbying effort to push for this, astroturfing organizations, the whole thing.

And while unions should (in theory) also be in favor of socialized medicine, I can imagine the UAW being ambivalent about it: if there were socialized medicine, it would be one less thing they could bargain over and use to prove their worth to their members.

Sure, the insurance industry is big in the USA and would fight against this. But it isn't the only big industry.
posted by adamrice at 8:18 AM on July 3, 2007 [2 favorites]


Thank you for the link - and the morning chuckle at the Rush reference in the title of the post.
posted by rmm at 8:21 AM on July 3, 2007


The most depressing thing about the health care debate for me is that we had it as topic when I was on the debate team more than 10 years ago.

The big change though is that (non-health care)big business in the US is starting to realize that health care is a huge cost that they might prefer to deal with the government on than the insurance companies. I wouldn't be surprised if we start seeing companies like Ford actively lobbying for a single-payer system.

(or in other words adamrice nails it).
posted by drezdn at 8:30 AM on July 3, 2007


Also, much of innovation is being paid for by the public sector (state university research labs) and then is sold off by the private sector in the US.
posted by drezdn at 8:31 AM on July 3, 2007 [2 favorites]


One thing I've never understood about the debate over socialized medicine in the USA is why big business doesn't get behind it.

They are. Slowly. Sort of. GM and Ford, especially, have started making noise about reforming healthcare somehow.
It's a delicate edge for them, though, being the traditional beacons of American capitalism that they are (discounting their current financial woes, of course) It would be a huge disturbance in the force for such companies to start lobbying for something completely socialized, though. I can't see them ever supporting that.

I think this is another reason we will end up with the results I outlined in my first post. Something that takes the burden off the GMs and Fords, and places it squarely on the shoulders of their employees...with some minor assistance from the gov't on cost to the consumers. Maybe in the form of tax credits for employers who help with the employee's costs.
posted by Thorzdad at 8:35 AM on July 3, 2007 [2 favorites]


Huh. My upstairs neighbour fell and fractured her ankle just over a week ago. She got a ride in the ambulance with friendly EMT guys, a loooong stay in Emergency (some complaining there), was in surgery the next day having the ankle bolted back together, a private room to recover in, a taxi voucher to get back home, and follow up care for the next couple of months. It cost 8 bucks for the pain medication she recieved on prescription.

The system creaks and groans, and it's not perfect. But it works.
posted by jokeefe at 8:36 AM on July 3, 2007 [1 favorite]


The US system is the best in the world if you are rich. I read a stat once in regard to wealth that 10% of the US population thinks they are in the top 1% and another 15% thinks they will be in the top 1% one day. The fact is that the top 1% changes less than 1% from generation to generation but this illusion that 24% of Americans hold is a key reason why the true 1% garner so much support among the general public when they oppose social programs that will benefit the vast majority of the public.
posted by any major dude at 8:46 AM on July 3, 2007 [1 favorite]


Jokeefe, where do you live?

Among the high twenty-somethings I know, most of us have a horror story of losing $500 or more because of a medical problem that popped up while we were between insurances because we switched jobs (and couldn't afford COBRA).

For me, just before my wedding, I had the first and worst asthma attack of my life. The Urgent Care visit that ended up eating up much of the money we received as wedding gifts.

Now, I have an HSA (Bush's proposed solution to social security) with a High Deductible insurance plan. Due to allergy testing to address the asthma, I've already met my deductible this year. But the insurance company has recently moved the medicine that is keeping my asthma in check to a schedule where they don't cover any of the costs.
posted by drezdn at 8:48 AM on July 3, 2007


Wheras, of course, in the States, no discussion about health care can possibly be separated from a discussion about "health insurance" and its brother "a job."

As someone with a chronic illness, I could NEVER take a risk and try to start a business on my own. I can't be without insurance, not even for a day, because I could need emergency surgery on any particular day. Instead I must keep working for the man.
posted by waitingtoderail at 9:02 AM on July 3, 2007 [1 favorite]


I wonder how much the Canadian system suffers just from Canada's proximity to the US? Are well-off Canadians crossing the border to undergo expensive procedures in the US frequently enough to undermine their own system?

Rather than undermining the Canadian health care system, it exposes its many shortcomings, such as life-threatening waiting times for crucial procedures.

At this point in time, I would say the Canadian system beats the American one in terms of accessibility, but it's simply too broken to handle Canada's growing, and aging, population. This will cause the quality of Canadian health care to decline even more in the coming decades.

This reminds me of those who say "Canada can easily afford to be a peaceful nation - they've got the good ol' USA to protect them." Grrrr.

All things considered, a fairly true statement.
posted by Krrrlson at 9:11 AM on July 3, 2007


Now, I have an HSA (Bush's proposed solution to social security) with a High Deductible insurance plan...
Have you reached your annual renewal date yet? If not, be prepared for a nasty financial shock. As in: choose between a substantially-increased monthly payment, or a substantially-increased deductible.
Just so you know...
posted by Thorzdad at 9:14 AM on July 3, 2007


All things considered, a fairly true statement.

The US is protecting Canada from whom exactly? America spends more money on its military than every country on the planet combined. Maybe Canada doesn't spend enough? I'm not so sure.
posted by chunking express at 9:15 AM on July 3, 2007


Rather than undermining the Canadian health care system, it exposes its many shortcomings, such as life-threatening waiting times for crucial procedures.

I wonder how the family of Edith Isabel Rodriguez might feel about this statement.
posted by Blazecock Pileon at 9:28 AM on July 3, 2007


I am not sure how it works in Canada, but in other countries free and universal health care systems co-exist with private insurance and health facilities for those who want and can afford them. For example, many people (not necessarily the super-rich) choose to spend some extra money so that when they give birth they have their own sleeping-living quarters to celebrate with the family instead of a shared room. Generally, what these mixed systems provide in exchange for extra cash is more convenience rather than better treatments. In fact, the private insurers might send you right back to the public health care system as it tends to be better equipped for the more costly treatments.

BTW: the US might be leading in medical innovation, but it certainly is not leading in life expectancy, low infant mortality rates and other indicators of a healthy population. In my eyes, the average U.S. citizen is getting a rotten deal.
posted by magullo at 9:33 AM on July 3, 2007


caddis writes "You don't have to be wealthy to have them in the US, but you probably do need to have a job that provides them. In that vein, I am constantly amazed by people who would eschew the benefits of one job in favor of a different job with a few thousand per year higher salary but which lacks health benefits."

This is one huge advantage of the Canadian system that is hard to and therefor almost never quantified. Canadians have much greater ability to switch shitty jobs because their healthcare doesn't depend on staying where they are. How many times have we seen semi panicked questions on Ask from people between jobs who either can't afford COBRA or whose benefits are running out?
posted by Mitheral at 9:50 AM on July 3, 2007


"My country does a lot to support the arts but the health-insurance system is single greatest advantage Canadian artists have" - Robert J. Sawyer
posted by djfiander at 9:52 AM on July 3, 2007


The US is protecting Canada from whom exactly?

space aliens is the likeliest answer IMO.

krrrlson of course mistakes US power projection for "defense" spending.

the average U.S. citizen is getting a rotten deal

but the gays can't still marry and as the media reminded us in 2004 that's the important issue facing Americans today.
posted by Heywood Mogroot at 10:00 AM on July 3, 2007


Jokeefe, where do you live?

Vancouver, B.C.

I honestly can say that I have had nothing but good experiences with the health care system. I had a high-risk pregnancy that involved a month-long stay in the hospital, surgery a couple of times (tonsils, etc.), a broken leg, and so on. Care was always efficient, timely, and well conducted. After my son was born I paid 5.00 a day for a private room (this was in 1986). I've had the same doctor for almost twenty years, so she's completely familiar with my history. I do pay extra, through my employer, for extended medical benefits, which cover the bulk of prescription costs.

When my father was dying, the care was exemplary. He was able to stay at home with a team of home care visitors and nurses, a state-supplied machine for oxygen, morphine, and so on. I'll always be grateful for that. My ex told me that when his father was dying, from emphysema, they were forced to buy oxygen one bottle at a time, selling off their assets to do so. I can't imagine, really. And they were a home-owning, middle class (his father owned a heating supply business) family in the suburbs of St. Louis.
posted by jokeefe at 10:16 AM on July 3, 2007 [1 favorite]


This is one huge advantage of the Canadian system that is hard to and therefor almost never quantified. Canadians have much greater ability to switch shitty jobs because their healthcare doesn't depend on staying where they are.

I believe this is the unconscious conspiracy between business leaders on why many have opposed national healthcare for so long. Much easier to keep employees around that are underpaid because they cannot afford to switch jobs and deal with the possibility of being without healthcare.
posted by any major dude at 10:19 AM on July 3, 2007


I wonder how much the Canadian system suffers just from Canada's proximity to the US? Are well-off Canadians crossing the border to undergo expensive procedures in the US frequently enough to undermine their own system?

Well that would actually be beneficial to the Canadian system, because then the government wouldn't need to pay for those procedures.
posted by delmoi at 10:20 AM on July 3, 2007


This reminds me of those who say "Canada can easily afford to be a peaceful nation - they've got the good ol' USA to protect them." Grrrr.
All things considered, a fairly true statement.


Protect them from what? Mexicans? Other Americans? The British? Who does Canada need protection from?
posted by delmoi at 10:28 AM on July 3, 2007


The United States has 10 Nimitz-class aircraft carriers, at $4.5 billion each. The Iraq War has cost over $423 billion and we're spending about $8.4 billion per month.
posted by kirkaracha at 10:44 AM on July 3, 2007


jimmythefish said this:
A CEO-type he had as a new patient said that his former employer in the US had paid for a full body MRI every month. Here, there's no facility to even attempt to do that sort of thing and certainly not part of corporate health care structures. As with everything in the US, it's better if you're rich.

A full-body MRI is an extravagant waste of money with somewhere between very little and no diagnostic value. Modern MRI has pretty good resolution, but when you are scanning the whole goddamn body, you aren't likely to catch anything smaller than a friggin potato, because of the enormous amount of visual data that must be processed (by a trained professional). This is the sort of thinking that is destroying American medicine—the idea that more is always better.

We dump fantastical sums into expensive diagnostics and heroic care, and next to nothing into prevention, and that is the reason that American healthcare outcomes are not any better than those in Canada or Western Europe. The focus is on acute events and prescription medications, not on long-term health maintenance and improvement.
posted by Mister_A at 11:12 AM on July 3, 2007


Gruber recently put up a callout concerning one average-Joe's Canadian's cancer healthcare experience over this year. Interestingly detailed longitudinal, if limited, blogging look at the Canadian system. Pretty much what one would expect, I guess.
posted by Heywood Mogroot at 11:25 AM on July 3, 2007


has 10 Nimitz-class aircraft carriers, at $4.5 billion each

to be fair, these can be a serviceable substitute for Viagra for a not insignificant segment of the population.
posted by Heywood Mogroot at 11:29 AM on July 3, 2007


Heywood Mogroot, I read through some of his posts on cancer. Does he complain about the health care system here, I didn't find a post like that. I also wonder how much his treatment would cost in the US. If you get cancer and are poor in America, do you just die, or what?
posted by chunking express at 11:40 AM on July 3, 2007


This reminds me of those who say "Canada can easily afford to be a peaceful nation - they've got the good ol' USA to protect them." Grrrr.

All things considered, a fairly true statement.

Protect them from what? Mexicans? Other Americans? The British? Who does Canada need protection from?


Iraq, of course. Saddam was after us with those WMDs. And terrorists, who are always trying to blow up the CN tower.

In all seriousness, if I had to pick the country that is most likely to try to invade Canada, it would have to be the good old USA (probably to get at our cheap prescription medicine, but still).
posted by ssg at 11:55 AM on July 3, 2007


Apples and oranges:

1) Canadian healthcare expenses are subsidized by the United States both from
. a) cheaper pharmaceuticals because of price discrimination and
. b) wealthy Canadians spending health-care dollars in the US when they can't get the care they desire in Canada (simultaneously increasing US healthcare "costs" while reducing Canadian healthcare costs).

2) United States residents have a much less healthy lifestyle than Canadian residents, so the similar "results" reflects the fact that the US healthcare system does much more work than the Canadian healthcare system to bring US residents back up to par despite the headstart Canadians have.

Canadian healthcare results wouldn't be possible if the US adopted Canadian-style healthcare.
posted by commander_cool at 12:07 PM on July 3, 2007


1. No one knows if the Canadian system would scale to the size of the american system and maintain its benefits.

The thing is that Canadian health care is not administered by the federal government, but rather by the provinces, so it's not really a matter of 'scaling up' in the sense that the federal government of the US would have to take on a lot of additional responsibilities.
posted by greatgefilte at 12:09 PM on July 3, 2007


commander_cool: You're funny!
posted by Turtles all the way down at 12:26 PM on July 3, 2007


cheaper pharmaceuticals because of price discrimination

ie cutting out the phat profit margins Big Pharma is enjoying. The pharmaceutical income statements are truly obscene, even taking the gold-bricking of R&D and SG&A at face values. But pharma itself is not the dominating expense of health care delivery.

Does he complain about the health care system here

A little, but just the generic stuff about not getting enough information to be an informed consumer, so to speak. Plus I enjoyed is observation about the number of Porsches in hospital parking.
posted by Heywood Mogroot at 12:29 PM on July 3, 2007


seanmpuckett, beautifully put, thank you.

I'm an American ex-pat, Canadian citizen since 2001, and live in Calgary. I answered this survey because I was afraid that the surfeit of American oil exec (and non-execs) here would skew the results in favour of the US system, and went out of my way to extol the Canadian one (and especially the strengths of the regional-health-authority organizational approach of Alberta Health); I lauded precisely the equality of access that seanmpuckett mentions. Did I have better care in the US? From my first HMO, GHC in Madison Wisconsin, no co-pays, no waiting, tremendous company (at least 1986-93 when I was covered as a grad student), but subsequent HMOs sucked more and more. When I left my last job and emigrated in 1997, I had no insurance for 90 days- I could not afford COBRA at $587 a month (for a single man!), and OHIP (I moved to Toronto, came west in 2000) did not provide coverage for those 90 days, which is fine if you're coming from another province (Alberta does the same thing) but is shitty if you are an immigrant. Okay, it's far from perfect, but I love equality!
posted by ethnomethodologist at 1:14 PM on July 3, 2007


A CEO-type he had as a new patient said that his former employer in the US had paid for a full body MRI every month

The availability of MRIs or other shiny machines that go ping is a bad predictor of health care outcomes and the underlying nature of the health care system. Consider that Japan has a nationalised, single-payer system, but Japan has *by far* more MRIs per capita than any other country in the world. Why? Japnese love the appearance of high tech, and many of the manufacturers are subsidized. Seriously, it's almost like every local clinic has one.

Anyway, as for the idea that the US health system is better for the more well-off...
Disease and Disadvantage in the United States and in England
The US population in late middle age is less healthy than the equivalent British population for diabetes, hypertension, heart disease, myocardial infarction, stroke, lung disease, and cancer ... These differences are not solely driven by the bottom of the SES distribution. In many diseases, the top of the SES distribution is less healthy in the United States as well.

As for the idea that the US's existing nationalised systems uniformly suck:
How VA Hospitals Became The Best
The VA runs the largest integrated health-care system in the country, with more than 1,400 hospitals, clinics and nursing homes employing 14,800 doctors and 61,000 nurses. And by a number of measures, this government-managed health-care program—socialized medicine on a small scale—is beating the marketplace. For the sixth year in a row, VA hospitals last year scored higher than private facilities on the University of Michigan’s American Customer Satisfaction Index, based on patient surveys on the quality of care received. The VA scored 83 out of 100; private institutions, 71. Males 65 years and older receiving VA care had about a 40% lower risk of death than those enrolled in Medicare Advantage, whose care is provided through private health plans or HMOs ... The VA’s cost per patient has remained steady during the past 10 years. The cost of private care has jumped about 40% in that same period ... It’s becoming more and more “ideologically inconvenient for some to have such a stellar health-delivery system being run by the government,” says Margaret O’Kane, president of the National Committee for Quality Assurance.

Finally, the idea is often expressed that many Canadians are fleeing their country to seek medical care in the US. This may be true, but I also see literally millions of USians fleeing their country (most virtually, but some desperate ones forced physically) to obtain medical care in the form of cheaper medications from Canada, India, and other places where the pharmaceutical companies have not rigged the system so comprehensively. Frequently, some even travel to foreign countries to have procedures done because the cost in the US is prohibitive.
posted by meehawl at 1:59 PM on July 3, 2007


wealthy Canadians spending health-care dollars in the US when they can't get the care they desire in Canada (simultaneously increasing US healthcare "costs"

If healthcare is delivered in the US on a "for profit" basis, then how can sucbh institutions lose money by selling care to Canadians?
posted by meehawl at 2:01 PM on July 3, 2007


I'd still like to know how Canadians seeking special treatment in the US raise the cost of Canadian healthcare, since it is already paid for by tax revenue. The solution to that riddle escapes me.
posted by Blazecock Pileon at 2:14 PM on July 3, 2007


I don't know about wealthy educated Americans, but here's what a Canadian doctor thinks:
It's compelling material -- I know because, born and raised in Canada, I used to believe in government-run health care. Then I was mugged by reality.

Consider, for instance, Mr. Moore's claim that ERs don't overcrowd in Canada. A Canadian government study recently found that only about half of patients are treated in a timely manner, as defined by local medical and hospital associations. "The research merely confirms anecdotal reports of interminable waits," reported a national newspaper. While people in rural areas seem to fare better, Toronto patients receive care in four hours on average; one in 10 patients waits more than a dozen hours.
posted by vsync at 2:39 PM on July 3, 2007


If healthcare is delivered in the US on a "for profit" basis, then how can sucbh institutions lose money by selling care to Canadians?

Especially given that the Canadians are most likely being charged close to the full price for the services, the same as any other uninsured person.
posted by Thorzdad at 2:41 PM on July 3, 2007


I am a Canadian. I just went to the doctor this morning for a biannual female health checkup. I also discussed some health concerns I've been having. The doctor spent some time discussing my symptoms and what they could mean, then decided to schedule an ultrasound for me in order to see what's going on.

The best thing is, even if I made far less money than I do, I would have had the exact same course of treatment. Even if I didn't have a dime, I would not be thinking about whether or not I could afford to get an ultrasound, or even see a doctor in the first place. I would not have to make that choice.

It always takes me aback when I read comments on here from Americans who admit they are putting off getting medical treatment because they can't afford to see a doctor. It is a very alien thing to me and it makes me a little sad. I don't go to the doctor very often, but when I have a health concern, I don't have to think about my economic situation before I make that doctor's appointment.

I am glad to live somewhere that gives very good care to everyone rather than superlative care to the very few.
posted by hurdy gurdy girl at 3:10 PM on July 3, 2007 [1 favorite]


communist.
posted by Heywood Mogroot at 3:15 PM on July 3, 2007


The US has more MRI machines because they treat more gunshot wounds.
posted by jb at 3:19 PM on July 3, 2007


communist.

:-)

As pinko as they come!
posted by hurdy gurdy girl at 3:42 PM on July 3, 2007


* I'd still like to know how Canadians seeking special treatment in the US raise the cost of Canadian healthcare, since it is already paid for by tax revenue. The solution to that riddle escapes me.

* If healthcare is delivered in the US on a "for profit" basis, then how can sucbh institutions lose money by selling care to Canadians?

Huh? I didn't say they lost money. I said the US expenditures subsidize Canadian results. If a Canadian spends $10,000 getting surgery in the US that he can't get (or doesn't want to wait for) in Canada, that adds $10,000 to the United States health care expense total, even though it's a Canadian getting the benefit. The US runs a trade deficit in most matters, but in health, the US runs a trade surplus, but all those health expenditures in the US on behalf of non-USians count against the US spending-per-capita number.

I didn't say it was bad for the US. I said it was bad for the statistics, and it's misleading to point to those distorted statistics without adjusting for this effect. Canada's healthcare results are made possible by US spending.

The US has more MRI machines because they treat more gunshot wounds.

The US has more MRI machines because they are allocated by market forces rather than by a central bureaucracy that decides that it would rather not spend taxpayer money on a newfangled device.

It's entirely possible the US has more MRI machines than is economically efficient, but that's because of distortions to the market caused by the combination of people not paying for their own healthcare and too many healthcare decisions being made in the shadow of gigantic malpractice liability risks.

But pharma itself is not the dominating expense of health care delivery.

I didn't say it was. I said Canadian cost-benefit results would not be possible if it weren't for the subsidization by American spending on pharmaceuticals. We can have smaller pharma profits and fewer life-saving and life-improving pharmaceuticals; the evidence is more than clear that every dollar cut from pharmaceutical profits reduces the amount of pharmaceutical innovation, which in turn reduces lifespan. The drug companies are improving healthcare results, and the left's populist attack on them makes the world worse off.

Again, Canada would not achieve the results they achieve if they didn't have the US as a neighbor.
posted by commander_cool at 3:42 PM on July 3, 2007


While people in rural areas seem to fare better, Toronto patients receive care in four hours on average; one in 10 patients waits more than a dozen hours.

Yes, that sucks, when it happens, but for serious things it really doesn't. If you're in serious pain (e.g., my girlfriend a few years ago with a UTI) you'll get treatment pretty soon. And really, what would you choose, 10 hours in a waiting room drinking lousy coffee, watching CTV Newsnet and reading dog-eared Maclean's magazines, or to ante up $5000? Not a great time, but all things considered a pretty good deal.
I've had to go to Emergency just twice in my life, with asthma, and there was a minimal wait; a third time with a fractured skull from a climbing accident I wasn't cogniscent but I doubt there was any waiting that time.
My life has been spent in various stations of the British empire and for me medical treatment has always just been like your schooling - it's there for you when you need it; it's part of what the government does and not something you have to lay out cash for. I just can't understand why it should be otherwise.
posted by Flashman at 3:48 PM on July 3, 2007


Are well-off Canadians crossing the border to undergo expensive procedures in the US frequently enough to undermine their own system?

delmoi said: Well that would actually be beneficial to the Canadian system, because then the government wouldn't need to pay for those procedures.


My thought was that it would cause an under-supply of high-end medical procedures if providers could just set up in the US and still skim the top of the Canadian market. Canada might be relieved of the cost of the procedures sought outside of Canada, but it won't have the facilities to provide for the poor patients.
posted by mullacc at 4:02 PM on July 3, 2007


the evidence is more than clear that every dollar cut from pharmaceutical profits reduces the amount of pharmaceutical innovation, which in turn reduces lifespan.

I wonder if this is only true because of the existence of the US system? If the US adopted a universal health care system, where else are the pharmas going to go to make their profits?

I suppose one response would be that the R&D scientists would leave medicine to focus on other, more profitable, industries. But that presupposes that the decrease in innovation is a result of decisions made by, or in coordination with, R&D departments rather than a capital-allocation decision handed down from management/investors.
posted by mullacc at 4:12 PM on July 3, 2007


the evidence is more than clear that every dollar cut from pharmaceutical profits reduces the amount of pharmaceutical innovation

the evidence is clear that big pharma's R&D expenses are 3 or 4 down the list of line items, after profit, SG&A, and gold-bricking.

You're entirely full of shit here, substituting free marketeerism for facts, not to mention demonstrating a childlike parroting of inherently meaningless (in this context) buzzwords like 'innovation' instead of any sort of understanding of social goods.
posted by Heywood Mogroot at 4:21 PM on July 3, 2007 [1 favorite]


I wonder if this is only true because of the existence of the US system? If the US adopted a universal health care system, where else are the pharmas going to go to make their profits?

Their profits will definitely take a hit. And improvement in world healthcare results will decrease, because US-subsidized innovation will decrease. That's good for the people who are happy with the drug lineup we have now, and bad for the people who want drugs that haven't been developed yet.
posted by commander_cool at 4:24 PM on July 3, 2007


Say what you want about the for-profit nature of the US system encouraging innovation or what have you, but I really can't see this system sustaining itself. I've discovered the hard way thanks to my new employer that they don't really have to offer you the plain-ol' HMO, pay $10 and you're done anymore. I had my choice of PPO plans, which for me, don't work because I can't just shell out $500 to see a doc until I hit my deductible. So I took the best plan I could and have to hope for health.

Healthcare, as provided by major companies, is not insurance, per se. The health insurance company administers the plan, but the company pays the costs. They are basically banking that you (their employees in total) won't get sick for more money than you paid in. Which is why the costs are shifting to the individuals more and more. Because we're letting them get away with it.
posted by Eideteker at 4:25 PM on July 3, 2007 [1 favorite]


Facts: Effect of pharmaceutical price controls on innovation.

Facts: Effect of pharmaceutical innovation on lifespan, and that paper doesn't even account for the positive externality of outside-US health.
posted by commander_cool at 4:27 PM on July 3, 2007


The fact is that the top 1% changes less than 1% from generation to generation

Not remotely true.

Tax year 2003, top 1% was $295,495 and up, and thus included me. I sure wasn't in the top 1% a generation ago, and I probably won't be in the top 1% a generation from now, not least because I waste too much time on Metafilter.
posted by commander_cool at 4:33 PM on July 3, 2007


Apologies in advance for the long comment - I just want to respond to the issues brought up in this post. As a Canadian/American ex/repatriate (with lots of health problems to boot!), I like to think I have a pretty good perspective on how the two compare. I am not a "wealthy American" by any stretch, but I think my experiences might be of interest, at least in an anectdotal sense..

As a young child in Canada with a lot of health problems, seeing the doctor, getting referrals to (near endless) specialists, and yes, even going to the emergency room was never much of a hassle to me or my family (especially when compared with, you know, dying). My illness never presented much hardship other than how it physically manifested itself in my day to day life. I fondly remember going to a picnic at the Children's hospital and having the doctors who had treated me pat me on the head and say how glad they were to see me.

As a teenager in the US, my health was a nightmare for me and for my family. Now, bear in mind that there was also a socioeconomic shift here, considering I moved into a single-parent home, clinging to the lower reaches of the middle class. By the time I hit high school, my medical problems had run the household firmly into the working class. We received hounding phone calls from medical billing collectors all hours, harassing my family to pay money we did not have. My doctor was hesitant to prescribe me newer, pricier medicines, because the potential positive benefit would likely put us in the poor house. We lost our house.

An ER doctor's reluctance to keep me overnight, due to the potential financial burden on the family (it would have been the tenth time I had been admitted that year - thousands of dollars of hospital bills and no health coverage) ended up sending me into full cardiac arrest the very next day and in Intensive Care for weeks. My family has still not recovered from this financial burden. I went through all of high school and university with no health insurance, getting my (expensive) prescriptions filled by going to Canada 1-2 times a year, or otherwise I just played Russian roulette and went without. I often waited until I was in near critical condition trying to avoid the costs associated with being ill.

As an adult making ~30k in the US, I had health insurance that my younger, college-student self would have dreamed of. I still had to pay quite a bit on meds and copays for doctors visits, and I had to wait a LONG time to get to any kind of specialist. In the year I worked there, I only managed to see the doctor when I needed prescriptions written, and often had to resort to going to urgent care facilities (and taking a day off work to do so) because none of the doctors my insurance covered were "accepting new patients."

Moving back to Canada has allowed me to make the leap to the career path I wanted to follow (which wouldn't have been affordable considering health care costs in the States). I don't have to worry about seeing a doctor. There's a half dozen walk-in clinics I can go to if I need immediate attention, but I don't have to use it because my GP takes walk ins as well. Referrals take a couple of months to get an appointment, but living in a big city I find that I'm not waiting half as long as I did with health insurance in South Florida. Despite the fact that I have NO prescription coverage here, I pay HALF of what I did in the US for meds, and far less than I ever paid with prescription coverage in the US. And I can claim these medical expenses on my taxes.

None of my friends here have settled for shitty wage slave jobs because they happen to offer health insurance. I haven't heard the common worry "what if I fall and break my leg?" since I lived in the States. If you fall, you'll go to the hospital without bankrupting yourself. All of my young, struggling friends in New England are moving to Massachusetts because at least there's an affordable health care option there.

Every single day I am grateful to be here, to have access to this level of care, and to know that just a few years ago I was putting my health in jeopardy because I just couldn't afford to take care of myself. I know that I can't move back to the US until either a) I'm making enough money to be able to afford being sick, b) that I get a job with very good health coverage or c) health care reform actually happens. I'm very privileged that this is a choice I can make, and I wish for everything in the world that I could somehow share that choice with all the people in the States who are going through the hell that I went through for years.
posted by SassHat at 5:00 PM on July 3, 2007 [9 favorites]


I said Canadian cost-benefit results would not be possible if it weren't for the subsidization by American spending on pharmaceuticals. We can have smaller pharma profits and fewer life-saving and life-improving pharmaceuticals; the evidence is more than clear that every dollar cut from pharmaceutical profits reduces the amount of pharmaceutical innovation, which in turn reduces lifespan.
posted by commander_cool at 6:42 PM on July 3


You're assuming that the only people doing research to develop new drugs and drug treatments are for-profit pharmaceutical companies. That's not the case. Canadian universities do a lot of drug research; the government provides proof of concept grants specifically targeted at turning promising research to practical use. Since universities generally spend more of their budget on actual research (as opposed to promotion, advertising etc.) it's actually a more cost-efficient way to research.
posted by joannemerriam at 5:34 PM on July 3, 2007 [1 favorite]


Implementing socialized medicine would be the biggest boon to entrepreneurialism that the US has ever seen.

I personally am planning to ditch a brand new employer, because they don't really offer health insurance. I took the job, because I have to have some income, I have to pay rent and buy food and all that. But I know that I'm planning to leave as soon as I can find something decent with insurance. I'm not eligible for an individual policy - I called and asked about a condition I have, and was told I'd be rejected if I applied. But in the meantime this company hired me and will pay me, and they'll get some significant disruption when I quit. Sorry 'bout that.

My employers seem like nice people, but they're never going to be able to attract and keep employees like this. I don't know how any small business can get off the ground in our system.

While people in rural areas seem to fare better, Toronto patients receive care in four hours on average; one in 10 patients waits more than a dozen hours

And exactly how is that any worse than what we have here (see ER horror stories in the comments), except that the people in the waiting room aren't worrying about the bills and didn't put off going because of that? Or that the waiting area doesn't have people using the ER as a primary care clinic because they can't afford regular care? So it's slow sometimes. It's slow most of the time here, just for rather horrible reasons.
posted by dilettante at 5:40 PM on July 3, 2007


don't bore us with your whiny woe-is-me anecdotal BS, Sasshat, the top 1%-er Command Cools of this country have the facts on their side and are quite happy to see you stop leeching on our amazing, world-leading private-public "system" and go back to your inferior overburdened, soon-to-fail, socialized medicine-infested pinko-commie nationalized mess.

oh, and Command Cool, "The elasticity of the number of chemotherapy regimens with respect to the number of cases is 0.53. The elasticity of MEDLINE drug cites with respect to cancer incidence throughout the world is 0.60. In the long run, a 10% decline in drug prices would therefore be likely to cause at least a 5-6% decline in pharmaceutical innovation." is not a "fact", but the prediction of a model.

The actual facts is that where the rubber meets the road, big pharma would still an immensely profitable enterprise if they had to disgorge half of their rent-seeking income.

posted by Heywood Mogroot at 5:45 PM on July 3, 2007


Maybe it would've been wonderful for the US to have had socialized healthcare since the 1970s, but then maybe things like MRI would never have been invented.

Maybe. But maybe the Briton (i.e. it's not exclusively an American invention), one of two men awarded the Nobel prize for its invention, would have persevered on his own.... in spite of the UK's socialized healthcare.

Innovation isn't exclusively driven by the private sector. Plus new hospital equipment is in demand in every industrialized nation -- all but one with public healthcare.
posted by NailsTheCat at 6:10 PM on July 3, 2007


Innovation isn't exclusively driven by the private sector. Plus new hospital equipment is in demand in every industrialized nation -- all but one with public healthcare.
posted by NailsTheCat


I don't think anybody's arguing that it's "exclusively" driven by the private sector, but that it's overwhelmingly driven by the private sector.
posted by mattholomew at 8:44 PM on July 3, 2007


The United States has 10 Nimitz-class aircraft carriers, at $4.5 billion each. The Iraq War has cost over $423 billion and we're spending about $8.4 billion per month.
posted by kirkaracha at 10:44 AM on July 3

So by the logic that defines socialized medicine as 'free', war is free too! Bonus!
posted by mattholomew at 8:54 PM on July 3, 2007


The US has more MRI machines because they are allocated by market forces rather than by a central bureaucracy

Did you read the article I linked above, exploring how it is that a nationalised system such as Japan can have such an absurdly large per capita number of MRIs to en extent that makes the US look tame? Focussing on shiny machines that go ping is, again, not a very useful metric. Focussing on outcomes is more useful - mortality stats, years lost to disability, that sort of thing.
posted by meehawl at 9:20 PM on July 3, 2007


hoverboards says: Maybe it would've been wonderful for the US to have had socialized healthcare since the 1970s, but then maybe things like MRI would never have been invented.

If you didn't get your information from FoxNews or speed dial faxes from the RNC you would know that the Nobel Prize was awarded to Paul Lauterbur of the University of Illinois, Urbana-Champaign and Sir Peter Mansfield of the University of Nottingham, England. You also might know that five of the top ten pharmaceutical companies are outside the U.S.
posted by JackFlash at 10:39 PM on July 3, 2007


That is to say, the Nobel Prize for invention of the MRI.
posted by JackFlash at 10:41 PM on July 3, 2007


You're assuming that the only people doing research to develop new drugs and drug treatments are for-profit pharmaceutical companies.

No, I'm not. I'm assuming, based on empirical evidence, that, at the margin, more innovation happens because of the promise of profit. It costs $900 million on average to get a new drug approved by the FDA, and then there's a multi-billion dollar litigation risk if it turns out after the fact that the drug has a rare side effect. At the margin, reduce the profit opportunities, and there will be fewer risks taken. American profit opportunities result in the social good of new drugs that Canadians get a free ride off of. Without those profit opportunities, the drugs would be less likely to exist.

Focussing on outcomes is more useful - mortality stats, years lost to disability, that sort of thing.

Unfortunately, it's not an apples-to-apples comparison, because USA lifestyles differ from Canadian lifestyles. If Canadians exercised and ate and smoked and joined gangs and had teen pregnancies (and spent money on premature babies) like USA residents do, their health stats would be a lot worse. (The smoking is about even these days.) And if Canadians weren't allowed to seek healthcare in the US, one would expect some decline also.
posted by commander_cool at 11:30 PM on July 3, 2007


Don't forget about the seat belt wearing, the legal teenage drinking and the relative lack of getting our asses blown off in foreign countries.
posted by Mitheral at 2:20 AM on July 4, 2007


If you didn't get your information from FoxNews or speed dial faxes from the RNC

So it's true: anyone who breaks the echo is automatically a Republican stooge. My comment about "things like MRI" being a product of the American system, quite apart from it not meaning "MRI was invented by Americans, for Americans, and nobody else even tried to help", was based on the article I linked to in my first comment. Which was from the New York Times. They are a separate company from Fox News and have been known to deviate from Republican talking points occasionally.
posted by hoverboards don't work on water at 5:55 AM on July 4, 2007


I don't understand the argument that a single-payer system reduces the incentive for people and companies to innovate. In contrast, that is, to a system in which a huge amount of effort is wasted by patients, physicians, and insurance companies in working out the myriad details of insurance claims.

This sounds suspiciously to me like Clinton era health plan scaremongering: in Soviet Canuckistan, there's no reason for companies to produce new medical products because the government forces doctors to boil and resterilize rubber tubes, just as they must resharpen huge steel needles.

There is a huge amount of money spent on medical drugs, equipment and supplies in Canada. There is an equally huge incentive for companies to continue doing business in this field. If the US were to switch to a single payer system (which I doubt it ever will or can) it would continue to need medical products and companies would compete by producing newer and better ones.

Oh, but they might have to charge less for them. My understanding for the reason that prices for pharmaceuticals are lower in, for example, my province of B.C. is that just like Costco provincial health plans have enormous buying power and so can negotiate prices lower. This is just good business, which should appeal to those on the right, and it would be unlikely that big pharma would pack up its operations and leave town if the US were to adopt this model. They continue to make a lot of money on us Soviet Canucks up here and most of us understand that drugs are (even here) expensive because that's the price of R and D and regulation.
posted by Turtles all the way down at 6:46 AM on July 4, 2007


People here seem to think that Canadians heading down south for operations is rampant, which I'm fairly sure it isn't.

And people arguing about lifestyle differences between Canada and the US should note that the Canadian government probably spends a fair amount on anti-smoking, anti-this, anti-that, adverts because it has an interest in preventative medicine and keeping health care costs down. Something else to think about.

I'll never understand why American's are so afraid of nationalized health care.

I wonder how many Canadians, Brits, etc, post questions like: "I have a weird growth on my back, what do you think it is?" to Ask.Mefi.
posted by chunking express at 7:03 AM on July 4, 2007 [2 favorites]


Or, to put my argument a different way: an American single payer system would divert money away from insurance company and HMO profits, money which could then be spent on the care of even more patients. That money would eventually end up in the hands of the providers of medical equipment, supplies, and drugs. Even if we assume that the wealthy and well ensured have 'excessive' care lavished on them in the present system, my guess is that the increase in numbers of patients with access to services would more than compensate for this potential loss (and let's face it, it's not going to be much of a loss--no American system is going to reduce the level of care enjoyed by the wealthy and powerful.)

It's not as dramatic as the CEO having a whole body MRI every month (awesome!) but a whole bunch of people suddenly being able to have their weird-back-growth looked at or to have their pre-existing conditions treated with drugs or surgery has to be an opportunity for somebody. Or, goshdarnit, America isn't the can-do, roll-up-your sleeves nation I know it is! And on that note, happy Fourth of July!
posted by Turtles all the way down at 8:15 AM on July 4, 2007 [1 favorite]


And people arguing about lifestyle differences between Canada and the US should note that the Canadian government probably spends a fair amount on anti-smoking, anti-this, anti-that, adverts because it has an interest in preventative medicine and keeping health care costs down. Something else to think about.
posted by chunking express at 10:03 AM on July 4


At least in Nova Scotia, the nicotine patch is quite cheap - I forget the figures but iirc it's cheaper than two packs of smokes. (Anti-smoking ads are generally cleverer, too, though I think that's because the American hippies who draft-dodged ended up in advertising rather than anything to do with socialized healthcare.)

more innovation happens because of the promise of profit
posted by commander_cool at 2:30 AM on July 4


Profit still happens in the Canadian system. Pharmaceutical companies are not crown corporations. They still make tons of money.

Also, prestige (the reward in the university, not-for-profit research world) is a lot cheaper than profit, and is just as motivating for researchers.
posted by joannemerriam at 8:31 AM on July 4, 2007


I'll never understand why American's are so afraid of nationalized health care.


because free health care is for commies (Cuba). and terrorists -- Hamas gives free health care, too. who are you, Michael Moore?

as the old skool demonization of Sweden's welfare system by the American right in the1970s indicates, it's all about attacking, no matter how irrationally, something that scares you exactly because it's popular and because it works and because, shit, one day Americans may try to argue that givin g less money to the military-industrial war profiteering corporations and using that ocean of cash to create a health care system similar to the Canadian one could be a good idea. and you don't really want that, for reasons explained above.


I wonder how many Canadians, Brits, etc, post questions like: "I have a weird growth on my back, what do you think it is?" to Ask.Mefi.

if they live in the US and they're uninsured, I guess more than a few. but then one does not want to interfere to the Americans right to have to decide between groceries or a doctor's bill or even, say, to decide between bankruptcy or death -- it's all about freedom, again. the freedom to die like a cockroach, for example.
posted by matteo at 8:34 AM on July 4, 2007 [3 favorites]


hoverboards, when you make an ignorant statement like "Maybe it would've been wonderful for the US to have had socialized healthcare since the 1970s, but then maybe things like MRI would never have been invented." without even knowing that the mathematical foundation for MRI was developed in a country with socialized medicine, your statement deserves ridicule. You might also consider that the author of the article you linked, Tyler Cowen, is not on the staff of the New York Times, but is from the right-wing economic blog Marginal Revolution. When you site sources, you have to keep in mind that many people on the right oppose universal health care purely for philosophical reasons and will invent arguments out of whole cloth to support their prejudices. If you were more discerning in your reading habits you might avoid such embarrassments in the future.
posted by JackFlash at 9:03 AM on July 4, 2007 [1 favorite]


Canadians who suffer heart attacks are less likely to survive than their American neighbors. And that's before one accounts for healthier Canadians, statistically adjusting for those results in a 17% difference, entirely because Americans are three times more likely to be revascularized.

it would be unlikely that big pharma would pack up its operations and leave town if the US were to adopt this model.

Strawman alert. Noone says Pfizer shuts its doors. The issue is what happens at the margins. “If the manufacturer or investors, anticipating [regulated prices], expect that the prices the various jurisdictions will ultimately set will not in the aggregate cover the cost of development plus a return to capital, the manufacturer will not develop the drug, even though the willingness to pay for the drug in the world might greatly exceed the drug’s development costs.”

One way that Canadians keep health-care spending on drugs down is not buying them: "One hundred new drugs were introduced in the United States from 1997 to 1999. In that same three-year period, only 43 of those medicines became available in Canada."

prestige (the reward in the university, not-for-profit research world) is a lot cheaper than profit, and is just as motivating

Yet somehow, more profits results in more research and development.

Just the very prospect of the Hillary Clinton health care plan in 1993 substantially decreased pharmaceutical R&D in 1993 and 1994, and perhaps cost thousands of lives.

You also might know that five of the top ten pharmaceutical companies are outside the U.S.

"In 1988, American manufacturers developed only 19 of the 50 best-selling drugs worldwide. By 1998, American manufacturers sold 33 of the top 50 drugs. American firms were selling 8 of the top 10 drugs worldwide, and one of the remaining two was from a joint venture between Takeda (Japan) and Abbott (U.S.). The pattern for biotechnology drugs is most striking, as U.S. manufacturers account for 14 of the top 15 biotechnology drugs."

many people on the right oppose universal health care purely for philosophical reasons and will invent arguments out of whole cloth to support their prejudices.

Which NEVER happens on the left, huh? Can you explain why Tyler Cowen is wrong, or is the misnomer "right-wing" sufficient refutation for you?

happy Fourth of July!

And use it to celebrate the good that American healthcare does: An Asian female living in Bergen County NJ has an expected lifespan of 91 years.
posted by commander_cool at 9:06 AM on July 4, 2007


commander_cool writes "One way that Canadians keep health-care spending on drugs down is not buying them: 'One hundred new drugs were introduced in the United States from 1997 to 1999. In that same three-year period, only 43 of those medicines became available in Canada.'"

Well part of that is because we pay so much less for drugs we don't need to make dozens of analogs available in order to save a few dollars. Plus that seems like a suspiciously cherry picked year range, especially considering it predates the article by 7-10 years. She couldn't find numbers for a ten or 15 year period that would have averaged out the vagarities of the approval process? I wonder if 2000 saw 50 drugs approved in Canada vs. 15 in the US?

I also wonder how available those 57 new drugs were to the 16% of the US population who have no health insurance of any sort.
posted by Mitheral at 9:29 AM on July 4, 2007


commander_cool, do you have a bag of links that explains why collective bargaining is a bad thing also?
posted by chunking express at 10:04 AM on July 4, 2007


The US has more MRI machines because they are allocated by market forces rather than by a central bureaucracy

I just wanted to quote that statement from cc to bask in its glowing lights of ignorance, religion, bias, and fallacy.

CC is continually confusing "best-selling", "innovative", "market forces" with "better", when these words do not mean what CC and his ilk think they do.
posted by Heywood Mogroot at 10:43 AM on July 4, 2007 [1 favorite]


The solid statistics amassed since the 1970s point to only one conclusion: like it or not, believe it makes sense or not, publicly funded, universally available health care is simply the most powerful contributing factor to the overall health of the people who live in any country. And in the United States, we have got the bodies to prove it.

To take a page from the complacently cold ... must be all those rich Canadians clambering for the innovative medicine squewing the statistics by dying.
posted by phoque at 11:46 AM on July 4, 2007


JackFlash, please read the second clause of the second sentence in my last comment, and also please understand that I am not your enemy.
posted by hoverboards don't work on water at 1:18 PM on July 4, 2007


hoverboards: please understand that I am not your enemy.

Agreed.
posted by JackFlash at 1:41 PM on July 4, 2007


vsync: Consider, for instance, Mr. Moore's claim that ERs don't overcrowd in Canada. A Canadian government study recently found that only about half of patients are treated in a timely manner, as defined by local medical and hospital associations.

In a previous discussion, one poster pointed out that the waits themselves may well have more to do with artificial restrictions on the supply of providers by professional associations than the single-payer system.
posted by weston at 3:27 PM on July 4, 2007


I wonder how the family of Edith Isabel Rodriguez might feel about this statement.

I wonder what the fuck that has to do with the Canadian health care system.

The US is protecting Canada from whom exactly?

So, in your opinion, Canada's geographical proximity to the US has nothing to do with the fact that Canada doesn't bother (or need, really) to sustain a decent-sized military?
posted by Krrrlson at 11:08 PM on July 4, 2007


I wonder what the fuck that has to do with the Canadian health care system.

Your complaint about the Canadian health care system could easily be levied against the American health care system, so your comparison is bullshit.
posted by Blazecock Pileon at 12:51 AM on July 5, 2007


"One hundred new drugs were introduced in the United States from 1997 to 1999. In that same three-year period, only 43 of those medicines became available in Canada."

Echoing Mitheral, how many of those 100 "new" drugs were simple, futile variations on the theme of ACEs, statins, or tricyclic antihistamines? Because of its rigged market, US drug introductions tend to favour a bunch of redundant, overly expensive pretenders.
posted by meehawl at 7:02 AM on July 5, 2007


So, in your opinion, Canada's geographical proximity to the US has nothing to do with the fact that Canada doesn't bother (or need, really) to sustain a decent-sized military?

We have a military. It's not huge. Does it need to be huge? No. If America decides to invade, we're pretty much fucked, irrespective of how big our army is. (The same would have been true of Russia back during the cold war.) I really can't think of any other country coming to Canada to blow shit up. Most people don't have any serious beef with Canada. We haven't been shitting on the world for the past 60 years. Who do we need to be afraid of? And unlike the States, Canada doesn't seem all too interested in starting wars with random people, so we don't need a huge army to do that either. Canada doesn't need a big army because most things can be sorted out with diplomacy.

And what does this have to do with Health Care? Canada has a reasonably sized army AND national health care. Germany, Britain, France, all have large armies AND national health care. Fuck, Sri Lanka, where my parents are from, is fighting a freaking civil war AND it has nationalized health care. Sri Lanka.

The US can sell a base somewhere in the pacific, sell a few B-52s, and start paying for people's visits to the doctor, all while still having a stupid sized army.

Fuck, just tell your government to stop giving all your money to Haliburton and you'd be set.
posted by chunking express at 7:22 AM on July 5, 2007 [2 favorites]


Man, this whole 3-day old thread misses the point entirely.

Healthcare isn't more expensive in the US because of wait times or malpractice insurance, according to this study by Johns Hopkins, which strikes me as a credible source considering they run one of the most advanced and pioneering research hospitals on the planet.

And before everyone applauds the R&D spending, keep in mind that most of the R&D in the country is done not by Big Pharma, like Pfizer or Glaxo, but bytiny biotech startups, who if they get a successful drug get bought by Big Pharma, or they die in bankruptcy. The "profits" do not pay for the research - Wall Street and private investors who by stock in these biotech companies pay for the research.

The problem in the US is the insurance industry, not the hospitals. In the US, everyone can get healthcare - you walk in to the ER with a heart attack and you get treatment. Period.

Most people in the US have insurance, about 80-85%. The problem is that while there is competition among doctors, HMOs, and hospitals, most Americans get their health insurance through their jobs, and most jobs offer it through only one company. So there really isn't a market for health insurance in the US, unless you go out and get your own (and then you don't get the benefit of group rates, etc.

We buy home and auto insurance on the open market, there's no reason we can't do the same with healthcare. Getting health insurance through your jobs reduces labor mobility, depresses salaries, and distorts the health insurance market by raising the price.
posted by Pastabagel at 7:20 AM on July 6, 2007


And before everyone applauds the R&D spending, keep in mind that most of the R&D in the country is done not by Big Pharma, like Pfizer or Glaxo, but bytiny biotech startups, who if they get a successful drug get bought by Big Pharma, or they die in bankruptcy. The "profits" do not pay for the research - Wall Street and private investors who by stock in these biotech companies pay for the research.

This wildly misses the point. Pharma won't pay big money for the biotech results if they can't turn around and resell the drugs at a profit; if pharma reduces the price paid for biotech successes because they face price controls, then the expected return of biotech goes down, there will be less investment in biotech, fewer biotech successes, and fewer lives saved.

We buy home and auto insurance on the open market, there's no reason we can't do the same with healthcare. Getting health insurance through your jobs reduces labor mobility, depresses salaries, and distorts the health insurance market by raising the price.

I agree. We need to change the distorting effects of the tax code to break the connection.
posted by commander_cool at 9:28 AM on July 6, 2007


I wonder what effect privatizing services like fire and police would have on the quality and stability of life in society. I'd wonder if Americans would find that situation acceptable, if fire and police services were to have the same types of problems that private healthcare has created today.
posted by Blazecock Pileon at 11:40 AM on July 6, 2007 [1 favorite]


I don't think anybody's arguing that it's "exclusively" driven by the private sector, but that it's overwhelmingly driven by the private sector. [...]

So by the logic that defines socialized medicine as 'free', war is free too! Bonus!


So by the logic that concludes that socalized medicine would overwhelmingly hurt medical research, the U.S. has always sucked at defense tech research due to our socialized military!
posted by Zed_Lopez at 1:22 PM on July 6, 2007 [1 favorite]


the U.S. has always sucked at defense tech research due to our socialized military!

Yes, it has: hundreds of billions of dollars of boondoggles and wasted money. Or are you trumpeting American defense spending as a triumph of efficiency and cost-effectiveness?
posted by commander_cool at 2:35 PM on July 6, 2007


Seriously - the whole MRI thing is about gun shot wounds. MRIs can help with pulled ligaments, other injuries, but not so much that they are really cost effective. Where they are truly invaluable is for treating gun shot wounds - that's where an MRI is the difference between life and death.

Canadians just don't get as many gun shot wounds, so it doesn't make sense for us to have as many MRI machines.
posted by jb at 9:15 AM on July 7, 2007


« Older I was a fanatic...I know their thinking. If a Brit...  |  Wendy Shalit keeps it genteel.... Newer »


This thread has been archived and is closed to new comments