A few things in the health care debate have been riling my feathers lately. The first is yesterday's post by Ezra Klein examining how the folks over at the right-leaning The Corner are busy questioning the definition of "is". Ramesh Ponnuru writes:
I don't think [universal health care] is possible, actually. If you can't get an operation because your country's national health insurance system has you on a long waiting list, in what sense have you enjoyed "universal coverage"?
Ezra goes on to discuss how one can, in fact, define universal, and that definition is "everyone in the population receiving health insurance".
Jon Cohn addresses the latter part of Ponnuru's argument over at The New Republic's blog, the Plank, and dug into the stats on waiting lists:
Here's the summary findings from an exhaustive survey by the Organization for Economic Cooperation and Development (OECD):
The health system in France is regarded as delivering high quality services, with freedom of choice and generally no waiting lists for treatments.
--Page 69, sourced to a 2000 study by a trio of academics
And: In Germany, "Waiting lists and explicit rationing decisions are virtually unknown."
--Page 70, citing a World Health Organization study.
If Ramesh knows something the OECD doesn't, I'd love to hear about it.
I'm going to throw myself into the fight here, and debunk another favored myth of the Right, which is that the Canadian health system is so bad, millions of Canadians come here for their health care.
A 2002 Health Affairs paper examined hospitals near the border, as well as national surveys to tease out how many Canadians actually visit the U.S. to receive elective procedures.
In terms of hospitals along the border offering advanced treatments or special diagnostic technology (i.e. CT scans and MRIs), about 640 Canadians were seen, along with 270 for procedures like cataract surgery. They compare this to about 375,000 and 44,000 similar procedures in the region of Quebec alone during the same period. If you divide the total number of Canadians seeking those treatments in the US, divided by the number in Quebec alone that's about 0.09%. Not even a tenth of a percent.
But the most striking stats come from the Canadian National Population Health Survey (NPHS). From the article:
Only 90 of 18,000 respondents to the 1996 Canadian NPHS indicated that they had received care in the United States during the previous twelve months, and only twenty had indicated that they had gone to the United States expressly for the purpose of getting that care.
Only 20 of 18,000 sought care in the United States. I can't believe how many people are coming over here! Their system but be truly awful.
But let's give this number some context. We've all heard about seniors getting their prescriptions from Canada. (Hell, even driving to visit my sister at college in rural Kansas, I saw a billboard for "Canada Drug of Topeka!") But how many seniors really do that? Is it exaggerated, like the claims of Canadians coming stateside?
Polling data from 2003 (approximately a year after the Health Affairs article) indicates that 8% answered YES to the following question:
"Have you ever bought prescription drugs from Canada or other countries outside the United States in order to pay a lower price?"
If 8% of the 18,000 Canadians polled in NPHS had expressly sought care in the United States, that would be 1,440. Not 20, as the survey showed.
In other words, we have 72 times the number of Canadians seeking care in the US going to Canada (or at least calling there) to get prescriptions.
What angers me so much about the Right's rhetoric on health care reform is that their arguments are so weak that they're now essential questioning the definition of "is".
Universal health care has been achieved in dozens of nations on this planet. One of which has some waiting lists, while others have essentially none. According to surveys, less than 0.1% of Canadians are expressly seeking care in the U.S.
The bottom line is our health care is twice as expensive, fails to cover 46 million people, has questionable quality, kills around 100,000 people a year from error, and for all this we have worse health indicators (i.e. lower life expectancy, higher infant mortality, etc). Other countries do it better, and they do it with the help of government to pay for health costs.
We can at least move to a system where everyone has health insurance. Or, you can believe the folks over at the Corner who are arguing that universal coverage doesn't exist.
What do you want?