Canada's premier medical journal

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Canada's premier medical journal has weighed into the fracas over U.S. healthcare reform with blunt words: Partisan attacks and horror stories are threatening a "precious opportunity" to give Americans the healthcare they deserve.

These tales "are so absurd and full of fantasy that they would be laughable -- if not for the fact that many Americans believe them," the editors of the Canadian Medical Association Journal said.

On the other hand, the skill and talent of U.S. healthcare professionals -- and the wealth of the country -- could give Americans unparalleled healthcare "if they find the courage to embrace change."

"Lamentably, in the current partisan circus playing out on Capitol Hill, analysis is short and sophistry ... is long," they said.

The Canadian healthcare system is not perfect, they argued, but it gives much better results than the U.S. system, citing 2006 statistics from the Organisation for Economic Co-operation and Development:

* Average American life expectancy is 78.1 years, compared with 80.7 in Canada -- nearly three years shorter.

* U.S. infant mortality is 6.7 deaths per thousand live births, compared with 5.0 in Canada.

* The U.S. economy spends -- "or increasingly, borrows" -- more on healthcare than Canada's, at 16% versus 10.1% of the economy.

* Despite the extra spending, Americans see their doctors less often than do Canadians -- 3.8 visits a year versus 5.8.

"The inescapable truth is that, compared to Canada, America is achieving poor value for money from its healthcare system, and that is killing Americans," the journal's editors said.

"We cannot condemn strongly enough," they added, "the intellectual dishonesty (LIES) of the lobbyists and politicians whose distortions of Canada's health system camouflage their appalling rejection of reform for uninsured and underinsured Americans."

The editorial noted that Canada spends $156 billion U.S. a year to provide medical coverage for all its 32 million people -- fewer than America's 47 million uninsured.

At that rate, the editors argued, the Obama administration's estimated $100 million a year to cover the uninsured is a "screaming bargain."

The issue of rationing care is also a nonstarter, the journal's editors said. "The only cruelty in rationing healthcare comes in doing it the wrong way," they said.

The wrong way, they argued, is to have private insurers that refuse to cover people with preexisting health conditions. "That is the worst kind of rationing, aimed mercilessly at those who need medical care most," they said.

In contrast, Canada aims to ration medically futile treatments -- residents are not denied coverage for preexisting conditions, and there is no cutoff age, they said.
"Where we occasionally make mistakes is in rationing new treatments that in hindsight prove to be useful, not futile," the editors said.

The editorial admitted that Canadians do face waiting lists for healthcare.
"But that does not mean Canadians routinely die waiting for tests and operations," they argued, "because the lists are for elective procedures, such as joint replacement surgery, and not for emergency or life-saving care."
The journal noted that a common feature of American life -- staying in a job to keep health benefits -- does not exist in Canada.
Finally, the editorial noted, Canada's healthcare system had its origin in the western province of Saskatchewan in the 1940s, when health bills forced many families into bankruptcy.

"That same tragedy is replaying in America, where more than half of personal bankruptcies are medically related, the editorial said -- a number that is likely to climb as health costs rise, the population ages, and the U.S. dollar loses ground as a reserve currency.


Primary source: Canadian Medical Association Journal
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