The peer-reviewed study, The Hidden Costs of Single Payer Health Insurance: A Comparison of the United States and Canada, compares some of the key aspects of the health care systems in both the U.S. and Canada, including the supply of medical resources, access to technology and effective health insurance coverage.
"The point of the comparison is to show that all of the costs of a single-payer health care system are not as obvious as the dollars spent," Skinner said.
The study shows that health care in Canada appears to cost less because relative to the United States, Canadian public health insurance does not cover many advanced medical treatments and technologies, common medical resources are in short supply, and access to health care is often severely delayed.
"On average, Americans spend more of their incomes on health care but they get better access to superior medical resources," Skinner said.
"If Canadians had access to the same quality and quantity of health-care resources that American patients enjoy, the Canadian health-insurance monopoly would cost a lot more than it currently does."
According to the most recent data, the United States outscores Canada on many key indicators of available health care resources, including:
- Number of MRI units per million population in 2006: US: 26.5; Canada: 6.2
- Number of MRI exams per million population in 2004/05: US: 83,200; Canada: 25,500
- Number of CT Scanners per million population in 2006: US: 33.9; Canada 12
- Number of CT exams per million population in 2004/05: US: 172,500; Canada 87,300
- Number of inpatient surgical procedures per million population in 2004: US: 89,900; Canada: 44,700.
Even on health insurance coverage, the Canadian system does not perform much better than the U.S. when it comes to actually delivering insured access.
"Access to a wait list is not the same thing as access to health care," Skinner said.
The study cites government data showing an estimated 1.7 million Canadians (aged 12 and older) were unable to access a regular family physician in 2007. And it points to other research showing that the actual number of "effectively" uninsured Americans is less than half of the figure usually reported and that being uninsured is usually only a temporary condition.
Based on these figures, the study estimates that the percentage of the population that was "effectively" uninsured for non-emergency, necessary medical services at any given time during 2007 was not significantly different between the two countries: 7.9 percent in the U.S. compared to six percent in Canada.
"When Canadians can't get access to health care because they can't find a physician or wait so long that they are effectively uninsured, they are no better off than uninsured Americans," Skinner said.
The study concludes that both Canada and the U.S. should look to countries such as Switzerland or the Netherlands, where the government is not in the business of providing health or drug insurance at all. Instead, individuals in those nations are required by law to purchase comprehensive health insurance in a regulated pluralistic private-sector market. Access to health insurance for low-income people is facilitated through a publicly-funded means-tested subsidy that varies according to the income and assets of the insured person.
"With Canada witnessing the failure of its own single-payer health insurance system, why would Americans want to adopt such a system for themselves?" Skinner asked.
"Making everyone eligible for government-administered medical benefits that are fully subsidized by taxpayers is the worst way to achieve universal health insurance coverage."
