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D. Brad Wright

D. Brad Wright

Posted: September 7, 2009 12:55 PM

Why Poor Women With Breast Cancer Should Move to Canada


A popular way to criticize anything even remotely resembling more government involvement in health care is to draw comparisons between the envisioned future of U.S. health care and the systems in other countries, which opponents of reform have somehow concluded are far inferior to our own. Of course, the comparisons can't journey too far afield, lest they not hit close enough to home. Thus, we hear horror stories of how horrible things will be here when we put in place a Canadian or British style health care system (putting aside for a moment the rather vast differences between the two). The ghost of "socialized medicine" begins to visit us with haunting visions of "rationing," "waiting lists," and "denial of coverage."

Such things are anti-American, where our mantra is: "We want whatever we want and we want it now!" Even when we don't know what we want or, more precisely, what we need, we know what we don't want, and that's to be told "No."

A recent article in the Journal of Clinical and Investigative Medicine finds that a move to Canadian-style wait times might actually be an improvement for the United States. The study, by Kevin Gorey and colleagues, compared wait times for breast cancer treatment in the United States with those in Canada, and found that low socioeconomic status was a major factor in creating long wait times for patients in the U.S., whereas it played no role in determining wait times in Canada.

On the whole, there were not group differences in wait times between the U.S. and Canada. The authors note that high-income Americans had shorter waits than the average Canadian, but that low-income Americans had longer waits than the average Canadian. Most notably, while Canadians might face slightly longer waits than wealthy Americans, they were all able to receive the treatment that they needed. By contrast, in the United States, many of the least well-off were subject to what the authors term "the longest wait of all." That is, they received no treatment at all.

What does this tell us? Primarily that the Canadian system is far more equitable than the highly inequitable system observed in the United States, characterized by the polarized groups of people at the extremes of an income distribution. This is evidence, first and foremost, that we already ration care in the United States, not on the basis of need, but on the basis of price. The study also demonstrates that on the whole, the increased waits that would be experienced by a few of the wealthiest Americans would be more than offset by the decreased waits experienced by those less well-off.

The question is: How selfish are we? Are slightly better wait times for a few worth longer wait times and denied care for many others? I suppose how you answer that depends on which moral principle drives your decision-making. Do you believe in doing the greatest good for the greatest number, or do you believe in maximizing your personal benefit only? In America, I'm afraid solidarity's not in the dictionary, and I fear that no academic study no matter how damning will ever convince the majority of us to love our neighbors as ourselves. So, if you're a poor woman with breast cancer, you probably ought to consider moving to Canada.

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