American Health Care Reformers Can Learn from Canada, Britain

Posted April 24, 2009 at 5:30pm

Our country should work toward providing universal access to health care. While a nationalized, government HMO could prompt tax increases, inflation and a decline in quality, we can enact policies to dramatically expand health care access for Americans.[IMGCAP(1)]

When we reform health care, we should follow key principles. First and foremost, reforms should enhance your relationship with your doctor. Insurance companies already interfere with your care — a government HMO might do worse. Second, reforms should reward the development of better treatments and cures. Americans support treating diseases like diabetes but are passionate about a cure. Finally, reforms should be sustainable because so many senior citizens will depend on them. The worst thing we can do is to enact a program we cannot afford.

In considering U.S. health care reforms, many Americans look to Canada or Britain as models. Canadians have a different view. While more than 60 percent of Americans are actually satisfied with their health care plans, only 55 percent of Canadian seniors are satisfied. More than 90 percent of Americans facing breast cancer are treated in less than three weeks, while only 70 percent of Canadians get such quick treatment — meanwhile thousands of Canadians come to U.S. hospitals instead. The average Briton waits in line even longer: 62 days. Britain has fewer oncologists than any other Western European country. It is no wonder that Britain ranks 17 out of 17 industrialized countries for surviving lung cancer. Similar statistics tell the tale of lower quality care for coronary heart disease (94 percent of Americans treated vs. 88 percent of Canadians) and emphysema (73 percent of Americans treated vs. 53 percent of Canadians).

The most dramatic differences come in the field of cancer where Britain’s most-respected medical journal, the Lancet, published the results of a very broad review of European and American survival rates. In short, here is what the Lancet reported in September 2007:

Cancer Survival Rate

American men: 66 percent
European men: 47 percent

American women: 63 percent
European Women: 56 percent

Of the 16 cancers studied, only Sweden showed survival rates nearing American rates of more than 60 percent.

Diabetes is one of the principal causes of senior health care problems. In the U.S., 93 percent of Americans are treated within six months, while in Canada less than half (43 percent) see a doctor in the same time. In Britain, it is worse — only 15 percent of British diabetics are seen within six months. More than 80 percent of American women received a mammogram, while only 73 percent of Canadians received one. Hip replacements offer a stark contrast. In the U.S., more than 90 percent of seniors are treated within six months. In Canada, less than half of patients are treated in the same time with many waiting over a year. Britain is not a place to break a hip — only 15 percent of patients are treated within six months. Many die during the wait.

Many of the advances in 21st century medicine come from MRI scans. Most Americans wait less than a week for an MRI; most Canadians wait over a year. In America, doctors use 27 MRI scans per million. In Canada and Britain, it is less than a fifth of that at just five MRI scans per million.

Care for children also varies. Newborns most at risk need the close care of a neonatal specialist. In the U.S., we have over six neonatologists per 10,000 live births. In Canada, they have fewer than four; and in Britain fewer than three. In this country, we have over three neonatal intensive care beds per 10,000 births, with just 2.6 in Canada and less than one in Britain. No wonder babies in Britain have a 17 percent higher than average chance of dying compared to 13 percent a decade ago. Overall, the life expectancy of a Briton below the poverty line is falling, especially for women.

The starkest difference in care appears when you are sickest. In Britain, government hospitals maintain nine intensive care unit beds per 100,000 people. In America, we have three times that number at 31 per 100,000. In sum, Britain has less than two doctors per 1,000 people, ranking it next to Mexico, South Korea and Turkey. Even dentists are in short supply. The average American dentist sees 12 patients a day, while the average British dentist must see more than 30.

Stories of poor care under a government-only system are common in Britain. Last February, the Daily Mail reported on Mrs. Dorothy Simpson, 61, who had an irregular heartbeat. Officials at the National Health Service denied her care and told her she was “too old.— The Guardian reported in June that one in eight NHS hospital patients wait more than a year for treatment.

Governments regularly run out of money and this can have a real impact if they are in charge of your health care. Ontario canceled funding for child immunizations, routine eye exams and physiotherapy services. Government unions also go on strike. In British Columbia, 5,300 surgeries were canceled during a health care worker strike. The Fraser Institute, an independent Canadian research organization, reported the average wait for surgery is now up from 14 weeks to 18 weeks. Queen Elizabeth hospital in Halifax reports its X-ray machine (no MRI available) was installed during the Nixon administration. To compare, Northwest Community Hospital in Illinois would flunk its own publically-reported quality standard if a patient does not receive a percutaneous coronary intervention test within 90 minutes of heart surgery.

In Washington, there are many proposals to have the government take control of health care. Some bills in Congress even call for pushing all uninsured people, including illegal aliens, into Medicare. We should look carefully at such ideas. Medicare covers over 40 million patients at a taxpayer cost of over $400 billion annually. Adding another 40 million patients to Medicare’s costs would likely cost taxpayers an additional $400 billion annually. Knowing the government will run a $2.6 trillion deficit this year during the worst recession in living memory, can we enact a tax increase to cover this or just borrow it from China?

Seniors and lower-income Americans depend on the promises we make. The worst thing we can do is make commitments that are too expensive and pull the rug out from under those who can least afford to cope. We should back reforms the government can afford to keep.

There are a number of steps that Congress should take to expand access to care and bring down the cost of medicine.

First, we should expand the number of Americans with access to employer-provided health care. One of the best ways to do this is by allowing small businesses to band together to form larger pools of insurable employees and family members. We should also allow franchises to offer national health care plans to their members so that Starbucks, AlphaGraphics or Subway can create one large, national insurable poll of generally young and currently uninsured employees to cover.

Second, Congress should expand access to care for millions of self-employed Americans without insurance. A refundable tax credit for individuals and families equal in value to the same tax breaks large employers get would help them to buy insurance. Individuals could be eligible for a credit worth up to $5,000 annually. Lower-income families would be eligible for a credit worth up to $8,000 annually.

Third, as jobs become more portable, so should health insurance. We should protect Americans who lose their jobs and families excluded from coverage by pre-existing conditions. Congress can remove the current 18-month time limit on COBRA continuing coverage, giving family members the option of always sticking with the insurance plan they currently have. This expanded coverage would also act as a bridge for retirees who are not yet eligible for Medicare.

Fourth, we must pass common-sense measures to bring down health care costs. The Department of Veterans Affairs already uses fully electronic medical records to care for 20 million patients while saving lives and cutting wasteful spending. We also need lawsuit reform. State supreme courts controlled by the plaintiff’s bar (like Illinois) are expected to strike down local lawsuit reforms capping noneconomic damages in medical liability cases. We need federal lawsuit reforms to lower malpractice insurance premiums and retain doctors in high-risk professions.

Finally, the federal government should mandate and enforce the right to see data on in-house infections caused by hospitals. Nearly 2 million Americans contract hospital infections every year, costing Medicare $5 billion annually. We should create incentives for hospitals to reduce their infection rates and help us lower the cost of health care.

In sum, there is a great deal the next president and Congress could do to improve health care without making the mistake of Xeroxing 40 years of mistakes already made by government health care systems in Canada and Britain.

Rep. Mark Kirk (R-Ill.) is co-chairman of the Tuesday Group.