The Cost of HillaryCare

Maggie Gallagher

10/25/2007 12:01:00 AM - Maggie Gallagher

This weekend, Sen. Hillary Clinton talked tough on health care. "It is time to have quality and affordable health care for all Americans," she said in East Las Vegas. Hillary brought forth two women, including a breast cancer survivor, as proof the American system needs HillaryCare.

I thought of that breast cancer survivor, in particular, as I read an important new National Bureau of Economic Research paper by June O'Neill and Dave O'Neill, two respected Baruch College economists, "Health Status, Health Care and Inequality: Canada vs. the U.S."

Canada has universal single-payer national health insurance. In theory, Canadians who get free health care as a government "right" should be much healthier than Americans, who face more barriers of cost to accessing health care, right?

And by some widely touted measures, Canadians are healthier -- both life expectancy and infant mortality are better in Canada. But as these two scholars point out, life expectancy and infant mortality "are poor measures of the efficacy of a health care system" because they are "influenced by many factors that are unrelated to the quality and accessibility of medical care."

If more people drink too much, drive too fast and don't wear seat belts, life expectancy will be lower for reasons having nothing to do with the health care system. Similarly, if you misspend your youth eating too much, sleeping too little, exercising only occasionally and are genetically predisposed to diabetes (like, say, me), you are more likely to get sick in middle age than people who adopt healthier lifestyles. Doctors can only do so much.

For judging whether nationalized health care beats the U.S. health care system, the question people really want to know is: Under what system are you more likely to get the health care needed to prevent and treat chronic or life-threatening illnesses?

Recent data from the Joint Canada-United States Survey of Health (jointly designed and conducted by Statistics Canada and the National Center for Health Statistics) shed new light on this urgent question.

Here's the surprising bottom line: It's somewhat better to be sick in the United States than in Canada.

Americans are -- and this astonishingly countercultural truth bears repeating -- more likely to get preventive health care treatment for serious or chronic health conditions than Canadians who have a government-guaranteed right to health care. In particular, Americans are more likely to get screened for common cancers, including breast cancer, cervical cancer, prostate cancer and colon cancer. Canadians also have far less access to sophisticated medical screening technologies, such as MRIs and CT scanners (the authors call the gap "very large").

Plus, "waiting times are significantly longer in Canada than in the U.S." Thirty-three percent of Canadians who say they have an unmet medical need reported being in pain that limits their daily activities, compared to 22 percent of Americans who report an unmet need. Moreover, U.S. residents "give significantly higher ratings to the quality of care received and were more satisfied with health care services received than were Canadians," note the scholars.

But perhaps less-affluent people do better in Canada? Not really. Among working-age adults (18-64), the health gap based on income is actually greater in Canada than in the United States, according to this new, more accurate income data.

Americans who have cancer may well face harrowing problems that need addressing by presidential candidates. But we are also significantly more likely to survive and be able to make it onstage with Hillary to complain about the U.S. health care system.

I don't know why Canadians tolerate a system where sick people are routinely denied quick access to care that they need. But the logic of "free government health care" is this:

"When no one is faced with any charge for services, demand is unrestrained and costs surge," June O'Neill and Dave O'Neill report. "It is not surprising that shortages developed and explicit rationing became widespread in Canada."

Is that really where Hillary wants us to go?