La clínica del doctor Cureta

Ramiro me manda este artículo sobre el informe que indicaría que los canadienses son más sanos que los norteamericanos del que hablaba hace unos días.

Es muy llamativo que haya especialistas que sigan proponiendo un sistema socializado de pagador único como la panacea para la salud. Mi primera impresión es que no tienen la menor idea de lo que están diciendo. En Canadá, el sistema de salud depende de la provincia. El sistema de Québec es reconocido ampliamente como uno de los que mejor funcionan en el país.

Uno de los pasatiempos favoritos en las reuniones y fiestas con amigos, parientes y compañeros de trabajo son las historias de horror sobre el sistema de salud. Esperas de 6, 12 o 24 meses para exámenes rutinarios. Esperas de 3, 6 o 12 horas para atención de emergencia. Pacientes que murieron por no ser diagnosticadas a tiempo. Personas a las que, después de esperar 6 meses para un tratamiento, se les hace el procedimiento incorrecto por un error administrativo.

Un amigo nos contaba, con resignación budista, que un médico, de parado en un pasillo, le diagnosticó cáncer en estado avanzado. Mirando una radiografía de pecho en la luz de una ventana. Había ido a una consulta por una tos persistente. Por supuesto, cuando consiguió que lo vea un especialista, se enteró de que el diagnostico había sido un disparate. Por supuesto, como el personal de cuidado de la salud trabaja para el estado provincial, son empleados públicos, no existe la menor posibilidad de un juicio por mala praxis. La recomendación fue que ni siquiera presente una queja contra el médico que lo atendió.

Vuelvo a insistir con lo que vengo diciendo, creo que es importante poner las cosas en su lugar. Las personas no se mueren por la calle en Canadá ni mucho menos. Pero debemos entender que existen dos maneras de asignar recursos, los precios y la escasez. Los sistemas de pagador único, como el de Canadá, ajustan por el lado de las listas de espera y de limitar severamente el acceso a especialistas, tratamientos y medicinas.

Lamentablemente, ni siquiera es posible tener algún consuelo pensando en la supuesta igualdad del sistema. La medicina privada está prohibida en los hechos, pero las personas con ingresos relativamente más altos tienen seguros médicos en EEUU. Y, por supuesto, los miembros del parlamento tienen su propio sistema de salud, sin listas de espera ni limitaciones de atención.

Where Would You Rather Be Sick?
By DAVID GRATZER

Is socialized medicine the prescription for better health? A recent study comparing Americans and Canadians, widely reported in the press, seems to suggest just that. But there is much less here than meets the eye.

The study, based on a telephone survey of 3,500 Canadians and 5,200 Americans (conducted by Statistics Canada and the U.S. National Center for Health Statistics), was released by the American Journal of Public Health. According to it, Canadians are healthier and have better access to health care than Americans, and at lower overall cost. So is the Canadian system, where the government pays for and manages the health-care system, superior? "Our study," says co-author Dr. Steffie Woolhandler, "is a terrible indictment of the U.S. health-care system. Universal coverage under a national health insurance system is key to improving health."

It is not so clear that the survey data back up these claims. Consider access. According to the survey, Canadians are more likely to have a regular physician, to have seen a doctor in the past year, and to be able to afford medications. But the data are ambiguous; Americans are more likely to have received a pap test and mammogram, as well as treatment for high blood pressure. Moreover, Americans are generally more satisfied with their health care. (The survey did not ask about access to specialist care or diagnostic imaging.)

The survey's most trumpeted conclusion was that Canadians are healthier than Americans. According to co-author Dr. David Himmelstein, "We pay almost twice what Canada does for care, more than $6,000 for every American, yet Canadians are healthier, and live two to three years longer." The survey says Americans have higher rates of diabetes ( 6.7% vs. 4.7%), arthritis (17.9% vs. 16.0%) and high blood pressure (18.3% vs. 13.9%). Americans are also more likely to be obese and lead a sedentary lifestyle. It's damning stuff. But we shouldn't confuse problems in public health with flaws in health-care systems. Americans may be heavier than Canadians, but this speaks more to genetics, diet, exercise and culture than to the accessibility or inaccessibility of health services. The remedy for obese Americans will be found in less fast food and more gym memberships.

So how does American health care actually measure up? If we look at how well it serves its sick citizens, American medicine excels. Prostate cancer is a case in point. The mortality rate from prostate cancer among American men is 19%. In contrast, mortality rates are somewhat higher in Canada (25%) and much higher in Europe (up to 57% in the U.K.). And comparisons in cardiac care -- such as the recent Heart and Stroke Foundation of Canada study on post-heart-attack quality of life -- find that American patients fare far better in morbidity. Say what you want about the problems of American health care: For those stricken with serious disease, there's no better place to be than in the U.S.

Socialized health-care systems fall short in these critical cases because governments strictly ration care in order to reduce the explosive growth of health spending. As a result, patients have less access to specialists, diagnostic equipment and pharmaceuticals. Economist David Henderson, who grew up in Canada, once remarked that it has the best health-care system in the world -- if you have only a cold and you're willing to wait in your family doctor's office for three hours. But some patients have more than a simple cold -- and the long waits they must endure before they get access to various diagnostic tests and medical procedures have been documented for years. Montreal businessman George Zeliotis, for example, faced a year-long wait for a hip replacement. He sued and, as the co-plaintiff in a recent, landmark case, got the Supreme Court of Canada to strike down two major Quebec laws that banned private health insurance.

Dr. Karen Lasser, the study's third author, says that "Based on our findings, if I had to choose between the two systems for my patients, I would choose the Canadian system hands down." Perhaps she would. But as a physician licensed in both countries, I'd disagree.

Dr. Gratzer is a senior fellow at the Manhattan Institute.