If folks aren't following the debate between Jon Cohn and David Graetzer, they should check it out. Cohn is my fellow social democratic health-wonk-in-arms, while Graetzer is a Manhattan Institute libertarian type and so they, predictably, debating who gets better care, Americans or citizens of nations with universal systems. Graetzer has tried to focus the argument on high-level care outcomes -- if you get cancer, are you better off in America or England? -- but he's done so with oddly poor timing.
Even putting aside Jon's effective rebuttals, a new study was released today comparing care outcomes in the US and Canada. It addresses, in fact, the precise disagreement between Cohn and Graetzer, and does so on grounds that should be favorable to Graetzer -- Canada is often considered a fairly mediocre system. Yet, of the 38 studies examined, 14 showed clear advantaged for Canadian patients, five suggested US care was superior, and the remainder were mixed. The studies showing the Canadian systems superiority found effects both on income -- low-income Americans with breast or prostate cancer do much worse than low-income Canadians with the same conditions -- and care effectiveness. For conditions like kidney failure or cystic fibrosis, Canadian care was simply better. You can pick through the tables with all the results here.
It's not that the data shows unbelievable advantages for Canada, to be sure. As the authors conclude, "although Canadian outcomes were more often superior to US outcomes than the reverse, neither the United States nor Canada can claim hegemony in terms of quality of medical care and the resultant patient-important outcomes." The question raised is slightly different: How can we possibly countenance a system that costs twice as much as the Canadian system but delivers slightly worse care? Even assuming diminishing returns, our expenditures should result in care outcomes at least 20% or 30% better than Canada's. Instead, they're about 5% worse, but cost around 187%. Does it sound like we're getting a good deal?
