Regardless of whether you are fan of President Barack Obama's health-care reforms, it was downright impressive to see Americans instigate and survive a massive overhaul of their system in a matter of months. North of the border, public discussion of health care, let alone actual reform, is as muted as it is incremental.
For those of us who hanker for a more fulsome debate, the one recent flash of controversy that looked like it might ignite a national medicare conversation was Newfoundland and Labrador Premier Danny Williams's decision to have heart surgery in Miami. But significant numbers of Canadians felt Mr. Williams was justified in seeking medical treatment outside the country.
After all, it was his heart and his health. If money isn't an object (and it clearly isn't for this multimillionaire), who would prefer to languish on a waiting list in an overcrowded health system when sleek private clinics and beaches beckon in Florida? The begrudging acceptance of the Premier's decision by many aging and upwardly mobile Canadians was the result of his public validation of their less-than-favourable opinion of state-funded health care.
But are such assumptions indeed correct? Will you always get better and faster health care in the United States? Here are several cross-border health-care comparisons to help you decide:
Cost: The American system will cost you more any way you "slice it." For a Canadian to travel south for knee or hip replacement surgery, it would cost upward of $70,000. The actual cost incurred by a U.S. hospital for that hip replacement is approximately $12,000, compared to $6,000 in Canada. Accordingly, per-capita spending for health care in Canada was $3,678 compared to $6,714 in the United States, as of 2006.
Waiting times: While it will cost you more, you won't wait as long. According to a 2007 Commonwealth Fund study, 42 per cent of Canadians had waited two hours or more in the emergency room during a visit in the previous two years, versus 29 per cent in the United States. And 57 per cent had waited four weeks or more to see a specialist, versus 23 per cent in the United States.
For that $70,000 knee replacement, recent Canadian statistics show that depending on the province, the median presurgery waiting time ranges from 112 to 291 days. In the United States, it can be a matter of days. U.S. patients have the second-shortest wait for specialists worldwide. As for more general consultations, the median wait time to see a specialist physician in Canada is a little over four weeks. A 2009 study found that the average wait to see a specialist in the United States is 20.5 days. Long waits are also more likely in Canada, with 27 per cent of patients waiting more than four months for elective surgery, compared to just 5 per cent in the United States.
Survivability: Where are you safer? Canada has lower rates of unadjusted in-hospital mortality (1.4 per cent versus 2.2 per cent in the United States). If you are over 65, the United States has slightly higher surgery mortality rates. If you have colorectal cancer or childhood leukemia, or are getting a kidney or liver transplant, you chances are better in the United States, but if you have breast cancer, you are better off in Canada.
Infections: Hospital-acquired infections are a major problem in both countries, and have recently risen significantly in recent years. While there are few comparative studies, rates of drug-resistant Staphylococcus, a leading killer, are higher in Canada, were there are 5.2 cases per 1,000 hospital admissions, versus 3.95 in the United States.
Satisfaction: Will you be happy with your care? It's more likely in Canada. An OECD study found that more Canadians were satisfied with their health system than Americans, and another showed that 44 per cent of U.S. citizens were "not very" or "not at all" satisfied with their system, compared to 36 per cent of Canadian citizens.
Of course, it is better not to get sick at all. And here, the clear advantage goes to Canada. Infant mortality, heart disease mortality and obesity rates are all significantly higher in the United States, and Canadians live longer. Overall, health outcomes are higher in Canada, and overall health service performance is higher. As they say, an ounce of prevention is worth a pound of cure.
Rudyard Griffiths is the moderator of the Munk Debates (www.munkdebates.com). On June 7, debaters will consider the resolution: "Be it resolved: I would rather get sick in the U.S. than Canada."
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