Journalist, Adjunct Associate Professor of Public Health, Hunter College, NYC and media advisor, EvidenceNetwork.ca
Trudy Lieberman, a journalist for more than 40 years, is an adjunct associate professor of public health at Hunter College in New York City. She is a longtime contributor to the Columbia Journalism Review and blogs for its website, CJR.org, about media coverage of health care, Social Security and retirement. As a William Ziff Fellow at the Center for Advancing Health, she contributes regularly to the Prepared Patient Blog.
Last fall when I visited Canada, I met a Toronto doctor named Gary Bloch who has developed a poverty tool for medical practitioners. Bloch's idea was to zoom in on the social determinants of health -- food, housing, transportation -- all poverty markers linked to bad health and poor health outcomes.
Yes, we do ration healthcare in America. It's just that those affected the most are those who have the least income. In America, we have become oddly blasé about income inequality and its consequences, increasingly willing to let those without simply do without. But the mere hint that a needs -- or evidence-based -- process might be used to allocate scarce or high-priced healthcare raises an outcry from those accustomed to getting what they want, when they want it.
As in the U.S., there's much soul searching about whether the country is getting as much bang for the bucks it spends. Does the quality of care match the country's outlay? A number of studies, including the latest international comparison from The Commonwealth Fund, show that Canada and the U.S. both fall down on several dimensions of care.
What would you think if your doctor handed you a prescription that recommended filing your tax returns or applying for food or income benefit programs instead of the usual medicines for high blood pressure or diabetes? You'd probably say the physician was nuts. Tax refunds? Food? What do they have to do with making you healthier?
One thing Americans and Canadians can agree on is that we don't want each other's health care systems. In truth, most Americans don't know how Canada's system works and Canadians don't know much about the U.S. system. Yes, there are waiting lists for some services -- but, no, Canadians are not coming across the border in droves to get American care. Separating fact from opinion as the Canadian ambassador long ago urged was something I tried to do as I made my way across Canada while visiting there recently. In some ways, the Canadian system is very different from U.S. health care. In other ways, it's very much the same and faces similar challenges in the years ahead.
We know that the U.S. has the most expensive health care in the world. But beyond noting that dubious achievement, we seldom ask why. On my recent visit to Canada as a Fulbright scholar, I stopped by to pose that question to one of their leading health care experts, David Dodge, an economist who has served as federal deputy health minister and seven terms as governor of the Bank of Canada.
During my recent visit to Canada, I had a chance to meet Dr. Yoni Freedhoff, an obesity expert. What he had to say about reducing obesity was somewhat surprising and could be useful for people who are struggling to lose weight or helping others who are.
Some 2,250 homeless people in five Canadian cities enrolled in the program in 2011. Half of them received mostly private-sector housing; the other half got the usual community or shelter referrals. Those in the private sector group chose an apartment in a neighbourhood they liked, and the program provided the furniture.