Sarah Palin’s gross misrepresentations of the Canadian and American medical systems confuses the public by perpetuating a number of myths, and hijacks what we both need: a constructive, fact-based debate on how our citizens can access timely, affordable, high-quality health care.
The downstream effect of people like Palin, on both sides of the border, who make false comparisons, propagate falsehoods, and stoke fears is that many Canadians and Americans are under the delusion that their country has “the best health care system in the world.” The reality is far different.
Here are some facts. The U.S. spends more money on health care per person than any other nation in the world— $7,439 per person, which amounts to 16 per cent of the country’s GDP.
Canada ranks fifth in spending at $3,895 per capita, or 10.1 per cent of GDP. Yet what do citizens get for this? How do we compare with the rest of the world?
The basic litmus test used to determine the health of a population and how well a nation’s health system cares for its people is to measure infant mortality rates and life expectancy.
According to the Organization for Economic Co-operation and Development (OECD), Canada and the U.S. rank 22nd and 28th respectively in infant mortality rates, and 8th and 24th respectively in overall life expectancy. These are appalling outcomes given the massive amount of money spent every year.
It also clearly indicates that the question, “Who has the best system?” has a very uncomfortable answer: neither does!
So, which countries do have the best health-care systems?
Of the world’s top 20, 17 are European (Finland, Sweden, Norway …). They all share similar traits: all have mixed systems that combine both public and private providers, everyone is covered, no one is hurt financially when they fall ill, and there is widespread use of new information technologies to improve efficiency and reduce both medical errors and cost. None has the litigious environment that wastes so much money and poisons the efficient provision of care.
All spend less on health care per person than either Canada or the U.S. and patients are treated based solely on medical need. Iceland, for example, has the lowest infant mortality rate in the world yet spends $3,319 per person per year on health care costs. Japan, which has the third-lowest infant mortality rate and highest life expectancy, spends only $2,581 per person.
Each of these countries also experiences significantly shorter, or no, wait times.
By focusing on the timely and efficient delivery of the best possible care, while adhering strictly to the principle that no citizen will go without health care because of an inability to pay, these countries are providing models that both Canada and the United States could adapt to our own domestic needs.
On top of this, a perfect storm is brewing in North America. Our aging populations and increasingly expensive new technologies are widening the gap between demand for health services and the resources available to pay for them. This is in the face of a shrinking work force. Today, in Canada, there are four workers for every retiree; in 20 years, this will shrink to 2.5 workers for every retiree. Demand for health already outstrips resources; this difference will only widen in years to come, leaving people unable to access care during their time of greatest need. Recently, U.S. President Barack Obama’s budget adviser said that unless we rein in health-care expenditures now, nothing else will matter in the future for we will lose control of our budgets.
In both Canada and the U.S., political parties have used the issue of health care as a cudgel to attack their opponents and garner short-term political advantage. The tremendous cost of this craven approach is being measured in lives lost, disabilities endured, and squandered economic prosperity and productivity.
For the sake of the ill, our economies, and our collective futures, it is time to stop sacrificing health care on the altar of short-term political expediency.
It is time for us to have the courage to identify what works and to embrace those changes that will right this rapidly shrinking ship.
Keith Martin is a physician and six-term Liberal member of Parliament. Dr. Martin is also leading an initiative to create Centres for International Health and Development at North American universities that will link with institutes in the developing world