Why Do Americans pay more for Healthcare than Canadians?

[Scylla]

[QUOTE=Freddy the Pig]
In the end, the answer always seems to be that stuff in the United States costs more. Our doctors, nurses, hospital stays, medical equipment, and drugs are all more expensive than they are anyplace else. We don’t consume more of them, we just pay more for what we do consume. I don’t know why this is so.
[/QUOTE]

First we are the medical pioneers in the world, developing drugs and treatments and pioneering research at a much higher rate than any other country, and that costs money. You really can’t look at these things in a vacuum and compare Canada’s health care system to the US healthcare system. In reality, the US healthcare system is shouldering the burden for a portion of the rest of the world’s health care by doing the developmental work.

When was the last time you heard of a hot new drug or lifesaving procedure coming out of Canada, or the UK.

Secondly, we reserve the right to sue our health care providers and drug companies if they screw up and hurt us bad.

My friend is an OBGYN here in PA. His personal medical malpractice for himself alone costs $350,000 a year, which is more than his salary as a full partner.

He is a male doctor, so any time he is seeing a patient he has to have a female nurse in the room with him so he cannot be accused of molestation.

[BrainGlutton]

[QUOTE=John Mace]
Why Do Americans pay more for Healthcare than Canadians?
[/QUOTE]

Our dollars are worth more than their dollars! DUH!

[BrainGlutton]

[QUOTE=Scylla]
When was the last time you heard of a hot new drug or lifesaving procedure coming out of Canada, or the UK.
[/QUOTE]

Actually, I have heard of new drugs coming out of Cuba, of all places. They do original pharmaceutical research there – funded by the state, of course.

[XT]

[QUOTE=BrainGlutton]
Our dollars are worth more than their dollars! DUH!
[/QUOTE]

Someone beat you to it…check out post #77.

[QUOTE=BrainGlutton]
Actually, I have heard of new drugs coming out of Cuba, of all places. They do original pharmaceutical research there – funded by the state, of course.
[/QUOTE]

What new drugs in wide use have come out of Cuba? I’m curious…do you have some cites?

<back to lurking mode>

-XT

[Scylla]

[QUOTE=BrainGlutton]
Actually, I have heard of new drugs coming out of Cuba, of all places. They do original pharmaceutical research there – funded by the state, of course.
[/QUOTE]

Funny you mention that. I thought the same thing about 30 seconds after I posted. Cuba is at the forefront of Neuroscience and they are a pioneer in several other areas as well, so they certainly qualify as an exception to my point.

[BrainGlutton]

[QUOTE=xtisme]
What new drugs in wide use have come out of Cuba? I’m curious…do you have some cites?
[/QUOTE]

Dunno about “wide use,” but here’s a good cite about Cuban pharmaceutical/biotech research.

[mazinger_z]

[QUOTE=Scylla]
First we are the medical pioneers in the world, developing drugs and treatments and pioneering research at a much higher rate than any other country, and that costs money. You really can’t look at these things in a vacuum and compare Canada’s health care system to the US healthcare system. In reality, the US healthcare system is shouldering the burden for a portion of the rest of the world’s health care by doing the developmental work.
[/QUOTE]
While I do believe this, and I do believe i saw something like this stated in Time magazine at least 2 years ago, I cannot find a cite for this. So, cite? Also, has anyone mentioned that the US’s relative size makes it nearly impossible for us to have centralized health care? When I was in school, the argument against socialism/communism (we were discussing communism, but the professor pointed out too many similarities between the two), other than basic human greed and the absolute attraction to not care for/use of free stuff, the bane to such a system is the bureaucracy involved in administering it. Sweden and northern europe is fine, but extrapolate the model to something the size of the US or larger, and let’s see what kind of medical care is delivered, particularly when a free market no longer for health care exists.

[XT]

[QUOTE=BrainGlutton]
Dunno about “wide use,” but here’s a good cite about Cuban pharmaceutical/biotech research.
[/QUOTE]

I only skimmed your cite, but I don’t see much innovative there…or in wide use, except in Cuba. Certainly (according to your cite) the Cuban’s have made strides in both fields…but those strides are pretty much walking in the steps other countries have already forged ahead for them. Has Cuba developed any innovative new drugs that are available outside of Cuba? Again, I ask this because I don’t know the answer…and perhaps with your fixation on Cuba you do.

-XT

[RickJay]

[QUOTE=Scylla]
First we are the medical pioneers in the world, developing drugs and treatments and pioneering research at a much higher rate than any other country, and that costs money. You really can’t look at these things in a vacuum and compare Canada’s health care system to the US healthcare system. In reality, the US healthcare system is shouldering the burden for a portion of the rest of the world’s health care by doing the developmental work.
[/QUOTE]

Jesus, it just never ends.

What does, say, drug research have to do with the price of seeing a family physician? No, we aren’t piggybacking on your system.

When was the last time you heard of a hot new drug or lifesaving procedure coming out of Canada, or the UK.

http://www.ctv.ca/servlet/ArticleNews/story/CTVNews/20060316/diabetes_break_060316/20060317?hub=Health

That was just the first page of a Google search. Gosh, that was easy.

Secondly, we reserve the right to sue our health care providers and drug companies if they screw up and hurt us bad.

My friend is an OBGYN here in PA. His personal medical malpractice for himself alone costs $350,000 a year, which is more than his salary as a full partner.

He is a male doctor, so any time he is seeing a patient he has to have a female nurse in the room with him so he cannot be accused of molestation.
[/QUOTE]

[Bookkeeper]

[QUOTE=Scylla]
When was the last time you heard of a hot new drug or lifesaving procedure coming out of Canada, or the UK.
[/QUOTE]

One of the complaints raised by Canadians about drug research (and R&D in general) is that US companies have a bad habit of buying Canadian ones and then moving all the R&D to the US. (I believe this is due to tax advantages under US law.) One of the arguments used against NAFTA when it was first proposed was that much of the regulatory power used to prevent this would be removed or reduced under NAFTA.

[John_Mace]

[QUOTE=jsgoddess]
If you buy based on actual demand instead of buying to make sure that you don’t lose business to those guys down the street you’d tend to have a better guess.

A local small city had two hospitals about three blocks apart. They had duplicate everything. One bought the other and now they have very different facilities. One has an emergency room that’s solely for pediatrics and maternity. The other handles the rest of the emergency cases, and isn’t overrun. You go to one hospital for X, the other for Y. One for an MRI. The other for a CT scan. (I’m making up that last example. I’m not sure which hospital has what.)

They didn’t need figure out “in advance” exactly what they needed. They weren’t starting from scratch, with absolutely no idea. They had experience to draw from, just as the rest of the US already has. I’d bet someone could give you a very good idea just how many MRI machines are actually needed based on the data of how they are currently used. If two MRI machines are each in use 10% of the time, you have too damned many MRI machines.

If demand increases, you get another MRI machine. You just don’t do it so that your facility looks more inviting to a customer, because then you have to recoup those unnecessary costs somehow. And because you have a very captive customer base, you can recoup those costs eventually.

We have huge capacity in some fancy, expensive areas, and not nearly enough in some less glamorous ones.

Edited to add: By “areas” I meant medical areas, but geographic areas are in the same situation. Medical services are trying to go where the money is–the way all capitalistic systems work. But where the money is isn’t necessarily where the need is.
[/QUOTE]

I’m not following your argument. If they can recoup this added cost because they have a captive customer base, then how is one hospital able to lure people from other hospitals in the first place? Surely they’re not such stupid businesspeople as to miss something like that. And they have to be offering something that people value more or those people have no motivation to switch. Maybe it’s a newer MRI with better resolution or something.

And if hospitals are run like a business, then I don’t see how they’re going to be successful by having expensive equipment sitting around gathering dust. Some else is going to figure out how to do it without the dust collection.

At any rate, I’m not so much interested in these types of theoretical discussions in this thread, but rather I’d like to see actual data. So, if you have some data you can bring in about MRI utilization in the US vs Canada, I’d love to see it. That would be a very good contribution to this thread.

[wonky]

[QUOTE=John Mace]
I’m not following your argument. If they can recoup this added cost because they have a captive customer base, then how is one hospital able to lure people from other hospitals in the first place?
[/QUOTE]

Because they look like they are top of the line and fancy and progressive and not behind the times. So if you had to choose between the one hospital, or doctor’s office, with the MRI and the one without, you choose the one with the MRI. If they both have MRIs then you can’t use that against them. They are trying to compete with one another after all.

Then, they have to make sure that they use these fancy new gadgets, so you’d better have an MRI on that trick knee just in case. And look! It’s right here in the office/down the hall. No waiting. Heck, no walking. Roemer’s law in action.

So, people choose the doctors and/or hospitals where they can get this advanced diagnostic imaging right then and there, forcing the other doctors and/or hospitals to put in the equipment to stay competitive, to look good to customers and potential employees, even if the area doesn’t need another MRI.

It’s an arms race.

Here’s an article with some data, though I haven’t fact checked it:

Ohio has more than 250 MRI units, including 26 in Lucas County, and another is scheduled to come online today in partnership with Medical College of Ohio. Michigan has 155 MRI units. Canada has a total of 151 MRI units.

Unlike Ohio, Michigan has what’s known as a “certificate of need” law. That law requires state approval for expansion or addition of various health services and medical equipment. The goal of the law is to hold down health-care costs by preventing unnecessary duplication of services in a community.

Ohio eliminated its certificate of need law in 1998

[John_Mace]

[QUOTE=jsgoddess]
Because they look like they are top of the line and fancy and progressive and not behind the times. So if you had to choose between the one hospital, or doctor’s office, with the MRI and the one without, you choose the one with the MRI. If they both have MRIs then you can’t use that against them. They are trying to compete with one another after all.

Then, they have to make sure that they use these fancy new gadgets, so you’d better have an MRI on that trick knee just in case. And look! It’s right here in the office/down the hall. No waiting. Heck, no walking. Roemer’s law in action.

So, people choose the doctors and/or hospitals where they can get this advanced diagnostic imaging right then and there, forcing the other doctors and/or hospitals to put in the equipment to stay competitive, to look good to customers and potential employees, even if the area doesn’t need another MRI.

It’s an arms race.

Here’s an article with some data, though I haven’t fact checked it:
[/QUOTE]

But that article doesn’t say anything about MRIs sitting idle. It just notes that there is a controversy over whether the tests are needed or not. Isn’t that something that, like abortion, should be left up to the patient and his or her doctor to decide?

Besides, you going to have trouble convincing me that turning the decision of which MRIs go where over to politicians is going to be better. Surely you are aware of how legislators pull all kind of strings to get perks for their districts. MRIs will become the new pork project for every half-wit Congressman out there.

[wonky]

[QUOTE=John Mace]
Besides, you going to have trouble convincing me that turning the decision of which MRIs go where over to politicians is going to be better. Surely you are aware of how legislators pull all kind of strings to get perks for their districts. MRIs will become the new pork project for every half-wit Congressman out there.
[/QUOTE]

I thought you weren’t interested in theoretical discussions.

In any case, I never claimed the article said anything about MRIs sitting idle. I said it had some data. Obviously, it doesn’t contain all the data.

[John_Mace]

[QUOTE=jsgoddess]
I thought you weren’t interested in theoretical discussions.
[/quote]

Hey, nobody is perfect.

In any case, I never claimed the article said anything about MRIs sitting idle. I said it had some data. Obviously, it doesn’t contain all the data.

OK. Maybe I was confused because that was the original argument you were making.

Still, you might have hit on some aspect of what is going on here. Maybe there is a small, but significant, minority of Americans with these really great health insurance plans, and maybe they can command all sorts of tests that are of questionable value and that explains at least some of the discrepancy in $$ spent between the two countries. So we’d have make those kinds of tests unavailable (read: illegal) in order to actually bring our total expenditures down, because these same people are still going to want the tests and they’re still going to want the insurance that allows them to get the tests and someone is going to find a way to sell that to them. But I’m heading into theoretical territory here…

[wonky]

[QUOTE=John Mace]
OK. Maybe I was confused because that was the original argument you were making.
[/QUOTE]

My original argument was that duplication of capacity/services can lead to wasted money.

This article, well, it’s really more of an editorial I guess, talks a little about the difficulty in figuring out what the true demand is for things like MRIs:

The last point, regarding expansion in capacity, is important for a number of reasons. In the absence of insurance, we would be much more comfortable believing that demand is high and the market is meeting demand. But in health care, as we know, demand is difficult to truly measure: since the patient rarely bears the full cost of the study, it may be that demand is artificially high. Furthermore, physicians may encourage demand for defensive medicine reasons or even financial self-interest. Finally, we have all witnessed instances where examinations are ordered for marginal indications. If capacity is driving demand (supplier-induced demand), then we need to ask what may be driving supply.

Then later:

In calculating the equipment component of the technical reimbursement of CT and MRI services, CMS assumes that the CT or MR scanner is only being used 50% of the time that the practice is operating. In assuming this, the average embedded cost of a scan is higher than it would be if the scanner were used 80% or 90% of the time. In MedPAC’s own recent (self-admitted nonscientific and limited) survey of practices [2], it found that the mean use rate for MRI was 91% and the mean use rate for CT was 73%.

That 91 percent (given the limitations the author points out) shows MRIs not sitting idle. But not sitting idle doesn’t eliminate the possibility that this is one of those Roemer’s law situations again.

Supplier-induced demand becomes a huge issue whenever you’re dealing with a situation where one party is pretty ignorant of exactly what is going on. The informational difference between a doctor and the average patient is massive, which means the doctor can inadvertently or on purpose take advantage of that asymmetry.

That, in turn, means that they can spend more money on shiny things to attract the patients and still recoup those dollars.

[BrainGlutton]

[QUOTE=mazinger_z]
While I do believe this, and I do believe i saw something like this stated in Time magazine at least 2 years ago, I cannot find a cite for this. So, cite? Also, has anyone mentioned that the US’s relative size makes it nearly impossible for us to have centralized health care? When I was in school, the argument against socialism/communism (we were discussing communism, but the professor pointed out too many similarities between the two), other than basic human greed and the absolute attraction to not care for/use of free stuff, the bane to such a system is the bureaucracy involved in administering it. Sweden and northern europe is fine, but extrapolate the model to something the size of the US or larger, and let’s see what kind of medical care is delivered, particularly when a free market no longer for health care exists.
[/QUOTE]

If we had a Canadian-style single-payer system, we would still have a free market for health care, just not for health insurance. Canada is a big country – but the single-payer system is administered at the provincial level, and it works well enough. If Canadian provinces can do it, why not American states?

[Northern_Piper]

That’s right - the term “single-payer” is a bit misplaced. While the federal government pays a considerable portion of the medicare system, it’s delivered by the provinces and territories, which have jurisdiction over health care. So we have 13 “payers” - the 13 provincial and territorial governments. Within each province and territory there is a single payer.

[Capt.Ridley_s_Shooting_Party]

When was the last time you heard of a hot new drug or lifesaving procedure coming out of Canada, or the UK.

Do you live in a fantasy? When was the last time you heard of a hot new drug or lifesaving procedure coming out of the UK?

Possible cure for Rett syndrome, a severe illness affecting 10,000 children in the UK alone, University of Edinburgh.

Safer way to administer chemotherapy, using fibre based technology, University of Bath

Vaccine looks to be successful at completely protecting segment of population against Malaria, technology also looks promising for hepatitis B, HIV and TB, University of Oxford.

Just three examples from a quick browse. The idea that the UK is some backwater when it comes to biological and biomedical research is bizarre. What team discovered the structure of DNA? Where was DNA fingerprinting developed? What team cloned the first mammal?

[wonky]

[QUOTE=Dominic Mulligan]
What team discovered the structure of DNA? Where was DNA fingerprinting developed? What team cloned the first mammal?
[/QUOTE]

The A-Team?

Sorry.

Wasn’t the new inhaled insulin also developed in the UK? I might be thinking of the wrong thing.