In the seemingly endless, endlessly fractious debate over health care reform, one of the most provocative buzz phrases has been “government-run health care.” Opponents of current health care reform legislation claim that President Obama is trying to initiate a government takeover of the U.S. health care system, while most supporters emphatically deny such claims. (Although still others wish he would do just that, by doing something like expanding Medicare to cover everybody under 65 as well.)
The reality, of course, is that the health care reform legislation currently in Congress, in its various incarnations, doesn’t amount to a government takeover of health care. But what would it mean if it did? It’s impossible to know for sure, because all other models of fully government-run health care are in countries and economies very different from the United States in terms of everything from population size to rates of chronic medical conditions.
But a quick look at three “government-run” systems — in Canada, France and the United Kingdom — offers some insights into the ups and downs of what might happen if, someday, the United States ever did take this approach. (Lumping these systems together is a little unfair too because they all take slightly different approaches to payment, access and coverage, but they all have some significant element of government involvement.)
If these three other countries are anything to go by, a more or less government-run health care system would be significantly less costly. Canada, France and the United Kingdom spend only a little over half of what we do on health care for every citizen (about ,000 vs. nearly ,000). As a matter of fact, the United States spends more on health care than any country in the world — either per person, or as a percentage of gross domestic product.
And Americans spend more by a wide margin. U.S. health care gobbles up in the ballpark of .3 trillion a year, and rising — a whopping 16 percent of GDP, compared with 9 percent in other industrialized countries.
So, for all that extra money per person, what are we getting? Not necessarily better health outcomes. Our average life expectancy of 78 years ranks 27th in the world — Canada, France, and the United Kingdom are all ahead, between about 79 and 81 years. We rank 34th in maternal mortality and our infant mortality rate is 29th in the world — even worse than its ranking of 27th eight years ago. France is ninth, while Canada and the United Kingdom are lower than that but still well above the U.S. ranking.
In fact, a Commonwealth Fund study comparing U.S. health care to other nations ranked us last in most areas, including access to health care, patient safety, timeliness of care, efficiency and equity. And according to a January 2008 study published in the journal Health Affairs, the U.S. placed dead last among 19 countries surveyed for deaths considered preventable through health care.
Most recently, a study released by the Urban Institute in August compared U.S. treatment outcomes and other quality indicators with that of at least 30 developed countries, including Canada, France, and the United Kingdom. The United States did well in certain areas, particularly cancer care, but we ranked below average in others, like asthma care and childhood immunizations. Overall, the United States had a much higher rate of conditions like heart disease and stroke in its over-50 population than most European countries. “In fact, there is no hard evidence that identifies particular areas in which U.S. health care quality is truly exceptional,” the authors wrote.
So the American system, despite all we spend on it, currently isn’t buying us much better results than Canada’s, France’s or the United Kingdom’s. But how about those waiting times? You’ve heard the horror stories about having to schedule your gall bladder surgery a year in advance in Toronto. At least if you need to get a mammogram here, you can get it right away. Right?
Not necessarily. A Commonwealth Fund study found that waiting times for health care were worse in the United States than in any of six other industrialized countries except Canada (Germany was tops; France wasn’t studied but is generally considered to have fairly short wait times).
Even Canada actually appears to be improving its legendary long lines for care, through such approaches as pilot programs and reporting data (there’s nothing like embarrassing people to get them to fix things). According to Statistics Canada, the median wait time for elective surgery there is now three weeks, which is less than how long many Americans wait for such surgery. (The median waiting time for all specialized services was between three and four weeks.) Meanwhile, wait times here in the United States are getting longer — by more than a week since 2004, according to a survey by the consulting firm Merritt Hawkins and Associates.
But what about the government-run bureaucracy? According to T.R. Reid, author of “The Healing of America: A Global Quest for Better, Cheaper, and Fairer Health Care,” U.S. health insurance companies have the highest administrative costs in the world, spending about 20 cents of every dollar for non-medical costs, such as paperwork, while Canada’s universal insurance system, run by government bureaucrats, spends 6 percent on administration. Canada in fact most resembles the current system we have under Medicare, whereby everyone pays premiums for an insurance plan run by the government.
None of which is to say that other systems offer health care utopias, either in terms of outcomes or finances. For example, breast cancer survival rates in the United Kingdom are between 10 percent and 14 percent lower than in the United States, according to two recent studies from the Lancet Oncology. In France, the national health system was nearly billion in debt last year.
For that matter, everybody’s struggling with the skyrocketing costs of care. Although Canada, France and the United Kingdom spend far less than we do on health care, the fact is that we’re all increasing our health care spending at a rate that outpaces economic growth. When it comes to health spending, we’ve all got problems to solve.
But there’s one financial figure that does separate the United States from Canada, France and the United Kingdom: Each year, 700,000 Americans are forced into bankruptcy because of medical bills. In France, that number is zero, as it is in Canada and the United Kingdom.
Realistically speaking though, the United States isn’t heading toward a France-style system any time soon, for good or ill. It’s just not in the political cards. But a look at these other health care systems belies the notion that involving “government bureaucrats” in the health care system automatically means long lines, rationing and poorer care. So maybe that “public option” in the health care bill — which would allow the public to choose a government insurance plan that competes with private companies (although states could “opt out” in the Senate version, at least) — wouldn’t be such a bad idea.
In any case, don’t blame Canada.
About the Author
Gina Shaw is the medical writer for The Washington Diplomat.