Alternative health systems

The debate over whether the United States should move toward a health-care system similar to that of Canada’s gained a twist last week when a report in the New England Journal of Medicine highlighted the differences in cost between the U.S. and Canadian systems.

The report is important because it nullifies a major arguing point of the detractors of the Canadian system, who claim it is hopelessly flawed because medical services there are rationed, and because it points out that tacit rationing already exists under the U.S. system.

Americans pay about 72 percent more than Canadians do for the same amount of health services. With more than 37 million Americans lacking health insurance, the high cost of receiving medical treatment effectively denies many people the opportunity to seek help. In fact, according to the study by Victor R. Fuchs and James S. Hahn of Stanford University, on a per capita basis Americans receive only about three-fourths of the services that Canadians do. The statistic refutes the hypothesis that the lower cost in Canada is achieved at the expense of services.

It is true, as the American Medical Association argues, that this country’s large regions of poor people and cultural diversity would decrease some of the effectiveness of Canada’s system, which relies on a more homogeneous population, but the system should not be dismissed entirely. Nor should the fact that Canada has relied heavily on the United States for medical research and development, a condition that in large part exists independently of its health-care system.

Some aspects of the Canadian system that the United should consider are the availability of essential health care to all of citizens and its relatively low cost maintained through, for instance, negotiated fee schedules and reduced administrative costs in a single-payer system. As important, a U.S. system must include an elevated role for preventative medicine, which can save large amounts of money by detecting problems before they require complex treatment.

Although the Fuchs-Hahn study was limited to the United States and Canada, the health-care systems of other countries reinforce the link between cost of services and their availability. Japan, for instance, spent $831 per person on health care in 1986, compared with the United States, which spent $1,926. Japan, which guarantees access to health care for all citizens, has the lowest infant-mortality rate and the highest life-expectancy rate in the world. Though social and cultural conditions as much as the country’s national health system contribute to these admirable statistics, the United States could profit from considering ways that the Japanese system could be applied here.

Like Canada and Japan, West Germany guarantees a minimum level of health care for all its citizens, and it does so at about half the per capita expense rate of the United States. It would be foolhardy to suggest that the federal government should simply impress wholesale this or any of these systems on Americans, but it must recognize that other industrialized countries of very different cultures have managed to offer comprehensive health care to virtually all of their citizens at substantially less than the U.S. rate.

Cost of services, as the study demonstrated, strongly influences who will receive health care and who will be denied. For the millions of Americans who cannot afford, or who are unable to obtain health insurance, the U.S. lead in medical technology means considerably less than their inability to receive basic treatment.