You don’t always get what you pay for

SV notes a study revealing that Canadian coronary bypass operations are cheaper than those in the US:

MONTREAL, July 12 – The hospital cost of a coronary artery bypass procedure is nearly twice as high in the U.S. as it is in Canada.

Yet despite the increased cost, there is no difference in outcome, reported Mark J. Eisenberg, M.D., of Jewish General Hospital here.

One question not addressed by this study is how many Canadians died while on a waiting list. Of a certainty, this would change the “outcome” calculations.

At the same time, in-hospital mortality was 2.2% in the U.S. and 1.4% in Canada (p=0.004), while the length of stay in hospital was 16.8% longer in Canada. However, after controlling for demographic and clinical differences, there were no significant differences in mortality between countries.

Why report it then? “[I]n-hospital mortality” “demographic and clinical differences” seem likely to be related to higher risk patients – who, in the US, actually get an operation.

If you have to ration heart surgery, as does Canada, then you triage those with lower chances to the bottom of the list. After all, they aren’t paying and they’ll reduce your success rate..

Statscan tells us the metrics, if not any actual measures. I do note that there is a category for “over 180 days.”

The sterile language of statist judgment is scary without any actual figures:

Provincial/territorial health systems/health authorities have a role in achieving reasonable wait times for services by ensuring effective management of wait lists and operating room schedules, effective bed utilization strategies, and appropriate budget allocation for prevention, treatment, and follow-up care. Wait times are commonly used as indicators of the efficiency of the system. A variety of factors can impact the wait times such as the demographics of the population, treatment patterns of physicians, the number of emergency surgeries, which have higher priorities in use of resources, nurse shortages, or job action.

Read it twice. What you see is that there may well be more Canadians uninsureds (all of them – in the sense an American would expect) than there are uninsured Americans.

Finally, the most revealing, and the charitable might say the silliest, comment of the article:

“In Canada, there’s only one insurance company — the government — so the level of bureaucracy is much, much less here,” [Dr. Eisenberg] said.

The good doctor might have meant less paperwork. Certainly, when doctors are paid government determined fixed fees, payment is simple. Administrative overhead is lower.

So is availability of care: one reason that lower administrative cost is not even necessarily a good thing. See Arnold Kling, here and here.

And even if it is sometimes a good thing, Quebecers have had way too much of it. According to Canada’s Supreme Court which ruled waiting times in Quebec are, in effect, “cruel and unusual.”

In a 4-3 decision, the panel of seven justices said banning private insurance for a list of services ranging from MRI tests to cataract surgery was unconstitutional under the Quebec Charter of Rights, given that the public system has failed to guarantee patients access to those services in a timely way.

As a result of delays in receiving tests and surgeries, patients have suffered and even died in some cases, justices Beverley McLachlin, Jack Major, Michel Bastarache and Marie Deschamps found for the majority.

In any case, there is not one health insurance company in Canada. That is, there is none. There isn’t any.

And you can’t sue them. Or, well you can, but even if you win you’re whim-of-the-government SOL, as Canadian veterans found out not so long ago.

The federal government agreed the veterans were owed the interest. However, it pointed to legislation passed by Parliament in 1990, which prevented veterans and their relatives from making claims for interest that went unpaid from the end of World War I up until that time. The measure was spearheaded by the Progressive Conservative government of former prime minister Brian Mulroney.

An economist hired by the class-action lawyers estimated the money owed could be as much as $4 billion.

The lawyers tried to challenge the 1990 legislation by resurrecting the little-used Diefenbaker-era Bill of Rights. Unlike the Charter of Rights and Freedoms, the bill protects property rights.

Despite Dr. Eisenberg’s parsing, bureaucrats are more generally understood to inhabit the nooks and crannies of government command-and-control systems than otherwise.