Based on the comments I’ve seen over the last week, many of you are still going with that well used meme in the health care debate that people in other countries – frustrated by wait times and rationing – come to the United States for care. These are almost always anecdotal stories and you should know by now how much stock I put in anecdotes.Go read the original post to get the embedded links.
As always, when we can we should turn to evidence and research, and on this topic it does exist. The most comprehensive work I’ve seen on this topic was published in a manuscript in the peer-reviewed journal Health Affairs. That study looked at how Canadians cross the border for care. Most anecdotes involve Canadians, since it’s easy for those on the border to come here. And, the authors used a number of different methods to try and answer the question*:1) First, they surveyed United States border facilities in Michigan, New York, and Washington. It makes sense that Canadians crossing the border for care would favor sites close by, right? It turns out that about 80% of such facilities saw fewer than one Canadian per month. About 40% saw none in the prior year. And when looking at the reasons for visits, more than 80% were emergencies or urgent visits (ie tourists who had to go to the ER). Only about 19% of those already few visits were for elective purposes.Look, I’m not denying that some people with means might come to the United States for care. If I needed a heart/lung transplant, there’s no place I’d rather be. But for the vast, vast majority of people, that’s not happening. You shouldn’t use the anecdote to describe things at a population level. This study showed you three different methodologies, all with solid rationales behind them, all showing that this meme is mostly apocryphal.
2) Next, they surveyed “America’s Best Hospitals”, because if Canadians were going to travel for care, they would be more likely to go to the most well-known and highest quality facilities, right? Only one of the surveyed hospitals saw more than 60 Canadians in one year. And, again, that included both emergencies and elective care.
3) Finally, they examined data from the 18,000 Canadians who participated in the National Population Health Survey. In the previous year, only 90 of those 18,000 Canadians had received care in the United States; only 20 of them had done so electively.
As a Canadian I can confirm that some Canadians go from Canada to get medical care in the US. They are sent by our health care system for specialized care which is either not done because our lower population doesn't justify having the expertise or because we have "line-ups" and the overflow is sent to the US in order to speed the delivery of care.
I can also verify that Americans in Canada sometimes jump the queue here by using their fame or dollars (e.g. movie stars and sports stars) to get to the head of the line in our "socialized" medicine. This is a scandal and the official position is that jumping the queue is "never done" but there are several well known cases. In my mind this is proof of corruption in the system here or stupidity, i.e. officials here are so "excited" about the needs of a big shot American that they temporarily forget the rules and rush the American in for treatment before the waiting Canadians. Chalk that up to a colonial mentality or a branch plant mentality. Yes, Canada has a long history of being subservient to the UK or the US. So a lot of officials here think their duty is to the "mother country" or "the defender of the Free World" and not to the citizens of Canada. Those officials are fools and should be fired.
Since my family is spread over both sides of the border I can attest to the following:
- My mother, a US citizen, had a knee problem and had to get emergency care in Canada. The wait time was about 10 minutes, the doctor drained fluid on the knee, and the hospital charged $50 for the treatment.
- My mother needed emergency treatment in the US and was forced to wait over four hours for a doctor. She finally left because she was fainting from hunger and it wasn't clear when or if they would treat her in "emergency".
- My brother had a kidney stone that was causing him excruciating pain. I took him to emergency in the US. He spent five hours in the waiting room at the US emergency room and passed the kidney stone (in horrible pain). When they finally took him in they x-rayed him and confirmed that he had passed the kidney stone. For this "service" of using the waiting room to pass a kidney stone and to get a few x-rays and see a doctor, they charged him $5,000. He is a Canadian. If this had happened in Canada, he would have gotten treated within half an hour (or less) and it would have cost nothing.
Oh... and as for competence. We have the odd case of medical incompetence and cases where a hospital has a serious malpractice problem. But what are the odds of a couple both dying within a month of each other in a medical system that (a) operates on a brain tumour and doesn't properly monitor for a hematoma and kills the patient and (b) takes an emergency case of heart fibrillation and fails to treat the patient for 4 days because they have a rule that the family physician must first attend and their notification system failed to notice that the alert of the family doctor never made it there? Well (a) happened to my mother and killed her and (b) happened to my father and contributed to his death a month later. That a 100% malpractice rate in one family. I've never heard of that in Canada. But that is my personal experience with the US medical system, the "finest" in the world.
Sure, my examples are anecdotal. But they are not generalizations. They are specific instances with validity to puncture the balloon of "superior American medical services". It only takes a few cases to debunk a generalization. To prove a generalization using anecdotes is wrong-headed. But anecdotes can establish that a generalization is false. American medical care is not superior. And the above facts from The Incidental Economist put the lie to the idea that Americans are "fleeing socialized medicine" to get care in the US.
Our "socialized medicine" costs us a lot. One reason our taxes are higher here than in the US is that we pay for our medical care through our taxes. But because we use a rationalized system with a single payer, doctors and service providers here don't have to have collection agencies and they don't fill out reams of paperwork for insurance companies. Doctors don't have to worry about collecting from deadbeats. But our doctors do get paid less than US doctors because our doctors negotiate with the government for their salaries. In the US doctors can charge whatever the market will bear. Consequently a fair number of newly minted Canadian doctors head south each year because they got into medicine, not to help their fellow citizens, but to enrich themselves. Sure, they had to fill out application forms talking about their "love of medicine" and pretend that they want to help their fellow Canadians. But in reality, these are eager-to-become Americans who can look after Number One by charging whatever they can get away with. Yes, this small handful of Canadians truly are fleeing socialized health care in Canada.