Canadian medicosclerosis and American medicomania

Impossible to compare

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I follow several physicians from Canada on Twitter.  Since I do not have first hand experience of that health care system, I find their accounts instructive.

Some tweets are sadly biting:

Shawn Whatley, a Canadian physician I also follow, wrote in a recent blog post entitled “Medicine resists change” that:

Canadians took a bold, progressive move in the 1960s and created Medicare. And we’ve blocked change ever since.

Sure, we dribble in new technology. Embarrassment demands we buy at least a few PET scanners and robotic surgical assists. But our core system is unchanged.

Government and Organized Medicine insist that basic clinical services work the same as in the 1960s. Patients see their family doctor. Doctors send patients for ‘high-tech’ X-Rays, ultrasounds or blood tests. Patients drive to licensed and controlled lab facilities. Then they trudge back for results days later.

That sounds grim.  But the apparent Canadian medico-sclerosis Whatley describes would have been even worse if it weren’t for the American medico-mania which has disgorged an unbelievable number of innovations and technologies over the last half century.  Most of these innovations, such as the PET scanner, have been exported all over the world, including Canada.

It occurred to me that the extent to which other countries have benefited from this American cornucopia seems to be under-recognized in the perennial debates that compare different health care systems.  What would single-payer systems like those of Canada and Europe (let alone those of the developing world) look like today without the impetus exerted by the American dynamo?

“Life expectancy is just as good in the NHS!” we are told.  But hasn’t the NHS benefited from the development of modern intensive care units, pacemakers, heart-lung machines, bypass surgery, coronary angioplasty, neonatology, CT scanners, MRIs, and myriad inventions which have seen the light of day primarily by virtue of the existence of the American system?

Now, in pointing out the technological and scientific dependence of the world’s health care systems on the US, I am neither trying to boast about American inventiveness (clearly, a large number of inventors have been foreign born, and a good number of inventions originated abroad—even in Canada!) nor establish the American health care system as superior.

In fact, to the extent that our system’s medicomania is fed by a bulimia of debt, that it defers onto future generations a painful day of reckoning, that it creates boondoggles and encourages cronyism, and that it causes those with health care benefits to inevitably drive prices out of the reach of those without those same privileges, then I am perfectly willing to accept that the American model offers as much to be embarrassed about as the Canadian one.

The point worth making is how difficult it is—impossible, in fact—to make any economic comparison of one system against the other on the basis of empirical observations alone.  One can’t say “Look, here, single-payer system, it works!” anymore than one can say “Look, there, crony capitalism, it works!”

Yet that’s precisely the approach that a colleague has taken to rebut my previous criticism of single-payer economics.  Adam Gaffney, a Boston physician and active member of Physicians for a National Health Program wrote that

Now…it’s a bit quixotic to invoke the political philosophy of a neoliberal economist to argue against what is essentially [an] empirical point, i.e. that the United States spends more on health care administration than nations that have a single-payer system (emphasis mine).

But Gaffney missed the point I had made at the end of my post where I said:

Although a single payer could conceivably reduce administrative burden and cut costs, its doing so will never be on the basis of “knowledge of the particular circumstances of time and place” that is at the heart of genuine medical care.

The realm of human affairs is an inextricable mishmash of causes and effects.  It can be clarified only if we begin with first principles and proceed by way of reasoned deductions.  An appeal to empiricism just won’t do.¹

So as to which of Canadian medicosclerosis or American medicomania is the best disorder to have, I’d say they both need radical surgery and would simply leave it at that.


1.  Anyone interested in learning about these first principles of natural economic reasoning should definitely read Henry Hazlitt’s 1946 classic essay Economics in One Lesson, now available free online.

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4 thoughts on “Canadian medicosclerosis and American medicomania

  1. I had the great pleasure of hearing journalist T. R. Reid (PBS documentary–“Sick Around the World”) speak in Louisville, KY on July 21. I would like to hear his take on this debate. He pointed out the benefits–both human and economic–of universal, publicly funded, government-run systems such as Canada’s Medicare. He is currently working to see single payer adopted in Colorado and in Oregon.

    The Canadian system isn’t perfect. The current Harper government is stingy with funding, would love to allow private for-profit insurers. Like the US, Canada needs more physicians, pharma-, dental- and vision- care. But they take care of their people, and drugs cost 1/3 what we pay here. Reid noted that putting a few more per capita dollars into Canada’s Medicare budget would fix many of their problems. Go on the health ministry of Ontario’s web site to see wait-times posted for non-urgent surgeries. Are we that transparent?

    As to the Canadian medical community being slow to adopt innovations–I’d like to see more data on that. Our US physicians are often hampered by insurer interference–edicts that such & such an innovative procedure or drug will not be covered.

    In the final analysis–we spend almost twice what the Canadians spend and over 30 million of our people are denied access to the “cornucopia” of medical care you refer to–whether innovative, high tech, or otherwise. Low-income persons must go through the humiliating process of proving they are poor enough to be cared for. As T. R. Reid said the other evening, “It’s a moral issue.”

    You can always find a patient who complains–or a physician. You might ask that BC surgeon if he’d rather practice in a general hospital in the US.

    Americans who want to join the grassroots movement for a single -payer system should consult to find a group in their local community. Physicians are urged to follow Dr. Gaffney’s lead and join/support

    In addition to recent Canadian work on robotics, here’s another link to Canadian innovations:

    • Harriette,

      Thank you for your comments. You make some points I agree with, some I disagree with, and some that can’t be settled by “more data.” And that’s my main point. The debate won’t advance by making empirical comparisons.


    • I also had the chance to hear T.R. Reid speak on healthcare. He addressed a room full of Canadian physicians, all of us in system leadership.

      Reid was deeply mistaken on a many significant facts. He described Canadian Medicare as it was in the 1960s and 70s. He referenced the Beveridge Report as though it were modern history For example, he described Canada as a blended system where doctors owned and operated hospitals. Out of nearly 200 hospitals in the province of Ontario, less than 6 are still allowed to be privately owned.

      We had high hopes for Reid. We pay big dollars to hear from notable speakers and writers with international acclaim. Reid had not done his homework. He seemed far more enamoured with the idea of a Medicare system built on the now abandoned British National Health Service of the 1950s.

      If you want a current, readable analysis by an American Democrat, take a look at Catastrophic Care, by David Goldhill



  2. I grew up in Thunder Bay, Ontario. I now live in the Pittsburgh, PA area, where I happen to volunteer as an EMT.
    When I was a kid and needed to go to a clinic (not the ER) because of an ear ache or something similar, I could expect to wait hours to be seen.
    Here, in the US, I can walk into one of many urgent care facilities and expect to be seen within about 20 minutes.
    In Thunder Bay, going to the ER was something you generally would pack for. You expected to be in the waiting room with dozens of other people for hours and hours on end unless you were actively dying. A report after I moved away done by the Ontario government congratulated itself for processing admitted patients within 27 hours!
    The best way to eliminate “work-related injuries” was to tell people that to have that substantiated, they needed to go to the ER for an eval. Even if the employer paid for it, nobody wanted to go and sit through that.
    Here in the Pittsburgh area, I know that most hospital ERs will process patients, even at the busiest of times, within 8 hours. Most ERs are setting up “fast-track” systems to quickly process minor issues and get them out the door quickly.

    Another thought: At close-to minimum wage of $10, even waiting an extra 10 hours is worth $100. I’d much rather pay the extra money and save myself the time and possibly the pain associated with the wait.

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