Friday, August 12, 2005
Today's Wall Street Journal published a run-down of the troubles experienced by Canada's national single-payer health care system. It's "Canada's 'Free' Health Care System Has a High Price Tag," by John H. Fund. (The joke in the title is from P.J. O'Rourke's line that if you think the price of health care is high now, just wait until it's free.) Among Fund's observations:
- "[L]ast June, a majority of Canada's Supreme Court struck down a Quebec law that banned private health insurance and held that the public system inflicted cruel and unusual punishment on many of its patients. . . . Canada's Supreme Court was scathing in its indictment of the system. 'Access to a waiting list is not access to health care,' the court ruled. 'Delays in the public health care system are widespread . . . in some serious cases, patients die as a result of waiting lists.' The court struck down a Quebec law banning private medical insurance, which should lead to successful challenges to similar laws in other provinces." The opinion is Chaoulli v. Quebec (Attorney General), 2005 SCC 35 (June 9, 2005).
- "The Fraser Institute has found it takes an average of 17.9 weeks between the time a patient makes an appointment to see a general practitioner and when he can then see a specialist. He will then be treated by a system that ranks 13th out of 22 advanced countries in access to MRI technology; 17th out of 21 in access to CT scanners and seventh out of 22 in access to radiation machines. The safety valve in the system is that nearby U.S. hospitals can provide treatment for emergency cases and patients willing to pay."
As the article also points out, however, Canada's Medicare program enjoys healthy levels of public support -- Fund would say irrational levels of support -- despite its weaknesses. During the first few decades of the system, Canada experienced robust growth in its economy most years, and a steadily increasing pie helped buffer Canadians from the economic pain that would otherwise have resulted from steadily increasing health care costs. When the Canadian economy stopped showing strong growth, the Medicare system came under enormous pressure to cut back. Somehow, through it all, Canadians remain loyal to their system. The question raised by Fund's article is this: Are Canadians poorly informed about the performance of their health care system, or are Fund and other critics of Canadian Medicare looking at the wrong indicators? What matters most: the number of MRI's and mean waiting times, or infant mortality, life expectancy, and other measures of health care outcomes?
Thanks to my former student, Julie Timmer, for sending me this article. [tm]