from the world's big
Canadian healthcare system shows how much money America could save
The Great White North has found a way to provide universal healthcare with more salubrious results and trimmed national costs. Take notes, America.
- The United States scores dramatically lower than other high-income countries in healthcare benchmarks, despite overspending them.
- A recent report published in JAMA suggests this discrepancy results from runaway administrative costs and U.S. practitioners charging more for the same medical services.
- By taking lessons from Canada's single-payer system, the U.S. may be able to reduce its healthcare costs but simultaneously improve medical access for wider range of the population.
Americans are split over Canada's single-payer healthcare system. Some see it as a model to be adopted by the United States. Others see it as an inefficient system that will hinder America's competitive edge. Proponents of either side can, of course, regale you with stories of former neighbors, distant cousins, or one-time coworkers who fled across the border to seek that elusively greener healthcare on the other side.
In truth, each system has its flaws. Canada's healthcare is universal, assuming you ignore the gaping oversight of not covering essential prescriptions; meanwhile, the U.S. has some of the best healthcare in the world, if you don't mind bankrolling a litany of unnecessary tests and treatments.
But Canada dominates its southern neighbor in one healthcare facet: cost savings. Despite publicly funding universal healthcare, Canada spent only 10.45 percent of its national GDP in 2014. The United State's expenditure was 17.4 percent of GDP. Per capita, Canada spent $4,641. The U.S.? Double that.
How does Canada do so much more with less?
Amputating administrative costs
In 2014, Canada spent 10.45 percent of its national GDP on healthcare. The United State's expenditure was 17.4 percent.
(Photo from Our World in Data)
According to a report published in the Journal of the American Medical Association, the reason the U.S. outspends Canada — and 10 other high-income countries —is not due to social spending or healthcare utilization. The culprit was price inflation across the board.
The report detailed that in the U.S. medical practitioners earn significantly more, individual services cost more, and Americans spend more on pharmaceuticals per capita.
Administrative costs were also singled out as a major price driver. According to the report, U.S. administration accounted for 8 percent of healthcare expenditures. In other high-income countries, that amount ranged from 1 to 3 percent.
"We have this discombobulated, fragmented system that leads us to have very high administrative costs, and everything is disconnected," said Dan Polsky, executive director of the University of Pennsylvania's Leonard Davis Institute of Health Economics. "You have to go from one system to another when you go from one provider to another. Some health [information] gets lost with the transfer from one provider to the next. And there's a private healthcare system that funds you when you are under 65, and when you're over 65, you get funded by Medicare."
A simplified overview of the U.S. healthcare system shows it comprises Medicaid, Medicare, Tricare, the Veteran's Health Administration, and a panoply of private health plans.
Further adding to the discombobulation, many Americans manage coverage through a patchwork of policies. A senior citizen, for example, may be on Medicare (a government-run program) but augment her coverage with a Medigap policy (insurance provided by a private company specifically to offset Medicare costs).
Meanwhile, the Great White North is currently debating whether to extend universal healthcare to encompass prescriptions. A report published in the Canadian Medical Association Journal, titled "How to pay for national insurance," found that implementing such a plan in 2020 would require $9.7 billion in new public funding.
The benefits? In addition to providing universal access to pharmaceuticals, national pharmacare would save the private sector $13.9 billion, a net savings of $4.2 billion.
The CMAJ report found that "[a]ccess to medicine is best facilitated when direct charges to patients are limited" and "[c]ost control is best achieved by single-payer systems that reduce administration costs and consolidate purchasing power."
So how much would America save if it adopted Canada's low cost, universal approach? According to a Commonwealth Fund report, the U.S. would save $1.4 trillion if it adopted Canada's healthcare approach.
Spending more, getting less
If the U.S. adopted Canada's healthcare approach, it could save as many as 101,000 lives from preventable deaths.
(Image from the Commonwealth Fund)
The United States' unprecedented spending would be worthwhile if it could produce results above and beyond those of Canada and other high-income countries. Sadly, the data suggests the opposite is true.
As noted in the JAMA report, the U.S. system covers less of its population — 90 percent compared to the 99–100 percent range of its peers. Americans go to the doctor less often and spend fewer recover days in the hospital.
The consequences of these differences are stark. Canadian citizens sport a higher life expectancy (82.21 years compared with 79.24 in the U.S.). The country's maternal mortality rate is also significantly lower. Only 27 pregnant women died in Canada in 2015, compared with 550 in the U.S. In fact, the United States' maternal mortality rate is the worst in the developed world.
As for those infamous Canadian wait times, they do exist but their effect on the Canadian healthcare system has been greatly exaggerated. They are mostly applied to elective procedures as a means of reducing cost.
As such, adopting Canada's healthcare approach would save the U.S. more than money. The aforementioned Commonwealth Fund report noted that the U.S. would avoid 101,000 fewer preventable deaths, 4,800 fewer infant deaths, and 42 million fewer American adults neglecting care because of costs.
Saving more than money
How is it that the U.S. system outspends so many other high-income countries, yet produces far less salubrious outcomes? The answer is an unequal distribution of healthcare, with spending being concentrated at the socio-economic top.
In the United States, the top 1 percent of spenders account for more than 20 percent of total healthcare expenditures. The spending of the top 5 percent accounts for almost half.
According to Esteban Oritz-Ospina and Max Roser, inequality in healthcare spending is to be expected — the elderly and individuals with complicated health conditions will always require larger expenditures. However, the discrepancy of spending in the data suggests to them that the United States suffers from an "inequality of access over and above inequality in need."
In contrast, Canada uses cost control to curb administration costs, allowing the country to cast a wider healthcare safety net that extends from the top to the bottom.
In sum, Canada's healthcare system isn't without its flaws, but we shouldn't make the best the enemy of the good. If the United States would learn from Canada's example, it could do a lot of good — and save some money in the process.
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From "if-by-whiskey" to the McNamara fallacy, being able to spot logical missteps is an invaluable skill.
- A fallacy is the use of invalid or faulty reasoning in an argument.
- There are two broad types of logical fallacies: formal and informal.
- A formal fallacy describes a flaw in the construction of a deductive argument, while an informal fallacy describes an error in reasoning.
Appeal to privacy<p>When someone behaves in a way that negatively affects (or could affect) others, but then gets upset when others criticize their behavior, they're likely engaging in the appeal to privacy — or "mind your own business" — fallacy. Examples:<br></p><ul><li>Someone who speeds excessively on the highway, considering his driving to be his own business.</li><li>Someone who doesn't see a reason to bathe or wear deodorant, but then boards a packed 10-hour flight.</li></ul><p>Language to watch out for: "You're not the boss of me." "Worry about yourself."</p>
Sunk cost fallacy<p>When someone argues for continuing a course of action despite evidence showing it's a mistake, it's often a sunk cost fallacy. The flawed logic here is something like: "We've already invested so much in this plan, we can't give up now." Examples:<br></p><ul><li>Someone who intentionally overeats at an all-you-can-eat buffet just to get their "money's worth"</li><li>A scientist who won't admit his theory is incorrect because it would be too painful or costly</li></ul><p>Language to watch out for: "We must stay the course." "I've already invested so much...." "We've always done it this way, so we'll keep doing it this way."</p>
If-by-whiskey<p>This fallacy is named after a speech given in 1952 by <a href="https://en.wikipedia.org/wiki/Noah_S._Sweat" target="_blank">Noah S. "Soggy" Sweat, Jr.</a>, a state representative for <a href="https://en.wikipedia.org/wiki/Mississippi" target="_blank">Mississippi</a>, on the subject of whether the state should legalize alcohol. Sweat's argument on prohibition was (to paraphrase):<br></p><p><em>If, by whiskey, you mean the devil's brew that causes so many problems in society, then I'm against it. But if whiskey means the oil of conversation, the philosopher's wine, "</em><em>the stimulating drink that puts the spring in the old gentleman's step on a frosty, crispy morning;" then I am certainly for it.</em></p>
Slippery slope<p>This fallacy involves arguing against a position because you think choosing it would start a chain reaction of bad things, even though there's little evidence to support your claim. Example:<br></p><ul><li>"We can't allow abortion because then society will lose its general respect for life, and it'll become harder to punish people for committing violent acts like murder."</li><li>"We can't legalize gay marriage. If we do, what's next? Allowing people to marry cats and dogs?" (Some people actually made this <a href="https://www.daytondailynews.com/news/national/cats-marrying-dogs-and-five-other-things-same-sex-marriage-won-mean/dLV9jKqkJOWUFZrSBETWkK/" target="_blank">argument</a> before same-sex marriage was legalized in the U.S.)</li></ul><p>Of course, sometimes decisions <em>do </em>start a chain reaction, which could be bad. The slippery slope device only becomes a fallacy when there's no evidence to suggest that chain reaction would actually occur.</p><p>Language to watch out for: "If we do that, then what's next?"</p>
"There is no alternative"<p><span style="background-color: initial;">A modification of the </span><a href="https://en.wikipedia.org/wiki/False_dilemma" target="_blank" style="background-color: initial;">false dilemma</a><span style="background-color: initial;">, this fallacy (often abbreviated to TINA) argues for a specific position because there are no realistic alternatives. Former British Prime Minister Margaret Thatcher used this exact line as a slogan to defend capitalism, and it's still used today to that same end: Sure, capitalism has its problems, but we've seen the horrors that occur when we try anything else, so there is no alternative.</span><br></p><p>Language to watch out for: "If I had a magic wand…" "What <em>else</em> are we going to do?!"</p>
Ad hoc arguments<p>An ad hoc argument isn't really a logical fallacy, but it is a fallacious rhetorical strategy that's common and often hard to spot. It occurs when someone's claim is threatened with counterevidence, so they come up with a rationale to dismiss the counterevidence, hoping to protect their original claim. Ad hoc claims aren't designed to be generalizable. Instead, they're typically invented in the moment. <a href="https://rationalwiki.org/wiki/Ad_hoc" target="_blank">RationalWiki</a> provides an example:<br></p><p style="margin-left: 20px;">Alice: "It is clearly said in the Bible that the Ark was 450 feet long, 75 feet wide and 45 feet high."</p><p style="margin-left: 20px;">Bob: "A purely wooden vessel of that size could not be constructed; the largest real wooden vessels were Chinese treasure ships which required iron hoops to build their keels. Even the <em>Wyoming</em> which was built in 1909 and had iron braces had problems with her hull flexing and opening up and needed constant mechanical pumping to stop her hold flooding."</p><p style="margin-left: 20px;">Alice: "It's possible that God intervened and allowed the Ark to float, and since we don't know what gopher wood is, it is possible that it is a much stronger form of wood than any that comes from a modern tree."</p>
Snow job<p><span style="background-color: initial;">This fallacy occurs when someone doesn't really have a strong argument, so they just throw a bunch of irrelevant facts, numbers, anecdotes and other information at the audience to confuse the issue, making it harder to refute the original claim. Example:</span><br></p><ul><li>A tobacco company spokesperson who is confronted about the health risks of smoking, but then proceeds to show graph after graph depicting many of the other ways people develop cancer, and how cancer metastasizes in the body, etc.</li></ul><p>Watch out for long-winded, data-heavy arguments that seem confusing by design.</p>
McNamara fallacy<p>Named after <a href="https://en.wikipedia.org/wiki/Robert_McNamara" target="_blank">Robert McNamara</a>, the <a href="https://en.wikipedia.org/wiki/United_States_Secretary_of_Defense" target="_blank">U.S. secretary of defense</a> from 1961 to 1968, this fallacy occurs when decisions are made based solely on <em>quantitative metrics or observations,</em> ignoring other factors. It stems from the Vietnam War, in which McNamara sought to develop a formula to measure progress in the war. He decided on bodycount. But this "objective" formula didn't account for other important factors, such as the possibility that the Vietnamese people would never surrender.<br></p><p>You could also imagine this fallacy playing out in a medical situation. Imagine a terminal cancer patient has a tumor, and a certain procedure helps to reduce the size of the tumor, but also causes a lot of pain. Ignoring quality of life would be an example of the McNamara fallacy.</p><p>Language to watch out for: "You can't measure that, so it's not important."</p>
A new study looks at what would happen to human language on a long journey to other star systems.
- A new study proposes that language could change dramatically on long space voyages.
- Spacefaring people might lose the ability to understand the people of Earth.
- This scenario is of particular concern for potential "generation ships".
Generation Ships<span style="display:block;position:relative;padding-top:56.25%;" class="rm-shortcode" data-rm-shortcode-id="a1e6445c7168d293a6da3f9600f534a2"><iframe type="lazy-iframe" data-runner-src="https://www.youtube.com/embed/H2f0Wd3zNj0?rel=0" width="100%" height="auto" frameborder="0" scrolling="no" style="position:absolute;top:0;left:0;width:100%;height:100%;"></iframe></span>
Many of the most popular apps are about self-improvement.
Emotions are the newest hot commodity, and we can't get enough.