Brillaint breakdown on the actual numbers here. Including debt servicing in the healthcare cost calc is really smart because it shows the true fiscal burden instead of just the upfront spending. The $9,195 vs $5,000 gap basically obliterates the whole "Americans have private healthcare" talking point when taxpayers are footing nearly double what Canadians pay. I've seen this play out in state budgets where healthcare obligations keep crowding out everything lese, and most people have no idea how much public money is already in the system.
The gap is wide, but our domestic costs are shifting gears. Actually, CIHI data shows health spending hit $9,054 per person in 2024, or 12.4% of our GDP. This matches the highest ratio in our history, excluding the pandemic.
While we spend less than the Americans, our growth is now outpacing the economy. This is driven by an aging population and high utilization of hospital and physician services, which account for over half of our total spending. It is less about a bargain and more about managing a system under mounting pressure.
I completely agree. I'm definitely not advocating for more spending. If there's one point that I hope we can take from this post it's that, at this point, money - and political ideology - may matter a lot less than structural coherence. The system has to fit the current reality rather than what policy wonks were thinking in the 1960s.
Also: these days, the labels "private" and "public" are largely meaningless. One way or another, nearly everything comes back to government. I mean, I didn't even factor in the billions in tax credits that are "lost" to government revenue through medical claims for privately funded expenses (like dental, prescription, chiropractors, etc.)
So can we envision what our HC would look like if per capita government spending in Canada was doubled to match the amount of government spending the US places into a "private" system?
I know it's a complicated apples to oranges to cars to cows system that makes comparison difficult BUT as the US system is the most frequently used alternative in discussion, and we're spending half of what they are perhaps more funding is needed?
I agree with you that, even if more money was the answer (something I doubt), there's simply no more money available. I wasn't clear enough in the article, but I really just wanted to demonstrate that public funding isn't the key differentiator between success and failure. And, perhaps, that Canadian smugness was - at best - overdone and gross.
I'm midway through Dr. Brian Day's book ("My Fight for Canadian Healthcare: A thirty-year battle to put patients first") so your post is timely. One of the things he posits is that in the American system, a stunning amount of funding is consumed by the endless lineup of people and organizations who do nothing but process paper and shift money around. Canada is not much better, of course. Literally legions of keyboard warriors employed by the Feds, every one of the provinces, "regional health teams", individual hospitals and clinics, all carving away funds that could have been/should have been used to hire more physicians and nurses, buy more MRI machines, build another surgical suite.
The American system is insanely complicated. I've read that some private clinics that refuse to accept any insurance are somehow able to provide services at a fraction of the normal cost. Which suggests a lot of the waste is happening inside the HMOs.
Just came across this: "In 1988, New York had about 18 million people and spent about $10 billion on Medicaid. Today, the state has about 20 million people — and spends about $120 billion. Even with inflation adjustments, New York is spending about four times as much per-person."
Interesting. I think that says as much about the growing complexity of U.S. healthcare as it does about the fact that true private healthcare in the U.S. is a minor player in that market.
Allowing people to buy insurance plans across states would help. More competition in health insurance plans. Healthcare companies like IBX destroyed small physician owned private practices, which is why we have private equity. They have more leverage when it comes to contract and rate negotiations. However considering the government spends 3.2 trillion, approximately, on healthcare systems companies are they mostly paid out to? Public healthcare spending is rife with fraud. Regulate insurance companies and public spending. In all seriousness, why do we even get taxed for federal spending on healthcare, like Medicare and Medicaid, when the federal government prints its own money via federal reserve?
Brillaint breakdown on the actual numbers here. Including debt servicing in the healthcare cost calc is really smart because it shows the true fiscal burden instead of just the upfront spending. The $9,195 vs $5,000 gap basically obliterates the whole "Americans have private healthcare" talking point when taxpayers are footing nearly double what Canadians pay. I've seen this play out in state budgets where healthcare obligations keep crowding out everything lese, and most people have no idea how much public money is already in the system.
The gap is wide, but our domestic costs are shifting gears. Actually, CIHI data shows health spending hit $9,054 per person in 2024, or 12.4% of our GDP. This matches the highest ratio in our history, excluding the pandemic.
While we spend less than the Americans, our growth is now outpacing the economy. This is driven by an aging population and high utilization of hospital and physician services, which account for over half of our total spending. It is less about a bargain and more about managing a system under mounting pressure.
I completely agree. I'm definitely not advocating for more spending. If there's one point that I hope we can take from this post it's that, at this point, money - and political ideology - may matter a lot less than structural coherence. The system has to fit the current reality rather than what policy wonks were thinking in the 1960s.
Also: these days, the labels "private" and "public" are largely meaningless. One way or another, nearly everything comes back to government. I mean, I didn't even factor in the billions in tax credits that are "lost" to government revenue through medical claims for privately funded expenses (like dental, prescription, chiropractors, etc.)
So can we envision what our HC would look like if per capita government spending in Canada was doubled to match the amount of government spending the US places into a "private" system?
I know it's a complicated apples to oranges to cars to cows system that makes comparison difficult BUT as the US system is the most frequently used alternative in discussion, and we're spending half of what they are perhaps more funding is needed?
I agree with you that, even if more money was the answer (something I doubt), there's simply no more money available. I wasn't clear enough in the article, but I really just wanted to demonstrate that public funding isn't the key differentiator between success and failure. And, perhaps, that Canadian smugness was - at best - overdone and gross.
Personally, I suspect that we'd be far better off moving towards some kind of private/public hybrid system. Such things seem to have worked a lot better in Europe: https://www.theaudit.ca/p/national-healthcare-funding-systems
I'm midway through Dr. Brian Day's book ("My Fight for Canadian Healthcare: A thirty-year battle to put patients first") so your post is timely. One of the things he posits is that in the American system, a stunning amount of funding is consumed by the endless lineup of people and organizations who do nothing but process paper and shift money around. Canada is not much better, of course. Literally legions of keyboard warriors employed by the Feds, every one of the provinces, "regional health teams", individual hospitals and clinics, all carving away funds that could have been/should have been used to hire more physicians and nurses, buy more MRI machines, build another surgical suite.
The American system is insanely complicated. I've read that some private clinics that refuse to accept any insurance are somehow able to provide services at a fraction of the normal cost. Which suggests a lot of the waste is happening inside the HMOs.
David Graeber's contentions about "bullshit jobs" and "managerial feudalism" keep getting more appealing.
Just came across this: "In 1988, New York had about 18 million people and spent about $10 billion on Medicaid. Today, the state has about 20 million people — and spends about $120 billion. Even with inflation adjustments, New York is spending about four times as much per-person."
https://substack.com/home/post/p-182870487
Interesting. I think that says as much about the growing complexity of U.S. healthcare as it does about the fact that true private healthcare in the U.S. is a minor player in that market.
Allowing people to buy insurance plans across states would help. More competition in health insurance plans. Healthcare companies like IBX destroyed small physician owned private practices, which is why we have private equity. They have more leverage when it comes to contract and rate negotiations. However considering the government spends 3.2 trillion, approximately, on healthcare systems companies are they mostly paid out to? Public healthcare spending is rife with fraud. Regulate insurance companies and public spending. In all seriousness, why do we even get taxed for federal spending on healthcare, like Medicare and Medicaid, when the federal government prints its own money via federal reserve?