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No, 'Every Other Developed Country' Does Not Have Single-Payer Health Care

One of the figures that gets a lot of attention from the “single-payer solves everything” crowd is infant mortality rates. Canada, indeed, has a lower infant mortality rate than the U.S. Our rates are indeed a scandal -- but maybe not because of our health care system.

A big chunk of our problem in this area is that black infant mortality rates are more than double the white rate. Maybe that’s because we have a lousy health care system and blacks are getting inferior health care (and America has a large black population, unlike Canada and most other developed nations). But Canada isn’t much better on this -- ranking 16th out of 17 peer nations on infant mortality.

Adding to the problem of international comparisons is that we aren’t all measuring infant mortality the same way:

A European report on perinatal indicators, for example, noted a wide variation in how European countries define infant mortality, due to differences in birth and death registration practices (that is, differences in the cut-off points for acceptable weight or estimated gestation period to be registered as a birth and subsequent death).

In short, it appears that the U.S. and Canada may both look bad compared to other developed countries because we’re more accurate in how we record infant mortality.

Finally, our infant mortality rate is indicative of behavioral problems that are unrelated to health care. Infant mortality rates are strongly correlated with low birth weight, which, in turn, is caused by smoking and substance abuse -- an area where the U.S. is, unfortunately, well ahead of other nations, including Canada.

Perhaps the most startling study is one published in 1999 by a research organization funded by the Ontario Ministry of Health and Canada Public Health Agency: "Health Care Delivery in Canada and The United States: Are There Relevant Differences in Health Care Outcomes?" They concluded that there were definitely differences in particular areas of health care. In some cases, Canada did better; in others, the United States did better (for example, American heart attack victims were more likely to enjoy “increased functional status” than their Canadian counterparts). But overall, they concluded that there wasn’t a significant difference in health care outcomes and acknowledged that demographics might be a part of the mortality differences.

I’m not happy with our current health care system, and I have previously explained some of my proposals to improve coverage for the uninsured. But I’m even less happy with the way in which advocates of single-payer falsely portray hybrid systems as “single-payer” and the differences in health care outcomes as entirely the result of differences in the health care system.