Talk:Comparison of the healthcare systems in Canada and the United States/Archive 1

Archive 1

Archive 2

POV is apparant

This article, as are most articles relating to Canadian Health Care has an unbalanced POV. Remember we have to be unbiased folks!—The preceding unsigned comment was added by Baldwin.jim (talk • contribs) 18:35, 9 July 2005 (UTC).

Agreed. I fixed the blatantly right wing part about malpractice and addressed it with actual facts.167.206.19.12 10:33, 11 December 2006 (UTC)

How much money do doctor's spend trying to aviod and be ready for Malpractice suits? Malpractice insurance, and secretaries to do the paper work that Malpractice insurance requires you to do?

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Hey, noone is talking about children. The most troubling aspect of US system is that children are held responsible for the acts or the status of their parents.

E.g.: If you are the son of an unemployed negro and a hispano floor-cleaner, you have less than 20% chance to survive childhood leukemia, because doctor, care and advanced medicine costs are astronomical. With just the basic help, you chances are minimal. But if you are born into a family of an interior designer and a stock market analyst, the chances are 65-70% in your favour. How can infants be held responsible for their parents' life? They did not choose to be born there or anywhere else in the first place!

We know that talent is very little related to genetics. A child of poor afro-hispanic origin is just as likely to become a useful or creative member of the society if given good education. But first he needs to survive. Maybe you are losing a latino Einstein, while a Richie Rich would-be Enron exec lives on.—The preceding unsigned comment was added by 195.70.48.242 (talk • contribs) 12:39, 1 October 2004 (UTC).

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"However, despite this Canada continues to be a world leader in the research and development of pharmaceuticals."
I am troubled by this line. The article reads like a condemnation of the US health care system, and it approaches non-NPOV in several places. I would like to see some numbers or evidence that backs up the assertion I quote.- Jburt1 20:00, 6 Dec 2004 (UTC)

The slightly out of date numbers found here find that Canada was 6th in terms of total pharmaceutical patents granted (the United States was number one). Not only that but according to [1] over the last decade Canada has seen the fastest growth of all G7 nations in the number of pharmaceutical patents issued. According to this study Canada is 11th in the world in terms of the percentage of its economy devoted to pharmaceutical research (the United States is fourth). See also this WHO report for a number of other statistics. - SimonP 01:02, Dec 7, 2004 (UTC)

Encyclopedia entry?

This isn’t a bad essay, but I can’t help but think that it’s not something you’d find in an Encyclopedia. It’s not really describing anything. I suppose it helps readers understand the difference between the US health care and the rest of the world’s.—The preceding unsigned comment was added by Seano1 (talk • contribs) 05:43, 22 April 2005 (UTC).

I agree. The very nature of the article is unencyclopedia. Not to mention it's horrible POV angle. - unsigned flamebaiting by Barneygumble (talk · contribs · deleted contribs · nuke contribs · logs · filter log · block user · block log) 21:53, 8 August 2005 (UTC)

I agree as well. I think this would be better off deleted. This looks more like a political essay given its POV. Besides, other than the fact the US and Canada are neighbours, why would we need a specific entry dedicated to the comparison of these health systems? I could see a survey essay that makes general comparisons between the health care system of G8 countries or even OECD countries, but Canada and the US are too different to make many relevant comparisons.—The preceding unsigned comment was added by 68.144.64.35 (talk • contribs) 17:44, 13 March 2006 (UTC).

Meh

Health care tends to be of greater interest to Canadians in polls, in part because Canadians do not care much about issues that are important to Americans, like terrorism, the War in Iraq, or the economy.

This seems bizarre, out of place and POV. I find it very hard to believe that Canadians "do not care much" about their economy or terrorism and the assertion that Canadians care about healthcare because they don't care about the US's issues - two of which have only been an issue recently, while Canada's healthcare system has been in place some time - is ridiculously US-centric.—The preceding unsigned comment was added by 82.32.86.41 (talk • contribs) 10:51, 3 May 2005 (UTC).

• My sense is that the Canadian Healthcare system is sort of a National prestige item to Canadians, sort of like the Space program is to Americans. In the US, even small-government conservatives and libertarians often defend the space program, even if they suspect it's mismanaged and wasteful. In a similar way, Canadians seem willing to look past its flaws and see their health system in its idealized form as part of their identity. --208.204.155.241 19:47, 6 July 2006 (UTC)

$$$i like the comparison actually, living in america my whole life and not having medical insurance the past ten years of my life has really taken its toll on my body and i beleive it would be nice to have something like canadas system put into place here in the states.—The preceding unsigned comment was added by 4.155.21.36 (talk • contribs) 07:12, 3 April 2006 (UTC).

Vote for Deletion

This article survived a Vote for Deletion. The discussion can be found here. -Splash 01:01, 16 August 2005 (UTC)

SIMONP

I wish SIMONP would keep a NPOV in the article instead of adding his left wing bias.—The preceding unsigned comment was added by Baldwin.jim (talk • contribs) 23:08, 23 August 2005 (UTC).

Supporting evidence?

Where is the supporting evidence for the claim that "the wealthy are more likely to be healthy in the United States than Canada"? WM —The preceding unsigned comment was added by 70.18.197.83 (talk • contribs) 20:12, 24 December 2005 (UTC).

"Totally disputed" banner

I have placed the neutrality and factual accuracy banner on this article; more so do to accuracy than neutrality. I apologize to those who have done a lot of work on this article, but it reads more like an essay than an encyclopedia. Other than to scrap every uncited sentence, I haven't the faintest idea on how to fix it. Perhaps someone could help with my concerns, starting with the opening paragraph.

1. First sentence: "The comparison of the health care systems of Canada and the United States is of great importance to both nations." I presume this is true, but all content must be verifiable. Is there a citation for this? Maybe it is of great importance to some Canadians and Americans, some importance to others, and of no importance to the remainder.
2. Second sentence: "The very different methods of delivering health care allows citizens and politicians to look to the other side of the border for alternatives." I'm sure it allows them to do it, but are they doing it? Again, a citation would be nice.
3. Third sentence: "In Canada, the United States is used as a model and as a warning against increasing private sector involvement in health care. In the United States, meanwhile, Canada's monopsonistic health system is seen by different sides of the ideological spectrum as either a model to be followed or avoided." Perhaps all Canadians view the US system as a warning against the evils of the private sector, but there should be a specific reference to who holds that view. If it's only 95% who feel that way, then the survey should be cited. The number of Canadians who feel that way is an interesting piece of information that should be shared. Similar to the US views of Canada.

- AED 07:33, 28 February 2006 (UTC)

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I changed the first sentence to:

A comparison of the health care systems of Canada and the United States has been made by various governmental and non-governmental health and public policy analysts.

This presents information neutrally and, as noted above, it is verifiable information. -AED 20:34, 10 May 2006 (UTC)

Aging Population?

This article is very interesting. This is a topic I've researched thoroughly for sociology. Im concerned because the person(s) who wrote this are only expressing one side. There was no mentioning of the fact that if you are the "aging population" they would rather not treat you or delay your treatment simply because it's not going to be as profitable in the long run as treating someone who is going to pay taxes for another 40 or so years. I would like to have seen this article be more balanced because the truth be told there are advantages and disadvantages to either healthcare system.—The preceding unsigned comment was added by 207.69.139.6 (talk • contribs) 04:53, 8 March 2006 (UTC).

Please Use Citations

"Although the United States spends fifty percent more on each cancer patient..." Where can readers find this information?—The preceding unsigned comment was added by Idavidcrockett (talk • contribs) 01:23, 12 March 2006 (UTC).

POV & Ommissions

Entire article is riddled with POV.

• American doctors and hospitals are far more likely than their Canadian counterparts to purchase new and expensive devices and technologies. Canadian doctors have a tendency to be far more skeptical and thus wait until technologies are proven and have fallen in price.

Totally dismisses contributions that Canadians have made to health sciences. This article makes it seem like Canada is a leech on the medical wonder that is the U.S. system. Canada has a very modern, innovative and world-respected health care system. Many treatments, procedures, methods, etc. are invented and/or developed here, and exported around the world. We don't just wait around for the prior generation cast-offs in terms of equipment and procedures.

There is so much more wrong with this article but I wanted to point this particular issue out. --69.157.122.126 06:29, 17 March 2006 (UTC)

SOURCES!

I like this article, and find that's it's pretty neutral even if not perfect. The main issue I have with it is that it lacks sources.

More statistics would be important as well.

--A Sunshade Lust 07:12, 19 April 2006 (UTC)

Question: It is well-established in the Medicare Part D debate that Medicare cannot negotiate drug prices; Republicans say that is best left to the private carriers that run the plans, while Democrats see it as a fatal design flaw that preserves drug company profits. However, what is the source for the article's claim that Medicaid cannot negotiate drug prices either? I work for a state Medicaid agency (though not in that program), and my state has tried to set Medicaid drug prices in the past (but failed for unrelated reasons). --Anon

This statement appears in this article "Visits to many specialists may require an additional user fee. Also, some procedures are only covered under certain circumstances. For example, circumcision is not covered, and a fee is usually charged when a parent requests the procedure; however, if an infection or medical necessity arises, the procedure would be covered." This procedure is no longer covered in Canada because the Candian Medical association as well as the American pediatric association deems it as an unnecessary procedure. I believe this should be added to that article as it seems as if the Canadian system denies patients some sort of necessary procedure. Adaniels 05:13, 26 June 2006 (UTC)adaniels

The wealthy are more likely to be healthy in the USofA

This is in fact true, there aren't specific data points to back it up, but it can merely be inferred. Healthcare is free in Canada, ergo everyone, whether wealthy or poor gets healthcare. Meanwhile, in the States, healthcare costs money, 'astronomical amounts', ergo the impoverished, or even minorly poor cannot afford it. Implying that the wealthy will be the only healthy ones, becuase they are the only ones who can afford healthcare.—The preceding unsigned comment was added by 209.250.173.254 (talk • contribs) 15:38, 23 May 2006 (UTC).

OR

1. . Too few citations.
2. . More important and unavoidable for pages like these (they perhaps shouldn't exist in the first place, as comparison pages are almost always OR): "Synthesis of published material serving to advance a position" Sijo Ripa 09:19, 24 July 2006 (UTC)

I completely agree on both points. -AED 09:55, 24 July 2006 (UTC)

It might make sense to take this to Wikipedia:Articles for deletion. We shouldn't have an article with an essay-like title. Jkelly 03:48, 26 August 2006 (UTC)

Similar "comparison" articles have survived AfD in the past, so it's likely that this one would, too. I think OR can be minimized if content is made to conform to WP:V. Strict enforcement of this policy, however, seems to meet with resistance. -AED 19:01, 26 August 2006 (UTC)

Bad Statistics

"the overall performance for health care is much better in Canada than the US; Canada ranks 7th in overall performance, while the USA ranks 70th, worse than China, and comparable to Iraq."

from the source provided http://www.who.int/whr/2000/en/annex10_en.pdf I see 37th and 30th respectfully... whereas china is 144 and Iraq is 103.

Can someone show me where is says 7th and 70th??

John 66.57.10.155 06:18, 14 September 2006 (UTC)

Politics of health (privatization)

This section is poor. The assertion that there are private emergency departments in Quebec is totally unfounded. Overall, the article implies that there is more private (that is, market-based) medical care in Canada than there really is. Readers are not informed that many operations deemed "private" are in fact physician practices that operate independently of formal systems, but which nonetheless bill all their services to the government (I added this clarfication to the opening section).

This article is useful conceptually in that addresses a flashpoint of comparison between the two countries and provides some good basic information. As far as POV is concerned, it is really more ill-informed on the economic aspects of health care than it is an apology for the Canadian system, as some here have argued.

Some of the issues discussed at the end do not really pertain to the comparative topic. A separate article on Canadian health care economics would be more desirable for covering those controversies.

Hwhitbread 04:22, 22 November 2006 (UTC)

From CBC [www.cbc.ca/health/story/2006/11/24/private-emergency.html] There is a private medical centre operating in Montreal that provides services for minor emergencies, but Godley said his centre will offer full emergency medical, diagnostic and surgical procedures. So, obviously, hwitbread's complaint is only partially correct. the article is about B.C.'s private emergency room. Also, see earlier CBC articles about the mandatory renting out of hospitals to private health firms during off hours. I agree that the article is biased, but it seems more that there are free-marketeers in canada writing about how much better the american system is, and socialised health care proponents in the states writing about how much better canada's is. --Chalyres 06:33, 20 December 2006 (UTC)

So not neutral

I completey dispute the fact that this article is neutral. While I was reading this I completely felt the biasis. My problem was with this:

"Drug abuse and violence are all more common in the United States than in Canada[citation needed], and all place a burden on the health care system... Recent history has meant that the United States has far more veterans and war wounded, also somewhat increasing cost. Accounting practices also differ and in Canada fewer capital investments are included in health care costs[citation needed]. Another important caveat is that research and development spending in Canada is lower, but Canada still benefits from the research done in the United States[citation needed]. This leads some scholars, such as David Gratzer, to argue the actual cost difference, while still real, is much smaller than the straight GDP numbers would indicate.[citation needed]"

What is up with that? C'mon, no citations?

CHANGE THE ARTICLE FELLOW WIKIS!

Although, I did like the comparison thing, I've always been a sucker for a good American/Canadian perpspective. 66.183.154.180 23:39, 2 December 2006 (UTC)

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The bias in this article is troubling. I tend to believe it is an inadvertent bias that generates from the authors of the various studies cited and that the author of this article related to it easily, yet innocently and unintentional, as a matter of custom from their upbringing.

I believe it would be must enlightening and advantageous to the author if percentages were not used to quantify value relating to the GDP of the two countries and that instead a statement of the GDP of each country is made at the beginning (with cited authority), then when amounts spent are referenced these are instead stated in their calculated U.S. dollar currency equivalent.

On one hand this could easily show that, for the generally statistic model of health care provided (those procedurally "routine" ails) the Canadian Health Care System provides exceptional care, yet on the other hand the U.S. capitalism/free market health care system, as being compared here, it's customers spending quite a bit more in actual dollars, would be given the opportunity for reasonable and accurate elaboration.

For instance, the investment of U.S. pharmaceutical companies in R&D from their current profits to develop future products for future profits (the free market incentive system) which has been the same incentive to derive the drugs and diagnostic equipment, i.e. MRI, CT, angioplast, etc., and how this has decreased mortality rates all over the world via those nations who buy the drugs and/or equipment.

The point being that this article fails miserably to show how the U.S. capitalism and free market health care system, and businesses funded thereby, make a contribution through the free market system to the entire world and every health care system willing to buy the drugs and equipment to meet their citizen's needs, drugs and equipment these nations haven't and cannot afford to develop, that their government is unwilling or unable to afford the development of.

Understand that knowing you are a dual citizen (if I accurately understand what you stated under "Cost of Care Cleanup") creates a form of (unintentional innocent cultural) bias which is natrually reflected in your article failing to set forth the aid that the free market economy, capitalism, has provided and the results therefrom: a net positive effect on all health systems because these U.S. companies will sell the result of their R&D and re-investment of profits to the rest of the world whose publically funded health care systems cannot afford to make such investment.

I bring this forth to you in the interest of balance if this article is aimed at informing people versus merely citing study after study with whatever happens to appear related to the study, especially those items that highlight the higher cost/return ration in percentages and does not take into account the investment of those dollars, as a historical reality that developed the current technologies and thereafter for this same investment system as used today (for a profit) being the investment in the drugs and technologies of the future, ones that other health care systems willing to afford them will be able to use.

This is a very important influence to these studies as without the profit driven (free market) pharmaceutical companies, for instance, Canada (as well as any other nation than the United States) would not have many sources to be negotiating buying pharmaceuticals from in bulk, or diagnostic equipment, or patented procedures determined by studies funded by these pharmaceutical companies via grants to the private and public U.S. colleges and universities as well as their own studies.

Cheers, and I hope you take this suggestion seriously as otherwise it would then appear this article was not intended to be informative but instead as intentionally biased political propaganda and inappropriate to be posted on wikipedia.

24.117.206.70 18:37, 14 August 2007 (UTC)

Anonymous user, are you aware that Siemens (Germany) and Hitachi (Japan) are major designers and manufacturers of MRIs and CTs? Nbauman 23:30, 14 August 2007 (UTC)

Have you read the article fully? The U.S. is not lucky enough to have a free market health care system. Direct government control of the market approaches 45% and indirect restrictions certainly makes the American system more socialist than free. The free portion of that market just happens to be more productive. JoeCarson 13:41, 15 August 2007 (UTC)

Cost of care cleanup

Made a few small changes. Edited the paragraph about the theory explaining the differences in cost between canada and the states. the source argues against socialised health care, that should be mentioned.
also added "police-reported" to the line about the differences in crime. the only statistics available are police-reported, and both the fbi and the Juristat (which compiles data within canada) clearly make this distinction. Both the FBI and Juristat would be a potential citation for that sentence, though i have not seen one source which clearly compares the two. the differences in 2003 were 2.1 percent murders in canada to 5.4 in the states. while that confirms the assertion, unless someone can find sources more recent (i'm not buying the Juristat report--in canada, information can cost quite a bit of money). There are SO many uncited statements in this article that i'd argue it should be re-written from the ground up. And before anyone accuses me of being the national of one country believing the other is better, i'd point out that i currently live in one and maintain citizenship in the other and do not, for a second, believe that either side has even a slightly better health care system than the other. I'm hoping never to get sick in either country. --Chalyres 05:44, 20 December 2006 (UTC)

Good Job!

You know, this is a pretty damn controversial topic, the sort of topic that is supposed to demonstrate wikipedia at its worst. And yet, I was pleasantly surprised to see the general overall quality of the article. Yeah, there are some POV soft-spots and it definitely needs to be made more encylopaedic, but it's advancing nicely.. Keep up the good work! Cacofonie 01:39, 1 February 2007 (UTC)

American system underperforms other nations

I had to reword this statement because the references didn't say that at all. Out of the three references, one of them was a dead link, and the other was some random news article that didn't state that the American system underperforms all, most, or even some nations with universal coverage, only that Canada's performs favorably. It actually states specifically that the American system outperforms others in specific categories while the Canadian system outperforms in others.

The only credible source -- and in my opinion the bias of the source and the study is questionable -- is from the Commonwealth fund. The cited study's methodology is based on surveys given to doctors and adults who indicated their health as fair or poor in 6 different nations. Now, I don't know about anyone else, but from my perspective this is a very questionable source to be adding to an encylopedic reference. Surveys are always opinion based. You can't compare what an arbitrary, or even two thousand arbitrary New Zealend doctors say about coverage in New Zealand vs. two thousand arbitrary doctors in another country and chalk these anecdotes up to encyclopedic fact about the quality of healthcare in a nation.

I reworded the statement to indicate that some studies suggest that the US system underperforms the Canadian system. I'm sure we can dig up some references that say the opposite to add balance to this article.

Emach 17:51, 25 June 2007 (UTC)

How about the World Health Organization? Their study from 2000 also rates Canada's system as outperforming the U.S. I've added that as a reference. -- Sfmammamia 21:05, 25 June 2007 (UTC)

The Commonwealth Fund publishes its results in peer-reviewed journals like Health Affairs. [2] Can we all agree that a publication in a major peer-reviewed journal is a reliable source? Nbauman

Should we expand this article?

The article would be more encyclopedic if it compared many different health care systems, not just North America.JoeCarson 15:28, 6 July 2007 (UTC)

I am also thinking about including info about health disparities as they relate to different racial and ethnic groups. There have been ample studies in the US, but I'm not sure about Canada.JoeCarson 15:30, 6 July 2007 (UTC)

I like the focus of this article on the most local comparison with the U.S., but I don't have a strong opinion about expanding the article. I just wanted to note that there's already a somewhat U.S.-focused article on Health disparities among racial and ethnic groups. Linking it here would make sense, but only it can be done with a sourced comparison to Canadian similarities or differences. -- Sfmammamia 16:42, 6 July 2007 (UTC)

NPOV tag

This is a one-sided piece. There are plenty of critics of the Canadian system, and whole books (e.g., Sally Pipes) favorably comparing American healthcare to Canadian healthcare, and plenty of studies that do the same (e.g., [3]), but they can't be found in this article. Nor is there anything about the fact that Americans subsidize Canadian healthcare prices through pharmaceutical research and price discrimination--the word "pharmaceutical" is entirely absent from the article, and American pharmaceutical availability is far superior, because Canada won't purchase the newest drugs. THF 04:39, 8 July 2007 (UTC)

This article does have criticism of the Canadian health care system, in the sections on "Drugs" and "Technology." The problem is that the editors couldn't find evidence to support those criticisms. If you can find evidence, feel free to add it.

I do think we should clearly distinguish between claims made in peer-reviewed medical journals and claims that have never been peer-reviewed. Sally Pipes doesn't seem to have published anything in a peer-reviewed medical journal, as far as I could tell from PubMed.

It's not a fact that Americans subsidize Canadians with pharmaceutical research -- Canadian investigators publish articles in every major medical journal and they're particularly strong in evidence-based medicine. A group in Vancouver just published that study on SSRIs and birth defects that you may have seen in the news last week.

The article doesn't use the word "pharmaceutical", but it does use the word "drug", and it does mention some of the complaints about Canadians not getting new drugs as quickly as Americans.

Some people claim that it's an advantage to get new drugs faster, but many doctors disagree. After all, Vioxx didn't save any lives.

It did seem to make a difference in heart attacks, though. You do have a point with the WebMD article. Cardiology is a major peer-reviewed publication, and Kaul does seem to have a point that survival after heart attacks was better in the U.S., because of aggressive revascularization, than in Canada in the early 1990s. The 2004 article in Health Affairs also said that Canada had lower survival after heart attacks than Australia and New Zealand, although they didn't have comparative data for the U.S. Nbauman 06:12, 8 July 2007 (UTC)

Neither WP:NPOV nor WP:RS requires "peer review", but there are plenty of peer-reviewed studies favoring the US that are not included. And, again, if this article wasn't so one-sided, there wouldn't be any trouble finding them. I leave it to others to do. THF 11:26, 8 July 2007 (UTC)

The WikiProject_Medicine/Reliable_sources#Cite_peer-reviewed_scientific_publications_and_check_community_consensus WikiProject Medicine requires peer-reviewed sources, but I won't hold you to that.

In my reading of the peer-reviewed literature, this article follows the peer-reviwed studies, which are summarized by the Open Medicine article.

Every scientist loves to read peer-reviewed studies on both sides of a controversy, but I haven't seen many (except for that one in Cardiology) that disagree with the Open Medicine article. If you believe that this study is one-sided, and there are peer-reviewed studies on the other side that I've looked for and haven't found, then I welcome having you show me what they are. Nbauman 21:32, 8 July 2007 (UTC)

Many of these issues are economic issues and public policy issues, not medicine issues, and medical journals, even the peer-reviewed ones, handle economic issues poorly. THF 22:03, 8 July 2007 (UTC)

There are peer-reviewed journals like Health Affairs. I read the New England Journal of Medicine, BMJ and sometimes JAMA, and they regularly invite policy experts, like Bill Frist, to submit articles and editorials. If you can find other sources as reliable as peer-reviewed journals, I'll be glad to read it. But if somebody makes claims without supporting data, I don't think fair-minded people are going to believe it. Nbauman 22:26, 8 July 2007 (UTC)

If you want to support the npov tag you have to provide reliable sources.--BMF81 22:32, 8 July 2007 (UTC)

First, there are many sources cited in this article that are not peer-reviewed, so there's a separate POV problem that one RS standard is established for criticisms of Canada while a softer standard is established for paeans. Second, I've provided multiple reliable sources that meet Wikipedia criteria (one which cites many more), and more are readily available if one doesn't POV-push. There are many many economists and public policy officials who find fault with the Canadian system, yet somehow the article doesn't identify any of them. There are many many economists and public policy officials who explain the issues involved in relative pharmaceutical pricing in Canada and the US, from Calfee to Danzon to Pitts on down, and none of them are cited. That you claim that you haven't seen any of them indicates an echo-chamber problem. The Fraser Institute is cited once in the introduction, but not once are any of its substantive critiques addressed. The POV tag remains because the article doesn't even attempt to include all significant points of view. THF 22:52, 8 July 2007 (UTC)

I believe the RS standard of peer-reviewed articles should be applied to both criticism and praise of Canada. I haven't added anything that wasn't peer-reviewed. If it's necessary to use less reliable sources to find critics, I'm willing to do that, for the article to include critics.

Under Wikipedia rules, if you think the article is missing something, you're supposed to go ahead and add it. Nbauman 03:39, 9 July 2007 (UTC)

While Wikipedia rules encourage people to do the fixing themselves, and it would certainly be better for the project if I had the time to do the extensive rewrite this article requires, it's hardly a rule requiring a critic to do so. See, e.g., the discussion at Talk:Competition_law#Criticising_vs._contributing. I tag to identify the problem, and hope others fix. THF 04:26, 9 July 2007 (UTC)

Would you be willing to compile a list of references for us to check out?JoeCarson 12:42, 9 July 2007 (UTC)

• There is extensive discussion of problems with Canadian healthcare in the Chaoulli v. Quebec decision.[4]
• Similarly, CMAJ reports that Quebec breast cancer patients have had to sue over potentially fatal wait-times for cardiology.[5]
• The Kaul study in Cardiology
• Dale Rublee, "Medical Technology in Canada, Germany, and the United States," Health Affairs, Fall 1989
• A Seismic Shift: How Canada’s Supreme Court Sparked a Patients’ Rights Revolution
• Michael Walker, "From Canada: A Different Viewpoint, Health Management Quarterly, Spring 1989
• Michael Walker, "Cold Reality: How They Don't Do It in Canada," Reason, March 1992
• Ed Haislmaier, Problems in Paradise: Canadians Complain about Their Health Care System (Washington: Heritage Foundation, February 19, 1992).
• United States vs. Canadian Health Care: An Information Package (Washington: National Committee for Quality Health Care, March 1990).
• "Canadians Cross Border to Save Lives," Wall Street Journal, December 12, 1990.
• John Lancaster, “Surgeries, Side Trips for ‘Medical Tourists’; Affordable Care at India’s Private Hospitals Draws Growing Number of Foreigners,” Washington Post, October 21, 2004, p. A1 (Canadians forced to travel to India to get healthcare).
• Nadeem Esmail and Michael A. Walker, “Waiting Your Turn: Hospital Waiting Lists in Canada, 15th Edition,” Critical Issues Bulletin (Fraser Institute), October 2005.
• Clyde Farnsworth, "Now Patients Are Paying amid Canadian Cutbacks," New York Times, March 7, 1993.
• The Top Ten Things People Believe About Canadian Health Care, But Shouldn't
• Buyer Beware: The Failure of Single-Payer Health Care\
• Lives At Risk: Single-Payer National Health Insurance Around the World, by John C. Goodman, Gerald L. Musgrave, and Devon M. Herrick
• The Fraser Institute, Sally Pipes, Jack Calfee, David Frum, and the Atlantic Institute for Market Studies have repeatedly written on the subject, and cite numerous additional sources.

-- THF 15:17, 9 July 2007 (UTC)

OK, that's something to work with. I want to pull out the best evidence from that list. I wish those articles from Health Affairs (1989) and CMAJ (which refers to cases in 1989) were recent. The Chaoulli case is important, but it also goes back to the state of health care in 1990.

Everybody agrees that the Canadian health care system had wait times, possibly resulting in deaths of patients, in the past. We can say that.

The Canadian health managers claim that they've reduced the waiting times substantially since Chaoulli. I'd like to see the best evidence for and against that claim.

The CAMJ, under its editor John Hoey, was ranked one of the top 5 medical journals in the world, and it's open access. I recommend you search there if you're looking for evidence. I'd consider anything from the CAMJ to be reliable (and it's certain to be better-written and more understandable than anything from Heritage or Fraser).

I'm going to add a section to the article about waiting lists in Canada. You may not like it, but this is just a quick draft and you're free to come up with your own arguments. I think waiting lists are an important issue and I think it's important to present the strongest arguments on both sides.

I also think there's good evidence to support the argument that lower expenditures on technology resulted in worse outcomes for myocardial infarction, and I'll try to add that. Nbauman 18:11, 9 July 2007 (UTC)

You seem to be implying that by your rejection of the Heritage and Fraser POVs there is a standard other than WP:V and WP:RS to be applied in judging whether an article meets the WP:NPOV requirement of fairly representing all notable points of view. I'd like to see the rationale for that. THF 18:18, 9 July 2007 (UTC)

I agree that Heritage and Fraser are notable points of view that belong in the article. I just don't believe that they're reliable. I'm willing to include unreliable POVs, even when they're wrong, as long as I can add accurate information along with them. I'd say the same about Michael Moore.

If you show me an article from Circulation that says Canadian outcomes are worse than U.S. in heart attacks, I would assume that it's accurate (although it reflects the situation in 1990-93, not today).

The most accurate information I know of is peer-reviewed medical journals. For Heritage, Fraser and Michael Moore, their work is reviewed by like-minded believers in their ideology. At the CMAJ, NEJM, JAMA, and other journals, their articles are reviewed by people who both agree and disagree with the views of the author, and they challenge the authors on facts and unsupported arguments. They insist that the author make the best arguments for and against his position. Which do you think will be more accurate? Nbauman 20:03, 9 July 2007 (UTC)

Again, WP:NPOV rejects the sort of value judgments you're making. I think a lot of medical journals are inaccurate, even when peer-reviewed, but I don't get to delete them, even if I can present stone tablets carved by God refuting them: the standard is verifiability, not accuracy, and that way we avoid a lot of arguments and permit collaborative editing even when editors disagree on the underlying facts. Because these are not extraordinary claims, there's one threshold for WP:V, which is WP:RS, and Fraser and Heritage pass that threshold. THF 20:11, 9 July 2007 (UTC)

WP:RS says, "Reliable sources are authors or publications regarded as trustworthy or authoritative in relation to the subject at hand. Reliable publications are those with an established structure for fact-checking and editorial oversight." The Heritage and Fraser reports I've read didn't pass that threshold. But I'm not going to press the issue. I think we have to include all significant positions, even the ones that are wrong. And I haven't yet read their studies which are linked in this article, so I'll withhold judgment until I do. Nbauman 22:13, 9 July 2007 (UTC)

I just read the Fraser Institute report by Esmail. It has some problems. They openly state that this is an advocacy piece to show the benefits of free markets, and it's obvious.

They also divide the mortality by the incidence of cancer, which as I explained above is meaningless. I've never seen that in a medical publication, and I don't think any medical journal would let them do that. Neither of the 2 authors are doctors. The Fraser Institute board is composed of economists.

They give a lot of statistics on waiting times, depending heavily on a study by Blendon in JAMA, which I know and consider reliable. However, they don't discuss actual medical outcomes. For example, they discuss patient satisfaction. But they don't give survival rates for any of these diseases. What difference does it make how long you have to wait longer to see a specialist -- if you have a better chance of surviving despite that wait?

They also cherry-pick the data by comparing Canada to the U.S. when the comparison favors the free-market system, i.e. waiting times, and dropping the U.S. when the comparison goes against the free-market system, i.e. infant mortality, life expectancy, quality adjusted years of life. Most of the report doesn't deal with the facts -- they just give their opinions on the benefits of the free market.

The US has a free market system? Zuh? You do know what you're talking about right?--Rotten 18:48, 10 July 2007 (UTC)

They even argue that government support for the poor isn't necessary because the charitable sector can do that more efficiently.

Nonetheless I think this is a valid --thugh wrong -- point of view that could be included in the article. Nbauman 23:10, 9 July 2007 (UTC)

This is the talk page for discussing improvements to the Canadian and American health care systems compared article. This is not a forum for general discussion about the article's subject. Your opinion about the Esmail report is irrelevant. (Don't take it personally: my opinion about the Esmail report--that I trust economists more than doctors on this economic issue--is also irrelevant, unless I publish something about it in a reliable source.) THF 23:19, 9 July 2007 (UTC)

I'm discussing here the merits of the Fraser report, not the merits of Canadian health care. You were complaining above that the substantive issues in the Fraser report were not discussed in the article. I'm explaining to you why I don't think the issues in the Fraser report were substantive, and why the last person who dealt with it couldn't find anything substantive either. I believe there are problems with the Canadian health care system. This Fraser report doesn't tell us what they are. If you can find a substantive issue in this Fraser report, I wish you would tell me what it is, so we can include it in the article. Nbauman 00:29, 10 July 2007 (UTC)

"Free market" health care system

Personally, I object to the premise that the US has a "free market" health care system. I'd rather strip that notion out of this article.--Rotten 19:40, 10 July 2007 (UTC)

I don't see where the article itself says that. If you see a section where that is implied or stated, please go ahead and edit it. -- Sfmammamia 21:11, 10 July 2007 (UTC)

I think he means the section on Canadian_and_American_health_care_systems_compared#Medical_professionals

It's one of the more confusing sections. If there's a theme in there, I can't find it. It's repetitive, and keeps rambling through several unconnected ideas. Worst of all, it has essentially no sources. For that reason alone, I think we could delete the entire section (especially since the article is getting pretty big). If somebody wants to write a section on medical professionals, CMAJ should have all the information you need. Nbauman 22:42, 10 July 2007 (UTC)

I've made a few edits, removing the "free market" reference. It appears that OECD health data is the source of income statistics as well as the per-capita figures, which I updated. The latest update is coming out July 18. If someone has access to the full data set and can check/update these stats, it would be helpful. I agree that this section needs additional sources, but I think it would be better to improve the section rather than deleting it altogether. -- Sfmammamia 01:54, 11 July 2007 (UTC)

I haven't looked closely at this question with respect to this article, but all these references to primary sources makes me wonder if we have a WP:SYN//WP:NOR problem. THF 03:19, 11 July 2007 (UTC)

Zywicki cite

WP:V states Self-published material may, in some circumstances, be acceptable when produced by an established expert on the topic of the article whose work in the relevant field has previously been published by reliable third-party publications. Todd Zywicki is one of the three most prominent bankruptcy law scholars in the United States, and his blog entry (on a notable blog, no less) qualifies. I'm restoring the cite. THF 02:33, 11 July 2007 (UTC)

Thanks for the explanation, and sorry for the extra effort to restore it. Given the scrutiny and debate over appropriate sources for this article, it's good to document such decisions here for other editors to see. -- Sfmammamia 03:14, 11 July 2007 (UTC)

Where has Zywicki's work on the subject of bankruptcies caused by medical expenses been previously published by reliable third-party publications? Nbauman

Here, and in his congressional testimony as well. THF 06:08, 11 July 2007 (UTC)

"Web sites now give Ontario waiting times"

Web sites give waiting times for all the provinces. Why single out the province with the best waiting times, rather than the ones where people still have to wait two years for hip surgery? THF 21:01, 11 July 2007 (UTC)

The letter was written by the head of the Toronto University Health Network, so he gave the Toronto web site. If you have the links to other web sites with different waiting times, what are they? Do you have any evidence that people now are waiting 2 years for hip surgery, as opposed to 2003? Nbauman 02:34, 12 July 2007 (UTC)

Google name of the province plus "waiting times." Easy enough to find all of them, such as this Nova Scotia one indicating that over a third of patients in some regions are waiting over a year for hip replacements as of March 2007 (and that several still hadn't had surgery after waiting 540 days), and that a significant number of patients are waiting over three months for breast biopsies. And I picked that one at random. THF 03:59, 12 July 2007 (UTC)

Fact after the chart on cancer mortality

However, incidence rates for all cancers tend to be higher in the U.S., although this is not true of all cancers. Incidence rates for certain types, such as colorectal and stomach cancer, are actually higher in Canada than in the U.S.[60]

There is no need for this fact. The graph says this fact already. User:Renny11

We cannot make statements that draw conclusions only from the data in the table, because that would violate WP:OR. There has been lengthy discussion about even including the table. I have made an attempt at reorganizing the entire cancer section so that the several studies that have been added over the last few weeks flow together a little better, including the one that was lingering below the table. -- Sfmammamia 15:18, 18 July 2007 (UTC)

I always meant to ask what that statement meant. When it says, "incidence rates for all cancers tend to be higher in the U.S., although this is not true of all cancers," I think it means, "incidence rates for some cancers are higher in the U.S., and incidence rates for other cancers are higher in Canada." I would change it to read that way.

As a professional tip, when you try to rewrite a statement based on a medical article, it's much easier to go back to the original source and see what the facts actually were, than to try to figure out what the writer before you was trying to say. Nbauman 18:18, 18 July 2007 (UTC)

A "professional tip"? Are you a professional Wikipedia editor?--Rotten 21:06, 18 July 2007 (UTC)

Professional medical editor. Nbauman 23:28, 18 July 2007 (UTC)

Agreed, and summary statement modified, though not exactly as suggested. -- Sfmammamia 19:14, 18 July 2007 (UTC)

JoeCarson, I don't want to get into an edit war. do you understand what statistical signficance is? Nbauman 17:13, 19 July 2007 (UTC)

Then make good edits and there will be no need to fix them. And don't patronize me. Do you know the integral of ln(x)? JoeCarson 21:19, 19 July 2007 (UTC)

Let's do a thought experiment. We want to determine the average mass of 10 year olds in our neighborhoods. Method A: I weigh them all on my nifty Tanita scale set to kg. I average the masses. Method B: You construct a gigantic balance and buy standardized weights. You place all the 10 year olds in your neighborhood on one side and add weights to the other until you reach parity. You divide by the total number of 10 year olds in your neighborhood.

Our methods are not guaranteed to give comparable results, but it is illogical to reject the possibility that they do.JoeCarson 21:36, 19 July 2007 (UTC)

JoeCarson, let's take an example from the quantum physicists. If you throw a bunch of watch parts in a box, shake the box, and turn it over, it's illogical to reject the possibility that a complete watch will fall out.

But the possibility of those cancer data being compatible by chance is like the chances of a complete watch falling out.

People have been collecting cancer statistics in a serious way for about 50 years. They've made lots of mistakes along the way, and they've figured out how to avoid making those mistakes. They've done a lot of things that seemed logical but turned out to be wrong. There are standard conventions for reporting and describing cancer statistics, and if you don't use those conventions, you're going to get the facts wrong and mislead people.

If you suggest that they may, by chance, be comparable, you're deceiving people.

It may seem logical to you, but it's not. In science you take logic and you check it against facts. The experience of medicine is that when people use the logic you're using here, they turn out to be wrong.

If you're doing a study where peoples' lives depend on an accurate measurement of hemoglobin, and you have 2 labs measuring hemoglobin, and they don't callibrate their machines the same way, and they use different machines, you have to say that the results are incompatible. You can't say that the results might by chance turn out to be the same. No medical journal in the world would let you do that.

Every medical journal in the world would print statistics like that with a disclaimer saying that they're not compatible.

You haven't even read the complete Canadian report in your own footnote, because they explain this. They give the example of prostate cancer, where the more people you test the more prostate cancer your report, and where there are incompatibilities from state to state in the U.S. Your own sources explain why those statements are wrong.

And in any case, it's WP:OR and [[WP:SYN] to collect data and draw conclusions from those data. Nbauman 22:28, 19 July 2007 (UTC)

According to QM, there is a non-zero probability that you will have tunneled into your neighbors bedroom in the next five minutes. But the possibility of those cancer data being incompatible is like the chances of you getting into your neighbors bedroom by any method that cannot be described by classical physics. I do not doubt that they have error associated with them, but it is illogical to state they are so different as to be completely incompatible without data to back it up.

Replace tunneling into your neighbors with the decay of your favorite radioactive substance of long half-life if you're nitpicky.

We should certainly be more cautious with the language but the section does not currently present any conclusions not found in the refs. JoeCarson 22:58, 19 July 2007 (UTC)

I deal with statistics like this all day. You're speaking nonsense. I'll have to get someome from the Wikipedia Medicine project to review this. Nbauman 00:59, 20 July 2007 (UTC)

You've made that claim before. It certainly doesn't show. If you don't like the data, bury your head in the sand. But it behooves the editors to present the data. JoeCarson 10:16, 20 July 2007 (UTC)

Length of cancer section

I did a quick word count of the overall article and the cancer section. Rough word count for overall article (not including references): 5,800. Rough word count for cancer section: 725 words. My opinion is that the section is getting rather long, plenty for one topic in this comparison, and my suggestion is that we look for ways to trim, or at very least, stop adding here. Other thoughts? -- Sfmammamia 18:56, 20 July 2007 (UTC)

I don't think we can do anything with it because we have a disagreement over what is valid text and what isn't. To put it as impartially as possible, JoeCarson is writing conclusions and/or interpretations (or whatever term you prefer) that I believe are wrong, and I can't convince him otherwise. Any attempt to shorten it would get into a lot of disagreements about what should go and what should stay. Nbauman 19:22, 20 July 2007 (UTC)

What conclusions? The conclusions of the authors of the papers I cite? JoeCarson 10:22, 21 July 2007 (UTC)

By the way, thanks for coming over to the light side. Me holding you to a higher standard got you to add some real value to this section.JoeCarson

I suggest we remove the Honolulu/Toronto paragraph. It does not add anything that isn't covered by the rest of this section and neither city is representative of the demographics of the nation it is in. Let me know if you feel strongly about keeping this in. Also, I plan to remove the prostate cancer data in the table because of screening differences elaborated upon earlier in the section. Any constructive suggestions are appreciated. JoeCarson 16:40, 21 July 2007 (UTC)

Agreed. Honolulu/Toronto paragraph removed. -- Sfmammamia 20:43, 22 July 2007 (UTC)

Actually, the Honolulu/Toronto paper gives unusually strong evidence that the poor get better treatment in Canada than the U.S., if I remember correctly. I think that's an important point to make, although I don't know if this is the section for it. It's significant because lots of people claimed that Hawaii had the best access to health care for the poor in the U.S. Even the best state in the U.S. can't provide care for the poor. Nbauman 04:19, 24 July 2007 (UTC)

Nbauman, please look over the section as it stands now. As I read it, it still references two comparison studies that came to similar conclusions, although one comes right out and cites socio-economic disparities in U.S. survival rates, and another alludes to disparities in the U.S. by race. I think the point is supported by those two broader studies. It seems to me the more local study is just more of the the same. -- Sfmammamia 06:25, 24 July 2007 (UTC)

Hsing article

JoeCarson, is the article Hsing A. W., Tsao L., Devesa S. S., International trends and patterns of prostate cancer incidence and mortality, Int. J. Cancer, 85, 60-67, (2000) available on the Internet? Do you have a copy of it? Nbauman 19:22, 20 July 2007 (UTC)

http://dceg.cancer.gov/pdfs/hsing852000.pdf -- Avi 22:09, 20 July 2007 (UTC)

The Mackillop paper is worth a read too. They talk about the problems with prostate cancer comparisons as well. I plan to add more info about their sans prostate comparison soon for better flow with the Hsing paragraph. JoeCarson 10:25, 21 July 2007 (UTC)

Why does this article exist?

If a person wants to compare the health care systems of America and Canada, they can do it by reading the American and Canadian health care systems' respective articles. This page is more like an essay than an article; it has no business in an encyclopedia. It's like having an article comparing the PS3, Wii, and Xbox 360. We don't need an article explaining why the US sucks and why Canada is the greatest thing since sliced Norway. Dylan Bragers 00:27, 22 July 2007 (UTC)

Because it's a POV fork and a way for certain editors to push a political POV. Oops, did I just say that? I meant it's a great article and we should STRONG KEEP or something. I guess it's here as a reminder of why nobody should ever take Wikipedia seriously as an encyclopedia. --Rotten 03:15, 22 July 2007 (UTC)

You might find instructive the discussion conducted during an AfD vote on this article in August 2005. It is archived here. See especially SimonP's comments regarding other such articles here on Wikipedia. -- Sfmammamia 03:50, 22 July 2007 (UTC)

It is absolutely not true that you can take the American and Canadian health care articles and compare them. For all the reasons we've been discussing, you can't simply take the number of days survival for breast cancer in Canada and compare them to the number of days survival for breast cancer in the U.S. -- even though politically-motivated people like David Gratzer have tried to do that.

There have been many articles in medical journals, which we have cited, comparing the two health care systems. They published them because there was an important reason to do so. Nbauman 23:24, 23 July 2007 (UTC)

Pretty much everything has already been said here, but you might also be interested to learn that the encyclopedia does have a fairly exhaustive comparison of the PS3, Wii, and Xbox 360. - SimonP 02:05, 24 July 2007 (UTC)

That doesn't invalidate his question.--Rotten 02:21, 24 July 2007 (UTC)

The answer is that it's very important in medicine to compare different health care systems. Doctors always compare different systems -- they compare states in the U.S., regions in Sweden, rural vs. urban areas, high-income vs. low-income areas, and they do all kinds of country comparisons. For example, there are many epidemiological studies of how cancer incidence compares between Asians in Asia, Asians who have emigrated to the U.S., and Asians who were born in the U.S., and these studies have produced valuable information about how diet affects cancer. I've been to medical conferences and I've seen many international studies, in which they try to figure out the reasons between the results they get in the U.K. vs. the U.S., the U.S. vs. Canada, etc. Most review articles on major diseases will mention the variations between countries, if it does vary. For example, multiple sclerosis is common in temperate climates but rare in tropical climates.

One of the major comparisons is Canada vs. U.S., because their medical practices have so few differences that comparisons can identify specific differences that affect results.

That's why it's important in medicine.

An encyclopedia should cover important topics of medicine. Therefore it belongs in Wikipedia.

Furthermore, it's important because of the interest in reforming U.S. health care, possibly to a single-payer plan on the model of Canada. People want the facts, and they come to Wikipedia to find out. This page has a high rank on Google (where you will also find many books and medical journal articles), so this is what internet users are choosing in the marketplace of ideas. If lots of people want to read this information in Wikipedia, we shouldn't take it away from them.

That's why it belongs in Wikipedia.

I think a lot of people object to having any discussion of single-payer health care, or comparisons of the Canadian and U.S. health care system, because they are politically opposed to government-funded health care, and don't want Wikipedia to contain anything to support it. That's not a good reason to exclude it. That's WP:CENSOR. Nbauman 04:09, 24 July 2007 (UTC)

Name of the article.

Wouldn't it be better if the name of this page was "Comparison of the Canadian and American health care systems" or something similar other than the current one? This one sounds a little awkward to me. - Fedayee 19:15, 22 July 2007 (UTC)

The current title follows a structure in keeping with other similar Wikipedia comparative articles. Examples: Canadian and Australian politics compared, Canadian and American politics compared, Canadian and American economies compared. For that reason, in my opinion the title should stay as is. -- Sfmammamia 20:30, 22 July 2007 (UTC)

Investment

Companies that sell medical devices, like General Electric, pay organizations like the Manhattan Institute and the Fraser Institute to write reports claiming that Canada has "underinvested" in technology, i.e., by not buying enough GE CT and MRI machines.

They have never proven that Canada needs any more CTs and MRIs, and in fact studies have shown that the health outcomes without them are just as good. (Sometimes they do more harm than good. There was a case history in the NEJM this week in which doctors using CAT scans missed a diagnosis until somebody took a plain film. There was a study published this week which found that women who had many CAT scans were getting doses of radiation high enough to cause more cancer.)

When you say that a CT scan is an "investment", you're pulling a word out of the GE sales literature. If a machine isn' useful or needed, it's not an investment.

"Investment" is POV -- the POV of equipment company salesmen. "Spending" is the neutral term.

You can't write in the article on your own authority that something is an "investment." That's an accounting term. You're not an accountant. That's WP:SYN. Under WP rules you need a reliable source that calls in an investment.

I challenge you to find a reliable source that uses the term "investment" for buying CT or MRI scans in Canada. The only people who use that term are the equipment vendors and the people they pay. Nbauman 02:21, 26 July 2007 (UTC)

You clearly do not understand the meaning of investment. A failed enterprise was still an investment. My purchase of a Ford Focus was an investment, a very bad investment in hindsight. Now I know and will never buy a Ford product again, but the car was still an investment. I do not care so much about using the word "investment" as I do about the quality of that sentence. Two "spending" sounds awkward. If you feel so strongly about that word, find an alternative that doesn't make the sentence sound awkward.JoeCarson 10:16, 26 July 2007 (UTC)

Just saw the new edit. That's fine. JoeCarson 10:18, 26 July 2007 (UTC)

Race/Ethnicity and misc.

I have just added a bit of info on ethnic/racial differences in health outcomes. I have copies of all the cited papers if anyone is interested. I also have a few others that I did not include. If anyone wants a particular journal article and doesn't have access to a university library, let me know soon. I'll be happy to send you a copy, but I go on vacation in a week and I doubt I will check wikipedia until I get back so let me know ASAP. JoeCarson 15:34, 27 July 2007 (UTC)

I don't quite understand that section. You say:

The U.S. and Canada differ substantially in their demographics, and these differences may contribute to differences in health outcomes between the two nations.

But all the sources we've compiled say that the differences in health outcomes are small. They're usually so small that they're not clinically significant, which was the conclusion of the Guyatt meta-analysis and Hussey in Health Affairs. The differences in outcomes between the U.S. and Canada in treatments with the best evidence, such as heart attacks, heart failure, breast cancer, and leukemia are much less than the difference from year to year as each country adopts newer treatments, like PCI and CABG for heart disease, and new chemotherapy for breast cancer. Any Canadian data for 2006 will show better outcomes than any U.S. data for 1996, and vice versa.

The only significant difference we've found is waiting times for specialists, costs, and access.

Are there supporters of the U.S. system who say, "Yes, the Canadians have better health outcomes, but that's because the U.S. has more poor people and minorities who are are worse off. It's not the fault of the health care system"? If that's what you're trying to say, get a quote from a reliable source and give the best evidence and significant viewpoints for and against it. Nbauman 01:18, 29 July 2007 (UTC)

Yes, health differences do seem small, but racial/ethnic differences do have an affect on macro figures like infant mortality (though whites in U.S. still worse than whites in Canada) and micro figures like specific cancers that are much more common in certain groups. The source for that sentence writes that different demographics can account for much of the infant mortality differences. I've said exactly what I was trying to and provided a source. If I expand that part of this section further, I will provide sources, but I do not anticipate elaborating more on that point. I am much more interested in raw data that the reader can use to draw their own conclusions. JoeCarson 09:52, 30 July 2007 (UTC)

Illegal immigrants

Wouldn't illegal immigrants also affect care in both countries, particularly in the US? Having a huge underground immigrant population would seem to affect the statistics a bit, no?--Rotten 07:31, 28 July 2007 (UTC)

Of course, and this is already mentioned in the article. See section "Price of health care," third paragraph. If you believe the subject is inadequately dealt with there, please feel free to expand on it, with appropriate sources, of course. -- Sfmammamia 23:58, 28 July 2007 (UTC)

Breast cancer statistics

I was just reading the data from the North American Association of Cancer Registries which is one of your sources. If you compare their rates for in situ breast cancer, they report twice to three times the rate in the U.S. as in Canada. As I explained above, carcinoma in situ is a low grade of breast cancer, and some oncologists don't think it's cancer at all. Only about 5% of untreated patients with breast carcinoma in situ go on to develop cancer. But if you do very aggressive breast cancer screening, you find a lot of carcinoma in situ.

This means that you can't compare the incidence and mortality of breast cancer in the U.S. and Canada, unless you separate the carcinoma in situ and the other cancers. Otherwise, if you mix them together, the U.S. numbers will show an inaccurately higher incidence rate, and an inaccurately higher cure rate (since 95% of carcinoma in situ isn't really invasive cancer, and the patient didn't need to be cured with surgery in the first place).

How much of the breast cancer in that table is carcinoma in situ? Nbauman 00:44, 30 July 2007 (UTC)

Good point, I was thinking about removing those cancers as well. Other sources have pointed out problems with breast cancer statistics. Though, we do mention this a couple of paragraphs above the table, so hopefully it has not led anyone astray. JoeCarson 09:42, 30 July 2007 (UTC)

Canadian health care -- Walk-in Clinics

Perhaps some information about walk-in clinics can be added (I'm thinking of adding info to this section --

""Coverage and access

In Canada, every citizen has coverage, but access can still be a problem. Based on 2003 data from the Canadian Community Health Survey,[29] an estimated 1.2 million Canadians do not have a regular doctor because they "cannot find" one, and just over twice that number do not have one because they "haven't looked". Those without a regular doctor are 3.5 times more likely to visit an emergency room for treatment.[29]"" )

In my neighbourhood, those without a doctor tend to go to walk-in clinics instead of the ER, after campaigns not to abuse emergency rooms in order to combat ER waiting lists from those with non-life threatening diseases.99.245.173.200 18:08, 31 July 2007 (UTC)

Cancer section

I am concerned about the continuing presence of the 1997 cancer mortality tables when the source for that data is no longer available. It seems that with the recent changes to that section and additions of other sources, the specificity presented in the tables may be unnecessary. Removing it would require some changes in wording, but I don't think the major points now made in the section would be affected. I hesitate to remove it because it appears a couple other editors are invested in the portrayal of content in this section, and one of the quoted sources on which the section relies is not available to me to check it against the points made. Other thoughts or comments? -- Sfmammamia 16:31, 6 July 2007 (UTC)

I tend to agree. Interpreting WHO statistics is also original research. It is much better to simply reference some of the secondary sources that analyze these numbers. - SimonP 17:58, 6 July 2007 (UTC)

There's a ton of easily obtainable data to parse through. We should replace the data in that table with one from a source that is easily accessed.JoeCarson 19:23, 6 July 2007 (UTC)

I write for medical publications, mostly for doctors, and I deal with these statistics all the time. I've had oncologists explain how they use these statistics and what their limitations are.

Many Canadian and American doctors compile cancer statistics to monitor the effectiveness of their own treatments, and to compare medical treatments elsewhere. Cancer is particularly complicated, and these statistical methods are fairly well established (and their limitations are fairly well recognized).

Because of the current debate over health care reform in the U.S., many people are using cancer statistics in the U.S. or Canada to support a political point. But many of them don't understand the statistics and get it wrong.

I think this section on cancer has a lot of original research, and the table in particular is original research -- and misleading.

You can compare the raw cancer incidence and death rates in 2 countries, but it doesn't demonstrate anything. Health statisticians have to correct those rates for many factors, including biases in reporting. It's difficult to compare the incidence between 2 U.S. states.

One of the Canadian government reports in the footnotes gave a good explanation for the example of prostate cancer. I used to write about prostate cancer, and I had to go through the prostate cancer statistics from U.S. sources (like SEER), and international sources. I reviewed prostate cancer statistics over the years. Everybody agrees that there are wide error ranges in the number of deaths, the number of prostate cancers, and the treatment effectiveness.

1. Prostate cancer deaths. Most elderly adults in developed countries have multiple diseases, usually heart disease, lung disease if they smoke cigarettes, and often cancer. Most elderly adults are not autopsied when they die, so nobody really knows why they died. In many states, the death certificate isn't filled out by a doctor. When they fill out the cause of death on a death certificate, even a doctor is usually making a guess from among the many conditions that could have caused the death.

During a couple of years when there were educational campaigns about prostate cancer to promote prostate cancer testing, the reported prostate cancer death rates went up, even though treatments were improving. Every urologist and oncologist I spoke to told me that this was almost certainly a statistical artifact as a result of over-reporting. So if U.S. doctors are more likely to attribute a death to prostate cancer than Canadian doctors, the statistics will report that prostate cancer deaths are increasing in the U.S. compared to Canada. But the deaths are actually the same.

2. Prostate cancer incidence. The more men you test for prostate cancer, the more prostate cancer you'll find. Most men will go for 15 years with prostate cancer, not even know they have it, and die of a heart attack or stroke. Prostate cancer tests pick up early prostate "cancers," many of which will never develop into harmful disease if you leave them alone. But the U.S. tests very aggressively for prostate cancer, so we report more prostate cancer cases.

3. Prostate cancer treatment effectiveness. Prostate cancer is usually treated by invasive surgery which leaves men impotent. If you treat young, relatively healthy men, with early prostate cancers, you'll have good results. If you treat older men, with advanced prostate cancer, you'll have bad results. If U.S. urologists are over-aggressive (as some people think they are), and diagnose and treat early prostate cancers that would never have caused any problems, they'll have great outcome statistics. But they're not saving lives; they're simply performing unnecessary surgery. Of course they have great outcomes: the patients were healthy to begin with.

Look at the table. It compares breast, prostate, intestinal, stomach, lung, and NHL. When I read medical textbooks, they give the incidence and mortality of every disease. It's tempting to divide the mortality by the incidence. In a steady population, that would be the mortality rate for the disease. But in a real population, it's not. Take lung cancer. The mortality rate from lung cancer is 100%. Everybody who gets lung cancer dies eventually (I think the 15-year overall survival is under 5%). So what does that .788 number tell you about outcomes? Nothing.

Look at breast cancer. I've written a lot about studies on breast cancer treatment, so I had to figure out the original studies. To simplify, there's early-stage and late-stage breast cancer. Early stage breast cancer can often be cured; with late-stage breast cancer, you're shooting for another 2 1/2 years of life. So the main thing that affects a doctor's survival statistics is his mix of early- and late-stage breast cancers. This table just lumps early and late breast cancers together under one heading.

(More significantly, doctors often diagnose and treat something called breast carcinoma in situ, which is controversial. A lot of doctors think that it's not really cancer, and you should leave it alone unless it progresses to something that really is cancer. But if a doctor treats a lot of carcinoma in situ, his mortality and recurrence statistics will be great, because his patients are young and healthy, and carcinoma in situ hardly ever progresses to cancer anyway. The U.S. diagnoses breast cancer -- and carcinoma in situ -- very aggressively.)

Look at "intestinal" cancer. This must mean colorectal cancer. I just wrote about surgical outcomes in colorectal cancer. Colon cancer is much easier to treat than rectal cancer, so the surgeons who do the most rectal cancer tend to have worse outcomes. Some populations have more colon cancer, some have more rectal cancer. If Canada has more rectal cancer, Canadian doctors will have worse outcomes, and vice versa.

There are other things you don't distinguish in that table. Cancers have different stages and grades, and there are different mixtures in different countries. NHL includes different diseases with completely different outcomes.

Cancer and epidemiology are two of the most complicated specialties in medicine. When I write for publication, I wouldn't write any conclusions that weren't explicitly stated in the doctors' article. Collecting numbers like that and comparing them in a table is a misleading and unjustified interpretation of the data. It's certainly original research in Wikipedia terms. I realize it took a lot of work, but I've often written a draft of an article that turned out to be all wrong, and I had to just rip it up and start all over.

When I want to compare the Canadian and American health care system, I'll find doctors who have compared it, and published their results in peer-reviewed journals[6], and quote their conclusions. Nbauman

It seems to be getting worse. Even though there's been significant effort put into this section over the last week or so, what it contributes to the overall article is very unclear to me, as the section does not point to a clear set of conclusions about what cancer data has to say about the comparison of the two health systems. At this point, I'm leaning toward deleting the whole section. -- Sfmammamia 18:27, 7 July 2007 (UTC)

The Canadian government has published comparisons between the two systems. They're very useful for doctors and health planners, because Canadian and U.S. doctors often do things slightly differently. For example, U.S. must be over-using CAT scans, because Canadian doctors often get the same outcomes without them. I'd like to keep it in, and maybe expand it to other diseases -- there are a lot of good Canadian government and other reports in the footnotes, but it's a lot of work to read through them.

Here's a peer-reviewed article that has a table comparing the cancer outcomes in 5 countries, including the U.S. and Canada. You could use the data for a new table, and quote their conclusions. Or you could expand it from cancer, and give the conclusions for all diseases.

Health Affairs, 23, no. 3 (2004): 89-99

Quality: How Does The Quality Of Care Compare In Five Countries? [7]

Australia, Canada, New Zealand, England, and the United States, studying five-year cancer relative survival rates, thirty-day case-fatality rates after acute myocardial infarction and stroke, breast cancer screening rates, and asthma mortality rates. "No country scores consistently the best or worst overall. Each country has at least one area of care where it could learn from international experiences and one area where its experiences could teach others."

Another one is:

Mirror, Mirror on the Wall: An International Update on the Comparative Performance of American Health Care, The Commonwealth Fund, May 2007 [8]

Compared with five other nations—Australia, Canada, Germany, New Zealand, the United Kingdom—the U.S. health care system ranks last or next-to-last on five dimensions of a high performance health system: quality, access, efficiency, equity, and healthy lives.

I do think that cancer section is ready for drastic surgery, though. Nbauman 22:17, 7 July 2007 (UTC)

The Commonwealth Fund study is already cited in the article, although the cite is incomplete -- see footnote #30. -- Sfmammamia 03:47, 8 July 2007 (UTC)

I can compute the motions and binding states for many of the chemical systems involved in disease, and I do so regularly for the systems of prostate cancer and androgen insensitivity syndromes, but I will defer to your knowledge of the statistics. However, there is no good reason to remove the table. Perhaps consideration should be given to removing the division operation, but it is not original research as defined by wiki. It is not a new theory or method, it is not an original idea, it does not define or re-define terms, it does not make an argument without providing a reputable source, it does not introduce a synthesis in a way the that builds a case favored by me and it does not use neologisms. It presumes incidence/mortality is a good proxy for cancer survival rates. We should mention the "fuzziness" inherent in these figures. I assumed the reader would know that.JoeCarson 10:13, 8 July 2007 (UTC)

I saw a presentation of binding states for androgen receptors at the American Chemical Society meeting, and I loved it, but clinical medicine operates on a different scale.

The main thing I learned about statistics is my own ignorance. That's a job for experts, and even the experts have trouble. (The classic example is [Simpson's paradox]). All I do is quote from reports and from statisticians.

If a medical statistician compiled the incidence and mortality rate for, say, breast cancer, and confirmed that they were diagnosing breast cancer the same way in Canada and the U.S., and that they were reporting the same kind of cancers, and they used the same diagnostic criteria, and they published them together in a peer-reviewed journal as comparative statistics -- O.K. But this table got the Canadian statistics from one report, and the U.S. statistics from another report, and lined them up as if they were equivalent -- which they're not. That's innacurate, misleading and original research. Just read the caveats in the Canadian Cancer Statistics 2007 report, which explains why cancer statistics may not be compatible from region to region (let alone country to country).

Take breast cancer. The raw incidence figures have to be adjusted, and the 2 government reports adjust them in different ways. Canadian doctors examine more of the population for breast cancer, so that would inflate Canadian figures. The U.S. tends to diagnose ductal carcinoma in situ as breast cancer. Does Canada? Are the ages equivalent? If a woman with breast cancer dies of heart failure as a result of the chemotherapy, do they record that as a death from breast cancer or from heart failure?

The first thing I did when I saw incidence and mortality statistics in a textbook was to divide them. But the incidence/mortality is not a proxy for survival rates -- or anything meaningful. If it was, the incidence/mortality for lung cancer would be 1.0. But it's not.

You can't assume that the readers will understand the "fuzziness". Doctors and PhD-level statistician co-author articles with mistakes (like the Simpson paradox study). If doctors who have studied medical statistics don't understand these things, how can the general reader understand them?

And there's no reason to use these numbers. If you want a table comparing Canadian and U.S. cancer survival, there are peer-reviewed, published data in the Health Affairs article. Nbauman 21:20, 8 July 2007 (UTC)

I just found a Wikipedia policy that's exactly on pont in Wikipedia:No original research

The cancer section violates WP:SYN: "Editors often make the mistake of thinking that if A is published by a reliable source, and B is published by a reliable source, then A and B can be joined together in an article to advance position C. However, this would be an example of a new synthesis of published material serving to advance a position, and as such it would constitute original research.[2] "A and B, therefore C" is acceptable only if a reliable source has published this argument in relation to the topic of the article."

The cancer section is synthesizing 2 studies, and drawing conclusions from them, in exactly the way that WP:SYN defines as original research. It has to come out. Nbauman 16:04, 10 July 2007 (UTC)

How about just presenting the data without drawing any conclusions then? --Rotten 16:12, 10 July 2007 (UTC)

If you take data on, say, prostate cancer incidence from a Canadian study, and line it up with prostate cancer incidence from an American study, that would be new synthesis in violation of WP:NOR.

It's also wrong in medical terms, because prostate cancer statistics from Canada are not compatible with prostate cancer statistics from the U.S. (Prostate cancer statistics from 1990 aren't even compatible with prostate cancer statistics from 1995.) If you want to compare prostate cancer statistics, find a reliable source that has compared them, such as the Health Affairs article. I can't even check the conclusions that have sources because the footnotes don't link to the original articles (and some of those data go back to 1993 or earlier). I read cancer statistics every week, and I've written about them. You can't combine numbers like that. This section is just wrong. I don't see how we could justify it, in WP terms or medical terms. Nbauman 16:37, 10 July 2007 (UTC)

No need to justify just presenting data, as long as you note that the two statistics aren't compatible. Why do you want to suppress the data so bad?--Rotten 18:47, 10 July 2007 (UTC)

The reason I want to suppress the data "so bad" is that it's meaningless and misleading. Anyone who divides those 2 numbers doesn't understand the statistics. If people want to understand medicine, they have to understand the statistics, and comparisons like that are miseducating them. It's junk data. I was trained to look out for misleading comparisions like that. That's the kind of comparisons drug companies used to make, until the FDA made them stop. They used false comparisons like that because it made it possible to make their drugs look good, even when they were actually harmful. This kind of statistics has caused lots of harm.

Or to put it in terms that everybody here can understand: it violates WP:OR and WP:SYN. Nbauman 04:59, 12 July 2007 (UTC)

Perhaps you should think this through more deeply. You may have a case for SYN, but certainly not OR as it relates to the data itself. Leave the data and remove the conclusions of the editor. However, a belief that mortality/incidence is not a good proxy for (1-survival rate) in these systems must be based on poor reasoning. Imagine a section of pipe with a slowly changing flow rate and several sinks between one end and the other. Using mortality/incidence is equivalent to using 1-(outflow rate/inflow rate) to measure the amount lost to the sinks. If you are comparing two pipes and the technique used to measure flow differs, you should mention that, but it is unscientific to reject the comparison unless at least one of the techniques is highly flawed. If that technique leads to bad data. The data in this scenario is outflow and inflow rate, not outflow/inflow. To make a case against outflow/inflow as a proxy you must either show that the change in flow rate is not negligible (problem with method, not data) or that the underlying data is not reliable, in which case you must reject the outflow and inflow measurements completely.JoeCarson 13:03, 12 July 2007 (UTC)

Medical statistics is a separate specialty because medical models are unusually complicated, and they have lots of experience with people using simple models that seem reasonable and turned out to be wrong. It seemed reasonable that the earlier you operate on cancer, the more likely the operation will cure the patient, but when doctors looked at the actual results of real cancers, it didn't work. Doctors come up with statistics like yours all the time, but they have to be validated to see if they do anything useful. That's the experimental method of science. You're ignoring the experimental method.

I understand sinks and pipes with inflow and outflow. Chemical engineers deal with that all the time. That's not a valid model for cancer incidence and mortality. If you use the scientific method, you have to test things, and when you test this model to see if it predicts anything useful, it does't work. The most obvious problem is that cancer patients have multiple diseases, especially cardiovascular (which is worsened by chemotherapy and radiation), and when they die, you don't know what they died of.

So the comparison is highly flawed. You're not comparing people who died of breast cancer in the U.S. to people who died of breast cancer in Canada, you're comparing people who died with breast cancer and heart disease who were recorded as breast cancer deaths in the U.S. with people who may have the identical disease who were recorded as heart disease deaths in Canada, and vice versa. When somebody writes an article on treatments for breast cancer in a medical journal, one of the basic things they do is correct for that. You're not correcting for that.

You're adding noise. The false Canadian/U.S. comparision is bad enough. When you divide deaths by incidence, you magnify the error. You get a number with a large random component. Canadian health care administrators rigorously monitor valid indicators, like 30-day mortality for different operations, and waiting times, so they can see where things are working well and poorly. But they would never divide mortality by incidence, because it doesn't show anything valid.

It's only useful for generating random statistics, which can then be used by people who cherry-pick statistics to justify a political position about private versus public health care. And that's what the Fraser Institute is doing. Nbauman 17:29, 12 July 2007 (UTC)

You'll have to forgive me, I'm not familiar with the Fraser institute. However, your insinuation that I am trying to lead the reader to believe that private is better than public by presenting this data is way off. I am not convinced that the American system is really more private than the Canadian system. The structure of government restrictionism just takes a different form in the American market. Government spending on x is an imperfect proxy for the extent of government control over x. Nazi Germany had many companies that were nominally private, but those companies were no more free than the government-run operations of the USSR.

Now do you have any reason to believe this "noise" is biased in any direction? If not, then you are only making a case for including a statement about the fuzziness of the statistics, something we have already agreed on. <(x+randn(0))/(y+randn(0)> = <x/y>. <--See any magnification of randn(0) there? JoeCarson 18:59, 12 July 2007 (UTC)

I have never thought that you were using this data to prove that private is better than public, nor was I insinuating that. I believe that these statistics produce numbers that are chaotic and not related to anything meaningful. Very often in medicine you get a lot of data that doesn't meet statistical confidence. I've talked to medical device manufacturers who tried to use their non-valid data to prove to me their products were actually useful. (You haven't heard of anybody getting laser angioplasty lately, have you?) When you calculate data this way, you get meaningless numbers. People in the Fraser Institute, and the Manhattan Institute, who are trying to prove that private is better, cherry-pick among those meaningless numbers and use it to sell their arguments to statistically ignorant people. That's why I don't want to use those numbers in the entry.

I don't understand that formula. But suppose the cancer rates in Canada were 100 ± 1%, and the cancer rates in the US were 100 ± 1%, in arbitrary units. If you divide one by the other, you get 1.00 ± 2%. That's what I meant. But it's not central to my point. Nbauman 22:39, 12 July 2007 (UTC)

The formula isn't really important. It just shows that if the error is normally distributed around 0, it is not expected to change the value of the measured average. Any error symmetric about 0 should have this property. I changed the table and removed the operation because it may be SYN.JoeCarson 00:37, 13 July 2007 (UTC)

This cancer survival table commits the ecological fallacy. I just came across that term in another article. I am giving notice that it should be deleted, because it's misleading, WP:OR, WP:SYN, etc. Nbauman 23:05, 18 October 2007 (UTC)

It does not meet the necessary conditions for the ecological fallacy. I suggest you read through that and think carefully about the requirements. You are making an assumption. JoeCarson 14:36, 19 October 2007 (UTC)

Comparison of wait times

Do the cited resources have a way of including people who have been denied treatment in the U.S? Someone who is denied treatment theoretically has an infinite wait time. And obviously, systems that do deny treatment to people are going to perform better in this respect. It's like comparing delivery times but discounting lost items. Or failing that is there a statistic about how much treatment is denied at least. Macgruder 11:28, 14 October 2007 (UTC)

Government regulation of the profession

One difference not mentioned is that in America, government regulates all health professions, including nursing and medical doctors, while in Canada the professions are self-regulated. Also, in America, many hospitals are government owned, while in Canada hospitals are private institutions. --The Four Deuces (talk) 11:04, 7 January 2008 (UTC)

I think a subtopic on regulation would be a good addition to this article. However, I think you are in error about ownership of hospitals. According to this Wikipedia article, two-thirds of U.S. hospitals are private non-profit, the remainder are split between public and private for-profit. In Canada, the vast majority of hospitals are public. --Sfmammamia (talk) 20:57, 7 January 2008 (UTC)

The cause of the confusion is the meaning of "public hospital". In Canada, a public hospital is actually private not-for-profit (unlike public hospitals in the UK, which indeed are government owned and run). So Canadian"public hospitals" are indeed private. See [Marchildon GP. Health Systems in Transition: Canada. Copenhagen, WHO Regional Office for Europe on behalf of the European Observatory on Health Systems and Policies. Downloaded from http://www.euro.who.int/Document/E87954.pd; cited on the Health Care in Canada Wikipedia page. To make things even more confusing, some provinces have wiped out individual hospital boards and consolidated them into regional authorities - also private, but often only nominally so. Hope this helps.R2SBD (talk) 04:33, 8 January 2008 (UTC)

Monopsony

It would be helpful if this section briefly explained what "monopsony" means.

Also, it is not correct that "The Canadian government has outlawed private medical care for services covered by the public health plan". Note that the cited Supreme Court ruling was on a law of the Province of Quebec. The ruling incidentally is not that the law was unconstitutional, but that it violated the Quebec Charter of Human Rights and Freedoms, which is not constitutional law, but a law of Quebec that takes precedence over other provincial laws. Furthermore, the Supreme Court also decided that the Quebec ban on private medical facilities did not violate the Canadian Charter of Rights and Freedoms, which is constitutional law, although it can be overridden by provincial legislatures.

Ultimately, the decisions of the federal and provincial parliaments will determine the future of monopsony. --The Four Deuces (talk) 02:37, 16 January 2008 (UTC)

It's my understanding that the Canada Health Act is the law that prohibits private health insurance for services covered by the public health plans. I've changed "care" to "insurance" in the sentence in question. If my understanding is incorrect, please clarify further. --Sfmammamia (talk) 06:45, 16 January 2008 (UTC)

The first paragraph of Canada Health Act article makes clear that the law provides criteria the provinces must meet in order to receive federal funding (which is only about 20%) for costs they incur. The provinces themselves enact laws that regulate the provision of medical services. The provincial laws prohibit the delivery of medical services outside provincial plans, except for services not covered by the plans. The federal government does not prosecute people who violate provincial health legislation. The Four Deuces (talk) 23:47, 16 January 2008 (UTC)

Okay, is it accurate then to say that "Canadian provincial governments outlaw private insurance for services covered by their public health plans."? --Sfmammamia (talk) 23:54, 16 January 2008 (UTC)

What about "Canadian provincial governments outlaw privately paid health care for services covered by their public health plans."? --The Four Deuces (talk) 21:34, 18 January 2008 (UTC)

Sounds good to me, I've incorporated the wording change. --Sfmammamia (talk) 22:17, 18 January 2008 (UTC)

I have added a direct quote from the New England Journal of Medicine which explains the role of private plans. The NEJM is better-researched and more reliable than most other sources. You can check the original article on-line and see if I've correctly summarized it. If not, we can include a longer quote.

But I too would like a simple explanation of what that "monopsony" sentence means. Nbauman (talk) 15:47, 27 January 2008 (UTC)

Don't know where that sentence comes from, but a monopsony is the opposite of a monopoly: since the single-purchaser in a single payer health care system can (to some degree) dictate prices, it can keep the cost of certain purchases down. This is a standard economic analysis where, for example, the seller is a monopolist - for example, of patented pharmaceuticals. (Put simply, one solution to deal with a monopoly is to compel the monopolist to deal with a monopsonist. Krugman has written quite a bit on this - in particular, that prices are lower in Canada for drugs due to use of this monopsony power, and that - in contrast - the expansion of medicare to pharmaceuticals was specifically designed to protect the drugs companies from Medicare administration using its purchasing power to drive down prices.

That said, the para in the article at present is gibberish, and has almost nothing to do with monopsony as is usually discussed in context of Canadian healthcare system (where it's generally a good thing). The key takeaway is that for certain goods/markets, a monopsonist can result in increased supply to consumers at lower prices - and in certain very specific circumstances, this might actually be beneficial to the producer, too. (Monopsony can also be bad, but also under fairly specific circumstances).--Gregalton (talk) 16:06, 27 January 2008 (UTC)

If the sentence is gibberish, it doesn't belong in the article. I'd like to give anyone who wants to include it a few days to make his point in simple English. I don't think it's necessary to use the word "monopsony," since I'm sure you could stop 10 people on the street and they couldn't give you a definition. A Wikilink to the monopsony article is OK. Nbauman (talk) 16:59, 27 January 2008 (UTC)

I agree. It would be useful to include something about it with respect to pharmaceuticals, but what's there now doesn't make much sense.--Gregalton (talk) 17:15, 27 January 2008 (UTC)

Is the current version helpful enough or should I try again? --Doopdoop (talk) 22:16, 27 January 2008 (UTC)

Are you trying to say, "Because the provincial governments are the sole purchasers in their jurisdiction, they have a strong negotiating position in setting prices."? I think it would be a lot easier to make a statement like that, without trying to work an unfamiliar word like "monopsony" into it.

I don't think we should even discuss monopsony unless we have a WP:RS making that point about the Canadian health care system. Somebody deleted my quote from Paul Krugman on the Manhattan Institute page because it was original research. If those are the rules on WP:OR, then we should apply them consistently.

The section isn't even about monopsony any more, it's about private care in Canada. We should change the heading. Nbauman (talk) 01:04, 28 January 2008 (UTC)

Private Care

May I suggest the following sentence be changed because it is inaccurate and biased:

"The ruling, which found that a Quebec provincial ban on private health insurance was unconstitutional when patients were suffering and even dying on waiting lists, has been called a turning point for the country's health system and is expected to lead to greater privatization."

First, the ban is not "unconstitutional" as I explained above. Second, the source for the "turning point" statement is owners of private clinics, including an article by one of the litigants published by the Cato Institute! It would be more helpful if someone wanted to describe how specific governments have reacted.

Suggest the sentence be re-worded as:

"The ruling found that a Quebec provincial ban on private health insurance was unlawful, because it was contrary to Quebec's own 1975 legislative act, the Charter of Human Rights and Freedoms." --The Four Deuces (talk) 20:43, 1 February 2008 (UTC)

The judgment was indeed very hard to deciipher because the judges split so many ways on different issues. But I agree it was not unconstitional in the sense that the Charter of Human Rights is not framed as constitutional law. If I remember rightly the judges overall decided it was constitutional for legislators to discriminate against the private sector in order to protect the public service. So I think you should make that change. --Tom (talk) 09:26, 2 February 2008 (UTC)

I have made the changes. The judgment is difficult to read, but the original writing left the impression that it was something like Roe v Wade. In fact, it only applies to Quebec, and the Quebec government has a number of options, including a legislative override of the Charter. --The Four Deuces (talk) 22:37, 3 February 2008 (UTC)

GA Review

The article is very comprehensive, well-written, and informative. I believe it mostly meets the Good Article criteria, with the biggest exception being the 'citation needed' tags in the article (mostly near the end, but some earlier ('medical professionals'). The only other minor issue is that the 'impact on economy' section is very short, and really only cites on case, so it's not exactly complete. It would be good if more studies on the economic impacts could be provided. Other than these issues, I think the article meets the criteria, and can be promoted once they are addressed. I will put this article on hold at WP:GAN until February 10, 2008, so that these issues can be solved. Cheers! Dr. Cash (talk) 17:23, 3 February 2008 (UTC)

In my view, it still needs a lot of clean-up. There are a number of errors and confusions, many pointed out on the talk page, but not yet dealt with. Can you extend the hold a bit, and I'll try to do some work on it. Note that as stands there are inconsistencies between the same topic as covered in this article and related ones, including Canada Health Act, Medicare Canada, and Health care in Canada.R2SBD (talk) 19:17, 11 February 2008 (UTC)

The table of comparative statistics on cancer outcomes is a howling error, almost as bad as David Gratzer/Rudolph Giuliani's comparison of U.S. to U.K. prostate cancer survival statistics. There are good comparative statistics, which Guyer cited, and we should use them in the article. If JoeCarson insists on keeping these in, this will never be a GA. Nbauman (talk) 01:27, 12 February 2008 (UTC)

Many POV issues are still remaining. --Doopdoop (talk) 22:15, 12 February 2008 (UTC)

Doopdoop, greater specificity to your comment would be very helpful to those of us interested in improving the article. --Sfmammamia (talk) 22:53, 12 February 2008 (UTC)

For example some parts of this article violate WP:SYN --Doopdoop (talk) 23:00, 12 February 2008 (UTC)

...And they are? What specifically? --Sfmammamia (talk) 23:08, 12 February 2008 (UTC)

Sentences that cite studies which compare American and Canacian healthcare systems are OK. To cite one general source about USA and another about Canada is original research. --Doopdoop (talk) 23:27, 12 February 2008 (UTC)

More than a week has elapsed since I put this one hold, and the issues I brought up still have not been addressed. Furthermore, based on the other comments that others have made above, I don't think it's time to pass this as a GA quite yet, so I have failed the article. It can be renominated at WP:GAN once these issues are resolved.

On a more technical note, I recategorized this in the {{ArticleHistory}} to topic=socsci instead of topic=natsci, since it deals more with the politics of healthcare than an actual scientifically-related medicine topic. Cheers! Dr. Cash (talk) 18:03, 14 February 2008 (UTC)

Article name change

I think we should change the name of the article to "Studies comparing Canadian and American health care systems". This change would reduce rampant original research that is now present in the article. --Doopdoop (talk) 00:44, 14 February 2008 (UTC)

Oppose Inconsistent with other, similar comparison articles, listed and linked higher up in the discussion (see topic 19). Once again, you are making a general complaint -- "rampant original research", I believe, is unfounded and, I find, unhelpful. If it were true, changing the article title would be a completely inadequate method of resolving it. --Sfmammamia (talk) 01:36, 14 February 2008 (UTC)

Waiting times

The article currently states "Waiting times for major non-emergency surgery have been longer in Canada". Does anyone know the source for this, and is it on a like-for-like basis? I suspect for the US they are counting the average wait time for people needing a procedure WHO HAVE the means to pay for it AND are willing to pay for it. The Canadian system is counting the average wait time for all patients recommended to have the procedure regardless. To make meaningful comparison we should also be told the wait time of those people in the US whose doctors have recommended the procedure but do not have the resource to pay for it or who have the resource but have decided that the price is so high they are not even prepared to pay for it. I am not sure anyone collects statistics about these people. --Tom (talk) 19:34, 7 December 2007 (UTC)

I want a big screen. I'll never be able to afford one, and therefore I won't get one. But oh do I want one. This does not imply, however, that I am "waiting" for one. You're an idiot. —Preceding unsigned comment added by 198.248.69.48 (talk) 02:14, 3 April 2008 (UTC)

Methinks you are confusing the words "need" and "want". In health care clinical "needs" are assessed independently by doctors to deliver a cure or alleviate specific physical or mental suffering. Not quite the same thing as "wanting" a big screen. I don't think Jesus will go around delivering big screens willy-nilly during His second coming. I suppose it is to much to ask you to sign in before throwing insults. --Tom (talk) 16:25, 3 April 2008 (UTC)

POV, WP:SYN and WP:NOR problems in the article

Wikipedia does not publish original research, and that includes any unpublished analysis or synthesis of published material that serves to advance a position. So if you want to compare costs of healthcare in USA and Canada, please use sources that directly compare healthcare in these two countries. To do otherwise is original research, and it is not allowed in Wikipedia. For this reason I think that NPOV dispute tag should be placed on top of this article.

It would be an original research if I had created an article called "Toyota Prius and Honda Accord compared" with the following fully cited text: "Prius may pose a safety risk to blind pedestrians who rely on engine noise to sense the presence or location of moving vehicles. Accord features better fuel efficiency due to Honda's Variable Cylinder Management (VCM) system, which shuts off 2 or 3 of the cylinders depending on the type of driving." --Doopdoop (talk) 19:53, 13 February 2008 (UTC)

The second sentence of the article compares the costs quite clearly, using a reliable source. I will look for a more up-to-date version of that comparison. Otherwise, I don't know what you are talking about. The sentence you deleted (and that both I and Gregalton restored) was not a comparative statement. --Sfmammamia (talk) 20:00, 13 February 2008 (UTC)

Please look at the Toyota/Honda example above. There are no comparative statements there. Original research prohibition covers both comparative and non-comparative statements. --Doopdoop (talk) 20:11, 13 February 2008 (UTC)

Let's see WP:SYN states no "synthesis of published material serving to advance a position". Please be specific about what statement attempts to advance a position that is not supported by a source. The statement that health insurance is expensive in the U.S. is well-supported by cost data throughout the article (per-capita, GDP, and private out-of-pocket cost comparisons are well supported by reliable sources in the article). Again, it's my understanding that, according to WP:LEAD, it is unnecessary to footnote statements in the lead section that act as highlights for material covered later in the article. The fact that costs are rising rapidly, I think, is not likely to be challenged by anyone's POV, but if you need a cite for that, I'm happy to add one. The last part of the sentence in question, about personal bankruptcies, is already supported by cite. --Sfmammamia (talk) 20:29, 13 February 2008 (UTC)

One of the many issues - source does not compare personal bankruptcies in the US and Canada. --Doopdoop (talk) 20:37, 13 February 2008 (UTC)

Perhaps because the structure of health care in Canada guarantees that Canadians do not go bankrupt because of health problems or hospital bills???? That's fundamental to the system's design. --Sfmammamia (talk) 20:45, 13 February 2008 (UTC)

Maybe. We will never know for sure unless we get a source that compares relative impact of healthcare systems on personal bankruptcies in US and Canada. --Doopdoop (talk) 20:57, 13 February 2008 (UTC)

I agree that it would be nice to find a source that compares causes of bankruptcy in the U.S. and Canada. But it is not necessary to do so, because the statement as written says nothing about Canada and does not attempt to synthesize two sources to make a comparison or advance a position about contrast between the two countries. It only states the situation in the U.S. So it does not violate WP:SYN or WP:OR. If you are saying that including the bankruptcy information only for the U.S. is POV, then fine, let's take out that clause until we can find a source that makes the comparison. Hopefully that will satisfy your concerns. If not, I hope you will continue to cite specifics here rather than making general complaints that do little to help us reach consensus on how to improve the article. --Sfmammamia (talk) 22:27, 13 February 2008 (UTC)

We did find a source who contests the conclusions in Health Affairs, and that is Zywicki, who we cited in the article. That satisfies the WP requirements of WP:NPOV, and bends over backwards to satisfy WP:WEIGHT.

It's an established fact, documented in Health Affairs, the Wall Street Journal, and many other reliable sources that in the U.S., health care costs are a major cause of bankruptcy. To claim that we must find a source to say that health care costs are not a major cause of bankruptcy in Canada is patently ridiculous. If anything, it's OR to raise such a bizarre counter-argument. I think it's enough for NPOV to say we've seriously examined every objection, no matter how desperate, and they don't hold up. Nbauman (talk) 00:41, 14 February 2008 (UTC)

Let's assume it is an established fact (Todd Zywicki source disputes this). But we don't know if health care funding costs (taxes or insurance contributions) are important for Canadian bankruptcies. If there were no healthcare tax payments and insurance , some Canadians would be saved from bankruptcy. I cannot quantify this effect and compare it to the US situation. But this comparison should not be performed here at Wikipedia, we should leave this role to the sources. --Doopdoop (talk) 00:59, 14 February 2008 (UTC)

According to this article between 7.1 percent and 14.3 percent of Canadian bankruptcies are attributable to “health/misfortune.” (Quoting J.S. Ziegel, “A Canadian Perspective,” Texas Law Review 79, no. 5 (2001): 241–256.) This compared to a rate of about 50% for the U.S. I will remove the POV tag which was always nonsense. It would have been better to have placed a citation request at the appropriate point.--Tom (talk) 18:13, 25 February 2008 (UTC)

Your comment is interesting but it is your original research. It is not clear that you can compare these bankruptcy rates directly (maybe research methodology is different in these two studies, maybe Canadian study does not take into account higher taxes paid by Canadians for health care funding. Article tags still apply. --Doopdoop (talk) 20:54, 25 February 2008 (UTC)

(undenting) Doopdoop, as the editor who added the POV template, would removing the statement regarding U.S. bankruptcies resolve your POV concern with the article? If not, could you please specify what other POV concerns in specific you have with the article? You have not posted anything in this discussion for more than 10 days, so I think Tom's removal of the POV template was justified, because you have made little effort at working toward consensus on your concern(s). The POV concerns of one editor do not make consensus. Thoughts of other editors on this suggestion?--Sfmammamia (talk) 21:27, 25 February 2008 (UTC)

I would strongly oppose removing the reference to the Health Affairs article on bankrutcy. That's a major characteristic of the American health care system.

I don't think the Zywicki article actually disputes the Health Affairs article, but I've been willing to leave it in just to make sure we're getting all points of view. But if Doopdoop wants to make an issue of it, I'd like him to quote the exact text from the Zwyicki article that disputes the Health Affairs article. Nbauman (talk) 21:57, 25 February 2008 (UTC)

Sorry for taking so long to reply. At this moment I think that removing bankruptcy sentence from the lead or moving it down to some other section would resolve POV issues in the lead. I think that POV, WP:SYN and WP:NOR problems not in the lead should be resolved by making edits or tagging the relevant sections. Until somebody removes bankruptcy sentence or moves it to some section below I am restoring the POV tag. --Doopdoop (talk) 19:26, 29 February 2008 (UTC)

The same problems remain in the "Government involvement" section - facts are compiled from different sources to advance a position, but WP:SYN prohibits that. This sentence is especially unfair in the context of this article: "The U.S. government spends more on health care than on Social Security and national defense combined". --Doopdoop (talk) 20:16, 1 April 2008 (UTC)

Please explain what you mean by "especially unfair". What POV do you ascribe to the statement? --Sfmammamia (talk) 20:34, 1 April 2008 (UTC)

It well might be that the same argument applies to Canada. Actually it is not easy to determine whether Canada spends more on health care than on Social Security and national defense combined, as the spending might be categorize differently in Canada. The line between the social security and health care spending might also be not very clear and consistent. --Doopdoop (talk) 20:59, 1 April 2008 (UTC)

Very good point. I'm impressed with this article. As an American living in Norway I know how difficult/impossible it can be to compare costs of living, tax rates, wages and pensions. And on and on. (Yes, I do pay over US$8 for each gallon of gas...) And the assumptions people make! -- "Health care" does or does not include dental care, glasses and all or some or no prescription drugs. Though contributors to this article have disagreements, I know it's difficult. I've learned a lot from this article, thanks. --Hordaland (talk) 22:28, 1 April 2008 (UTC)

In my opinion, it is entirely likely that the Canadian government also spends more on health care than on national defense and social security combined. But saying the same is true about Canada, if it could be sourced, is not notable. What is notable are the implied contrasts. Canadian government spending constitutes 70% of health care dollars but covers everybody, while in the US, the government's 45% of spending covers only 27% of the population. The Canadian military budget is $16 billion, or a mere 1.4% of GDP, compared to the 3.7% of GDP the US spends on its massive military budget, so that contrast is quite remarkable in and of itself. Social Security spending may be difficult to compare, but I imagine someone has done it. I will keep looking for sources. --Sfmammamia (talk) 23:13, 1 April 2008 (UTC)

I am removing the OR tag, as there has been nothing new stated here in talk about what statements in the government section involve original research. Please cite specific concerns here. --Sfmammamia (talk) 23:22, 1 April 2008 (UTC)

WP:SYN is just one kind of WP:OR. I thought that there is no separate tag for WP:SYN, but I've found one. --Doopdoop (talk) 20:18, 2 April 2008 (UTC)

So far, you still have not specifically stated what position is being advanced by the assemblage of facts in the government involvement section. To my eye, there's no conclusion reached about the differences between Canada's government involvement and that in the US. The sentences are assembled merely to summarize the differences. Hence, no WP:SYN is involved. I'm reverting the tag. --Sfmammamia (talk) 20:33, 2 April 2008 (UTC)

E.g. position "USA bad, Canada good" is advanced by the inclusion of the sentence "The U.S. government spends more on health care than on Social Security and national defense combined". --Doopdoop (talk) 21:27, 2 April 2008 (UTC)

In my opinion, there's nothing in that sentence that says or implies that the USA is bad. --Sfmammamia (talk) 21:53, 2 April 2008 (UTC)

This sentence is from a source that has criticised American system. --Doopdoop (talk) 21:57, 2 April 2008 (UTC)

So? The sentence, by itself, could just as easily be used by the right/libertarian point of view as support for getting the US government out of healthcare as it could be used by advocates for greater government involvement and spending. As such, the sentence itself does not advance a position. --Sfmammamia (talk) 23:00, 2 April 2008 (UTC)

The sentence advances critical POV (both leftwing and extreme rightwing). Just because you have split this POV in two means nothing, WP:SYN still applies. --Doopdoop (talk) 21:39, 3 April 2008 (UTC)

(undenting)Doopdoop, I suggest you reread WP:SYN. If the assemblage of facts does not serve to advance a specific position, it is not synthesis, by definition. Otherwise, everything in Wikipedia that derives from an assemblage of facts from a variety of sources would have to be labeled synthesis. Clearly this is not the case. I'm going to let other editors ring in on this one. --Sfmammamia (talk) 01:32, 4 April 2008 (UTC)

You forgot that this is a comparison article. Unless a fact advances a position that is cited from a source that compares US and Canadian health care, it is a POV and WP:SYN. --Doopdoop (talk) 21:11, 4 April 2008 (UTC)

From a quick look at other such comparison articles, I don't think your assertion is correct. See Canadian and American politics compared and Canadian and American economies compared for examples. Not every statement in these articles requires a point-for-point comparison sourced from an article conducting such a comparison. As this dispute about WP:SYN seems to be unresolved for now going on six or seven weeks, I've asked other editors to comment. --Sfmammamia (talk) 17:00, 5 April 2008 (UTC)

It is very likely that Canadian and American politics compared article has the same problems. --Doopdoop (talk) 19:18, 27 April 2008 (UTC)

Auto-archiving

I'm going to be bold and establish auto-archiving for this talk page, very long indeed. Objections welcome.--Gregalton (talk) 10:13, 26 February 2008 (UTC)

Source ...

This blog has some good links and ppt slides with comparative data that may be of interest: http://matthewholt.typepad.com/the_health_care_blog/2003/11/policy_oh_canad_1.html . I'll try to integrate later, but for others that may be interested...--Gregalton (talk) 15:09, 26 April 2008 (UTC)

Interesting. It could be useful for finding links to reliable sources -- and I would prefer peer-reviewed sources -- but remember that WP doesn't usually accept blogs as reliable sources.

I've looked at The Health Care Blog before, after it was recommended in the WSJ and elsewhere, and frankly, I was disappointed. I'd rather spend the time on the NEJM, and JAMA, and BMJ, and Health Affairs, and ....

There is one glaring error in that link, BTW, which is to imply that kidney dialysis isn't used in the UK when appropriate, which may have been true in the 1980s, but isn't true today, contrary to what the entry might lead you to believe.

As for Robert Blendon's surveys, I once met Blendon, and heard his presentation, BTW. The big caveat to everything he says is that, as he acknowledges, he's asking people for their opinions, and he doesn't try to find out whether their opinions are true. There was another study, which I linked to in this WP entry, which found that patient perceptions aren't an accurate predictor of the quality of medical care. It's relatively easy to survey doctors or patients for their perceptions, but it's harder to do a chart review to see what the quality actually was. It would be very easy to fill this WP entry up with surveys about Canadian and U.S. health care, but they don't reflect on the quality of care, unless they were at least published in a peer-reviewed journal like Health Affairs. Nbauman (talk) 18:02, 26 April 2008 (UTC)

All good points. I wasn't primarily suggesting the blog itself as primary source, but the various links (which some blogs are definitely good for).

One point on opinion comparisons, however: they are perfectly valid in at least two contexts, i) where the question actually is perceptions/"contentedness" (like doctors' opinion of system), which are frequently raised in punditocracy/blogosphere ("Canadians unhappy with system!"); and ii) if one accepts that health system is political choice of trade-offs, and there are some outcomes that are valued in political market but not so much in "market" outcomes, perceptions do matter. For example, some say Canadian society places high value on equality (at least some minimal level) or equity; if Canadians are of the opinion that the system is relatively equal and rate this aspect positively, then arguably political system has provided something of value. Which should not really be controversial - societies everywhere value things like police and fire services that are provided through taxation, and in most societies some degree of "equity" (expressed in a variety of ways in each society), but for some reason this is highly controversial in health care.--Gregalton (talk) 19:41, 26 April 2008 (UTC)

Total US cost

Didn't want to try to shoehorn this in, but US total healthcare spending cost was $700 billion in 1985, $2 trillion in 2005. Total family insurance premiums have risen (rounding) from $6,000 in 1999 to $13,000 in 2008. (these latter figures excluded Medicare tax). (US News and World Report, Oct 13-20, 2008, pg 72) Student7 (talk) 02:22, 13 October 2008 (UTC)

Universal Health Care

The United States "is the only wealthy industrialized country in the world that lacks some form of universal health care.[12]"

Switzerland, a wealthy industrialized country, does not have universal health care. It is compulsory that individuals purchase their own health insurance. The price of insurance plans vary depending on coverage. (Information based on my experience living in Switzerland during the years 1993-1999) 96.241.162.116 (talk) 23:44, 15 October 2008 (UTC)MaryP.

I think that could also be considered universal health care. Universal health care is not about the mix between government and private delivery of health care or its funding, but about ensuring that everyone has access to health care, i.e., that it is universal. The Four Deuces (talk) 19:34, 1 November 2008 (UTC)

UN evaluation

I would be inclined to be a bit suspicious with any UN comparison involving the US. The UN has an axe to grind which is mostly anti-US, and pro-socialist. I would believe just about any US or Canadian study before any UN study.Student7 (talk) 01:01, 6 November 2008 (UTC)

What specific findings do you question? The article provides other sources that agree with the WHO findings. The Four Deuces (talk) 06:15, 7 November 2008 (UTC)

US ranking 72nd out of 191 nations. If there is a scholarly source reflecting this, it should be used. Student7 (talk) 11:59, 7 November 2008 (UTC)

These rankings should be better explained and updated. According to the WHO, the US ranks first in responsiveness, that is it has the best health care available. The rating of 72nd is for efficiency, not "overall health" as the article states, because the costs are relatively high compared with life expectancy. This is not a meaningful statistic for this article, as it is a rarely cited figure and the article makes clear that spending on health care is higher in the US than in Canada. The overall rating, which rates the US 37th is a weighted balance, and reflects criteria chosen by WHO. This figure is important because it is often cited. I think the article should state WHO updated stats for responsiveness, life expectancy, and over-all ratings. The Four Deuces (talk) 05:39, 8 November 2008 (UTC)

I have corrected the reference. Although the WHO publishes a report every year, later reports do not use the same tables. The Four Deuces (talk) 10:01, 8 November 2008 (UTC)

Native born Canadians over age 70 recall this

Residents of Swift Current, Saskatchewan were the first to design and inaugurate a health care plan for all the town residents. So many other communities in Saskatchewan liked this idea that populist Premier, Tommy Douglas, began to entertain the idea of implementing this kind of a health care plan province-wide. This news set off alarm bells and a call to arms. Where?

The alarm bells were ringing in the headquarters of the American Medical Association. The AMA established a war chest in order to murder the neonatal community health care plan in its CRIB. They did everything possible to defeat the desires of Canadians living in Saskatchewan to distribute health care by the method they preferred. Canucks over age 70 recall that effort. Obviously - and to the benefit of all Canadians - the AMA lost that war. But here is something else to consider.

Canada has a national association of physicians. Imagine that this guild receives news that the residents of Tuskegee, Alabama are doing something of which they don't approve. Imagine that these Canadian doctors decide to throw money and carpetbaggers into defeating the will of these residents of Alabama. It would take Himalayan arrogance for Canadian doctors to do that. What conclusion can we draw about the AMA?

Americans who become apoplectic when other Americans express a desire for so-called universal health care, want to punish them for Thought Crime. That is the Orwellian basis to the health care reform debate in this country.

This 66 year-old writer has lived 33 years in the USA and 33 years in Canada, most of those years working in hospitals. Canadian health care was fine, marvelous, actually, until the renewal of the American battle against the Thought Crime of their Neighbor to the North. —Preceding unsigned comment added by 71.82.102.89 (talk) 14:04, 17 November 2008 (UTC)

The Alternative Care Scene

Alternative care issues and culture are entirely missing from this entry. —Preceding unsigned comment added by Grasshopperwisdom (talk • contribs) 07:28, 5 January 2009 (UTC)

illegal immigration

I put a citation marker up on the relative levels of illegal immigration. It may or may not be true. Surely the level of illegal immigration is always a matter of guesswork by definition. I've have heard some say that the level of illegal immigrants is a barrier to obtaining Universal Helath Care in the U.S. but I find that odd. Surely an illegal immigrant would not be able to get health care because he or she would not have the right ID. In Finland, for example, you have to demonstrate entitlement to care by producing a social security card. Illegal immigrants cannot get these. Moving to UHC would avoid the funding of illegals (who presumably could turn up at emergency rooms in the US and get free emegency treatment - but not more than that - under EMTALA.--Hauskalainen 02:43, 19 January 2009 (UTC)

Not sure how this answer will aid editing this article, but illegals showing up at ERs is not theoretical in the US. It happens a lot in San Diego. Wouldn't think this would affect Canadians but I don't know. Student7 (talk) 12:50, 20 January 2009 (UTC)

Illegal immigrants in Canada have no access to universal health care. Unlike the US however, most foreign seasonal workers enter the country legally under a guest worker program and their employers are legally obligated to provide them with private medical insurance that allows them the same services as citizens and permanent residents. Refugees awaiting determination of their status receive health care paid for by the federal government. The Four Deuces (talk) 20:25, 24 February 2009 (UTC)

Doctor Shortage

I don't really think the uncited claim of a Canadian doctor shortage is really justified, as OECD statistics put it very close to the US. True, relative to other countries, both the US and Canada are low. The Office of Technology Assessment published a comparative study 10 years ago and found that Canada had a surplus of doctors and was working to restrict supply. If true, it sounds like any decline in physicians was intentional and not a long-term product of the system. [9]

Concerning the above comment: I invite you to go to any emergency room in Canada and see for yourself the extreme shortage. I also suggest you read this:

"Today, five million Canadians are without a family doctor. A 2005 survey found that just 23 per cent of Canadians were able to see a physician the same day they needed one - placing this country last among the six studied, including the U.S., Britain and Australia. Canada's doctor-patient ratio is among the worst of any industrialized nation: with just 2.2 physicians per thousand people, it ranks 24th out of 28 OECD countries (well below the average of three). And among the G8 countries, Canada ranks dead last when it comes to physician supply." -Canada's Doctor Shortage Worsening (Macleans)

[10] 206.252.74.48 (talk) 19:28, 11 July 2008 (UTC)

The American flag should be on top

Someone keeps vandalizing this page by putting the Canadian flag on top of the American flag. This comes despite the fact that the American flag is to be respected and be placed above all other flags regardless of any other circumstances. Even if this is an international website, it is run in the United States and therefore we are obligated to show the due respect to our flag. —Preceding unsigned comment added by 192.77.143.167 (talk) 17:25, 17 January 2008 (UTC)

As an American I find the comment above most repugnant! It is not "vandalism" to put the U.S. flag below the Canadian flag, get over yourself you insecure jingoistic loser. It's people like this person that make so many people in other countries hate Americans. As an American who is not obsessed with American elitism, I apologize on the behalf of assholes such as the above American idiot 192.77.143.167.

Not to mention the fact that international law dictates that when flying the American flag with flags of other nations, it should be flown at equal height. Federal flag codes back this law. Just look outside the UN building (which is in America), and you will see evidence of this. 75.176.163.87 (talk) 20:40, 24 June 2008 (UTC)hart —Preceding unsigned comment added by 75.176.163.87 (talk) 17:33, 24 June 2008 (UTC)

I have reverted the flag order to reflect the wording order in the title. This is the only neutral way to present the flags, in my opinion. Otherwise, I suggest we delete the images or replace them with another image. Did it ever occur to you that American editors are not the only editors who work on this article? --Sfmammamia (talk) 17:37, 17 January 2008 (UTC)

192.77.143.167 has made a bold edit and placed the flags left and right. I understand that this layout is frowned upon per WP:LAYOUT#Images. Would an alternative compromise be to place both flags side by side and float both on the right side of the lead section? --Sfmammamia (talk) 02:31, 18 January 2008 (UTC)

In the real world (e.g., physical flags at a press conference or summit meeting) protocol would call for both flags to be of equal size and to be flown at the same height [[11]]. That rule would seem to be a good place to look for POV-neutral guidance in this situation. The critical issues would seem to be a) the images should be the same size, and b) they should be the same distance from the top of the page. The current arrangement would seem to meet those requirements, as would placing them next to each other on the right side of the page. —Preceding unsigned comment added by 146.145.79.247 (talk) 14:45, 18 January 2008 (UTC)

Done. Both flags floated right.--Sfmammamia (talk) 16:45, 18 January 2008 (UTC)

If this ridiculous pissing contest continues to be an issue, then get rid of both flags and put a generic hospital photo at the top. --David Shankbone 16:48, 18 January 2008 (UTC)

Another arrogant prick decides that America should precede everything else. Just put a generic hospital photo at the top. —Preceding unsigned comment added by 208.99.175.28 (talk) 14:01, 8 July 2008 (UTC)

Phooey! I don't know about "vandalism", but the United Nations and most nations follow this. Why not here? Come on! We are not obliged to reverse 200 years of precedent "just because" it doesn't "sound right" to somebody unfamiliar or careless about those rules.

Other countries have their own rules which the US follows. Why make such a big deal? Student7 (talk) 23:28, 8 March 2009 (UTC)

Flag ettigute dictates that all nation flags be at the same height, not one above the other. So both the Canadian and the US flag show be side by side as they are displayed now. - US Army Veteran —Preceding unsigned comment added by 75.73.165.132 (talk) 10:11, 2 May 2009 (UTC)

I think that the American flag is supposed to be displayed on its [right. I believe this is done at the UN (for example). Since this is a joint article, it should only be done if that does not disagree with Canadian etiquette, which is probably mute on that topic. Student7 (talk) 13:22, 2 May 2009 (UTC)

Are we sure we can't just put a large Union Flag on the top? No? Never mind then ^_^ Seriously though, Canadian first would make most sense due to the title of the article (or alternatively, change both to alphabetical order) Audigex (talk) 06:55, 29 June 2009 (UTC)

Section on Government involvement

The section on Government involvement indicates that "Canada's universal single-payer health care system covers about 70% of expenditures". It should be noted that this is total health care expenditures, which in addition to core medical services by physicians and hospitals also includes items such as prescription drugs, dental care, and optometry. In fact, "public funding accounts for approximately 91% of hospital expenditures, while 99% of total physician services are financed by the public sector" (http://www.parl.gc.ca/information/library/PRBpubs/944-e.htm). —Preceding unsigned comment added by 98.243.222.27 (talk) 02:21, 23 January 2009 (UTC) . Student7 (talk) 21:50, 22 February 2009 (UTC)

This section states that US governement involvement is limited to about 45% of healthcare spending. See "Paying for National Healthcare and Not Getting It" by Steffie Woolhandler and David U Himmelstein in Health Affairs Vol 21 No 4. They put US government at 59.8% of healthcare spending in 1999. My estimates for 2006 put it at nearly 70%. The 45% figure from the Federal Government does not include the cost of health insurance paid for by the taxpayers for the benefit of federal, state, and local government employees and retirees and their covered survivors. It also does not include tax subsidies for private insurance or flexible spending accounts. It might not capture state and local spending to subsidize healthcare. Rukridge (talk) 00:33, 27 February 2009 (UTC)

Because this is a comparison article, you would have to get the same stats for Canada. The Four Deuces (talk) 15:57, 27 February 2009 (UTC)

The part about the US Veterans Administration caring for FAMILY members of veterans is incorrect. The VA never has cared for family members, just veterans. Whats more, they don't even take all veterans. If you don't have a service connected disability and you make over a certain dollar amount, you can't enroll to be seen at the VA. Also, even if are seen at the VA for something that is not a service connected medical issue, the VA will turn around and bill either medicare of the veteran's private insurance if they have it. - Service Connected US Army Veteran —Preceding unsigned comment added by 75.73.165.132 (talk) 10:15, 2 May 2009 (UTC)

Longevity comparison

The longevity comparison is the typical type you'd expect from the UN - biased. Try comparing the different populations of each country. European descendants against European descendants, black vs blacks, etc. I think you will discover that there not as much difference in longevity as a biased comparison seems to indicate. Student7 (talk) 21:50, 22 February 2009 (UTC)

It cannot be biased simply because it does not examine the ethnic origins of the populations. If you have information that there is no or little variation when one compares ethnic origin sub-types within the populations, one country against the other, then by all means bring that to the article. Don't just declare it biased, because it isn't. The UN is merely reporting facts as they are and makes no conclusions about them. Your opinion is clearly a biased opinion if you cannot support it with evidence!--Hauskalainen (talk) 13:12, 23 February 2009 (UTC)

Some conservatives argue that the health care system isn't responsible for the difference between Canadian and American health outcomes. They say that the Canadian social safety net, with housing, food, unemployment and welfare benefits, along with better child care and a more widely available education system, and a relative equality and lack of racism, gives Canadians an advantage over Americans in the neo-Malthusian free market in the U.S., and those social advantages are more important to health care outcomes than the formal health care system.

If you could find a WP:RS to say that, I wouldn't mind including that in the article. Nbauman (talk) 17:44, 23 February 2009 (UTC)

You might try Staying Alive for both types of reference. One of the reasons for a decline in longevity in the US and Canada was a sharp increase in infant mortality in the early 21st century. Economic and race are mentioned as well.Student7 (talk) 01:53, 24 February 2009 (UTC)

What would we learn from such a comparison? That people with health in insurance in Canada and the US have similar life expectancies. The article already says that outcomes for insured people in both countries are similar and the UN report agrees. The Four Deuces (talk) 06:29, 26 February 2009 (UTC)

What you would learn is that people in the United states who are white, many of whom have no health insurance, have longer life expectancies than those in Canada who have national health insurance and are white (similar genes). It is possible that blacks in Canada, if in sufficient numbers to compare, might have a longer life expectancy than blacks in the US. If true, perhaps due to socio-economic influences rather than insurance. In other words, the comparison based on health insurance availability alone, while superficially causative, is not causative at all. Great correlation as long as the statistics seem to be on your side. Student7 (talk) 15:56, 27 February 2009 (UTC)

I think the point Student7 makes is valid, comparing health care systems with a one factor model, longevity, suffers from a correlated Omitted-variable bias. Socio-ecnomomic background, race, education, etc. are known to affect longevity as well, so leaving these out biases the one factor model. Mwalla (talk) 21:16, 27 February 2009 (UTC)mwalla

The article already says "there is debate about the underlying causes of these differences". The WHO rating (where Canada was 30 and the US was 37) used a composite of 8 factors of which life expectancy was only one. Because life expectancy in the US and Canada are close the relative ranking would probably not change very much. However, the ranking of both countries in relation to countries with low life expectancies would decline. What pushes the US down to 37th place is the cost of the system, including higher government spending than any other industrialized country.

It should be noted too that the United States government in fact does provide free health care to people who are unable to afford insurance or health care so all residents of both Canada and the US have access to health care. In that case differences in longevity in the two countries may have no relation to health insurance coverage. The Four Deuces (talk) 18:45, 28 February 2009 (UTC)

Sure anybody can get health care by going to the emergency room (well, for a public, not private, hospital anyway). The prob is that in between the ppl who are certifiably destitute and ppl who can afford to buy their own insurance, there are millions of ppl in the middle without insurance (or with inadequate insurance) who, if they went to the ER with a serious condition, would be forced to later pay that ER visit bill with all their remaining assets BEFORE the government would be obliged to pay the rest. So, sure, these ppl would have their health care paid for eventually, but, afterwards, would be forced to become homeless as a result. Not really a great option and an unacceptable embarrassment for a country as rich as the US.99.150.202.12 (talk) 17:33, 13 August 2009 (UTC)

My understanding is that there are people who fall through the net in the US. Not poor enough to claim medicaid until they are bankrupted and often by the time of bankruptcy their health is so poor anyway (maybe because they have not been prepared to spend sufficient to maintain their health). Many people in the US cannot get insurance because of existing conditions or they have already hit caps on their insurance. I don't think caps exist in the Canadian system. Clearly if you are prepared to spend yourself into bankruptcy then you may have an unrestricted right to health care in the US. But I am sure that people do not behave that way. The point I am making is that to say that it is an over simplification to say that all residents of the US have access to health care.--Hauskalainen (talk) 12:13, 1 March 2009 (UTC)

Hauskalainen is correct. According to the New York Times, Feb. 4, 2009, "Back story: Don't we already have a health plan for the poor?" Roni Caryn Rabin (sorry, I don't have the url handy), you can be "literally penniless" in 43 of 50 states and not be eligible if you're not a parent. In other states, if you make more than about $6-7,000 a year, or have more than about $2,000 in assets, you're not eligible. There are lots of sources for this. President George W. Bush said that anybody can get health care by just going to the emergency room, and there were many articles from WP:RS saying that he was wrong.

The Wall Street Journal had a long series of articles profiling people in the U.S. who got fatal, but treatable and curable diseases, including breast cancer and lupus, who couldn't get treatment because they couldn't afford it and hospitals refused to treat them, and died.

I've seen several articles recently that made the point that health care is a legal right in Canada, but not in the U.S. Nbauman (talk) 22:59, 1 March 2009 (UTC)

Some who are not protected with voluntary insurance have chosen to put their money elsewhere because they are healthy. It was originally thought that this was a legitimate use of their money. They will now be "brought to heel" I guess, and forced to help pay for those of us with health problems. But not all of those who are not covered feel uncomfortable or vulnerable with their choice. Most media articles, but not all, ignore those. Also, there are voluntary medical accounts where the relatively healthy can place their money and use it for medical expenses taxfree I think. Again, a lot less than insurance would cost. Emergency care in the US is an entitlement but not regular care. Student7 (talk) 23:23, 1 March 2009 (UTC)

I may be asking for statistics that simply are not there, but again we need comparisons between similar populations, e.g. Saskatchewan and North Dakota, not Ontario and Mississippi. It may well turn out that black populations in Canada as well as white each get superior treatment but they must be compared as a bloc not lumped together. Lumping them together is not meaningful, unfortunately.

For the record (in another field), northern US states brag that their students do better than southern states. Sometimes this is true, but more often, when their black population is compared separately from their white population, there is much more equality than meets the eye, some northern states having many fewer black students.

The same is true for medical/physical as well. If Canada does not separate their figures, we may be stuck unless we can assume that there are too few blacks to affect the outcome of Canadian comparison. There should be some figures for the US separately.Student7 (talk) 22:29, 29 July 2009 (UTC)

Well, just discovered a reference that said that white Americans expectancy was 78 years in 2003. Blacks considerably lower (as expected). So Canadians do, indeed, appear to be higher. a reference. If substantiated, one subsection would almost go away on ethnic differences. Student7 (talk) 16:30, 17 August 2009 (UTC)

Military and Veterans

Under the Cost of Healthcare section, the last sentence states "In addition, the U.S. has far more veterans and war wounded, also somewhat increasing cost." The train of thought in the paragraph goes from illegal immigrants' lack of preventive care increasing long-term costs to this sentence.

The sentence is not cited and seems like personal opinion. Veterans have the same medical issues as any other normal person, hence wouldn't intuitively raise costs.

As far as the "war wounded" bit, the 30,000 some odd wounded(1/1,000 of 1% of US population)--from fully recovered to paralyzed--veterans from Iraq and Afghanistan are no where near enough to alter national statistics on per capita medical spending--especially following the logic of the preceding paragraph. Without a citation or study to back this sentence up, I nominate it to be deleted.

U.S. military veterans are served under a totally U.S. government-funded Veterans Administration health plan for life. See: http://www.va.gov/

Wounded soldiers, depending on their age and status, are either served by the VA above or by the U.S. government funded TriCare program, which provides all services free of charge to the service member and his/her family. See: http://www.tricare.mil

--Theboondocksaint (talk) 20:38, 3 June 2009 (UTC)

There might be some minor effect there, but you are right that it is totally unreferenced. I've thus pulled that sentence from the article. - SimonP (talk) 21:39, 3 June 2009 (UTC)

Not sure how US veterans are summed up in health care costs. Some are career and are under Tricare, others are under the VA, still others never signed up for VA, though eligible, others who exceed low maximum incomes (most veterans) receive small or scanty care from VA. Veterans constitute a measurable part of the nations's homeless and are cared for when costs get high, under "indigent care" required "free" from all hospitals and therefore are the cost of doing business. The idea that all US Veterans are all cared for by the Veteran's Administration, is quite false.

Both countries have gone socialist and it is therefore hard, probably deliberately hard, to show what anything costs. When costs get embarrassingly high in a socialist society, those costs tend to get "buried." Student7 (talk) 01:11, 6 June 2009 (UTC)

Wait times

Why does this section compare wait times for specialists in Canada only to those of Medicaid patients in the US, despite the number of such patients being less than 10% of total insured? Seeing as how the majority of Americans have private insurance, shouldn't that be the main comparison? —Preceding unsigned comment added by 211.18.204.250 (talk) 06:51, 29 June 2009 (UTC)

because it is written by an Obama-care supporter. The article is a fallacy and the comparison is absurd. This is why Wikipedia is a farce. This "comparison" is a hallmark of Wikipedia. And whats worse, if you try to change this dubius paragraph, the wiki-hawks will descend on you with the 3 revert rules to protect their socialist defense. I have used the BC medical system (I am dual citizen) and I know for a fact that the wait times in BC are absolutely terrible. 6 months for an MRI...yes, believe it, because it is irrefutable and verifiable. The authors of this article don't have a clue what they are talking about.

This is a major problem with the article across the board; the statistics are chosen to reflect the best aspects of the Canadian system and the worst of the American. Why isn't the total wait time of social and private programs in the US listed in comparison to the totality of the Canadian? But this is just a microcosm of the article's larger issues. There is not a proper balance in sourcing, leaving statistics from Health Canada to depict their system's wait times while not giving a proper US assessment of theirs (or at least stating that there isn't one). Each statement about the Canadian system should be matched with equal representation from the US system if the statistics are to be relevant

I do not know what to make of this statement from "Price of healthcare costs": "However, U.S. government-spending covers less than half of all health care costs." What does this mean? If 91% of hospital expenditures and 99% of physician costs are covered by the private sector, should the level of US government spending on health care be highlighted as being high rather than diminished as being "less than half?"Also, there needs to be a better discussion of what "access" means in the various statistics presented.

The Consumer Reports section is sourced with a secondary representation of the article and the statics used to reach 40% are shaky at best. To say that more than a third of uninsured in the US have a household income over 50k but do not have heath insurance, 25% of the uninsured are eligible for care through government programs but do not use it, and 100% are given access to emergency care but not offer differing opinions on the definitions of under-insured and uninsured issued by a non-scientific publication seems to allow that group to have too much of a say in the "Access" debate. Mrathel (talk) 05:45, 24 July 2009 (UTC)

There is a big problem with the very concept of the term "wait time" in the United States because the concept does not really exist in the public's mind. You either have the insurance or funds to pay for your care (in which case you get it) or you don't (in which case mostly you don't). People in the latter category are "waiting" because they have no immediate way to access the care they need, but they would not categorize themselves as "waiting", just "uninsured". There are no official statistics in the United States and therefore questionnaires are the only sensisble way to get comparable data. I have seen such questionnaires but I think they are flawed because they refer explicitly refer to "wait time" which is not something recognized, either officially or unofficially in the U.S. People who are uninsured and who cannot afford care are really "waiting" (albeit indefinitely) but they would not regard it as such when asked about in a questionnaire in the same way that people in other civilized countries with guaranteed health care coverage would do--Hauskalainen (talk) 13:35, 24 July 2009 (UTC).

You have both brought up valuable points that need to be considered and answered.

There are some wait times in the US for a surgeon of your choice who is so popular that he has a wait list!

There are several states which have a comparable system to Canada: Vermont is one. If all the people in the state took advantage of the programs currently in place, Vermont would have as close to 100% health care as seems reasonable without mandating it. The only reason for Vermont to involve the federal government is to free up Vermont's tax money for some other social program.

In fact, most of the argument in the US is not over "giving" medical care to people that don't have it. It is over extracting money for (national) insurance from people who have decided they don't want to participate - they are "healthy enough" for example.Student7 (talk) 14:16, 29 July 2009 (UTC)

You ignored the point about people who cannot get insurance at an affordable level. The people who would like to have coverage but cannot get it is a real concern for many Americans I think. But there is also another problem of comparison. Wait time in England for example is the time from the moment that your personal physician refers you to a specialist (for an operation for example) until the time you actually get the operation. It therefore includes the time for getting the first appointment with the specialist, the time for all the tests to be carried out, the time to get back the results of the test and to discuss with the specialist the results and to discuss and agree the option to be taken (usually at a second appointment) and finally the schedule time for the op. So mostly this is not DEAD TIME. That the majority in England complete all this in 9 weeks is not a bad achievement. I don't know how the Canadians measure wait time, but I'd guess it is something similar, I wonder what the comparative time for this is in the U.S., for those with insurance (5/6ths of the population), and for those without insurance (1/6th of the population).--Hauskalainen (talk) 00:36, 30 July 2009 (UTC)

I agree that it is desirable to have wait times measured as precisely as the English. We need to record how wait times are measured in each country when statistics are presented. Not likely they are done the same.Student7 (talk) 18:19, 2 August 2009 (UTC)

Wait times reported by The Fraser Institute

I am troubled by the data reported as coming from the Fraser Institure. This is for several reasons.

1. The reference implies it comes from The Fraser Institute but the source quoted is not actually the Fraser Institure

2. I have been to the Fraser Institute web site in order to trace the original source. I found this http://www.fraserinstitute.org/commerce.web/product_files/WaitingYourTurn2008.pdf which may be it, but reading the document to determine how they got their numbers proved more and more troubling.

1. The report says "While this study and its widespread distribution have been enthusiastically supported by the Fraser Institute, the work has been independently conducted and the views expressed may or may not conform to those of the members and trustees of the Fraser Institute." So actually the Institute backs off from putting its name behind it. This means that the credibility of the report falls on the credibility of the authors and not on the Fraser Institute. All three of the authors do have backgrounds in economics and the Fraser
2. The authors are unclear about how they source their data. I have searched for how they collated the data but to me it is totally unclear.
3. There is much within the report which compares the authors findings with those of other sources. Of course one might expect methodologies of collecting data to produce differences but if the differences were random one might expect there to be as many over as under differences. But this seems not to be the case. But in nearly all cases the other sources wait times are lower than those reported by the authors. This seems to imply bias on the part of the authors.
4. There are clear indications of bias in the text of the report. Text like "The extent of Canada’s health system dysfunction"...and "the promise of the Canadian health care system is not being realized" and "This grim portrait is the legacy of a medical system offering low expectations cloaked in lofty rhetoric".. on one page alone.
5. The Fraser Institute is nominally a Canadian think tank, but www.sourcewatch.org says that it is primarliy a libertarian organization and funded by capitalistic foundations in the United States. Clearly then one might expect the Fraser Institute to have an agenda.

Thus because the publisher of the report (The Fraser Institute) has a background indicating a particular bias and reports data that seem to biased when compared to oficial statistics, and because the publisher is not even prepared to put its reputation behind the report the data and findings, I would suggest that this does not constitute a WP:RS. I am therefore inclined to delete the references to waiting times reported by Fraser and leave the offical statistics from Statistics Canada in place. Comments please.--Hauskalainen (talk) 18:56, 5 July 2009 (UTC)

A few of thoughts:

• The source cited is a reputable Washington, D.C. area newspaper (The Washington Examiner). There's no reason to suspect that it is not a reliable source for reporting on what the Fraser Institute has said on the issue. I don't receive the paper, and don't have a copy in front of me, so I can't verify off-hand which Fraser publication or statement the article is referring too, but I don't see the use of a newspaper as a secondary source as particularly troubling. Given the date on the Examiner article, my expectation would be that it was prompted by a 2009 release. It's also possible that - given the current state of play in the U.S. health care debate - the paper interviewed a researcher at the Fraser Institute and the figures mentioned have not yet been formally released. Again, it's not atypical to cite figures reported in newspaper interviews, so I don't see that as being a problem per se.

• If we can chase down the most recent Fraser Institute report, that would be good. It's always better to have more sources rather than fewer, and a Fraser publication would be a stronger source for what Fraser claims (though we could still want to include newspaper accounts to provide secondary sourcing which might provide any appropriate caveats).

• There is no organization active in the U.S. health care debate (or, I dare say - though I'm less familiar with it - in the Canadian health care debates) . When you read the reports issued by the Urban Institute, the Commonwealth Fund or the Kaiser Family Foundation, for example, they generally include outright advocacy statements - statements that are fully as intemperate as the ones you cite from the Fraser Institute (they just happen to be on the other side).

Fraser Institute reports and statistics routinely turn up in the political debate in the U.S. and in Canada. This is another instance where I strongly recommend that we play things straight, report exactly what the source claims, and who the source is. In this case, we have a Wikipedia article on the Fraser Institute that discusses the funding, governance and criticisms of the organization.

Let's report both sides, and let the reader decide. (Honestly, it's much easier that way. If we try to decide who's right, it's very likely that you and I will disagree - and if you add a couple more editors into the mix, it's virtually certain that we won't all agree.) EastTN (talk) 18:56, 6 July 2009 (UTC)

Summarizing the above, I hear the following: 1) Fraser Institute did not perform these studies. 2) Even if they did, You wouldn't believe them because they have an axe to grind.

My thoughts are these: 1) Most reports of delays are done by governments who are probably the worst people to report anything believable. 2) Nearly everyone has some axe to grind that lives in a) Canada or b) the United States. There are not a lot of neutrals here. If you are Canadian, you want to think that your health system works because it has to if you get sick! Unless you are in category b with an axe to grind against the government or have had to wait for services.

It seems to me that we can a) just forget about wait times as being unimportant. And BTW, I live close enough to Canada that I hear news reports complaining about specific wait times for various services that are public information. This is not as hidden as it seems to an American, or implied by the previous comment. b) use Frasers with quoted qualification "Fraser is a libertarian think tank who sort of supports these figures but not quite.." c) use the governments which will be beautiful, I'm sure. Student7 (talk) 00:43, 11 July 2009 (UTC)

Quite aside from my remarks above, the "Wait times" subsection doesn't read too badly, considering. Don't find much controversial stuff written at that level with good footnoting. The problem comes now when we try to "improve" it.  :) Student7 (talk) 21:15, 11 July 2009 (UTC)

I just reviewed the Wait Times subsection and I think it meets WP rules for WP:NPOV, WP:RS, etc.

I prefer peer-reviewed reports, but I think it's acceptable (and follows WP:RS) to give organizations like Fraser, and the best way to deal with their bias is to give organizations on the other side, and particularly to give people who critique Fraser's claims, like (I think) Paul Krugman.

My own experience is WP:OR and can't go in the article, but it does provide a reality check that we should be able to support with WP:RS. I speak to a lot of Canadians, who concede that wait times are a problem, but say that they are satisfied with the Canadian system overall. And there is a quote to that effect in the entry. --Nbauman (talk) 15:56, 12 July 2009 (UTC)

We have some general sourcing problems - I went to the Healthy Canadians report and couldn't find all of the statistics attributed to it. My guess is that sometime in the past some Canadian statistics were dropped in but not properly sourced, and then later on this source was added to substantiate the paragraph. I've edited the text to specifically identify the statistics that are covered by this source, and flagged the ones that aren't so we'll know that they still need support. EastTN (talk) 00:20, 13 July 2009 (UTC)

Border Hopping

If anyone has information about rates of patients (cancer patients?) crossing the border to receive health care or medication in the other country, I feel it would improve this article. Nakomaru (talk) 00:46, 21 July 2009 (UTC) There were several hearings in Congress recently (available via c-span.org) about people travelling to Canada with their Conressman to obtain medication and one instance of a Canadian woman living in the U.S. going back to Canada for health care reasons. But I have no information about RATES and I doubt that anyone has. Its not something that would be officially measured. I am sure the traffic must run in either direction but for different reasons.--Hauskalainen (talk) 19:01, 23 July 2009 (UTC)

I doubt it can run in the northern direction b/c I can't imagine that US citizens can use Canada's public system, but I would fear that adding such antidotes without statistical analysis of how big the problem is would not assist the article.Mrathel (talk) 08:48, 24 July 2009 (UTC)

Anyone can, but if you aren't covered by the Canadian single-payer plan, they make you pay (or your insurance, if your insurance covers you outside of your country.) At various walk-in clinics I've gone to in Toronto, Canada (I have a family doctor, but sometimes the clinics are just closer and thus more convenient), they would have a sign posted saying that if aren't covered, to see a doctor would cost $40. LittleMatchGirl (talk) 05:15, 14 August 2009 (UTC)

Yes,please, where are the border hopping statistics? This information would really complete the picture. Without them, all we have is a bunch of anecdotes. —Preceding unsigned comment added by 76.199.159.29 (talk) 21:54, 2 August 2009 (UTC)

Criticism of WHO study

I'm new to Wikipedia, but it seems that this claim in the first paragraph, "However, the WHO's study methods were criticized by some analyses." should be cited, since studies like this one are the basis for most of the claims in this article. There did not appear to be another section of the article dealing with this claim. Classicalguitar1988 (talk) 06:37, 24 July 2009 (UTC)

I think if you read down below that statement you will find a few criticisms of the type of the study which are cited; i agree that there could be a better tie between the criticisms and the statement, but I fear that an entire section on criticism of the WHO would bend the discussion too much towards the WHO report when it should not be more than a paragraph or so of the discussion. Mrathel (talk) 08:45, 24 July 2009 (UTC)

Exorbitant claims about bankruptcies made by media

CBS, probably closely followed by the other two, have claimed, or will claim that the major cause of bankruptcies is medical debt. I guess next, global warming?

More likely, a person stops working in serious medical stituations, and (typically American) keeps spending as before on his credit card. When these max out, he declares bankruptcies with the help of a lawyer who carefully lists medical debt at the top, not the flat screen tvs on his credit card! However, medical debt may not be that actively pursued, smart people realizing that you can't get blood out of a turnip. The credit card companies are a different matter, but that stuff may not look good in court, thus the switch. I don't trust the figures at all. They don't come from trusted sources like the fed or even the government. The media is simply doing this for political reasons.Student7 (talk) 01:19, 2 August 2009 (UTC)

One unbiased (US Department of Justice) analysis does not report any correlation between medical debt and bankruptcy. Instead it found a preoccupation with consumer goods, poor money management and divorce (either the cause or the result). See.

Most of these other jokers have an axe to grind about the proposed medical coverage: media organizations. PBS, etc. etc. They cannot be trusted.Student7 (talk) 02:30, 6 August 2009 (UTC)

Politics of Care

I'm usually pretty good at organization, but not so sure about my recent change to "Politics of care" dividing the lead subsection into subtitled sections, "Canada" and "US". I am now thinking that the original editor was doing okay until a recent change criticized the Massachusetts system. MAYBE if my changes were reverted, the section would still read okay. Move the criticism of the Massachusetts system somewhere else. This isn't the place for refutation. The original writer was just trying to show that both countries are experimenting and best results come from below.

The problem is now that the subsection titles tend to blend in with the other subsections; low visual differentiation from third and fourth levels. And I may have lost the original point showing experimentation. Having maybe mucked it up, I don't really want to tinker with it again with possibly the same result. Your call. Student7 (talk) 22:24, 10 August 2009 (UTC)

Changes to US System

Just a question, but if and when the public option comes a reality in the USA, will this article change, or will there be a new "current" comparison done? IMO, it would be nice to still have the old comparison around for historical reasons. LittleMatchGirl (talk) 05:17, 14 August 2009 (UTC)

It will take awhile for the new system, if any, to phase in. I suspect we are talking years here. We'll have time to think about it.  :) Student7 (talk) 11:38, 20 August 2009 (UTC)

Nursing homes

This has been the third rail of all medical programs in the US. Separate insurance is required. No current program, except Medicaid touches it. Medicaid is for the indigent. Beneficiaries turn over all assets including pensions and social security to the system in order to qualify. Medicare allow it for a few weeks, until the patient stops improving. Then coverage stops. There is a cap on weeks. Some of this ought to be in the article in some coherent fashion, which this isn't!  :)

How are nursing homes (state-supported homes for the non-indigent elderly) treated in Canada?Student7 (talk) 11:38, 20 August 2009 (UTC)

In Ontario residents at nursing homes pay a basic rate and the government provides a subsidy to the nursing home. If the residents are unable to pay their required amount (based on income not savings or other assets) the government pays the difference.[12] In practice the most desirable nursing homes are private not-for-profit, which have strong support from volunteers. People may also choose to stay at retirement homes, which receive no subsidies.[13] There are no special facilities or programs for indigent people. The Four Deuces (talk) 04:16, 15 September 2009 (UTC)

Total costs

Are we missing administration costs for either or both systems? Is the payroll of civil servants (or contractors) included, with retirement, vacations, benefits, etc. factored in? That would also have to include state and provincial costs, where applicable. The absence of these figures can make a system seem a lot less expensive than it really is.Student7 (talk) 18:38, 20 September 2009 (UTC)

Administrative costs are included. It was $465 in the US in 2004 compared with a median cost of $66 in other OECD countries(p. CRS29) according to a report to the US Congress.[14] The Four Deuces (talk) 23:38, 20 September 2009 (UTC)

States and provinces

How much do we really want to get into state and provincial initiatives? In the US, a single state initiative is going to have little affect on the total except to confuse the issue. Maybe they should be listed and forked? So far there are two states.

Vermont, not currently listed, has a pretty good system with nearly "everyone" covered (if eligible people would sign up!). "Everyone" = about 86%, as I remember it, not 100% by along shot. Not everyone needs medical care at a given time. Student7 (talk) 18:58, 20 September 2009 (UTC)

It seems important that in some Canadian provinces there are exceptions to single-payer while some US states provide something approaching universality. Otherwise the specific details of the health care systems in different states and provinces would make the article too detailed. The Four Deuces (talk) 02:08, 26 September 2009 (UTC)

Holmes case

I appreciate the Holmes case is well-documented (!!). While I think the higher level aspects of the case has merit (about reimbursement, etc.) I wonder putting individual cases in here. 23:09, 25 September 2009 (UTC)

Please see the discussion at the AfD page.[15] The Four Deuces (talk) 02:04, 26 September 2009 (UTC)

% Insured

According to the United States Census Bureau, 59.3% of U.S. citizens have health insurance related to employment, 27.8% have government-provided health-insurance; nearly 9% purchase health insurance directly (there is some overlap in these figures), and 15.3% (45.7 million) were uninsured in 2007.[24]

This adds up to 111.4% Doesn't seem right. —Preceding unsigned comment added by 76.118.32.78 (talk) 22:25, 17 November 2009 (UTC)

Well certainly there is overlap with employment-related insurance and government-provided insurance. If these figures aren't in the article, they should be, with appropriate footnote, of course. The 111% seems fine. It's the 15% uninsured that needs precision. Student7 (talk) 17:40, 20 November 2009 (UTC)

Biased, Bogus, And Slanted

Tell me, what is biased about this statement? A report published by Health Canada in 2008 included statistics on self-reported wait times for diagnostic services.[49] The median wait time for diagnostic services such as MRI and CAT scans is two weeks with 89.5% waiting less than 3 months.[49][50] The median wait time to see a special physician is a little over four weeks with 86.4% waiting less than 3 months. [49][51] The median wait time for surgery is a little over four weeks with 82.2% waiting less than 3 months. [49][52] In the U.S., patients on Medicaid, the low-income government programs, can wait three months or more to see specialists. If you cant see the obvious bias (i.e. citing a median vs. an extreme), then you are a typical socialist wikipedian male (most wikipedian authors are white, socialist males, younger than 30). Wait times in BC for an MRI are 6 months. I know this for a fact. Your article includes the non-socialist province of Alberta (the Texas of Canada) to "bump up" the abhorrent wait times in socialist BC. Canadian health care is PROVINICAL not CENTRAL. Your article is a gigantic fallacy. Once you take a look at each province, for example BC...you clearly see wait times are enormous and typical. —Preceding unsigned comment added by 24.18.97.239 (talk) 19:11, 23 November 2009 (UTC)

I agree that comparing medians to maximums is not ideal. I've added an average number from the States. Several of your other criticisms are off base. Alberta is fully under the Canada Health Act. While the health systems are all provincially run, they are required to meet the federal rules of universality and free access and Alberta does so just as much as every other province. According to this report BC has an average MRI wait time of 84 days (much less than your figure of six months). That is also one of the worst in Canada. In Ontario it is 32 days. - SimonP (talk) 22:40, 23 November 2009 (UTC)

I do not know why you call the BC government "socialist". The Liberals have been in power since 2001 and are really a sister party of the Alberta PCs, since they both are successors of the Socreds. The Four Deuces (talk) 23:18, 23 November 2009 (UTC)

The average wikipedian is socialist? Where are you getting this?--Stinging Swarm ^talk 23:24, 27 December 2009 (UTC)

Canadian and American???

Isn't the title wrong? Canadians are Americans too! Surely the article should be renamed "Comparison of the health care systems in Canada and the United States" --Hauskalainen (talk) 10:39, 20 September 2009 (UTC)

Is that so? Perhaps you should tell Canadians that, for having been to Canada many times, and having Canadian friends, I have NEVER once heard a Canadian refer to him/herself as "American", and I've always heard them refer to me as, surprise, surprise, "American". Odd that.99.150.205.83 (talk) 16:39, 15 September 2010 (UTC)

Canadians are considered to be North Americans, not Americans. The Four Deuces (talk) 13:01, 20 September 2009 (UTC)

4D, that is a US-centric interpretation of the term American. The title should be changed. -- RealGrouchy (talk) 22:00, 24 March 2010 (UTC)

Sorry, but you're fooling yourself here. If a citizen of Canada goes to Europe are they more likely to say, "Hi, I'm Canadian" or "Hi, I'm American (or North American)"? Would a European (or Asian, African, etc.) refer to a citizen of Canada as a Canadian or an American??? Sorry, but Canadians refer to themeselves--and ppl refer to them--as Canadian NOT American; and indeed, Canadians refer to people from the USA as Americans (just as the majority of the people in the world do). I've been to a number of places around the world and I've never once heard US citizens as being United Statesians, North Americans, or "citizens of the United States". I have, however, heard them refered to over and over again as "Americans". Have you ever watched the news and seen ppl in foreign countries talking about Americans (or saying Death to America/Americans)? Are these folks refering to Canadians (or Latin Americans) here as well as ppl from the USA? No, they are talking about ppl from the USA (i.e., Americans). When Germans use the nouns der Amerikaner/die Amerikanerin are they talking about Canadians or Latin Americans? No, they are talking about ppl from the USA (and you'll notice the exact same thing in most foreign languages). Hmmm, maybe it might have something to do with the fact that the formal name of the USA actually has the world AMERICAN in it, something that no other country (including Canada) in the New World has. Besides, what else would you expect ppl from the US to refer to themselves as? United Statesians? Citizens of the United States? Come on, ppl like nice, catchy sounding terms, so why is it so hard to believe that ppl from the United States of America would call themselves "Americans" (and how can you so readily ascribe such an obviously convenient measure as one of arrogance...or, perhaps, your own arrogance is in play here?)? Sorry but until Canada formally changes their name to the United Canadian Provinces of America, Canadians aren't Americans, just Canadians. Get over it.99.150.205.83 (talk) 16:35, 15 September 2010 (UTC)

Wow, what would happen if, let's say, Brazil changed their formal name to the "United States of Brazil"? Ppl in the US would no longer even be able to use the term "US" without offending even more ppl around the world with low self-esteem.99.150.205.83 (talk) 17:18, 15 September 2010 (UTC)

Overhead costs

Here is where the Denver Post got its figures on overhead costs: [16] The information comes from the New England Journal of Medicine, which says: "...administration consumes 31.0 percent of U.S. health spending, double the proportion of Canada (16.7 percent). Average overhead among private U.S. insurers was 11.7 percent, compared with 1.3 percent for Canada’s single-payer system and 3.6 percent for Medicare".[17] What brings the US figure up to 31% is the cost paid by providers for billing the insurance companies. The Four Deuces (talk) 22:42, 28 November 2009 (UTC)

The problem about trying to compare a socialist system with a capitalistic one, is that the latter is always going to look worse because there are accurate figures available. Socialist/bureaucratic systems have a way of burying costs. For example, they work in buildings that are maintained by "the government," not likely costed out to medical, they pay no taxes (! and are a tax sump, actually) - are lost taxes TO government included? In the US this is both to local, state and federal government. Is future retirement for the bureaucrats considered? With COLA of course. This IS factored in the capitalist system, of course. It has to be. Some of the work that is normally done by the insurance companies in America are, most likely shifted to the medical establishment, which "costs nothing" in Canada and can therefore stand the overhead, which is turn is unaccounted for. Assuming that the Canadian system is 11 times more efficient than the American is silly IMO.

Everything in a socialist system is "better" and "more efficient". Just ask the former Soviets and Eastern Europeans! They would easily have won any "cost analysis" with capitalism. The reason they rejected that system is because the answers no longer made any sense, no matter how well they looked on paper! Student7 (talk) 22:37, 30 November 2009 (UTC)

No, they rejected their system because it was a brutal dictatorship. If you go to Eastern Europe, you'll see that many of their evil socialist "social welfare" programs still exist and that the vast majority of ppl want to keep them. The problem with conservatives in the US is that, in the absence of education (and, especially, the will to keep an open mind and educate themselves), they think that enacting ANY form of social welfare program means that the country must go full blown socialist--and, to them, any form of socialism is equal to the extreme, totalitarian, dictatorial form of socialism that was practiced by the USSR.99.103.230.148 (talk) 15:57, 19 September 2010 (UTC)

That is not an accurate assessment. Ontario is not a socialist state and has in fact been ruled for most of its history by the Progressive Conservative Party of Ontario. The current leader even organized a "Canadians for Bush" rally! Hospitals are private not-for-profit and their financial statements are audited by the Big Four auditors. Medical professionals do not work for the government.

Defined benefit pensions for civil services are administered by the Ontario Pension Board, which was audited last year by Ernst and Young and are fully funded.[18] Defined contributions are reported in the year made. Rents are paid either to private sector landlords or to the ministry of government services. OHIP is audited by public accountants.

The overhead costs refer to health insurance, not health care. Obviously the administrative costs for private insurance companies is higher. OHIP's main function is to pay providers. It does not spend huge amounts on advertising, pre-screening customers, reinsurance, etc.

Incidentally, if either system is "socialist", it is the American system. First of all, it is administered by the federal government. The government owns hospitals and employs health care professionals. The American government spends more money on socialized medicine. Subsidies are given to health insurance companies and the drug industry. Unlike in Canada, doctors and nurses are licensed by the government.

The Four Deuces (talk) 07:37, 1 December 2009 (UTC)

I will lend my weight to what The Four Deuces says. (talk) makes lots of assumptions that are almost certainly inaccurate misrepresentations.--Hauskalainen (talk) 21:32, 1 December 2009 (UTC)

Most hospitals in the US are self-owned, not by the government. Most are not-for-profit and do not pay local real estate taxes nor corporate taxes. But most other providers (the majority of doctors) and private hospitals do both. Student7 (talk) 14:39, 4 December 2009 (UTC)

Out of 5,815 registered hospitals in the US (members of the AHA), 1,105 are owned by state or local governments and 213 are owned by the federal government.[19] It does not appear than any of the members of the OHA are government-owned.[20] The Four Deuces (talk) 16:29, 4 December 2009 (UTC)

Comparing overhead costs for Canadian public systems versus combined American public/private systems is relevant to the article because the comparison (1% versus 31%) is often made. The logic is that whatever is covered by single payer health insurance in Canada is covered by public and private insurance in the US and the administrative costs of those services in the US is probably consistent with the average for all insurance. The Four Deuces (talk) 12:24, 24 December 2009 (UTC)

Not sure why we are not allowed to say that the study is ten years old. Snapshots are usually dated. Most reliable material in Wikipedia has a time stamp on it for credibility.

Please check out the reference yourselves: it is http://www.pnhp.org/publications/nejmadmin.pdf and the figures we are quoting are located right on the main, first page.

The actual article reads, in part (date emphasis mine):

"In 1999, health administration costs totaled at least $294.3 billion in the United States, or $1,059 per capita, as compared with $307 per capita in Canada." While we are not using this currently, this implies a gross merged statistic of about 3:1 in overhead, not 30:1 that our article now implies.

This material is now in the article:"After exclusions, administration accounted for 31.0 percent of health care expenditures in the United States and 16.7 percent of health care expenditures in Canada."

"Canada’s national health insurance program had overhead of 1.3 percent;" This is the figure that is given prominence in our article, but not in the report.

"...the overhead among Canada’s private insurers was higher than that in the United States (13.2 percent vs. 11.7 percent)." With the exception of Medicare, most of US insurance is private and is more efficient, not less than comparable in Canada. The paragraph says just the opposite now.

So we are left with a dangling 1.3 percent overhead for Canada that really isn't compared with anything since the report does not have a comparable statistic for the United States. Student7 (talk) 12:45, 28 December 2009 (UTC)

The 1.3 per cent figure is not dangling and neither are the differences not explained. Table 1 and the article tells it all. The single payer system has lower insurance administration costs in the insurance system but the effect of having a major single insurer does not stop at having just low overheads in the insurance system. It carries on over into home care administration, hospital administration, nursing home administration and also into employers own costs. These savings are the effects of having a single major insurere rather multiåöe insurers, less need for brokers and other adminstrative personnel and global budgeting for providers who do not need to account for costs at the patient level. All told the effect is $752 per patient per year less administration costs in Canada versus the U.S. You claim that this is not compared with anything. But you are wrong. The 1.3% overhead costs of Canadian single payer insurance IS COMPARED in the article with the the average overheads in the U.S. private insurance system of 11.7%, with Canada's private insurance overheads of 13.2%, with U.S. Medicare's 3.6% overheads and U.S. Medicaid's 6.8% overheads. I am not sure why you seem to think they are not comparable because the article does indeed compare them. That was the whole purpose of the article. That Canadian private insurance has marginally higher costs than U.S. private insurers isn't really a surprise given its relative minor role in the system. --Hauskalainen (talk) 17:17, 28 December 2009 (UTC)

You may be right about the article. I want to raise again the "sanity check" on the small overhead.

Try to think of anything else in the world, cars, your teeth, your dog, delivery of your newspaper, anything that requires 1.3% of your time or less (time is ultimately money) to maintain. Anything with that little maintenance in our world would be truly wonderful if it existed. What is missing here is why overhead is so tiny. There must be no feedback whatever in the system. No one is ever out of money. There is never any care that is above a limit. There is never a question of anyone meriting care or a payment, there can be no feedback whatever (except maybe to Parliament once in a while!) for the accounting. It does not pass a sanity check unless some rather outrageous limits are simply ignored. There must be a reason why no one runs out of money and no hypochondriac is turned away, and people who turn up in ER are all treated, even for minor conditions, etc.

Which is why I don't believe it quite. Not that it is wrong. But just what does overhead consist of? Obviously not what everyone else's overhead consists of, that is for sure! In Generally Accepted Accounting Principles the United States, there would be requirements for accounting where fraud could be uncovered. Not sure they exist here, because something is built into the system apparently. What are these assumptions that no one else is using? Maybe a paragraph on that is needed. Overhead doesn't just "disappear". There are tricks involved.

I suspect that people are turned away when a check of their file shows they have exceeded their limit for (routine) procedure x for the year. (I'm not suggesting they are denied essential care). So it never enters the system to start with. Care rationing in other words. Doesn't quite explain fraud unless all doctors work for the government, then their services are "free." though limited by hours. ORs have to be free. I think the question of queuing may need revisiting. A trade-off of money and overhead for waiting.

And since the American system does have to worry about money and payment for treatment after the fact and not before, and is not concerned with "waiting," it is comparing apples against oranges IMO. The systems are just not comparable.Student7 (talk) 01:47, 31 December 2009 (UTC)

(outdent) All systems have to worry about money. American multiple payer, Canadian Single Payer, and even the British model. The payer/provider split and the existence of profit motive in both the Canadian and U.S. systems (musch less so in Canada though with more non-profits) means that there is more scope to "gain the system" through fraud. You may be right (as I think you imlpied) that the public insurers may have low nominal overheads but may have more fraud which does not appear as overhead (which of course it should). In the British system where more workers are effectively salaried and paid bonuses for performance (meeting targets on health outcomes, low wait times, improved choice) there is less scope for actors in the system to gain the system through fraud. The problem is that you need decent references to put something like this into the article. I frankly didn't not understand your reference to rationing. People being turned away? Where do you think this happens? Supply side constraints exist in all heah care systems and you are either honest and rational about it (people are queued for eventual treatment and access in the queue is determined by your relative need) which is what happens in Canada and Britain, or you let market forces do the dirty work and those needing tratment but unable to afford it are priced out and not queued. You either have brutal rationing or compassionate rationing. But all health care is rationed in every country no matter how it is done. --Hauskalainen (talk) 02:33, 31 December 2009 (UTC)

You can read the year ended March 31st, 2009 operating statement for the Ontario Health Insurance Plan (OHIP) on page 2-223 of the public accounts (p. 261 in the pdf document).[21] Of total expenditure of C$10.9 billion, C$10.8 billion was paid to providers. The accounts were prepared according to generally accepted accounting practices and were audited by the Auditor General, who is a chartered accountant and licensed as a public accountant. As part of generally accepted auditing standards, auditors conduct interim audits that test internal controls to ensure that fraud is prevented and/or detected. The accounting profession in Canada is universally accepted, including in the United States. OHIP goes through an annual budgeting process, where projections are made for the year ahead and approved by provincial parliament. Both government auditors and the auditor-general conduct audits into the efficiency and effectiveness of the program. The Four Deuces (talk) 05:28, 31 December 2009 (UTC)

Here is a link to an article about fraud against OHIP. Insurance fraud is however not unique to OHIP and there is no reason to believe that it is higher than in the private sector. My understanding of GAAP is that when fraud is identified it is set up as a receivable with an allowance made for bad debt. After all attempts have been made to recover the amount defrauded the balance is written off to general expenses (i.e., overhead) in the current year. The Four Deuces (talk) 09:04, 31 December 2009 (UTC)

I misspoke. I should not have said the systems are not comparable. That is what we are trying to do here. I meant that overheads per se, were not really that comparable.

But the answer above, transcends such, uh, trivialities. I did not think about the system being beatable in a government system. But of course, people are people whatever is being set up.

The above suggests a higher level structure (a "map"), for a new introduction about comparing the systems, it seems to me. The answer seems to suggest that the government model could be flawed as well as the private insurance one. It is easier to proceed with broadminded acknowledgment from both sides instead of persisting in the petty defense of one side or the other, and "counterattacking."

The idea (as before!) is to present both sides with all their myriad advantages and drawbacks, but direct comparisons of internal statistics may be difficult because of the huge differences. For example, I may come up with huge average apparent wait times in the Canadian system, BUT, the system may have delayed mostly "delayable" operations, not, as might happen in an American system, an operation that was needed immediately. So the perception that Canadians had to wait for an operation that was desperately needed is perhaps mostly false. And yes, operating quickly on everyone in the American system clearly costs a lot more.

And maybe "overhead", by itself, is in the same category?

I think the lead needs rewriting in this context. The overall system can be compared with the overall affect desired, but comparing selected individual statistics is probably not productive. Like comparing the number or distance of cricket hits/runs to baseball hits/runs or something to decide which was "better"!  :) You'd just have to like baseball or cricket! Student7 (talk) 13:26, 2 January 2010 (UTC)

Comparisons that are frequently made should be mentioned and properly explained in the article, including the WHO rating, overhead costs and wait times. But I see nothing wrong with the lead. Essentially both countries have a mix of public and private insurance and have similar outcomes for insured persons. But while the Canadian system provides universal coverage, the US governments actually spend more on health care. The wait times came about in the early 1990s when governments attempted to reduce deficits through cutbacks in social spending, and the federal government reduced its share of health care spending from 50% to 17%, but have become a priority in recent years. Calling non-government insurance in the US "private" is partly misleading. It is privately owned but subsidized and highly regulated. It would be interesting to see how a truly free market insurance system would compare. The Four Deuces (talk) 17:03, 2 January 2010 (UTC)

to Student7 who wrote "And yes, operating quickly on everyone in the American system clearly costs a lot more". What makes you think that everyone in the American system gets seen to quickly? See http://www.merritthawkins.com/pdf/mha2009waittimesurvey.pdf. The average wait time for an appointment with an orthopaedic surgeon in Dallas TX in 2009 was 45 days (the longest wait being 365 days) and the average across the country as a whole is 17 days. The situation is awful in general medicine. The average wait time to see a family practioner in Los Angeles CA is 59 days. In Boston MA it is 63 days! Nationwide in the U.S. the average wait time to see a family doctor is 20 days. In England, Finland or France you'll get seen the same day - in your own home if needs be! Those times in the US are just to get the first appointment. Then you have to wait for a surgery slot. And these are just the reported times for those asking for an appointment. There will of course be many people who need a procedure but who are priced out of the market or have been pushed out by the insurance system (the recinded and the excluded). These people wait but nobody counts them or measures their wait time. That simply does not happen in Europe.--Hauskalainen (talk) 04:55, 3 January 2010 (UTC)

Another form of rationing in private systems is to cap the total amount of claims that can be paid or to deny service altogether, often contrary to terms stated in the policies. The Four Deuces (talk) 05:54, 3 January 2010 (UTC)

Wait times in the US: I am a senior citizen. The reimbursements from Medicare (which is maybe not going broke but having "financial difficulties") to doctors is pretty lousy. Nevertheless, I have experienced no real wait time delays for any service. Once my family physician was booked for something that sounded less than emergency to her staff, so I walked into a 24-hour clinic. None of my contemporaries have expressed any concern about wait times. Doubtless some people who have selected HMOs experience them. But that wasn't my choice. We do have choices here. Care may be expensive but it is not homogenized. Or maybe that is why it is expensive!

20 days to see your family doctor? I have dozens of "mature" acquaintances. They have not reported this at all. I would seriously doubt any report which states this. People getting an annual physical or something routine, maybe they wait (and I do wait for routine follow-ups, but so what?). But something that needs attention, gets attention, or it gets headlines. And there are no headlines. With the media all supporting socialized medicine, they would be delighted to report the delays that you have mentioned, but none do, mainly because they don't exist except in some report which I would question.

Nor is my experience limited to my local area. We have children who have lived recently in San Diego, Washington DC, Alabama, Vermont. A nephew in Boston. Another NYC. Another Philadelphia. Relatives in Illinois. Nothing like this at all anywhere that I have heard of. Student7 (talk) 00:17, 5 January 2010 (UTC)

Ontario also has clinics which are (mostly) privately owned. Patients walk in and are served on a first come first served basis. When they are busy they may wait up to an hour and a half but it is usually faster. A bit likely going to a barber shop. Treatment is paid for by OHIP. Here are listings of various clinics in Toronto: [22][23]. I think the low number of family doctors is actually caused by the medical profession itself. Unlike in the US where the government decides who practices medicine, in Canada it is up to the profession itself. There are lots of foreign doctors driving cabs and doctors perform a lot of work that could be performed by nurses. The Four Deuces (talk) 01:09, 5 January 2010 (UTC)

Student7: I'm glad that you and your friends and family have not been affected but there clearly is a huge problem pending in the U.S. regarding general MDs. Both government and the medical profession recognizes this. And the perverse fee-for-service system used by insurers (which pays specialists more, causing more people to see expensive specialists because few doctors want to be generalists in that pay structure) and the insurers weird take on what is the right thing to do (happily paying out for a $30 000 foot amputation for a diabetic but forcing the regular 100 dollar foot care to prevent it on to the patient who may not be able to afford it) are surely to blame. The reality is you don't have a health care system that is fit for purpose. You have health care chaos.Anyway, we are straying away from the topic and I think we should close this thread as we seem to have stopped discussing overheads. --Hauskalainen (talk) 02:15, 5 January 2010 (UTC)

Agree, overheads in Canada are determined according to generally accepted accounting principles and are audited according to generally accepted auditing standards. If we are unhappy with this we should complain to the International Federation of Accountants and not argue the case here. The Four Deuces (talk) 05:12, 5 January 2010 (UTC)

There are more left wingers with an axe to grind than those seeking publish the truth on this article. If you believe that Californians wait an average of 60 days to see their family physician. If you are trying to convince someone, it's more fun to leave it than change it. No American will believe the article once they've read that far. And we have a sizable number of people in California. All waiting 60 days to see their doctors. Yup! For anyone left editing who is seeking to try to publish the truth, there is "something" wrong with either the quote itself or the source. Maybe it isn't reliable? Student7 (talk) 14:00, 7 January 2010 (UTC)

I was not aware that AMN Healthcare, whose subsidiary prepared the report, is a left-wing company. However the statistic is accurate but probably not helpful to the article. In the survey 20 doctors provided the wait a new patient would have for a first appointment. Their wait times ranged from 1 day to 365 days, with an average of 60 days. (I think 365 days refers to doctors that are not taking new patients, and it skews the results.) BTW right-wingers in countries with universal health care support the system just as right-wingers in the US support medicare. It's a bit like giving women the right to vote. Now that it's here, the opposition has disappeared. The Four Deuces (talk) 16:39, 7 January 2010 (UTC)

Ontario also has MedVisit.[24] They will send out a doctor in 1 to 4 hours in metropolitan areas and are covered by OHIP. The Four Deuces (talk) 23:47, 7 January 2010 (UTC)

RE: the Overhead costs...I should tell you that Generally Accepted Accounting Principles (especially those of the United States, which does not follow International Standards) do not dictate what is considered overhead and what is not considered overhead. Every organization, every company, and especially every hospital, has a different way of recording, allocating, and reporting overhead costs. I think that for someone to say such and such has lower overhead than this other system is a little misleading, especially when comparing overhead measurements in two countries using different accounting principles, unless you expound on what is actually included in overhead costs (for example, some hospitals may partially allocate executive pay to programs, while others may allocate it to fundraising, while still others may allocate it to admin). It all depends on how you convince the auditors that "overhead" is fairly stated... because GAAP is not clear and leaves space for a lot of judgment. Anyway, no reliable sources from me on this... just personal observations as a big 4 auditor working in the healthcare field... —Preceding unsigned comment added by 198.22.197.50 (talk) 23:47, 3 March 2010 (UTC)

(out) While accounting treatment of overheads differ, they are not adequate to explain the variances. And the calculation of overheads for insurance companies is fairly straightforward - total costs less insurance claims. The fact that government-owned insurance companies in Canada have overheads of 1.3% v. 11.7% for US insurances accounts for most of the variances. I brought the up the issue of GAAP to explain that OHIP cannot hide overheads like rent or pension liability, although obviously differing accounting treatments make exact comparisons difficult. The Four Deuces (talk) 16:08, 23 March 2010 (UTC)

"And that's the way it is."

Many readers will recognize the signature comment of Walter Cronkite, delivered nightly when he finished telling us The CBS Evening News. Fewer readers will remember that when Uncle Walter came back from some months in Vietnam, he regretfully told Americans that our country had no chance in hell of winning a land war there. Our best choice of action to save lives was to get out as quickly as possible. The nation was stunned, including President Johnson who soon announced that he was not going to run for reelection. This event established the credence and coinage of Walter Cronkite's opinion on major and critical issues. "Why is that relevant here?" you ask. It is relevant because of something Walter Cronkite did subsequent to his retirement from CBS News.

Walter made himself available for the creation of =documentary films= if the topic held interest and importance. In 1989 Cronkite made himself available for narration of a documentary bearing the title: BORDERLINE MEDICINE. Written and directed by Roger Weisberg, this was one of the earliest comparisons between the US and Canadian health care systems. Six families were followed, three Canadian and three American for their medical care of:1) pregnancy and prenatal, 2) coronary heart disease with bypass surgery, and 3) breast cancer. One reaction to the 1990 broadcast: "A powerful program that ultimately paints a frightening portrait of U.S. medical care and its availability to those who can pay." - said Booklist. The film won several coveted awards.

Something told me it would be important to videotape this broadcast for my healthcare library, and my hunch was right. Although this documentary film deserved to be mass produced for libraries across the USA and Canada, and although it deserved, eventually, to be put onto DVD and made available for purchase like other documentaries - - try locating a copy! The last thing the health care industry wanted was a widely available film of Uncle Walter showing the American public that their health care system sucked. They quietly did everything short of putting it into a space capsule and blasting it off to some other part of the galaxy.

The article -for which this is a Discussion- sounds as though the idea of comparing US and Canadian health care systems was finally thought of, in 2008. But 20 years earlier Walter Cronkite did just that. And one function that a People's Encyclopedia can serve is disinterment of skeletons that powerful institutions want to remain buried. And that's the way it is. —Preceding unsigned comment added by 71.82.67.202 (talk) 01:56, 3 March 2010 (UTC)

The DVD is available from the current copyright holder although it is not cheap. I've added a link to it to the External Links §. 72.228.177.92 (talk) 13:10, 23 March 2010 (UTC)

This page deserves some kind of award.

Lush date here. Great page that every American should read. Keep up the good work Wikipedians. --Dana60Cummins (talk) 18:22, 13 March 2010 (UTC)

Update Tag

It may be that the just passed legislation effectively really does nothing to alter the overall comparison but at least the effective changes (or lack thereof) that are purported or would be expected should be noted. Also there's another bill which may or may not pass the Senate but stuff can be discussed and I think the details of the second bill are probably well know to those who would update. 72.228.177.92 (talk) 17:29, 22 March 2010 (UTC)

OK, so if it is to be a brief acknowledgement of the change then perhaps:

The <nameOfBillOrBills>, being piecemeal modest reform of the American health insurance system rather than a fundamental health care reform, the expectation is that the comparison between the two systems will be largely unaffected however it will be some years after the new legislation is fully in effect before any empirical confirmation of any change could be made.

72.228.177.92 (talk) 21:16, 25 March 2010 (UTC)

Noting that the second bill did pass so update appropriate now. Also would change "piecemeal modest" to "regulatory". 72.228.177.92 (talk) 10:34, 26 March 2010 (UTC)

A source 72.228.177.92 (talk) 16:07, 27 March 2010 (UTC)

This article is not necessary + anti-American.

What is the point of this article? It only serves the purpose of appeasing those in the United States who favor universal health care, or anyone else for that matter, including many Canadians who seek to push a political agenda too, because it's a known fact that many Canadians insist on comparing everything to the United States. So this article serves two groups, the aforementioned group and those Canadians who insist on having a comparison of everything American to make themselves feel better as in Canada, quite often, a sense of national pride comes not from within, but from comparisons of other countries. It's just an article to push a political agenda. That is it's one and only purpose. Is there a comparison between the health services provided between other countries? Most certainly not. 72.39.210.23 (talk) 07:19, 29 March 2010 (UTC)

This is the English wikipedia, and it is natural and fitting for the largest English speaking country and its neighbor's health care systems to be compared and for that comparison to be an article subject in as much as health care is the focus of much recent attention in the former country and the two systems are substantially different. There are other comparisons certainly with various selections of the comparands, in particular the English, French, and Australian systems that I know of, although this is SFAIK, the only one specifically about such a comparison in this wiki. There are articles such as Sicko that are related. 72.228.177.92 (talk) 11:41, 30 March 2010 (UTC)

As far as the other term in the thread subject, it doesn't deserve comment. 72.228.177.92 (talk) 12:15, 30 March 2010 (UTC)

Why would it be natural and fitting for the largest English speaking country and its neighbor's health care systems to be compared? Where is the comparison between the U.S. and Mexican health care systems? Canada isn't the only neighbor the United States has, so why aren't there comparisons between the U.S. and Mexico? Ah right, because that doesn't fit in with the agenda that some have, for obvious reasons. If anything, this article is self-serving for those who wish to have their political views on health re-affirmed through an article on Wikipedia. As for the suggestion of anti-Americanism, you're correct that was an unnecessary comment. 72.39.210.23 (talk) 11:21, 31 March 2010 (UTC)

Canada-US comparisons are the subject of extensive study because of the great similarity between the two countries. (These include history, legal system, language and level of development.) The reasons for differences are therefore easier to isolate than for example a comparison between the US and Mexico. Since the comparison of US and Canadian health care systems has been studied an article is justified. The Four Deuces (talk) 14:26, 31 March 2010 (UTC)

Wait times has some really questionable phrasings in it, especially when dealing with the American system. Lines like "patients on Medicaid, the low-income government programs, can wait three months or more" are both a) textbook examples of the use of weasel words (especially given that it comes in between a series of statistics), and b) in desperate need of a source. I don't necessarily think it needs to be removed, but definitely revised. —Preceding unsigned comment added by 24.11.90.1 (talk) 01:21, 12 July 2010 (UTC)

The trouble with Canadian Health Care

See this Article: http://www.american.com/archive/2008/december-12-08/the-trouble-with-canadian-healthcare/

"Many people assume that Canadians enjoy universal healthcare coverage while receiving the same quality and quantity of medical goods and services as Americans. But the alleged superiority of single-payer health care is not consistent with the evidence. The reality is that, on average, Americans spend more of their income on healthcare than Canadians do but get faster access to more and better medical resources.

Healthcare appears to cost less in Canada than in the United States partly because Canadian government health insurance does not cover many advanced medical treatments and technologies that are commonly available to Americans. If Canadians had access to the same quality and quantity of healthcare resources that Americans enjoy, Canada’s government health insurance monopoly would cost much more than it currently does." — Preceding unsigned comment added by Fattyjoe (talk • contribs) 22:05, 19 October 2011 (UTC)

So, are you proposing adding some of this to the article, or are you just letting us know your views? Looking at your talk page, I suspect it's the latter. CüRlyTüRkey^Talk_Contribs 00:20, 20 October 2011 (UTC)

I'm not stating my views, just pointing out some facts. — Preceding unsigned comment added by Fattyjoe (talk • contribs) 01:47, 20 October 2011 (UTC)

This "article" is actually an opinion piece and should not be used for factual statements in the article. If we want to include these opinions then we need to follow WP:WEIGHT, which would mean explaining how widely accepted they are in mainstream sources and explaining how the subject is viewed in the mainstream. The WP article already points out btw that the U.S. has the best quality of health care for people who have access to health care than any other country. TFD (talk) 15:48, 20 October 2011 (UTC)

A small error in sentence structure.

Dogsinlove (talk) 17:05, 20 November 2011 (UTC) November 20th, 2011 Dogsinlove (talk) 17:05, 20 November 2011 (UTC) The following sentence suffered some sort of grammatical hiccup.

"The same survey states that 37% of Canadians say it is difficult to access care after hours (evenings, weekends or holidays) without going to the emergency department over 34% of Americans. "

The location is in "...the emergency department over 34% of Americans."

Perhaps it means, "...without going to the emergency department. Over 34% of Americans say the same." Do not quote that, it is just meant as an example to highlight the error.

I will follow the references and see if I can find the correct information.

Infant Mortality and Race

I would like it if someone could link to the actual debate about infant mortality in the US. The article states that it is higher among African Americans which may be true, but I think the article should link to a discussion about infant mortality in the US- why do Latin Americans have the lowest infant mortality rate. Is it true that the infant mortality rates have been rising as C-sections are being used more and more as a birthing procedure in the US? I am pretty sure that C-sections have been prescribed more and more in the African American population since the 90s. There is a statistical analysis of c-sections and their effect on infant mortality once they are over prescribed- I just can't remember the name of the study or find the article on Google. — Preceding unsigned comment added by 71.90.236.220 (talk) 16:44, 8 May 2012 (UTC)

Life expectancy comparison caveat

From the intro para: "simply comparing the life expectancy of two groups with different racial makeup and different obesity rates is likely not an effective way of determining which healthcare system is superior."

This sentence seems to pin differences in life expectancy on race and obesity differences, but there is no source to back up the claim that these are material to explaining why the rates are difference. How do we know age differences in the populations aren't more important? Or income inequality? And for that matter, other than the author's misgivings, how do we know that the comparison isn't in fact perfectly apt? — Preceding unsigned comment added by 38.99.133.32 (talk) 16:03, 24 April 2013 (UTC)

This article is missing a major cost reason

This article missed three of the major reasons healthcare is more costly in the US - Doctors and hospitals charge more per procedure, the US has and uses more specialists who charge higher rates, sometimes for conditions not requiring their attention, and there's a trend towards more specialists getting involved when it's not needed. [25]Mattnad (talk) 12:05, 21 January 2014 (UTC)

You would need a source that draws that conclusion. According to the Government of Ontario, family doctors in that province bill $150.000 per year more than U.S. doctors.[26] TFD (talk) 19:00, 21 January 2014 (UTC)

Semi-protected edit request on 28 February 2015

Hammoudchehab (talk) 03:22, 28 February 2015 (UTC) Comparasion of health care in Canada and the united states is that in Canada,Health care is public,whereas in the united states is a combination of both private and public health care.

Denied As has been explained in edit summaries during the past month to persistent IP editors adding this information, this is simply wrong. Both Canada and the US have both public and private components to their healthcare systems. The introduction of this article even states "In 2006, 70% of health care spending in Canada was financed by government, versus 46% in the United States." Meaning, of course, that the private sector accounts for 30% of healthcare spending in Canada and 54% in the United States. In Canada, this includes many drug expenses, which are either covered by private drug plans or paid for by the individual. Mindmatrix 03:39, 28 February 2015 (UTC)

comparassion of the health care systems in Canada and the united states is that in canada,health care is public,where in the united states is a combination of private and public health care. — Preceding unsigned comment added by Hammoudchehab (talk • contribs) 16:19, 28 February 2015 (UTC)

The other point is that health care in Canada is almost totally private. Doctors are self-employed and hospitals are private not-for-profit. It is only health insurance that is publicly run, although the equivalent of Medicaid - insurance for extra services for people on social assistance is privately run in Canada, unlike the U.S. TFD (talk) 16:37, 28 February 2015 (UTC)

Commonwealth Fund 2014 report

http://www.commonwealthfund.org/publications/fund-reports/2014/jun/mirror-mirror
K. Davis, K. Stremikis, C. Schoen, and D. Squires
Mirror, Mirror on the Wall, 2014 Update: How the U.S. Health Care System Compares Internationally
The Commonwealth Fund, June 2014.
Executive Summary. The United States health care system is the most expensive in the world, but this report and prior editions consistently show the U.S. underperforms relative to other countries on most dimensions of performance. Among the 11 nations studied in this report—Australia, Canada, France, Germany, the Netherlands, New Zealand, Norway, Sweden, Switzerland, the United Kingdom, and the United States—the U.S. ranks last, as it did in the 2010, 2007, 2006, and 2004 editions of Mirror, Mirror. Most troubling, the U.S. fails to achieve better health outcomes than the other countries, and as shown in the earlier editions, the U.S. is last or near last on dimensions of access, efficiency, and equity. In this edition of Mirror, Mirror, the United Kingdom ranks first, followed closely by Switzerland (Exhibit ES-1).
--Nbauman (talk) 10:16, 6 March 2015 (UTC)

Working with the Commonwealth Fund, the NEJM is having a series on international health care systems.

http://www.nejm.org/doi/full/10.1056/NEJMe1415036

Editorial: International Health Care Systems

Stephen Morrissey, Ph.D., David Blumenthal, M.D., M.P.P., Robin Osborn, M.B.A., Gregory D. Curfman, M.D., and Debra Malina, Ph.D.

N Engl J Med 2015; 372:75-76 January 1, 2015

DOI: 10.1056/NEJMe1415036

--Nbauman (talk) 12:02, 8 March 2015 (UTC)

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Annals of Internal Medicine, cystic fibrosis comparison

Here's a comparison of cystic fibrosis outcomes as reported in the NYT and as published in Annals of Internal Medicine. Aaron Carroll is an MD (pediatrics) and teaching professor at Indiana University.

https://www.nytimes.com/2017/03/20/upshot/why-cystic-fibrosis-patients-in-canada-outlive-those-in-the-us.html
Why Cystic Fibrosis Patients in Canada Outlive Those in the U.S.
Aaron E. Carroll
MARCH 20, 2017

people with cystic fibrosis are living on average into their 40s in the United States.

In Canada, however, they are living into their 50s.

A recent study published in Annals of Internal Medicine used the Canadian Cystic Fibrosis Registry and the United States Cystic Fibrosis Foundation Patient Registry to determine how patients fared between 1990 and 2013. Researchers compared the longevity results in the two countries, and controlled for a number of factors, including age, sex, genotype, pancreatic status and more.

Over time, they found, the median life span for patients increased. But it increased faster in Canada. Between 2009 and 2013, the median life span was 40.6 years in the United States versus 50.9 in Canada.

Compared with patients in the United States who had private insurance coverage, patients in Canada had a similar risk of early death. Compared with patients who had public insurance like Medicaid, Canadians with cystic fibrosis had a 44 percent lower risk of early death. And compared with Americans who were uninsured, Canadians had a 77 percent lower risk of early death.

http://annals.org/aim/article/2609289/survival-comparison-patients-cystic-fibrosis-canada-united-states-population-based
Survival Comparison of Patients With Cystic Fibrosis in Canada and the United States: A Population-Based Cohort Study
Anne L. Stephenson, Jenna Sykes, Sanja Stanojevic, et al.
Ann Intern Med. 2017.
14 March 2017
DOI: 10.7326/M16-0858

Abstract

Background: In 2011, the median age of survival of patients with cystic fibrosis reported in the United States was 36.8 years, compared with 48.5 years in Canada.

Conclusion: Differences in cystic fibrosis survival between Canada and the United States persisted after adjustment for risk factors associated with survival, except for private-insurance status among U.S. patients. Differential access to transplantation, increased posttransplant survival, and differences in health care systems may, in part, explain the Canadian survival advantage.

--Nbauman (talk) 15:31, 20 March 2017 (UTC)

Mizabot archiving working?

According to the template, Mizabot is supposed to be archiving discussions on this list, but the Archive 1 was never created, and it seems to be simply deleting the discussions. Some of the old conversations were useful, and explain why we do things certain ways now. Is there anybody who knows how to use Mizabot who can fix that and recover the old discussions? Or are they gone forever? --Nbauman (talk) 15:36, 20 March 2017 (UTC)

The Incidental Economist

This is a blog, but it's a blog by Aaron Carroll, MD, who writes for the New York Times and JAMA, and has published many articles and books; and by Austin Frakt, who is a health care economist, with similar credentials. So it would be an acceptable WP:RS. Carroll has written articles debunking a lot of memes about Canadian health care, such as the claim that Canadian doctors are moving to the US, or that Canadian patients come to the US for treatment.

http://theincidentaleconomist.com/wordpress/in-defense-of-canada/
The Incidental Economist
The health services research blog
In defense of Canada
June 5, 2011
Aaron Carroll
--Nbauman (talk) 18:07, 4 April 2017 (UTC)