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As the U.S. shuts down over Obamacare, Americans need to know the truth about the Canadian system

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The United States government is in the process of shutdown, though President Obama and some in the Republican Congressional leadership said up until the last minute that they still believed they could avert it.

Whatever happens as a result of this confrontation, one consequence is that Canada is, yet again, part of the American political debate.

This time it is not Canadian pipelines that are at issue.

It is Canadian health care, or, more precisely, our universal, public, "single payer" health insurance system.

Why so?

Because Republicans in the House of Representatives want to attach a clause to a normally routine budegtary measure (a "continuing resolution") that would seriously jeopardize the already-passed Affordable Health Care Act (a.k.a. "Obamacare") .

The Republicans could have been taking lessons in this sort of legislative bundling from their friends in the Harper government.

Canada's Conservatives have made a fine art of the omnibus bill that bundles together all kinds of disparate legislative initiatives, thus avoiding any serious debate or discussion on unpopular or controversial measures.

It has worked pretty well for Prime Minister Harper, so far.

The House Republicans resemble their Canadian cousins in another way, too. Both have a majority of seats without having won a majority of votes.

Harper won his majority in 2011 with less than 40% of the votes. More than 6 out of every 10 Canadians voted against his party.

In 2012, when Obama was re-elected with a respectable popular vote majority, the Republicans barely maintained their hold on the House of Representatives while losing the total popular vote to the Democrats by more than a million votes.

At the time, Bloomberg News Service had this explanation: "The outcome is the product in part of Republican-dominated redrawing of House seat boundaries after the 2010 census and of population shifts."

In the United States, it is partisan state governments (not a neutral body, as in Canada) that draw electoral boundaries. Republican state administrations used their power to engage in massive gerrymandering after the 2010 census.

That's how America's much touted democracy works.

President Obama's re-election was about many different issues, but the Affordable Health Care Act was one of the major ones.

No matter, the Republicans in the House claim their non-majority-of-votes mandate is the one that counts, and they are trying to make the most of it.

And so Americans are back to debating the merits of some form of publicly regulated or funded universal health insurance scheme.

Canadian health system: scapegoat for anti-Obama forces

The system Obama opted for, in the end, was not the Canadian one, in which there is one public insurer for each province or territory. That is the so-called "single payer" system.

Obamacare is largely a private sector affair, based, roughly, on the Swiss system. It obliges all citizens to have (privately purchased) health insurance and, at the same time, compels insurance companies to cover everyone without penalty, regardless of age or pre-existing condition.

Over the years, the Obama option is the system American conservative commentators and think tanks, such as the Heritage Foundation, have tended to favour.

No matter.

The Tea Party Republicans (who seem to call the shots in the House these days) characterize Obamacare as a "government takeover" of health care, and buttress their argument by denigrating the Canadian system.

This writer caught an example of that sort of denigration in a television debate on CNN between Ralph Nader, an ardent supporter of Canada's system, and a moderate (not Tea Party) Republican business executive, Carly Fiorina, a one-time candidate for the United States Senate.

Fiorina argued that there are unacceptable wait times in the Canadian system and that Americans get a higher standard of care.

Wait times are -- true -- a longstanding issue for Canada, though they vary from jurisdiction to jurisdiction and treatment to treatment.

As for standard of care, Fiorina cited the example of herself as a cancer survivor. She said she would not, based on the odds for both countries, have done as well in Canada as she did in the United States.

That is a pretty selective statistic, but it is the sort of number-mongering that goes largely unanswered in the United States debate.

The current Conservative government is certainly not leaping to defend the Canadian system. The Harper commitment to Canada's health-care system is based more on political expediency than principle.

Canadians live longer, do better for babies, have better access to primary care

The OECD has been in the business of comparing health systems and outcomes among its members for about a decade, and its facts and figures do not make the United States look very good, compared to Canada (or to most other wealthy and industrialized countries with similar public systems).

The OECD does not rank countries. It does, however, provide comparative data in a great many categories, data which tell their own story.

On one of the most basic measure of a people's health, for instance, life expectancy at birth, the 2009 OECD figure for Canada was 80.7, putting this country in 12th place. For the USA, it was 78.2, less than the average and near the bottom, in 28th place.

The OECD's researchers state that one measure of the quality of a country's prenatal care and infant health is the low birth weight rate. The OECD pegs low birth weight at 5.5 pounds or less. In Canada, that rate is 6% of all births, again better than the OECD average. In the USA it is above average, 8.2%.

The OECD also measures what it terms "avoidable hospital admissions." These are cases in which people must use costly and inefficient hospitals when lower cost primary care alternatives are in short supply.

"Hospital admission rates serve as a proxy for primary care quality," the OECD's researchers explain, "so high admission rates may point to poor care co-ordination or care continuity. They may also indicate structural constraints such as the supply of family physicians."

For respiratory conditions such as asthma, the OECD pegs that "avoidable" rate at 15.7 per 100,000 in Canada (second lowest), compared to a whopping 120.6 per 100,000 for the United States.

What is the reason for the high USA rate? It is, the OECD says, the result of a "less developed primary care system, with deficits in the supply of family physicians."

We in Canada tend to believe that we resort to hospital emergency rooms too often for primary care needs (such as sore throats and minor injuries) and that we don't have enough family medicine facilities. That may be so. Nonetheless, our majority public system performs far better on that score than the predominantly private American system.

High rates of obesity and huge 'unmet health needs'

The obesity rate measures more than just the health-care system. However, high rates of obesity are, at least in part, the result of inadequate "population health" measures. They also impose a great burden on the health-care system.

In Canada our -- admittedly too high -- obesity rate is 17% of all adults.

In the United States, it is twice as high: 34%. That high rate results in a lot of diabetes, heart disease and other chronic life-shortening conditions.

As for cancer survival rates, they vary from cancer to cancer, but are roughly the same in the United States and Canada.

The occurrence rate of all cancers combined is quite high in Canada; but experts point out that number is, in large measure, a function of the relative longevity of Canadians.

In countries with lower life expectancy people do not live long enough to get cancer, which is, in large measure, a disease of the elderly.

And so, Fiorina's argument that Americans stricken with cancer have a better chance than their Canadian counterparts is not supported by the statistics.

But perhaps the most telling statistic of all is for what the OECD calls "unmet needs."

The OECD has quantified the number of people who do not seek or get medical treatment (including doctor's visits and necessary drugs) because they say they cannot afford it, and the OECD divides that group into above average income earners and those with below average income.

For the above average group, that figure is only 6% in Canada, while it is a surprising one fifth (20%) in the United States.

In other words, even a large number of Americans in the middle- and high-income category frequently report they have unaffordable and thus "unmet" health needs.

But the really scary figure, for the United States, is for those with below average incomes.

For Canada, that number is a disturbing 18% -- meaning that despite our quasi-universal system there are still many Canadians who believe their basic health care needs are not met.

Canada must do better for that 18% of below average income Canadians.

In the United States, however, that number is more than double the Canadian, 39% (almost four in ten).

That is not  just an abstract number; it represents tens of millions of flesh-and-blood Americans.

For those people, their only chance at some kind of health coverage is the Affordable Health Care Act, which came into effect earlier this week.

Those are exactly the people the House Republicans have in their sights. 

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