Public Values

Privatizing health care is not the answer: lessons from the United States

Why the US spends more and gets less.

Dr Marcia Angellby Marcia Angell, MD, Canadian Medical Association Journal

October 6, 2008 — There are strong moves within Canada to make the Canadian health care system more like the US system by partially privatizing it. Those who favour this approach claim that the US system offers more choice and better quality of care and spares the public purse. Some proponents even go so far as to claim that it is more efficient. My purpose here is to disabuse Canadians of these myths by taking a close look at how the US system works and comparing it with the Canadian system.

In 1972 the Yukon Territory became the last jurisdiction in Canada to adopt the Medical Care Act, which set up a system to provide hospital and physician care to all Canadians. Before then, the Canadian and US health care systems were similar. Both were partly public, partly private, partly for profit and partly nonprofit. Both also left a great many citizens uninsured. The costs were also about the same — a little over $300 per person in 1970 — as were outcomes. At that time, life expectancy was about a year longer in the United States.

But with the implementation of Canadian medicare, the two systems rapidly began to diverge in all respects. The US system became more and more costly, leaving increasing numbers of Americans — now about 46 million people — uninsured. In 2005, expenditures were twice as high in the US as in Canada — US$6697 per person v. US$3326 in Canada. And although Canada insures all its population for necessary doctor and hospital care, the US leaves 15 percent without any insurance whatsoever. Those who are insured often need to pay a substantial fraction of the bill out-of-pocket, and some necessary services may not be covered. In a recent survey, 37 percent of Americans reported that they went without needed care because of cost, compared with 12 percent of Canadians.

Outcomes also now favour Canada. . .

To read further. . .

Marcia Angell is a senior lecturer in social medicine, Department of Global Health and Social Medicine, Harvard Medical School, Boston, USA

Privatization vs. Public Values Frame
  Health care is a market commodity / Health care is a right

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  Privatizing health care is not the answer: lessons from the United States, by Marcia Angell, MD, Canadian Medical Association Journal, October 6, 2008

Posted: October 22, 2008

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