Canadian vs. U.S. health care

Our health care system is neither rational nor moral, and it will almost certainly get worse under the present administration.

By Kenneth Krell, M.D.
Idaho Post-Register, May 17, 2017

Despite the U.S. spending twice as much per capita on healthcare compared to Canada, our northern neighbors have longer life expectancy (80.3 years vs. 78.6 years), lower infant mortality rates, lower rates of chronic cardiovascular disease and diabetes, and generally seem to get along quite well, thank you, despite spending 10 percent of GDP on healthcare as opposed to the U.S.’s 15 percent.

Some of that Canadian advantage has likely come from healthier living up north—obesity rates of 14 percent vs. the U.S.’s 30.6 percent, along with lower smoking rates and a generally healthier lifestyle.

It’s been unclear if their universal healthcare system — as opposed to our disjointed, hodgepodge of healthcare financing and delivery in the U.S. — is at least partially responsible for the differences in health outcomes.

Until now.

A study in the April 18 “Annals of Internal Medicine” compares survival of patients with cystic fibrosis in the U.S. and Canada, with shocking results.

Median survival in both countries increased between 1990 and 2013; however, survival in Canada increased far more, with a median age of survival 10 years greater in Canada than the U.S. (50.9 years vs. 40.6 years).

Much of the difference could only be explained by the lack of healthcare coverage in U.S. patients. Canadians had a somewhat lower risk of death compared to U.S. patients with continuous or intermittent Medicare or Medicaid, but they had a whopping 77 percent lower risk compared with U.S. patients who had no health insurance. And—perhaps most damning—there was no advantage in survival for Canadians when compared with U.S. patients who had private insurance.

The differences in survival were attributable to the health insurance status of U.S. patients. If you had private insurance you survive at the same rate as Canadians — if you don’t, your life is at stake — with a median 10 year less survival.

As the authors state, “no statistically significant difference in risk of death was seen between Canadian patients and U.S. patients with other insurance (primarily private coverage)… The fact that the risk for death in the United States varied depending on the type of health insurance coverage raises the possibility that differences in the health care systems may explain part of the survival gap documented.”

An accompanying editorial states, “Now we are faced with the more difficult task of trying to identify and implement solutions to bridge this survival gap., which seem to be based on fundamental differences in the two nations’ health care systems.”

In Idaho, since the Affordable Care Act, the percentage of citizens without health coverage has fallen from 22 percent in 2011 to 14 percent in 2015. That’s still 237,372 people without health insurance, including 78,000 who fall through the Medicaid gap. Over 237,000 Idahoans at risk for the kind of adverse health outcomes this study demonstrates, all of whom, for health care, would be better off in any other civilized country.

What is clear is that, as Americans, our health care system is neither rational, ethical nor moral, and will almost certainly get worse under the present administration. As a result more people will die. And, as Americans, we must live with that obscene fact until we decide the deaths will stop by moving to a sensible, equitable universal healthcare delivery system that insures coverage—equally—for all Americans.

Dr. Krell is an intensivist at Eastern Idaho Regional Medical Center in Idaho Falls.