• Tag Archives Canada
  • America Outperforms Canada in Surgery Wait Times—And It’s Not Even Close

    Canadian Medicare, our northern neighbor’s universal health care system, generally receives rave reviews from proponents of nationalized or socialized health care, but the Fraser Institute found that more than 63,000 Canadians left their country to have surgery in 2016.

    As Americans contemplate overturning our health system in favor of one similar to Canada’s, we must ask why so many leave.

    The Canadian system consistently ranks low or lowest across numerous metrics in the Commonwealth Fund’s extensive survey on health care. With regards to specialists and surgeries, the United States ranked best or nearly best.

    The Fraser Institute study did not examine where Canadians traveled for surgery, but given proximity and our much better metrics, most probably came here.

    Surgeries are scheduled after patients are seen by the surgeon, and most people see surgeons only after a referral by either their primary care physician in America, or their general practitioner in Canada. In the United States, 70 percent of patients are able to be seen by specialists less than four weeks after a referral. In Canada, less than 40 percent were seen inside of four weeks.

    After being advised that they need a procedure done, only about 35 percent of Canadians had their surgery within a month, whereas in the United States, 61 percent did. After four months, about 97 percent of Americans were able to have their surgery, whereas Canada struggled to achieve 80 percent.

    America is significantly outperforming Canada in surgery wait times even as it’s likely that tens of thousands of Canadians come here to use the American system.

    General surgery, procedures such as appendectomies, cholecystectomies, and hernia repairs, make up the largest portion of those who leave Canada for care. Based on the latest available date from the Organization for Economic Cooperation and Development, the total Canadian caseload for many of these procedures is about ten percent of America’s.

    America’s health system is certainly flawed and in need of reform, but there is clearly something working well enough that our system, despite already treating ten times more cases of appendicitis, can absorb the dissatisfied Canadians.

    This has been a consistent trend since at least 2014 when an estimated 52,513 Canadians left for their medical care. In 2015, the number went down slightly to 45,619. 2016 exceeded the 2015 number with an estimated 63,459 patients seeking care elsewhere.

    Moreover, both countries have had comparable rates of private health insurance coverage for the past 20 years, roughly 60-70 percent. But the Canadian private insurance market is entirely supplemental—it covers co-payments for services not covered or not entirely covered by the provincial insurance.

    Primary coverage, which is the predominant form of insurance in America, is all but illegal in Canada and would be under “Medicare for All” as well.

    In the United States, government insurance covers gaps left by the private market. Private insurance is the norm and Medicare and Medicaid provide a health insurance safety net for elderly or low-income Americans.

    In Canada, government-provided Medicare is the primary form of insurance, and private plans merely fill in gaps in coverage for those with more disposable income or employee benefits. The two systems are mirror opposites of one another.

    Health care is a product of the labor of physicians, nurses, technicians, and a whole ecosystem of health care workers. If making the government the primary payer for these services is so smart, why does the universal system next door shed patients by the tens of thousands to ours?

    American health care can be improved and should be; American health care performs about middle-of-the-pack for many other items on the Commonwealth Fund survey.

    There are many inefficiencies, often government-imposed, that increase the cost of health care and restrict the insurance market.

    The administration already has loosened some regulations that will give employers more flexibility in providing health benefits and has begun to push for price transparency, which also should bring down costs.

    Whatever the case may be, reforming American health care should focus on enabling our strengths. Under no circumstance should we tear it down and build it anew to resemble the system whose citizens escape by the tens of thousands just to be treated in a timely manner.

    This article is republished with permission from The Daily Signal. 



    Kevin Pham

    Kevin Pham, a medical doctor, is a contributor to The Daily Signal and a former graduate fellow in health policy at The Heritage Foundation.

    This article was originally published on FEE.org. Read the original article.

  • Canada’s Universal Child Care Program Suggests Elizabeth Warren’s Plan Would Be Disastrous for Children

    The state does such a stellar job of nurturing and educating children from preschool through high school, we should expand its role from birth onward. That’s the new proposition unveiled this week by US Senator Elizabeth Warren of Massachusetts. On Tuesday, the Democratic presidential candidate outlined a vast federal program of free and subsidized child care for children from birth until school-entry, including creating a network of government child care centers modeled after the federal Head Start early childhood program. Warren states: “Child care is one of those things we’ve got to do for working parents and we’ve got to do for our children.”

    The popular idea that the state should do things for parents, rather than allowing parents to do things for themselves and their own children, illustrates the pervasiveness of the welfare state mentality. What is framed as helping families instead strips them of their individual power and autonomy, making them more reliant on, and influenced by, government programs.

    Warren’s program is to be financed through a “wealth tax” on the most asset-rich American households and reportedly assures that all child care workers will earn wages that are on par with those of local public school teachers. Like other attempts at government price-setting, however, the economic impact of such a program would inevitably be to drive up prices, reduce variety and competition, and lead to more widespread shortages.

    The intentions of universal, government-funded child care may be good. Supporting children and families is a worthy ambition. But as Nobel Prize-winning economist Milton Friedman warned: “One of the great mistakes is to judge policies and programs by their intentions rather than their results.” We should reject Warren’s proposal both on principle and on consequence.

    The results of similar universal, government child care programs are dismal. In 2005, economists with the National Bureau of Economic Research, including Michael Baker of the University of Toronto, Jonathan Gruber of MIT, and Kevin Milligan of the University of British Columbia, analyzed the effects of Canada’s government-subsidized, universal child care program. Similar to Warren’s proposed child care plan, the Canadian program is available to all families—not just those who are disadvantaged. The researchers discovered that demand for child care increased significantly under the government plan, as more parents abandoned informal child care arrangements with family and friends in favor of regulated child care programs.

    While demand increased, the researchers found that children’s emotional and physical health outcomes declined dramatically with the introduction of government-subsidized, universal child care. Children in the Quebec program experienced increased rates of anxiety and decreased social and motor skills compared to children elsewhere in Canada where this program was not offered. The researchers write:

    We uncover striking evidence that children are worse off in a variety of behavioral and health dimensions, ranging from aggression to motor-social skills to illness. Our analysis also suggests that the new childcare program led to more hostile, less consistent parenting, worse parental health, and lower-quality parental relationships.

    Last fall, these economists published updated findings on their analysis of Canada’s universal child care program. Their recent research revealed similarly alarming results of government-funded child care, including a long-term negative impact of the program. They assert: “We find that the negative effects on non cognitive outcomes persisted to school ages, and also that cohorts with increased child care access had worse health, lower life satisfaction, and higher crime rates later in life.” This early institutionalization of children may have enduring, undesirable consequences.

    While it’s not clear exactly what is causing the negative outcomes of Canada’s universal, government child care program, the research hints at some possibilities. A primary explanation is that the program funneled more children into government-regulated, center-based child care facilities and away from more informal child care arrangements. There was also a drop in parental care, as the opportunity cost of stay-at-home parenthood rose.

    Proponents of universal, government child care programs often tout the expansion of allegedly “high-quality” child care options, suggesting that parental care or other unregulated child care arrangements are subpar. But who determines quality? If Canada’s program is any indication, the government’s definition of “high-quality” child care may, in fact, be harming children.

    In his recent article on the economic causes of current child care shortages and correspondingly high prices, Jeffrey Tucker explains that the key to affordable, accessible daycare for all is to reduce government regulation of child care programs and providers and allow parents to choose the child care setting that best suits them and their child. Let parent preferences drive the market for child care options, not government interventions that squeeze supply, devalue informal caretaking arrangements, and unnecessarily raise the cost of stay-at-home parenthood.

    We should all heed Tucker’s conclusion: “Daycare for all is a great idea. A new government program is the worst possible way to get there.”

    Kerry McDonald

    Kerry McDonald

    Kerry McDonald (@kerry_edu) has a B.A. in Economics from Bowdoin and an M.Ed. in education policy from Harvard. She lives in Cambridge, Mass. with her husband and four never-been-schooled children. Kerry is the author of the forthcoming book, Unschooled: Raising Curious, Well-Educated Children Outside the Conventional Classroom (Chicago Review Press). Follow her writing at Whole Family Learning.

    This article was originally published on FEE.org. Read the original article.

  • Media Fail Marvelously in Mocking Rand Paul for Surgery in Canada, “Land Of Universal Health Care”

    Senator Rand Paul is no stranger to public criticism. As one of the few principled members of Congress and an heir to his father’s legacy of anti-authoritarianism, he has grown accustomed to falling under public scrutiny for standing up for his beliefs. But this week he isn’t being condemned for his foreign policy views or his stance on criminal justice reform. Instead, the progressives have chastised the senator from Kentucky for going outside of the United States for medical treatment.

    When Paul was attacked by his neighbor while doing yard work in 2017, he was left with six broken ribs, a bruised lung, and a hernia, which has since been left unresolved. Needing surgery and being well-versed in the atrocity that is our overpriced and overregulated American health care system, Paul decided to join the 150,000 to 320,000 Americans who travel abroad each year in search of lower costs and high-quality health care. But since the medical facility in question happens to be in Canada, Paul has suddenly found himself a target of those accusing him of utilizing the same socialist system he so fervently decries.

    It wasn’t long after Senator Paul announced his intention to travel to Canada for surgery that the accusations began to make their rounds on social media. Democratic Coalition tweeted, “Oh, the irony: Kentucky Sen. Rand Paul, one of the fiercest political critics of socialized medicine, will travel to Canada later this month to get hernia surgery.” Likewise, Talking Points Memo also took a jab at Paul when it tweeted, “Rand Paul, enemy of socialized medicine, will go to Canada for surgery.”

    The media also had a field day attacking Senator Paul. Deceiving headlines intended to mislead the public read, “Rand Paul Heading To Canada, Land Of Universal Health Care, For Surgery” and “Sen. Rand Paul Is Having Surgery in Canada, Where Healthcare Is Publicly Funded.” But there is just one major problem with these tweets and headlines: They inaccurately assert that because the senator is traveling to Canada for surgery, he must be utilizing the country’s infamous socialized medical program. Nothing could be further from the truth.

    Had any of these overzealous Twitter users bothered to do some research, they would have quickly discovered that contrary to their claims, Senator Paul was not being a hypocrite at all. In fact, staying true to his beliefs, the senator plans to go abroad next week to make use of a top-notch private medical facility that offers competitive rates to patients.

    The Shouldice Hernia Hospital is a private facility in Thornhill, Ontario, that prides itself on being “the global leader in non-mesh hernia repair.” It also offers competitive pricing for those paying out of pocket, which is a huge plus for the uninsured. And since it is private, the facility also has more control over its pricing structure, giving it more autonomy to work with health care consumers.

    Paul, who has likened socialized medicine to slavery and who himself is an ophthalmologist, has always been an advocate for private solutions to our health care woes. And while many would like to condemn this decision to go to Canada as hypocrisy, it is actually right on brand for the senator.

    Kelsey Cooper, a spokesperson for Paul, defended his decision and wrote in an email to the Courier Journal, which broke the story,

    This is more fake news on a story that has been terribly reported from day one—this is a private, world-renowned hospital separate from any system and people come from around the world to pay cash for their services.

    While the media and talking heads continue to waste their breath gossiping about Paul’s personal medical decisions, the senator is demonstrating what a truly free market health care system could look like.

    In an interview with Wave 3 News in Washington, DC, Paul commented on his decision, saying:

    I looked for a place that did primarily that type of surgery. A place that actually accepts Americans who pay cash. It’s a private hospital. The funny thing is, people had an agenda that wanted to attack me said, “Oh, you’re going to choose socialized medicine.” I’m actually choosing capitalistic medicine because they only take cash from foreigners.

    He continued:

    We have some centers like this. Oklahoma has a center like this but doesn’t specialize in the surgery I need. I chose (Shouldice) because they are good at it and actually the price is right.

    Once it was made widely known that Paul would not be partaking in Canada’s socialized medicine, the critics switched to condemning the senator for going outside of the US for treatment, as if doing so was somehow anti-American in nature. And while many are using this instance as a means of shaming Rand Paul, his actions offer a great teaching moment for the country.

    It’s a mistake to view health care as some sort of phenomenon unrelated and immune to the market process. Health care is a commodity just like any other consumer good. And when choice in medical treatment is limited, health care consumers suffer greatly.

    Keeping health care options confined only to one’s own country of origin is an outdated concept. Medical tourism is a booming industry that gives patients more control over their health care by giving them the opportunity to go wherever the best possible care is available at the lowest costs. This has resulted in a boom for countries like India and Costo Rica.

    As I have previously written:

    For anyone unfamiliar with the term, medical tourism is when someone chooses to travel outside their country of origin, usually to less-developed countries, in search of affordable, quality medical care. And it also happens to be one of the fastest growing global industries. In 2016, this burgeoning sector was valued at $100 billion and is expected to experience 25 percent year-by-year growth by the year 2025. And in an era of soaring medical costs, it is saving health care consumers thousands of dollars and providing them with the care they so desperately need.

    The thought of traveling abroad for health care might scare a fair number of Americans. After all, we tend to think our own medical system as more advanced than others. But the truth is that excessive government regulation has actually stifled medical innovation and caused the cost of treatment to skyrocket. And while American politicians argue about how to best fix this problem, other countries have been innovating and relaxing regulations in order to offer competitive care to medical tourists.

    In India, for example:

    [T]he critically acclaimed Narayana Hrudayalaya heart hospital offers cardiac surgeries from $5,000- $7,000. The same surgery in the US would cost a patient upwards of $50,000. And as far as other medical procedures are concerned, in Costa Rica, a knee replacement surgery can cost a patient around $23,000. However, the same surgery, obtained in the US can cost anywhere from $35,000-$60,000.

    The dramatically lower costs have encouraged some US employers to encourage their employees to seek treatment outside the country rather than use their insurance policies to see an American doctor. For employees who need knee replacement surgery, Hickory Springs Manufacturing began offering a choice: pay $3,000 dollars out of pocket and have the procedure performed in the United States, or opt to take an all-expenses-paid vacation to Costa Rica for the surgery instead. And on top of the free trip, you will also receive a $2,500 bonus check. Since switching to this model, the company has saved more than $10 million on health care costs.

    The free market is not constrained to the political borders of one’s own country. And in order to have a robust health care market full of choice, consumers need to be able to go wherever the best care is available. Senator Rand Paul’s decision to go to Canada for surgery should not be condemned; rather, it should inspire the rest of the country to take a look at all the medical options available to us.

    Source: Media Fail Marvelously in Mocking Rand Paul for Surgery in Canada, “Land Of Universal Health Care” – Foundation for