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Posted on July 23, 2008

Health-care matchup finds Ohio falls short

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Buckeye State doesn’t measure up when compared to Ontario, which has Canada’s universal coverage

By David Knox
Beacon Journal staff writer
Published on Sunday, Jul 20, 2008

The United States pays far more for health care — more than $7,000 a year for every American, from infant to codger — than any other advanced nation in the world.

That’s an undisputed fact.

The only argument is whether Americans are getting their money’s worth.

There’s plenty of evidence they’re not.

A study released last fall by the research arm of Congress found Americans have shorter life spans and die at faster rates because of major diseases than the averages for 30 democracies that make up the Organization for Economic Cooperation and Development.

The death rate for infants is especially chilling: The United States came in third worst, ahead of only Mexico and Turkey.

But that dismal showing by the nation doesn’t necessarily say anything about the cost and quality of health care in Ohio.

To explore how Ohio compares to the nation and the world, the Beacon Journal looked 60 miles across Lake Erie to the Canadian province of Ontario.

How does Ohio measure up to its neighbor?

Not very well:

  • A 65-year-old Ontario resident can look forward to living about 20 more years — three years more than an Ohioan the same age can expect. At birth, the difference in life expectancy is greater — 76.4 years for Ohioans, compared to 80.7 years in Ontario.
  • In Ohio, nearly eight of 1,000 newborns die each year — significantly higher than the U.S. rate of 6.8 deaths. In Ontario, the infant mortality rate is 5.5
  • Ontario also has lower death rates for each of the top six causes: heart disease, cancer, stroke, emphysema and other chronic lower respiratory diseases, diabetes and accidents.

Overall, the gap in these key health-care yardsticks was wider between Ohio and Ontario than between the two nations as a whole in all but two categories: strokes and accidents.

That difference was striking because the state and the province are so similar demographically.

While the 300 million people in the United States are nine times more than Canada’s head count, Ohio and Ontario are close in population, overall economic size and demographic measures such as median age, average household and family size, and education.

Ohio and Ontario also have similar economies, with almost the same percentage of both work forces employed in manufacturing and retail and wholesale trade — the two largest industry categories. Wages and salaries also are comparable.

There are differences.

Ontario has a larger minority population — nearly 23 percent, compared to 17 percent for Ohio. But the largest group in Ontario is Asian. About three of four of Ohio’s minority residents are black, compared to about 4 percent in Ontario.

Canada adopted a national system more than 40 years ago calling for universal insurance coverage for all basic hospital and doctor care, with a “single-payer” — the government — picking up the bill. Private spending pays for care beyond the basics, including drugs, dental and eye care in most areas.

In the United States, public dollars pay for only 46 percent of health care, mainly for Medicare for the elderly and Medicaid for the poor. The rest comes from private insurance, often through employers, and out of pocket.

The United States is one of only three OECD countries — the others are Mexico and Turkey — without some form of universal coverage.

Millions uninsured

According to last year’s Census Bureau figures, about 16 percent of Americans — about 47 million — are uninsured at any one time.

Ohio’s figure is about 12 percent.

Canada’s system covers everyone, but struggles with long waiting lists for nonlife-threatening surgery and high-tech tests, such as magnetic resonance imaging (MRI) scans.

Earlier this year, the average wait was 121 days for cataract surgery, 216 days for a hip replacement and 110 days for an MRI.

Despite those problems, Canada typically scores higher than the United States in overall quality of health care.

An especially damning study released this year ranked Canada fifth and the United States last among 19 industrialized nations in deaths that could have been prevented “by timely and effective” medical treatment.

“They looked at things like people who died of diabetes before the age of 50, kids 15 and under who die of infectious diseases and people who die of treatable cancers,” said Robin Osborn, vice president of the Commonwealth Fund, a nonpartisan foundation that sponsors research on health issues.

“These are things we know we’ve got the medical artillery to attack — things you shouldn’t be dying of.”

Osborn cited the growing number of Americans without health insurance as one reason for the poor U.S. showing.

“If you don’t have health-care insurance, you’re not going to get the preventive care you need,” she said. “You’re basically going to get stuck in the emergency room.”

The study concluded that the United States wasn’t keeping pace with medical advances in other countries, noting that five years earlier, the United States ranked 15th in preventable deaths.

In contrast, Canada moved up a notch, over the same time. France, Japan and Australia were best.

Within the United States, Ohio fares slightly worse than the U.S. average of 110 preventable deaths per 100,000 population, according to another Commonwealth study.

A comparable score for Ontario isn’t available. But the Beacon Journal’s comparison found Ontario’s death rates are better than the Canadian average for three of the six leading causes of death.

Ohio’s rates are worse than the nation’s in every category but accidents.

Unhealthy lifestyles

Some experts argue such international comparisons are unfair because the United States is so much larger, wealthier and more culturally diverse than other countries.

Rather than lack of care, they blame the poor U.S. rankings on higher rates of illness, triggered by unhealthy lifestyles led by many Americans. In fact, studies do show Americans eat the most sugar, are fatter and have the highest rates of cancer and AIDS among developed nations.

While the factors behind the health results can be debated, there’s no question the Canadian system is less costly.

According to the latest OECD data, U.S. health-care spending in 2006 was 15.3 percent of its gross domestic product, with per-person spending more than double the average of all 30 member nations.

Latest figures from the Department of Health and Human Services put U.S. spending even higher: 16 percent of GDP and $7,026 per person.

Canada spends $3,768 per person, or about 10 percent of GDP. Ontario does even better, with health spending at 6.2 percent of GDP in 2004, according to the province’s Ministry of Finance. That works out to be less than $2,000 per person — about a third of what the United States spent that year.

Why is Ontario’s cost so much lower?

Canada’s universal health insurance system is better able to take advantage of the province’s large urban population, health ministry spokesman Mark Nesbitt said.

About 40 percent of Ontario’s 12.8 million people live in the Greater Toronto area, along the northwest shore of Lake Ontario.

“It’s less expensive to deliver health care where the infrastructure is already set up, where the transit is there, where the equipment and manpower is there,” Nesbitt said.

There are no comparable total health-care expenditure figures for states. But available data indicate that Ohio spends about 6 percent more than the U.S. per-person average.

On its Web site aimed at attracting new businesses, Ontario crows about how little the province spends for health care compared to the United States and other nations.

The pitch is aimed directly at companies in Ohio and other states saddled with providing health coverage for their employees: “This provides a valuable advantage for Ontario in competing for jobs against U.S. jurisdictions, especially in manufacturing sectors, where the cost of health benefits is cited as harming U.S. competitiveness.”

Costs add up

Indeed, in 2006, the Detroit News reported that health care added more than $1,500 to the cost of each General Motors vehicle assembled in the United States.

The same vehicles made in Canada cost GM $197 in health care. The company pays only for supplemental insurance covering dental bills and prescription drugs.

Workers also benefit from not having to fight for health insurance, said Gordon Lilley, an official with United Auto Workers Local 251, in southwestern Ontario.

“It makes negotiations easier because health care is a big-ticket item that isn’t on the table,” said Lilley, whose local represents about 2,700 workers in the auto-parts industry and other manufacturers.

Lilley acknowledged the Canadian system has flaws, such as the waiting lists, but he would never switch to a U.S.-style system that relied on private insurance.

“Absolutely not,” he said. “I have peace of mind, knowing that if anything happens to a member of my family or myself, that we’re taken care of and it’s not going to cost us our house or thousands and thousands of dollars.

“I just think it would be disastrous to have it go private. I think it would do away with our middle class.”

Most Canadians agree with Lilley, according to a 2007 survey sponsored by the Commonwealth Fund.

While 60 percent of the Canadians agreed that “fundamental changes were needed” in their health-care plan, only 12 percent favored “completely rebuilding the system.”

But more than a third of the Americans surveyed agreed with the statement, “Our health-care system has so much wrong with it that we need to completely rebuild it.”

That isn’t likely to happen soon, according to Dr. C. William Keck, who served 27 years as Akron’s health director, retiring in 2003.

Keck, a longtime critic of the American health-care system, blamed the insurance lobby for blocking change.

“There are a lot of well-monied, powerful, smart people who benefit from the system the way it currently is,” Keck said. “They have spread money in ways that make it difficult for anyone to take them on.”

Keck noted that all of the major presidential candidates “seem to have automatically ruled out a single-payer system.”

“It’s almost like they’ve conceded they can’t beat the insurance companies.”


David Knox can be reached at 330-996-3532 or dknox@thebeaconjournal.com