A few weeks ago I began a discussion about the quality of national healthcare (comparatively between nations) with a friend and I stopped because I realized I was not necessarily speaking from fact. My “certainty” was coming from hearsay, conjecture, personal skepticism partially created by mistrust, and sources that may (or may not) slant perspective to fit an agenda. I am confident that my friend's certainty may be influenced by similar factors, though instead of mistrust and skepticism, he revealed trust and confidence; (in my opinion, naively so), but I was suddenly uncertain so I told him that for me to continue the conversation I would need to gather some facts.

I began by simply searching for “quality” of healthcare and found some consistency in that Canada and the U.S. (the specific countries that initiated our discussion), are not typically in the top 10, and on one ranking from the World Health Organization not even in the top 25; (Canada is #30 and the U.S. is #37). But I also found that these rankings include a complexity of criteria such as life expectancies, mortality rates, cost per capita, cost as a percentage of GDP, and other (some unfamiliar, some vague and subjective) measurements such as years of potential life lost, patient rights, waiting times, services provided, quality, access, administrative organization and safety. Additionally I found that many of the results of these measurements may not reflect quality of healthcare as much as they reflect quality of life. And I found that the nature and character of the National patient in each country also impacts the results. More than in any other country, (except perhaps China), it appears that the typical U.S. patient is a demanding, bullying, pretentious, skeptical, argumentative crybaby who must have their way and plans to live forever. This drives up cost by forcing the system (already afraid of litigation) to order too many expensive tests and perform too many expensive procedures, and it (likely) adds to the stress of the individual thus possibly helping to explain our nation's recent reversal in a decades-long upward trend for life expectancy.

So where do I find the facts?

Or perhaps more importantly, what specific facts am I looking for?

I just blew up cost as an objective standard because the United States as the most (or one of the most) expensive countries, (depending upon the source), may be more reflective of our individual character than it is of the quality of our healthcare. And though an anecdotal case could be made, (as it was in a recent article from CBS News reporting on a caravan traveling to Canada for $30 insulin instead of staying at home and paying $340), I am afraid if I argued that case I would be overwhelmed by a plethora of other confirmation bias examples.

The best I can make of many other criteria including access and efficiency, from what little research I have done, is that much like cost, it becomes a matter of personal experience influencing perspective, and in its aggregate (between comparable countries) is probably close to a wash anyway.

The one outlier to “factors that are likely a wash” between the U.S. and Canada is simplicity or ease of use. If that were the yardstick, by all accounts the U.S. would come out on the short end. But one could argue, (and I suspect that most of us would agree), we would not mind going the greater lengths to add years; and when we do, (driving up cost in the process), we truly believe, as Americans, that we will get those years because we deserve those years; though again, the outcomes between the U.S. and Canada appear to be similar.

So do I go along with consensus algorithms and expert opinion and accept that there are many countries with better healthcare systems than both the United States and Canada with the small satisfaction that (as I originally claimed) Canada overall has the edge over the U.S.? Or do I stick to my guns and make up my own mind based on unfounded assumptions, childhood indoctrination and fake news, and continue to believe what I believe?

I suspect I am better off listening to the more moderate, reasonable, fact-based algorithms and experts, even if the results of their measurements do not reflect my perspective as impacted by personal experience and opinion. I also believe however that the more informed, realistic perspective of experts would be potentially more beneficial if we studied those countries found consistently in the top 5 or 10, and stopped arguing about middling countries like the U.S. and Canada. It is another example of why perhaps we would all be better off, on all fronts, if we paid closer attention to the experts.

Bottom Line for U.S. vs. Canada: because it is complex, cumbersome and difficult to navigate, and because I found more specific examples of higher cost here, I still believe that healthcare in the U.S. is of a lesser quality than that in Canada, though the gap is not as dramatic as I believed before my limited research.

So what am I going to say to my friend when I see him this weekend? I am probably going to cite the story on the insulin caravan and say, “see, I told you so.”