The US healthcare system is, of course, flawed. People contract diseases in hospitals, costs are high, staff are not always competant, fraud occurs, etc. That said, it is still among the best in the world -- I'd rather be sick in America than Canada, the UK, or Denmark (having seen a Cophenhagen ER once, up-close and personal) -- to name just a few "first-world" alternatives.
Cuba, on the other hand, is undoubtedly near the bottom of the heap: There are terrible shortages of even basic supplies, patients are not even fed adequately (patients must supply their own food! -- the linked study found a full 11% of patients were 'severely undernourished'), clinics are filthy, roach-infested, and even lack running water -- and since Cuba is now a socialist paradise, Castro has thoughtfully sent most of Cuba's doctors to Venezuela, to help his friend Chavez score as a similar PR coup.
So how blind do you have to be in order to be drawn in and convinced by the argument that the Cuban healthcare system is in some way a huge improvement over the US? One must either be hideously uninformed about the world, totally naive about existence of "propaganda", or aware of either, but so morally bankrupt that you're willing to knowingly invert the truth, and praise what is bad and condemn what is far less bad.
So that's part of my amazement about the Michael Moore Sicko pageant which unfolds before my eyes. For example, a friends' mom, who is allegedly a Christian, has become an ardent Michael Moore fan: she mails my friend article after article about what a wonderful (and undoubtedly honest) person Moore is. Yet my friend cannot get her to read or hear anything to the contrary.
Similarly, her father insists there are NO waiting lists in Canada -- and I expect he'll be right on board with Mr. Moore's praise of dictatorship and disease, and condemnation of freedom and a superior healthcare system.
Ironically, Moore's Cuban segment is only possible because of Cuba's gross healthcare inequality -- a concept the left usually condemns, but seems unmoved about in this case. Here, we're terribly concerned about a "two-tiered" system, where society's favored members get one level of treatment, and others get a lower level of care. But it doesn't occur to many, apparently, that Cuba's for-show clinics (available to foreigners and those favored by the government) might operate at a different level of service than the hell-holes to which the average sick Cuban will be consigned.
So we compare the worst here against the very best in Cuba, and decide it would be better to emulate what they do. I cannot understand it: it's like trading Mom's home cooking (generally nutritious, but sometimes the roast gets burnt, and the beans are overcooked) for a plate full of maggot-infested meat with a small half-slice of gourmet chocolate in the corner.
This is a litmus test for my fellow citizens. And, I'm sad to admit, many aren't doing well at all. We're obsessed, apparently, with having best physical health possible. But what about our moral health? What about our ability to tell good from bad and better from worse?
For many, the prognosis does not look good.
Imran: To be precise, I didn't say the the US healthcare system was better than Canada (though I *do* suspect it probably is, by this point): I simply said "I'd rather be sick in America than Canada" and that it was "among the best in the world" -- my main constrast being with Cuba which I say is near the bottom, and which Moore apparently extols.
Regarding Canada: Socialist systems work really well for a short period of time, but it's not sustainable. To use an extreme example, when we storm the rich man's house and redistribute his cash, many people get temporarily richer. But the problem is that, in the long run, nobody wants to be that rich man ever again.
When you cut open the goose, it can no longer lay the golden eggs.
Ever wonder why drugs are so cheap in Canada and so much more expensive in the US? It's because pharma companies have strictly regulated prices in more 'socialist' countries, and thus have to pass along R&D costs mostly to American consumers. In effect, this means the US consumers are subsidizing Canadian, UK, Swedish, and African (etc.) healthcare systems.
What would happen if the US adopted the same kind of pharmaceutical price controls Canada has? You know as well as I do: that expensive R&D cycle would be no longer worth it. The same for other kinds of medical equipment -- which would then lead to a downturn in the quality of healthcare in other nations, also, as these technologies stopped appearing, and as the hidden subsidy disappeared. As we learned from Quixtar, you can't get something for nothing: wealth is not created by simply moving it around.
So who *does* have the better healthcare system? As I said, I have relatives in Denmark, and know full well than when they're somewhat older, and contract cancer, they just let them die. It's a little technique called "rationing", and Canada does it too, albeit in subtler ways -- at the moment:
Canada and Sweden had the lowest [healthcare cost increases], at 2.3%, while the other countries lay about halfway in between. The authors note that Canada and Sweden's low growth rates are unsurprising, given their use of rationing to limit health care spending. Conversely, the high rate of benefit growth in other countries likely results from costly product innovations, such as the acquisition of CT scanners. [1]
In short: Canada is keep costs down by rationing, and by not investing in expensive (but beneficial) new technologies that other countries are embracing.
Total waiting time between referral from a general practitioner and treatment, averaged across all 12 specialties and 10 [Canadian] provinces surveyed, increased from 17.7 weeks in 2005 to 17.8 weeks in 2006. [2]
"Despite all of the promises made by Canada's provincial and federal governments, and despite the fact that Canadians are spending more on health care than ever before, the total wait time in Canada continues to hover near the 18-week mark as it has since 2003," coauthor Nadeen Esmail said in an interview for this article. "Equally troubling is the reality that the total wait time in 2006 is 91 percent longer than it was in 1993." [3]
Health care appears to cost less in Canada than in the United States largely because Canadian public health insurance does not cover many advanced medical treatments and technologies that are commonly available to Americans. [4]
And, to be fair, there is some rationing here in the US also (HMOs) -- but the wait times, in my experience, are nothing like what I'm hearing from Canada. And let's also note that Canada is losing doctors -- again, the inevitable result of price (read "wage") controls.
The numbers tell the story. A university medical education takes nine years, usually leaving new doctors with $100,000 in debt plus office rent, support staff salaries, equipment expenses, insurance and other overhead costs that devour at least 40 per cent of their earnings.
A family doctor bills OHIP $54 for a one-hour patient checkup (the gas or fuel oil company can charge $110 for a furnace checkup). A doctor receives $25 for a minor assessment while paying an average overhead cost of $15 to $17 per visit.
Family doctors and general practitioners in 1999-2000, working a typical 54.7-hour week, on average billed OHIP $168,300 a year, according to Ontario Medical Association figures. Their average net earnings after overhead expenses is $99,300, the OMA reports.
That means their pay is less than skilled tradespeople willing to work 50 to 60 hours a week, plus some weekends, installing and repairing machinery at vehicle assembly plants in Windsor, Oshawa, Oakville and St. Thomas. [5]
So countries like Canada and the UK increasingly try to get doctors who will work for less from foreign nations. But that's harmful too: while Canada or the UK might be able to keep enough doctors, they're depriving someone else, in another nation, of a doctor -- rather than allowing the incentives which would increase the total supply of doctors for all.
You can't get something for nothing.
The US spends much more money, per person, on healthcare than Canada (and every other nation). In fact, even if you only look at public money spend on healthcare, I believe the US still spends more than Canada or the UK (as a percentage of GDP), meaning we're already more "socialistic" than you. But I don't believe that correlates with quality of care (much of it is wasted as Medicare/Medicaid fraud). But the benefit we currently have is a lack of price controls and rationing.
In the end, I agree that it's really hard to directly compare two nations' healthcare systems, including those which are probably pretty close to each other like Canada and the US. Too many variables, too many regions, too many hidden effects.
Yet I also suspect, for the reasons I gave, that the US actually is better on average at the moment -- but even if it isn't, unless things change (and they very well might) I believe Canada's healthcare quality will continue to decline (just as the UK has) -- as it must by the laws of economics.
But point wasn't was to say the US was better than everyone else because we're the US. My point is that price controls, rationing, and a government-run monopoly is a bad move -- if the US adopted them, we'd soon experience the same problems Canada and the UK do -- probably on top of many of those we already have (such as high levels of government waste and fraud). And those innovation-killing effects would bleed over to hurt other nations' healthcare systems also, for the reasons I've just described.
And my intent was also a plea to my fellow US citizens to stop thinking of Cuba (and, yes, Canada) as some sort of healthcare utopia. We have problems and there may be better answers, but a government-run monopoly isn't among them.
Regarding Michael moore, he bends the facts. What I don't understand is why? He don't have to.
Sometimes, you're right. But other times, no: he must bend the facts (or even lie outright) to make a particular case.
For example, in "Roger and Me", he wanted to portray Roger Smith of GM as inaccessible. What he never told the audience was that Smith actually answered all his questions and granted him a 2-hour interview -- which landed on Moore's cutting-room floor. Yet without that omission, Moore would have had to address some of the real causes of GM's high cost of production (which Smith undoubtedly cited), including unsustainably high wages obtained by unions. So the lie was essential: Roger and Me wouldn't even have existed without it -- and Moore would have no fame.
But we love a man who lies to us.
Bowling for Columbine was apparently based on a similar deception: the very story from which the title was derived was untrue.
Perhaps it was the same, from his point of view, in this case: To show, essentially, that socialism works, what better to do that go to an entirely socialist country, one which has been that way for a long time -- and show that a maximal amount of socialism results in fantastic healthcare?
Perhaps comparing the US and Canada was too messy. Too many public studies people can access -- many showing problems or unclear differences. And perhaps Canada isn't socialist enough for Michael. So you use a closed nation where nobody can be interviewed or speak out, one with a few amazing clinics on display for visitors.
Or perhaps Michael even actually believes Cuba has great healthcare -- who knows? It's bad either way: tremendous dishonesty, or tremendously out of touch with reality. But he's not alone: many people hold the same view.
As I say, we love people who lie to us. Just telling it as it is isn't enough: there are many people who have done hard-hitting documentaries on the US healthcare system. (Thus, they're not famous.) But intellectual honesty and balance won't leave people believing that socialism is a wonder drug, which is the point here.
As a society/country, I'm getting more and more convinced that it's terminal ideological cancer. Since our ideological immune system (morals, logic, reason) has been comprimised, people aren't able to distinguish between good cells (ideas) and bad.
Hmm, while I'm stretching metaphors painfully thin, perhaps it's more like ideological HIV/AIDS, since it's ideas themselves (relativism/secular progressivism) that weaken it.
As an aside, and something that's probably been mentioned on this blog before, once a society loses any sense of transcendance, it has to become focused on the body, since that's the sole vessel of life.
Posted by: Michael Zappe on July 6, 2007 11:20 AM