In health care, expenditures to GDP may be misleading!

In debates over health care reform in the US, it is frequent for Canada’s name to pop up in order to signal that Canada is spending much less of its GDP to health care and seems to generate relatively comparable outcomes. I disagree.

Its not that the system presently in place in the US is so great, its that the measure of resources expended on each system is really bad. In fact, its a matter of simple economics.  Imagine two areas (1 and 2), the first has single-payer health care, the other has fully-private health care.

In area 2, prices ration access to health care so that people eschew visits to the emergency room as a result of a scraped elbow. In area 1, free access means no rationing through price and more services are consumed. However, to avoid overspending, the government of area 1 has waiting lists or other rationing schemes. In area 2, which I have presented as an ideal free market for the sake of conversation,  whatever people expend can be divided over GDP and we get an accurate portrait of “costs”. However, in area 1, costs are borne differently – through taxes and through waiting times. As such, comparing what is spent in area 1 to what is spent in area 2 is a flawed comparison.

So when we say that Canada spends 10.7% of GDP on health care (2013 numbers) versus 17.1% of GDP in the US, is it a viable comparison? Not really.  In 2008, the Canadian Medical Association produced a study evaluating the cost of waiting times for four key procedures : total joint replacement surgery, cataract surgery, coronary artery bypass
graft (CABG) and MRI scans. These procedures are by no means exhaustive and they concern only “excessive” waiting times (rather than the whole waiting times or at least the difference with the United States). However, the CMA found that, for the 2007 (the year they studied), the cost of waiting was equal to 14.8$ billion (CAD).  Given the size of the economy back in 2007, this represented 1.3% of GDP. Again, I must emphasize that this is not an exhaustive measure of the cost of waiting times. However, it does bring Canada closer to the United States in terms of the “true cost” of health care.  Any estimate that would include other wait times would increase that proportion.

I know that policy experts are aware of that, but it is so frequent to see comparisons based on spending to GDP in order to argue for X and Y policy as being relatively cheap.  I just thought it was necessary to remind some people (those who decide to read me) that prudence is mandatory here.

Obama’s Economic Policies: What’s Wrong, in a Nutshell

People are overwhelmed by the avalanche of bad news, and of news in general. It’s difficult to stop long enough to summarize objections to the new economic policies fostered by Presidents Obama and Pelosi.  Besides, if you tried, you might just strangle with horror and indignation. I made the effort. Here it is:

Pres Obama wants to re-distribute wealth when the amount of wealth available to re-distribute  is dwindling. It’s never happened, I think, in any democratic, market-oriented country before. Normally, you wait for a period when wealth is growing.

Pres Obama insists on an expensive stimulus package that will do, and has done little to stimulate the economy. Keynesian economics is largely wrong. This is Keynesian economics at its worst. It’s not even defensible by Keynesian standards.

Pres Obama choses a severe economic downturn to force us as a nation to try and do things we don’t know how to do. This includes switching from proven energy technologies such as coal and petroleum-based technologies to unproven ones such as air and wind technologies. It includes also constructing a satisfactory national health system, something no country has done. Normally, whenever you try something new, you make mistakes. You need a margin of error. You need to be reasonably rich. You don’t want to do it on a tight budget or when you are close to poverty.

Pres Obama is not evil. He has something I have seen hundreds of times in academia: He knows what he thinks he knows and he does not know anything else. He is narrow-minded and dogmatic. The more intelligent the person, the more stubborn in his narrow-mindedness and in his dogmatism. A less intelligent person would have the virtue of self-doubt, “Wait a minute, am I doing the right thing?”

Perplexing: There is an international media consensus  to the effect that the current global economic crisis was made in America. Yet, I detect no rise in anti–Americanism abroad. This would be a good time to be pissed off at us but, I don’t see it anywhere.

I wrote on this blog about “European Anti-Americanism.”  I suggested it was mainly based on envy. Perhaps, I was right: Others like us better when we are down and hurting. What do you think?

Recently, I mentioned the sentencing of a 75-year old woman to a whipping, in Saudi Arabia. I promised that I would check for indignant reactions on the part of Muslims. I have seen nothing on the website of the American Muslim Council and nothing of the website of the Islamic Society of North America.  I haven’t found anything either on French Muslim sites.

Of course, it’s disturbing. I would like it if someone told me that I am wrong and that I searched in the wrong places. I know I have Muslim readers. Get on your feet and do what’s right.

[Editor’s note: this essay first appeared on Dr. Delacroix’s blog, Bay Watch, on March 26th 2009]