A Tip Without An Iceberg: Americans, Not Canucks, Are The Real Medical Refugees

Once the Senate puts aside the irrational fracas over Sonia Sotomayor’s nomination to the Supreme Court – she eats spicy food, her name doesn’t sound American, she can be quoted out of context, she’s a secret socialist – and confirms her nomination, Congress can turn its attention to dealing with genuine problems such as providing universal health care.

Proponents will remind everyone that Canada’s national health covers everything from routine doctor visits to complicated brain surgery, from birth to death and at far lower costs than Americans pay. And sure as the earth is warming, opponents will scream that the Canadian system is so bad, massive numbers of Canucks flee to the US to obtain care because their own system can’t treat them.

In truth, the real flow of patients is from the US to Mexico, not into America from Canada.

Medical Refugees

A massive, peer-reviewed study just published in Health Affairs: The Policy Journal of the Health Sphere debunks the myth that Canada’s system is so broken that massive hoards of Canadian medical refugees flee south for treatment. Eighty percent of US hospitals reported treating 10 or fewer Canadians annually during the five year period of the study; another 15% reported seeing from 10 to 25 patients; only 5% reported seeing more than 25. None – nada, zip, zero – reported treating more than 75 Canadian patients in a year.

The study finds that hospitals in three large US metropolitan areas combined saw 640 Canadian patients for diagnostic radiology services such as CT scans or MRI’s over a one-year period. By comparison, Québec hospitals annually perform 375,000 CT scans.

Put differently, Québec hospitals do twice as many CT scans of Canadians every day than all the hospitals in three large American cities do in an entire year.

Contrast this study with one just published in the journal Medical Care by the UCLA Center for Policy Research.

It reports that, because of unaffordable or unavailable health care at home, nearly 1-million Californians cross the border each year seeking medical treatment in Mexico. This doesn't include the number entering Mexico to buy medication. Add to this total who knows how many tens of thousands of uninsured and underinsured people from Nevada, Arizona, New Mexico and Texas scoot across the border to see a Mexican doctor and the real number of American medical refugees would populate a decent sized city.

If more Americans lived closer to the Mexican border, chances are high that the number of medical refugees heading south would swell.

Fixing Medicare

Meanwhile, the right keeps yammering about Medicare going broke in another few decades, using it as an argument against national health as well as for killing off Medicare itself. While all of us aging baby boomers will soon be filling out applications for the service, we aren’t the cause of the problem. The two biggest reasons Medicare has long-term funding issues is the obscene rate of increase in the cost of private health care and Congressional mandates prohibiting Medicare from negotiating prices for drugs, supplies and medical devices the same way as do the VA and Dept. of Defence.

No less an authority than the non-partisan Congressional Budget Office reports that the VA’s cost-per-patient grew by only 1.7% between 1999 and 2005, after adjusting for inflation. That’s 0.3% per year and includes the enormous cost of treating thousands of service personnel hideously wounded in Iraq and Afghanistan starting in 2002. Meanwhile, Medicare’s cost per patient rose a whopping 29.4% over the same period, or 4.4% annually.

It’s tempting to suggest simply turning Medicare over to the Veteran’s Administration – which clearly knows how to treat patients cost-effectively – and use the savings to expand VA facilities into more communities while hiring additional doctors, nurses and support staff.

Oh, wait: That’s socialized medicine. Republicans and their conservative think tank enablers believe Americans would rather do without health care – or go to Mexico – than have a government sponsored, single payer plan. Why does the right never mention the VA model while spouting myths as fact in the health care debate?

For that matter, why isn’t anyone in Washington proposing an expansion of the health care plan that currently covers all non-DoD federal employees to include all Americans? There’s a relatively easy way to do it without creating a bureaucracy, leaving both choice of doctors and the insurance industry alone, and not making physicians employees of the federal government.

I’ll write about this idea tomorrow. Meanwhile, don’t get run over by the 1-million-plus Americans racing to Mexico for their health care.

A deeply appreciative h/t to Paul Krugman