Amy Ridenour's National Center Blog: Health Care Waiting Lists and the Stockholm Syndrome
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Sunday, March 18, 2007

Health Care Waiting Lists and the Stockholm Syndrome

The Other Club faces down a Canadian who is proud of a health care system that forced him to wait 11 months for surgery to relieve a painful condition.

There's a label that applies when people defend forces that harm them: The Stockholm Syndrome.

This reminds me of the time my husband wrote a paper demonstrating that the Canadian health care system was not less expensive, per capita, than the U.S. system. Many U.S. journalists and politicians had been claiming it was. David's analysis found that the figures being cited as Canada's total health care expenditures left out many health care expenditures that American figures included.

For instance, the Canadian figures commonly being cited left out private expenditures on health care (items such as prescriptions, dental care, ambulance services, eyeglasses, private hospital rooms, cosmetic surgical procedures, and more), while the U.S. figures included all public and private health care expenditures.

I mention this because, when David had an op-ed version of this paper published by the New York Times, he received a great deal of angry mail from Canadians. (This was before the popularization of the Internet, so these folks had gone to the inconvenience of writing ink-on-paper letters.)

As I recall, the Canadian letter-writers were especially angry because David mentioned Canada's long waiting lines for health care services. I would think people subject to waiting lines for health care would be angry because the lines exist, not because their neighbors noticed they exist.

The Stockholm Syndrome.

(Let us hope the hostages will be freed soon.)

At the risk of angering some of our Canadian neighbors, I'm republishing below the op-ed that got folks so bothered 15 years ago, as some will find it interesting. Obviously, the expenditure figures cited below are no longer current, but it is interesting how timely the op-ed otherwise seems:
Compared to Canada, Health Care in U.S. is a Bargain

by David Ridenour (1992)

The persistent claim by Congressional Democrats that health care is more expensive in the U.S. than in Canada is absolute hogwash. In fact, Congressional Democrats and presidential candidates who advocate modeling U.S. health care reform upon the Canadian system risk imposing a more expensive, less effective health system upon the American people. Here's why:

Canadian government expenditures on health care at both the federal and provincial levels totaled over $45.2 billion Canadian in 1990 or about $40 billion U.S. That's $1,481 for every man, woman and child in Canada. U.S. health care expenditures (including state, local and federal government programs; both government and private insurance programs; out-of-pocket expenses; and other private expenditures) during the same period were $666.2 billion, or $2,659 per capita. Congressional advocates of Canadian-style national health insurance, eager to score political points as elections approach, are quick to conclude from this data that health costs in Canada are less expensive -- about 44% less expensive. But while the U.S. spending figure includes all spending on health care, both public and private, the Canadian figure only includes government expenditures.

Consider the following:
�Ģ Expenses for dental care, prescriptions, ambulance service, private hospital rooms, and eyeglasses are not covered by the Canadian government, although these expenses are included in the figure for U.S. health expenditures. To provide such services for Canadians while preserving Canada's "universal," "care-for-all" health care program, Canadians would have had to spend between $30 and $40 per month in 1990 to acquire insurance. This would have added about $420 per year to each Canadian's annual health bill. Interestingly, that figure is remarkably close to the U.S.'s 1990 per capita spending on vision products, prescription drugs and dental services (about $452).

�Ģ Canada has a younger population than the U.S., with 11% of its citizen over the age of 65 compared to 12.2% in the U.S., and a much smaller population of inner-city poor (who tend to have higher incidence of drug abuse and teen pregnancy). Both factors add disproportionately to the U.S. health-care bill. The larger number of elderly in the U.S. alone, according to a recent study, could account for one-fifth of the difference in health spending between the U.S. and Canada, or $236 per capita. For those keeping track, I've already accounted for $656 of the $1,178 per capita difference in health care outlays between the U.S. and its northern neighbor (about 56%).

�Ģ The cost of Canada's 66,137 abortions each year (1988 figure) are not fully covered under the Canadian health program. Government policy on abortion varies widely throughout the country: Some provincial governments will pay for abortions, but only if they are performed in a government hospital and only if the pregnancies endanger the "life or health" of the mother. Others pay for abortion on demand. Some provincial authorities fund a portion of abortions performed in private clinics or hospitals in the United States, while others don't. In the United States, there are 1.6 million abortions performed each year, over two and one-half times more per capita than in Canada. With rare exceptions, abortions in the U.S. are "elective" rather than
medically-necessary. Nonetheless, they add 1-1.5 billion dollars annually to the U.S. health care bill (5-6 dollars per capita).

�Ģ The Canadian health system covers only part of expenses incurred by citizens who, fed-up with either the waiting lists or inadequate service under the government's "rationed" system, seek treatment in the United States or in private Canadian clinics. For instance, U.S. facilities for the treatment of alcohol and drug abuse are accustomed to treating a large number of Canadians. The number of Canadians occupying the chemical dependency wing of BryLin Hospitals in Buffalo, New York, for example, sometimes reaches 30% of the total. The treatment these patients receive is only partially covered by the Canadian government. Similarly, Canada only pays up to 75% of the bill of Canadian patients seeking cardiac surgery in the U.S. With bypasses costing between $35,000 and $75,000, Canadian patients can still be forced to pay tens of thousands of dollars out-of-pocket, none of which is included in Canada's health care cost statistics.

�Ģ The figure for U.S. health care outlays inadvertently includes a portion of Canada's health care bill. The expenditures of Canadians undergoing treatment in the United States are sometimes counted as U.S. outlays.

�Ģ The Canadian government health system does not cover the costs of many cosmetic surgical procedures, but these expenses are part of the U.S. health expenditure figure. In 1988 alone, some 600,000 Americans had portions of their bodies lifted, tucked, suctioned, sanded, cut or otherwise altered to improve their appearance. These procedures are expensive: Facelifts can run up to $10,000; breast implants (150,000 performed in 1991 alone) up to $5,000; nose jobs $6,000; and liposuction to $4,000.
No wonder health care seems less expensive in Canada -- services that cost Americans hundreds of billions of dollars each year are simply not counted as expenses under the Canadian system.

The truth be known, Americans actually get more bang for their health care buck. Consider these two points:
1. Even though American and Canadian health care expenditures are roughly the same per capita, Americans undergo 40% more surgical procedures than Canadians. To be sure, Americans are under the knife too often: Far too many surgeries are conducted for medically dubious reasons, inflicting needless hardship, pain and worry on patients and their families and adding fuel to health services inflation. But Canadians obviously do not undergo enough surgery -- at least, not enough of the surgery they need the most. In British Columbia, a waiting list of 700 to 800 people for heart surgery is not uncommon. In 1990, 15 people on such a list in British Columbia died before they could get their operations. For elective procedures, like hip replacement, the waiting list can be even longer, 13,000 patients long in some instances. A quarter million Canadians are currently waiting for surgery, by some estimates. Apparently, Canada's much vaunted government system does indeed provide equal access to health care for all Canadians -- equally poor.

2. American doctors, on average, have more training than Canadian doctors. In Canada, 50 percent of all physicians are general practitioners compared to only 10 percent in the United States. This means that 90% of the physicians in the U.S. have pursued specialties, requiring a minimum of two years additional medical training, versus only 50% in Canada.
Americans are receiving better care than Canadians for about the same price. Although health care costs in the U.S. continue to rise precipitously, it is clear that the Canadian system offers no solution. As Michael Walker of Canada's Fraser Institute has concluded, health care outlays in the United States are expanding "...because of those aspects of the U.S. system that are similar to the Canadian system, not because of the differences. Patients who have comprehensive, private or public insurance coverage in the United States... generally regard health care as a free good and they behave accordingly." Until health care providers devise an effective means to discourage frivolous claims by those they insure, the cost of health services will continue to skyrocket.

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Posted by Amy Ridenour at 12:20 AM 

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