Monday, March 30, 2009

An Amateur's Partial Comparison of Health Care Systems: Canda and England v. America

The following are some, certainly not all, relevant facts related to the discussion of America current health care coverage crisis.

The average family doctor in America earns about $190,000 per year. The average for all doctors comes out to around the mid-$250,000's.

The average family doctor in Canada earns about $202,000 per year. Specialists, like in America, earn closer to $300,000 per year.

The average general practitioner in England earns somewhere around $160,000-$200,000 per year.

The average student loan debt for doctors coming out of medical school in America is about $140,000.

The average student loan debt for doctors coming out of medical school in Canada is around $80,000 - $100,000.

The average student loan debt for doctors coming out of medical school in England is around $30,000. The lower student loan debts are due, in part, to the fact that the government provides much greater aid to medical students, and university students in general.

The average emergency room wait time in America is about an hour. That is just to get in to see the doctor. Treatment likely takes another one to two hours.

The average time it takes to register in an emergency room and be completely treated in England is four hours.

Canada has begun implementing England's four hour program.

You'll see from this link that the average monthly cost of cancer treatment in America is in the $3,000 to $8,000 range, while the total cost is in the $20,000 to $50,000 range.

In Canada and England the total cost of cancer treatment, as well as any treatment for any other illness or disease, as well as the cost of prescription medications, is $0.

In America, there are around 1.4 million new cases of cancer each year. Practically every family will, at some point, have to deal with cancer.

The median income in America is about $45,000. Personal income tax on that salary is about $6,000, leaving the median American with about $39,000. The average annual insurance premiums for a family of four is about $12,700. Lets assume that the employer covers about half that, which is generous, and the family pays, out of pocket, about $7,000 annually for insurance premiums, leaving about $33,000. This premiums only. If there were a serious medically problem the family would likely have an additional few thousand dollars in deductibles.

In England, that median American family making $45,000 would be taxed at a 22 percent. Leaving $35,100. There are no insurance premiums or deductibles.

Once the income starts to rise it is difficult to compare. In England the tax rate goes up to 40% at a fairly lowly income level (around $50,000), which would not be the case in the United States even with a universal health care system as England has socialized many more programs than the United States. But I would imagine, again, that the costs of health care under our current system would roughly equal the increased tax burden under a single-payer system.

What you see, then, is that in a system where every person has access to free medical care, the doctors are paid about the same, but with a lighter student loan debt load, and with slightly longer waits in emergency rooms. There would actually be more financial incentive for young people to become doctors than there is in America.

The majority of American families would spend less on health coverage while those with higher incomes would likely spend about the same or slightly more than they do now, factoring in all the variables.

Families would be free to go to any doctor or hospital for the care they need. The increased simplicity and universality of those systems would lessen the emotional and mental burden on families that are suffering medical or financial problems. People would be more likely to seek preventative help and treat early symptoms instead of waiting until the problem becomes more dire and more expensive.

England and Canada, and every other industrialized nation for that matter (we're the only one without a single-payer system), have certainly not created perfect systems. Polls show that no country is happy with their health care system, but that Americans are the least happy. I'm not sure a perfect system exists, but we should at least start with one that covers everyone and go from there.

The Mormon liberal argument for government intervention in certain cases is that there are serious systemic problems in our society and in some cases the government is best equipped to be used as a tool to combat those problems. The opposing argument, an argument I can understand and do not just dismiss blithely, is that each individual taxpayer should be able to choose how her money is spent on charities and social betterment.

The problem, though, is that this argument does not work for the health care crisis. You cannot give some pocket health care to the panhandler. You cannot go down to the health insurance kitchen and distribute health care to the poor. You cannot anonymously drop off a basket of health care coverage to your struggling neighbor. If we want everyone covered, and I think that should be our goal, then we have to look to institutions who can guarantee health care coverage for all by spreading the risk over the entire population, not just the most healthy people that the insurance companies will accept.


peter said...

It is interesting to compare health systems in the US, Canada, and the UK. Canada and the UK do have some aspects of their care that we should try to emulate, but why try and argue for the adoption of a broken single payer system? We have our own broken system with its own set of bright spots and problems. Why don’t we start where we are and try and keep the good parts while fixing the bad?

Sure, these two countries have universal access to health care, and we already agree that reasonable access to healthcare for everyone is desirable, but universal health care in these countries has come at an astronomical cost, limited access to up-to-date medical technology, rationing, and long waits (yes, these aren’t made up,, indicates average waits of 3.4 weeks for ultrasounds, 5.5 weeks for a CT, and 12.5 weeks for an MRI in 2005.)

There are problems with our current health care system, but there are ways to address these problems that don’t include adopting a health care system we know is already broken. There are many possible solutions and Americans are good at finding innovative solutions…let’s do that. I just fear that the current zeal for health care reform is going to get mired down by politics and power plays and any resulting plan is not going to be as healthy and sustainable as it could be. (Example, SCHIP legislation)

And, just as a note on your comparison of medical education costs in these three countries. Canada, whose system is remarkably similar to ours, does have a three year option to medical school…that one less year figuring into the debt-burden average could be a cause of the lower number from Canada. The UK’s system, their medical degree is almost exclusively at the undergraduate level, certainly makes a difference on the debt-burden of a newly practicing physician. That’s at least three less years of school. But they are moving closer to the US/Canadian model of medical school and I would expect their costs would rise. However, the desirability of the European model of post-high school education is another topic altogether.

Financial incentive is not usually a problem when considering becoming a doctor though it does come into play when choosing a specialty…with primary care on the losing end.


Jacob S. said...

I agree that we should not adopt in whole the health care systems of Canada, England, or any other country. I agree, as I stated, that those systems are not perfect. But they are so much better than ours. Their flaws are obvious, and we should be able to improve on them, but we have to start with the premise that everyone is entitled to health care. Anything else should offend our sense of justice and morality.

We are the wealthiest country in the world, we have the more resources and ingenuity than any other country in the world, and yet we have tens of millions without basic health care opportunities. We have the ability to change, but we, as a nation, are hung up by the personal inconveniences we might suffer as a result.

peter said...

I think that personal inconvenience is not as an important an issue as sustainability and the loss of medical advancement. Even if we give everyone basic health care, if we can't continue to pay for it, what's the point? Or should we just continue to watch the deficit balloon?

Did you read the link I included with England's analysis of Canada's health care system? I don't think we can go with the premise that they are "so much better than ours." It's different, but in just about as much trouble as our system.