Monday, August 15, 2005

Cognitive Dissonance on Healthcare

Decades of propaganda about Canada's health care system being the best in the world has produced a bizarre effect not unlike those found in public attitudes towards the government in totalitarian regimes: everybody knows from experience that it doesn't work yet everybody fervently believes it's their duty to go out and defend it against all enemies.

Canadians remain generally happy with their health-care system, but they consistently over-estimate how well it compares with the rest of the world, says the annual report card from the Canadian Medical Association.

"There's a gap between how well we're actually doing and what Canadians think," says association president Dr. Albert Schumacher. "Canadians have been shielded for too long about what the real facts are in the rest of the world. If we're going to use our health care as a national identifier and take some pride in it, then I think we need to examine it more carefully to make sure it actually is as good as we think."

The association released its fifth annual report card on Canada's health-care system on Monday morning as its annual meeting got under way in Edmonton.

Nearly two-thirds of the 1,000 Canadians surveyed gave the overall quality of the system a grade of 'A' or 'B', roughly the same rating as last year.

However, this year's survey asked respondents to compare how they thought Canada stacked up against 29 other countries from the Organization for Economic Co-operation and Development.

Respondents rated the Canadian government's portion of all national health-care spending as tenth-highest in the world. The actual rank is 21st.

The availability of doctors in Canada was thought to rank 13th. The actual rank is 26th.

They also guessed out-of-pocket spending by Canadians on health as the globe's 12th-highest. In fact, citizens of only six other countries spend more on health than Canadians.

On infant mortality, Canada was thought to rank 10th when the facts say 22nd.

And why the cognitive dissonance? Because we've been told for decades that there are no alternatives to reform other than the bogeyman of "American-style" for-profit health care. Never mind that the U.S. system does not, as claimed, leave countless millions without any medical coverage, nor does it bankrupt everyone who ends up with catastrophic medical expenses.

It is America--the Other--into whose clutches our sacred healthcare system must not fall.

Schumacher says the association hopes to use the report card to open a discussion about health-care alternatives that has been paralyzed by opposition to the U.S.-style for-profit model.

"I don't think we should look at American stuff," he says.

"We have to look at our peer nations that have a social infrastructure and safety net . . . the western European countries, Scandinavia, Japan.

Even as thoughtful an observer as Dr. Schumacher has had his thinking clouded by the anti-American myth of America as a land with no social safety net.

Nonetheless, his general point is correct: there are other countries with different mixed public-private healthcare systems out there. Only our national obsession with the United States is preventing us from seeing that fact, and expanding debate on healthcare from its current sterile state.


No comments: