Sunday, August 19, 2007

Canada is a very wide country

Here's a tale doing the rounds of the right-wing blogs. A woman in Calgary was pregnant with quadruplets. Labour began early and it was determined that the hospital best equipped to deal with the situation was in Montana, which is about 300 miles away. The issue was the need to have 4 spare neo-natal intensive care (NIC) beds available at once. The babies were delivered successfully and are now back in Canada.

Hence it's worth having a healthcare system that leaves about 15 percent of population uninsured and inserts a massively expensive bureaucracy -- insurance companies -- between the other 85 percent and whatever healthcare they need.

That apparently is meant to be point of the tale. Here are the latest OECD statistics on total healthcare spending as a share of GDP. See Chart 3. The US spends 15.3 percent. Canada 9.8 percent. That's a 5.5 percent difference, which is huge. You could run a long messy war on that amount of money. And, apparently, it's all worth it if you keep a bit of spare capacity in neo-natal intensive care units -- all for the highly unlikely event of quadruplets.

And there's a lot they're not telling us. For instance, what are the odds that a major city hospital in the US would have had 4 spare NIC beds? So the issue is demand as well as supply. What percentage of the Montana hospital's business comes from the US government? And think of how many extra NIC beds they could have if so much of patient spending on healthcare wasn't going to support the administrative expenses of insurance companies.

Incidentally, all the expenses of the quads birth in the US were paid by the public Calgary Heath Region, meaning that the family didn't have to deal with getting the intensive care pre-approved by an insurance company -- or the experience of getting a massive bill if they didn't get pre-approval.

Finally, illustrating the sad spectacle that is right-wing argumentation these days, the comment thread on the original propagator of the story, Don Surber, soon attracted complainers wondering whether the US government had paid for illegal immigrant births, who would then be citizens. Apparently the extra hospital capacity is worth 5.5 percent of GDP, but not 4 extra citizens from up north.

UPDATE: The Surber comment thread continues to be good for a laugh. Some of them don't understand that the size of a city affects the demand as well as the supply of healthcare facilities -- especially in the context of the oil boom in Alberta. And God forbid anyone bring up the statistical theory associated with arrival processes and whether it's optimal to carry excess capacity for low probability events. By the way, the provision of healthcare across national boundaries in scarce event cases happens in Europe, the land of socialised medicine, every so often.

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