Where Would You Rather Be Sick?

Is socialized medicine the prescription for better health? A recent study comparing Americans and Canadians, widely reported in the press, seems to suggest just that. But there is much less here than meets the eye.

The study, based on a telephone survey of 3,500 Canadians and 5,200 Americans (conducted by Statistics Canada and the U.S. National Center for Health Statistics), was released by the American Journal of Public Health. According to it, Canadians are healthier and have better access to health care than Americans, and at lower overall cost. So is the Canadian system, where the government pays for and manages the health-care system, superior? "Our study," says co-author Dr. Steffie Woolhandler, "is a terrible indictment of the U.S. health-care system. Universal coverage under a national health insurance system is key to improving health."

It is not so clear that the survey data back up these claims. Consider access. According to the survey, Canadians are more likely to have a regular physician, to have seen a doctor in the past year, and to be able to afford medications. But the data are ambiguous; Americans are more likely to have received a pap test and mammogram, as well as treatment for high blood pressure. Moreover, Americans are generally more satisfied with their health care. (The survey did not ask about access to specialist care or diagnostic imaging.)

The survey's most trumpeted conclusion was that Canadians are healthier than Americans. According to co-author Dr. David Himmelstein, "We pay almost twice what Canada does for care, more than $6,000 for every American, yet Canadians are healthier, and live two to three years longer." The survey says Americans have higher rates of diabetes (6.7% vs. 4.7%), arthritis (17.9% vs. 16.0%) and high blood pressure (18.3% vs. 13.9%). Americans are also more likely to be obese and lead a sedentary lifestyle. It's damning stuff. But we shouldn't confuse problems in public health with flaws in health-care systems. Americans may be heavier than Canadians, but this speaks more to genetics, diet, exercise and culture than to the accessibility or inaccessibility of health services. The remedy for obese Americans will be found in less fast food and more gym memberships.

So how does American health care actually measure up? If we look at how well it serves its sick citizens, American medicine excels. Prostate cancer is a case in point. The mortality rate from prostate cancer among American men is 19%. In contrast, mortality rates are somewhat higher in Canada (25%) and much higher in Europe (up to 57% in the U.K.). And comparisons in cardiac care—such as the recent Heart and Stroke Foundation of Canada study on post-heart-attack quality of life—find that American patients fare far better in morbidity. Say what you want about the problems of American health care: For those stricken with serious disease, there's no better place to be than in the U.S.

Socialized health-care systems fall short in these critical cases because governments strictly ration care in order to reduce the explosive growth of health spending. As a result, patients have less access to specialists, diagnostic equipment and pharmaceuticals. Economist David Henderson, who grew up in Canada, once remarked that it has the best health-care system in the world—if you have only a cold and you're willing to wait in your family doctor's office for three hours. But some patients have more than a simple cold—and the long waits they must endure before they get access to various diagnostic tests and medical procedures have been documented for years. Montreal businessman George Zeliotis, for example, faced a year-long wait for a hip replacement. He sued and, as the co-plaintiff in a recent, landmark case, got the Supreme Court of Canada to strike down two major Quebec laws that banned private health insurance.

Dr. Karen Lasser, the study's third author, says that "Based on our findings, if I had to choose between the two systems for my patients, I would choose the Canadian system hands down." Perhaps she would. But as a physician licensed in both countries, I'd disagree.