Canadians Love Their Health Care and Want it to be Even More Socialized

http://www.openleft.com/diary/14275/canadians-love-their-health-care-and-want-it-to-be-even-more-socialized
Canadians Love Their Health Care and Want it to be Even More Socialized


by: Daniel De Groot
Tue Jul 21, 2009 at 21:30

Digby writes about this McClatchy article, highlighting an online poll of Canadians about their (our) health care system.

While the results are generally positive for the Canadian system in comparison to the American one (though McClatchy characterizes it as a "split verdict"), my inner social scientist is always nervous about trusting opt-in online polls too much, and I know this topic actually comes up fairly regularly in Canada so here's a broader overview on the subject of comparative polling. It turns out we do have polling firms here that do real phone polling so there's no need to worry about the possibly libertarian bent of online poll respondents.

First up, this Harris-Decima scientific poll from July 5th gives an even brighter picture than McClatchy's effort, which as it relates to comparisons gives us this:


By an overwhelming margin, Canadians prefer the Canadian health care system to the American one. Overall, 82% said they preferred the Canadian system, fully ten times the number who said the American system is superior (8%).

Daniel De Groot :: Canadians Love Their Health Care and Want it to be Even More Socialized
Now granted one might expect this poll is skewed a bit by patriotism and the natural inkling to prefer the safe and familiar to that other horrid system over the border. For contrast, Harvard asked Americans some similar questions in spring 2008, and got this:


March 20 (Bloomberg) -- The majority of Americans say U.S. private health care may not be better than national systems in Canada, France and the U.K., according to a poll by the Harvard School of Public Health.

The survey, co-sponsored with Harris Interactive Inc., a Rochester, New York, research and polling company, found that 45 percent of Americans thought the U.S. medical system generally was the best. The remaining 54 percent either didn't know or thought other countries' systems were better.

Now I freely admit Canadians spend too much time comparing ourselves to Americans, and are probably a bit prouder of our health care system than it really deserves given its mediocre placement when compared on objective criteria to some other UHC systems, but no one has ever accused Americans of lacking in patriotism either. As an observer of your politicians, seeing them assert America's this or that is the best in the world without any factual basis cited is pretty common, and never fails to get applause so I take this poll as a pretty tepid endorsement of the US health care system.

Adding in ideology and party affiliation reinforces the significance of the Canadian result. Harris-Decima provides breakdowns by party, where only 12% of Conservatives preferred the American system and 76% preferred Canada's. Even among our right wing (who as a rule tend to be very pro-American), you don't find a lot of support for the American model.

More surprising to me is this from Harris-Decima:


Considering both cost and patient care factors, a majority of Canadians (55%) think that the health system should be more public, and only 12% think that more of the health system should be private. One in four (27%) believe that the current system strikes the right balance between publicly funded and pay-per-use care.

Canadians have been consistently worried about our health care system as an electoral issue for over a decade, and things like wait times, cost of drugs, and availability of family doctors (apparently not that big a problem) are regular political footballs. Amazingly, to the extent Canadians want our government run, bureaucrat ridden, inefficient, crumbling and totalitarian system to change, the majority want it to be even more "socialized."

The actual question asked here:


While emergency care, necessary treatments and trips to a family doctor are covered under the Canada Health Act, other services such as private hospital rooms, and certain medical procedures such as dentists, chiropractors and massage therapists are subject to user fees. Considering both cost and patient care factors, do you think that the current approach strikes that right balance between publicly funded and pay-per-use care, should there be more elements included in private health care, or should there be more elements included in public health care?

Again, even among Conservative party supporters, 55% want Canada's system more public, and only 12% want it more private. Canadians have had decades to see our system at work, probably most people have lived their whole lives under it, and seeing that, they would like to see their dentists and massage therapists moved under the socialist umbrella and out of the private insurance market (For dentistry I particularly agree. Basic dental care is not a cosmetic luxury). That is more than an idle endorsement in the abstract, doing any of this would probably involve an increased tax burden so we are putting our money where our mouths are.

Perhaps a bit stale, but in 2003, Gallup did a comparative poll of Canadians, Americans and Brits on health care, and here's what they found:

Pie charts of gallup results showing UK, Cdn systems more affordable


In all three countries, there is great variation of opinion within the population on both the quality of medical care and the availability of affordable healthcare. It is a testament to national health systems that people in Canada and Great Britain are significantly more satisfied with availability of affordable healthcare than their American counterparts are.

If you click through, the NHS seems to suffer in quality of care, but Canada stacks up fine and smashes the US on availability/affordability.

All of these do suffer from the flaw that presumably few of the respondents will have actual experience with the other systems in question. Not ideal, but we have this interesting poll of Americans living in Canada, which, despite the headline ("Americans in Canada prefer U.S. health care") and its statistically unscientific basis (opt-in, top heavy with 6-figure earners and masters degree holders), is an interesting look at what the best off Americans could expect to find under a single payer model:


Overall, the Americans said they preferred the U.S. system for emergency, specialist, hospital and diagnostic services, and said they preferred the timeliness and quality of the American system.

However, they also rated Canada's system high for access to drug therapy and ranked the services of family physicians almost equally in both countries. They also rated the equity and cost efficiency of Canada's system highly.

The participants were upper middle-class, mostly the kind of people likely to be well-insured in the U.S., said Lewis.

"They had high expectations of health care in Canada," he said. "I was surprised by they solidarity they showed for the Canadian system. Even their praise of the American system was qualified. They said, 'Yes, it is good. But it is expensive, and not everyone has access.' "

See the dirty secret here is that Canada has historically been notably less wealthy than the US (Nationmaster lists the US at $6K higher in GDP per capita for 2006) and there was always an element of apples to oranges in comparing our systems. We have fewer MRIs? Well, duh. Of course America should have had the better system, and at the upper end of the income spectrum, they probably do. The fact that we're ahead at all is itself an indication of how broken the US model is. Even so, the people at the top of the income pyramid in the US could expect to see their health care level decrease a bit under a single payer system, but not disastrously so. On the upside for them, people of conscience should like knowing the 47M uninsured had coverage too, and not for nothing either is this:


Meanwhile, 32 per cent also noted that while they lived in the U.S., health insurance concerns affected their decisions about where to look for a job, and 29 per cent said it influenced decisions about whether to remain at a workplace.

Even the upper middle class worries about their health care when it comes to choosing a job or a place to live. It's tempting to ignore these sorts of rich-people problems since what they could lose under a single payer system is mostly related to the hidden quota system of American health care, where the top 3/4 get much faster health care by virtue of excluding the bottom 1/4 from nearly any care. It's tremendously unjust but so broadly systemic that to the individuals benefiting from this mechanism, it is no surprise they don't really see the problem and are nervous about losing it. If you have good insurance, you just go in and get the procedures you need. It's not like you walk into the operating room and order the doctor to stop operating on someone poorer than yourself so he can treat you. The unfairness is obscured and so no one feels personally responsible for it.

So it's worth considering the benefits they'll get to blunt their opposition. It's unlikely the upper middle will ever be thrilled about UHC in America, but keeping them from vehemently opposing it is plainly important.

Overall, the picture in scientific polling is a much stronger endorsement of the Canadian model, and a stronger rebuke of the US model than found in the McClatchy survey. It really strikes me odd that right wingers fixate on attacking the Canadian model, since we do stack up so well. So be it, they're falliable and if they foolishly want to use us as their bogeyman, break out the flashlights and let's get spooky. This is one horror movie that won't qualify for a "based on a true story" tagline.

Tags: Canada, health care, public option, UHC, Single Payer, Polling, Digby, mcclatchy, (All Tags)
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Canadians Love Their Health Care and Want it to be Even More Socialized | 5 comments
by: you @ soon

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Anecdotally (4.00 / 1)
my sister who has lived in Canada for the last 35 years loves the National Health Service single-payer system both in terms of quality and speed of care. The proof though is in the fact that no party in Britain or Canada dares to oppose the health system...were it unpopular there is no question the Tories would be calling for its removal.
by: VLaszlo @ Tue Jul 21, 2009 at 20:56:35 PM CDT
by: you @ soon

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Good post (4.00 / 2)
and reflects my anecdotal experience talking to Canadians and Americans.
by: Ian Welsh @ Tue Jul 21, 2009 at 21:00:12 PM CDT
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A truly excellent and complete article. (4.00 / 1)
There is an ad running in the US, for the Republican Party or Health Insurance Companies, with a woman who says she is a Canadian, and that she spends 10's even hundreds of thousands of dollars in the US to avoid the Health Care system.

She represents that 8% and a few who would love to make money off of the need of Canadians for good Health Care. I would bet my bottom dollar that at any big enough public event you could get 50,000 thousand people to scream "Canada is our Health Care System." Or "Health must be free!!"

This not an ignored topic, this is not shallow, this wasn't a gift, it was demanded and earned. Canadians do not let people , politicians, hurt their system, even philosophical wondering about what is called "two tier" health will end your political career. 80% won't vote for you.

If they connect you to your party as if others might agree with you can sink you party for a decade. "Two tier" health means a system that has two kinds of healthcare, one for people with money and one for those without. Canadians want a system that delivers healthcare for one reason, for health of the person involved, no more, no less. There are Doctors in Canada who do cosmetic surgery and are paid to do it, by the client. But if you need plastic surgery to repair damage to achieve a normative look for example, its covered. If you need sex reassignment surgery, its covered.

Oh By the way, on abortion, Canada pays for that, its called: women's health, period. The man who fought long and hard, who drove government to recognize woman's health as a right, just got the Order of Canada. And because real sexual education is taught and for many other reasons, Canada has much much lower rates of unwanted pregnancies, and obviously fewer abortions, not more like Republican propagandists have suggested, even today.

The present Minority Conservative government promised very formally that they would not touch Canada's Health Care model in the middle of the last two elections.

Picture 30 million people, who like you like good relatives and neighbours, who, if you asked them, and only if you asked, would tell you your health system sucks, and the alternative is single payer. You can have a mixture if you need to, to see the differences, to watch what happens, like Canada did.

But the choice is either a right to health, like a right to vote, like a right to justice and a right to schools or a system that lets its people be victimized by the most powerful lobby, the richest, most manipulative con artists on the earth.

Pass this line in the Sand Bill, with the State Single Payer Amendment, start being healthy, for a change.

Very good article Daniel.

Change
"We must break up the banks and never again let them get so big that they distort our politics and take down the economy.
by: HousesofProgress @ Tue Jul 21, 2009 at 21:36:32 PM CDT
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History (0.00 / 0)
In 1972 I was in my senior year of my under-grad studies and I wrote a term paper on socialized medicine. In the paper I did a comprehensive analysis of the health care systems in Canada, Britain, Germany and the U.S.. I don't remember many of the details of that term paper but I remember the bottom line. All 3 counties with socialized medicine had impressive statistics regarding infant mortality and other metrics of good health and in these countries health care was only consuming about 3.8% of their GDP. In the U.S. the health metrics were poorer and health care was consuming over 7% of our GDP. The merits of socialized medicine were perfectly clear.

In 1972 I never would have believed that our country would remain with such a flawed system and watch the cost of health grow to over 16% of our GDP.
by: richgreer @ Wed Jul 22, 2009 at 07:33:58 AM CDT
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Dual Relatives Strong for Canadian System (4.00 / 1)
My relatives in Canada, dual US-Canada citizens all, both well off and OK (in the arts and non-profits), users of both US and Canadian citizens, all strongly support the Canadian system. They cannot believe the mendacious blather against the Canadian system that they hear from US sources.

My niece, on a highly selective fellowship in DC, found her US HMO experience disgusting. She was glad to get back to Canada. The older relatives have gone from being US conservatives to being US semi-liberals while remaining conservatives in Canada.

The term "conservative" in other developed nations does not include he nuttiness you get in the US nor does it mean letting the equivalent of Wall St run the government.