Comparing Canada & USA + PA & CZ
Comparing things is, of course, a human tendency, apparently. And so in the great debates over America we are oft comparing everything to what is done in Canada. Supposedly, from this, we can deduce some better system – if it “works” in American better than Canada, presumably the Canadians should adopt our methods. And if it “works” in Canada better than here, we should adopt theirs. After all, the two countries are said to be similar in so many ways as to be comparable. And so I want to look at the way these comparisons are done – not to diminish the value of any specific comparison, but to add a new dimension on how the comparisons should be done and what exactly are we comparing.
I launch the comparison by quote this website, which I would think is authoritative –
“Health care is one of the most expensive items of both nations’ budgets. In the United States, the various levels of government spend more per capita on health care than levels of government do in Canada. In 2004, Canada government-spending was $2,120 (in US dollars) per person on health care, while the United States government-spending $2,724.” (Their footnote.)
And so, we could immediately conclude, if these numbers are to be believed, and the comparison per capita at face value, that the US government was doing more for the people than Canada. I would think then, that if someone said “Canada has a better system than we do” I could, in our dollar-metric world, point to a Canadian source to say: “Not true, the US spends more per capita.” Wouldn’t that be the end of the argument? Of course not. Let’s parse the numbers, until we’re laughing funny, OK?
First, is the property values of the land and buildings in which the US spends this money higher than Canada? That is, is a gov’t buck on “health care” in NYC higher than say, in Toronto – those being the two “comparable” cities – both the preeminent in the land. Or, for better similarity – Los Angeles and Toronto – those two being more similar in size, and physical make up too – far more spread out is Toronto than NY, and approaching Los Angeles Sprawl. And so, if this metric is higher in NY or LA than Toronto – and it must be included, the cost of the land and building, yes? – than perhaps it would then turn out that both spent $2,000 per capita on actual “care” and Toronto $120 on infrastructure, and NYC or LA $724 on infrastructure. I do this to bring my play number to $2000.
Ah, but you say, Canada is what we’re comparing, with 33 million people. OK, let’s compare Canada to Texas or to California – both with roughly the same as Canada. And then, if we use the original figures we find this oddity: Canada is mostly urbane (not urban, urbane, sic, as in middle class) and white and less poor, and more homogenous, less immigrant – while CA & TX are far more racially diverse – with TX ahead in Black, CA in Asian, both roughly equal in Mexican – and since it seems so that Blacks and Mexicans are less insured, and more vulnerable to violence-related health care, then Canada might be providing more per capita – or less – for we don’t know how this per capita is spent.
Perhaps Canada has more administrators than doctors, and TX and CA have more doctors than administrators? Perhaps the offices in one or the other are cushier – did they cost the same? Perhaps the US is subsidizing Canada by paying more for new drugs up front, since the pharmaceutical companies and research are American – and Canadians benefit, but pay less, since the costs are, by law it seems, only given to the US side of the usage. Perhaps, too, that the research the CDC and NIH and other US gov’t , and the Texas Medical Center in Houston, and other US local gov’t research facilities – which must be in that per capita, no? – spend more than Canada, and then Canada gets the benefits, but not the costs? Wouldn’t that alter the comparison as to whom is “better”? Sure it would.
Then too, let us now compare to stranger things, that also would alter our perspective on the comparison of health care – or anything for that matter, as we shall see soon below – is so tricky as to defy comparison at all – except, of course, for partisan purposes or idle speculations. Let us take Ontario, Pennsylvania and the Czech Republic – all roughly equal in population at 11 million – and with three systems for sure – Ontario with the wonders of Canada-Care, Pennsylvania now with all sorts of Medi and Obama Cares, and the old homeland with what can be clearly called socialized medicine. I’ve used Czech medicine – went to a hospital there – my recommendation – hell, their recommendation was, “don’t” – and though, single payer, and free, it’s so abysmal one can’t fathom that “Europe,” oh vaunted Europe, has such dismal health care.
I had an abscess in my um, (so personal!) testicle; fortunately at the end of lengthy stay. The Czech hospital, Bulkova, used a black & white TV scan machine to tell me “Lop it off!” – and then the doctor said, “Nah, go home, quick, in the US they’ll do better.” – in four days I was in NYC – and walked in without insurance into St. Vincent’s in NYC’s emergency room – and presto, within 15 minutes I was beneath the color scanner being told “Ah, take this pill, call me in the morning.” So, the socialized system was dismal, and the private charity hospital was fine. There was an ATM, a “bankomat” right there at the counter in the Czech Republic – seems foreigners have to pay. Not much, just $80 for the 20 minutes with the doctor and the hour in the waiting room. The Catholic Hospital (a part of that Church I’m completely fine with,) charged me nothing.
Ah, waiting times! This is a comparison – supposedly it’s “2 hours” in emergency rooms or “1.7 hours” or of course, for the horror stories “5 hours” – back and for this comparison of wait times is done – yes, well, why? There’s so many variables I can’t imagine it’s even measurable. Waiting for what? For instance, is this measured here and there at the same time? Are emergency rooms busier on a Friday night or a Tuesday afternoon? Is it faster in the city or the country? Are the suburban more white people emergency rooms with broken bones faster than the urban more black people emergency rooms with gun shot wounds? Really, I see the aggregates and I sigh – waiting times. What a mush number. The studies would require such a level of information that it’s doubtful it could be done. Sometimes I think they simply ask people as they leave the emergency room “how long did you wait?”
And too, with “wait” – I have been in such places for broken bones – and some gun shot wound came in – my “quick” time because quite a “wait” time for triage alone. However, each time I ever walked into a hospital (only twice of late, post 50) and said “I’m over 50, white male, having chest pains” – I was nabbed so quick into the EKG that they barely had time for my name or to see my eye color. Wait, schmait – you’re a 50+ male with chest pains, you’re in – and presto, alas, for the feverish post-drunken college boy throwing up with a strange rash, well, his wait time just jumped a few minutes. Triage, I tell you, triage.
Back to the $2000 per capita left, after real estate – and what affect on say “Life Expectancy” – and this too is a weird comparison – all three countries – US, Canada and Czech Republic are roughly the same – certainly within 5 years of each other – and the three could run near the top depending on the exact measurements and variables. The US variable is of course always dragged down by four factors that simply must be included – yet that seemingly rarely are – 1) road kill – yes, US drivers are simply more apt to be killed on the road, especially the poor college boy left to wait a tad longer in lieu of my potential heart attack.
Two) Ethnic based diseases – sadly, it is true, African-American males in the US are more apt to die before they ever see a Social Security check – which alone is unfair and “racist” in a way. They pay in all those years, and then die at 65 and they nor spouse, or gal, or kids ever see a dime, while old Mr Johnsonfeld out on the prairie in Nebraska lives till 99. Now, that can alter the numbers. Indeed, if one removes Mexicans, Latino immigrants, Asian immigrants and African-Americans from the US numbers then the life expectancy of the white population climbs to #1 in the world. Ah, but the US is not #1 – yes, well, white folks don’t seem to die from diabetes, lupus, sickle cell anemia and gun shot wounds – which are whole other problems, I do not contest – but to compare “health care” one should, I would think, compare the same things. Is the 50+ white man, or the 25 year old white gal, getting more and better, cheaper and more efficient health care in the comparable places I’ve mentioned: The US, Canada, or Ontario, Pennsylvania and the Czech Republic, or New York & LA versus Toronto – is a man such as I in any of these places better off by the metrics in one or the other? Or are they the similar.
Three) – violence – oh yes, America is more violent – often amongst the sort of people Canada doesn’t even have. The 800,000 African-Canadians are nearly like the 15 million African-Americans in violence. Nor does Canada have Mexican’s doing shoot ’em ups. And too, less crazed lunatics walking into work places and shooting. Oh, it’s not the guns. I’d say it’s the genes. Yes, Canada got the milk toast, as was left behind in Europe too. Ah, but America – we got the crazies. Yes, in the beginning the Kings of Europe emptied their prisons, lunatic asylums, poor houses, dissidents, cranky fellows and every other sort of malcontent and rage-seething non-conformist and shipped them to America. We got the gumption-and-more people. This is a oft overlooked fact of Americans of this generation – we are descended from what were perceived as the worst of society – while Canada got the quiet ones. Ergo, less violence there. Not to mention no cross-race violence because there’s just not enough other races to make the difference.
Four) child mortality – well, yes, the same ethnic thing also affects this – not just because of “poverty” – though one can ascribe some of that to the issue – but because of the very genetic make up of the people having babies. It’s far more complex than merely saying “we loose 6 per 1000 and they lose 5 per 1000 so they’re better.” Once again, when it comes to whites, they’re equal, and then, when it comes to the non-whites, there’s just so many less in Canada that they can’t affect the number. Perhaps the difference in the spending is not “fraud waste abuse” or “administration” or “profit” but simply that we have more expensive people.
Meanwhile, under single payer socialized medicine I’d have lost the testicle. Under charity care in a Catholic Hospital I kept it – hmm. Perhaps it was more expensive to keep it, and cheaper to lop it off. Beats me, I like that I kept it though. Which brings up this little problem of comparing systems by the dollar – what is the dollar value of the kept testicle in terms of my happiness? That is, yes, it might be cheaper to lop it off – either in the single pay Czech place, or in the US charity place, or in Canada, and perhaps that would be the recommendation based on cutting or maintaining health care costs. It’s certainly um, cutting the issue down to size – but what of my happiness for the rest of my life? Is it worth the extra, oh, I don’t know, let’s say $1,000? That is – my happiness cannot be measured by dollars, and certainly not by any private-profit, charitable or single payer or “Free” health care measurement system. It’s impossible. We pursue more happiness in America, perhaps that’s why we spend more, and Canada and the Czechs get out the carving knife.
Then too, in looking at Canada versus the US, there “infant mortality” – and again, in the places I’m comparable – if you compare similar populations – blacks, whites, yellows, browns, you’ll get different numbers for each within the nations, but the same numbers between the nations. That is, Canadian Indians infant mortality is not that different than US Indians, but both Indians are worse off than whites. For the Czech Republic I’ll use Gypsies, since they are, I could argue, the “Indians” of that place – they too always are at the short end of the stick. We are not supposed to speak of any genetic factors or ethnic reasons for this difference, that would be “unfair” and “racist” – though it might also be true. We can only speak of “social differences” and “oppression” – which may also be true, but in different ways. The Gypsies are not on reservations, nor are all Indians, and Canada’s Indians have their own provinces.
And let’s also compare the white ethnic mix – Canada has more Northern Europeans than Southern Europeans than in the US – less Italians and Greeks – but more Eastern Europeans that the US – more Poles and Ukrainians – it’s all well parsed in our “we’re all equal” and color blind times – we know almost to the last child what the ethnic breakdown is in both nations. We have more Jews, so they have less Tay-Sachs. And well, so let’s compare a Polish heritage 50+ male living in a city of a 1,000,000 people in both countries – both of equal body weight (US is more Obese of course, which could be for a number of reasons that too can be parsed ad infinitum, to buttress your case.) Here you go – the gritty data –
I’m sure similar could be found in Czech, PA, TX, CA, and US chunks.
Then too there’s the salaries to the doctors, nurses, bureaucrats – etc etc – here, look –
more facts and figures than one could shake a fist at.
Here, more facts and figures:
Publication Date: September 1, 1999
In Code Blue: Reviving Canada’s Health Care System, David Gratzer takes a close look at Canada’s health care system—from the overcrowded emergency rooms of Montreal hospitals, to the thriving practices of Canadian doctors who have decided to head south. He explores our misconceptions about the American health care system, analyzes demographic trends, and exposes the emptiness of political debate on the subject. Gratzer argues convincingly that the problems with Medicare stem from its very structure, a structure that will only continue to weaken as Canada’s population grows older. Do the commonly proposed solutions to these problems—increased funding, two-tiered services, better management, user fees—really have what it takes to correct such major flaws? Gratzer concludes they don’t, and looks at several models in other countries before writing his own prescription for Canada’s.
Let’s throw in the Canadian Debt Clock – http://www.debtclock.ca/
Can$599,092,36.,…,… Or, $17,175 per person, and rising. I’m sure there’s many a site with US data – but was is just as ominous there as here is that it’s spinning so fast upwards one can’t even see the numbers rotate – it’s not the Amount – it’s the speed at which it’s increasing that will bring the doom and recognition of reality. Perhaps their debt is lower per capita – but it’s certainly half of ours – and how could so few have so much debt? It’s far out of proportion to ours, for sure.
Here’s a way or two to compare taxes –
Chart: The tax burden, by province
By Phil Froats | September 20, 2011
Chart: The ages of tax
Infographic: HST costs Ontario families more
Chart: Who pays the tax piper?
“To see who bears the burden of individual federal income taxes, a simple formula was devised. We took each province’s percentage of Canada’s population, then the percentage each province contributed to net federal income tax payable in 2008. Generally, provinces contributed fairly close to their share of population, with the variance between population and tax being less than 1%. For example, Saskatchewan has 3.07% of Canadians and contributed 2.75% of federal income tax. There were three exceptions. Alberta and Ontario were the only two provinces with positive variances, with Alberta coming in at 6.1%. The largest negative variance was Quebec, where a 23.3% share of the population contributed 19% of the tax for a negative variance of 4.3%.”
It can be seen that Alberta and Ontario are subsidizing Quebec – and the others. Ergo, it is a mathematical certainty that Quebequers are better off than the other two – for they work for what they get, and they get others to work to give them more than they originally would have. And true, Alberta and Ontario make a bunch that they give to Quebec – losing out on the use of their own revenues. That hardly seems fair in one sense – but fair in another. You can pick which you like: take from Alberta and give to Quebec so they both have the same, or let them each keep their own. I prefer the latter, and wonder why Quebec is inept at paying its own way, and maintaining itself with Alberta – is it not enough work, or too much spending? Profligacy or Laconic behavior? Beats me.
Ah, the “right wing” think tanks take on taxes: http://cdncommonsense.wordpress.com/2012/04/26/canadian-tax-burden-grows-like-a-weed/
Canadian Tax Burden Grows Like A Weed
“Governments in Canada take more and more of the earnings of their citizens every year. Here is an excerpt from a Fraser Institute release:” blah blah blah – who knows if any of it is true – for I will grant well that it is biased. As I contend all such studies are biased. Me, I’d perhaps take the average of three or four.”
But, all this aggregating, all this comparing, all this parsing of numbers – it’s mush – for you can do it as you please and come up with what you wish – for every sob story, I’ll present a success. For every hard luck horror, I’ll present an angelic saving – that’s easy to do – and in fact, it shows the very individuality of the matter – and debases the collective aggregates. After all, it may be perfectly true that a man with a fever sees a doctor quicker at the emergency room on a Tuesday afternoon than a gun shot victim on a Saturday night – and yet, morally, triage, medically – it would seem the gun shot wound should have less wait time. So when are you measuring the wait times again? To really compare them? Perhaps you should concede they are not comparable.
As for social security – and any other measure of comparison between Canada and the US I’d quibble and parse – and say – can’t be done. And throw in the Czech Republic v Pennsylvania or Ontario – and throw in LA v NYC v Toronto – and I dare say you’ll see so many pluses and minuses to each side that it’s impossible to say “this one is better – this one is worse” in their entirety – but only on such minute things as color screens on testing equipment, and wait times for different ethnicities for different reasons at different hospitals at different times. Oh, I’m sorry, I can’t believe one can get a study that accurate.
Strangely, you could take similar square miles of population densities in all these places and compare them household to household person to person and come up with such divergent figures that you’d see the aggregates over entire nations and vast populations are, in fact, always political driven numbers. I don’t care which party you’re for – which government plan or how or why or when – for that always requires the manufacture and game of statistics and comparables. And it points to the very individualism which I support as the way to get around the discussion.
I note too that those who wish for more government involvement in health care will always find or make the states which they like and those opposed will always make the case they like, that is true. And I’d agree almost across the board that in our “Left-Right” continuum as we perceive it you’ll find the big government versus big corporation folks bamboozling everyone, and often together as they pretend to be for this side or the other. For you know what is truer than all these comparisons and statistics and aggregates and individual stories? It’s this:
If each working person was required by law to put $20 a week into an interest bearing account for 40 years he’d have near unto a $1,000,000 in hand at 65. And he wouldn’t have to worry much about any comparable data sets – but each use his own money for his own purposes as his own realities necessitate. Oh, sure, make him save it – but let him spend it. The overhead for the tax and administration of government will collapse to near zero – and everyone gets what they want and more.
I also point out that a black man would pass on his legacy from social-security savings of this type, instead of it going to the next white folks in line.
We wouldn’t worry about which system spends more on administration, either, for there would be precious little. And likewise, since I don’t worry about the administration costs at Walmart versus Safeway where I buy my groceries is measured by other criteria.
And tying health care to employment was one of the worst ideas we could have done. For now like serfs everyone is tied to their company forever if they want to keep their health care. If they kept their $20 they could go from job to job and not worry about a thing. Gone would be unfunded liabilities or cut pensions or the threat thereof.
And I would think too that every American and Canadian would have no problem chipping in, oh $5 a week, or even $10 – for the “catastrophic beyond all normal circumstances safety net health care plan.” For to me, when some kid is born with a birth defect, for instance, regardless of the wealth of the parents – the costs are so extreme that society does bare some moral obligation to assist. I’d say for your garden variety broken bone, or even most cancers nowadays – pay for it out of your own savings – that $20 you were required to keep for your health care – in the bank of your choice – not told to put it here or there by government or any of its myriad of cronies looking for a fee to control other people’s money.
My goal is not to make a better government system – but to show how people keeping their own money is best for them – and then that is best for the collective – for more happier people is better than less happier people broken down into constituencies arguing over which politician has the better health care plan. And less political dissension and jockeying for power is better for all of us than which politicians runs the show and games the plan.
So, don’t compare the big stuff of Canada with the United States – compare an individual with his own million bucks after his working life and the state which took that $20 and now gives it back to him as the state sees might be best.
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