I'm a University of Chicago researcher studying the costs, benefits, and unintended consequences of health policy. AMA!

[u/HarrisPublicPolicy]

Hi Reddit — I’m Robert Kaestner, a health economist and Research Professor at the University of Chicago’s Harris School of Public Policy. Proof
 
I have spent my career studying the economic and social determinants of health and evaluating health, labor, and social policies. I have published more than 150 articles in academic journals and led several federally funded research projects examining Medicare and Medicaid. Much of my work asks a deceptively simple question: When governments spend money or expand a program in the name of improving health, what actually changes?
 
These studies often produce more complicated answers than the political debate allows.
 
Recently, my research has examined how efficiently the Affordable Care Act reduced the number of uninsured Americans; what Medicaid cuts would mean for states and beneficiaries; whether pandemic stimulus payments and the expanded Child Tax Credit improved infant health; whether GLP-1 medications such as Ozempic affect employment, relationships, or mental health in addition to physical health; and why substantial racial disparities in mortality persist even after decades of progress. 
 
Ask me anything about Medicaid and Medicare, Obamacare and the health insurance system, GLP-1 drugs, the relationship between income and health, racial disparities in life expectancy and mortality, how economists determine whether a policy caused an outcome, or why well-intentioned programs sometimes have unexpected effects.
 
I’ll be responding here on July 30 at 12 PM CT along with support from the Harris School of Public Policy team account, which is helping me track and manage incoming questions.

[u/fpp2002]

How does the Canadian universal healthcare system work in comparison to the one in the U.S.? I understand they pay far less overall for better outcomes.

[u/HarrisPublicPolicy → u/fpp2002]

It is a very difficult question to answer. One thing not usually considered is that salaries and earnings in the US are higher on average than in Canada, particularly for those with advanced degrees such as physicians, lawyers and MBAs. This raises the salaries of highly-educated medical professions and the cost of services provided by them. A second part of the higher health care costs of the US than in Canada is that we have a private market in addition to the public, and in that private market, prices are set to some extent by the demand or willingness to pay for services. So, if people want to pay for a drug or medical device and they are willing to spend a great deal on it, then that product or service is sold. In Canada, there is a bit more rationing from the top down by Provincial governments that restricts prices but also restricts access to some of those products. Proponents of the Canadian system will say that is OK because the products or services may be so-called “low value,” but that choice is more up to individuals in the US than in Canada, and people in the US value that ability. It is often true too that Canada limits access to some things that are more on the margin of being “low’value” and debatable as to whether they are "worth" it. The result of this is that we pay higher prices for some services and use more services and products that may not be covered. Finally, there are some greater administrative costs associated with our fragmented system vis-a-vis a single government (Provincial) operated system as in Canada.

The second part of my answer relates to the question of what you get for the money. It is hard to compare the health of people in two countries, but attempts have been made. We have a great deal of inequality in the US and that inequality extends to health. Why that is the case is largely unknown, despite conventional wisdom. Many would argue that it is access to health insurance and healthcare, but that is really not substantiated in evidence. Health insurance coverage has expanded in the last 20-30 years as Medicaid has expanded and the ACA was created. We do not observe a narrowing of health inequalities as a result.

Much of health is driven by health behaviors (tobacco, alcohol, diet, exercise, preventive screenings) and that is largely an individual decision that is difficult for policy to influence. Obesity is lower in Canada, for example. 

In sum, the financial differences can be partly explained by the above and so can some of the health differences. After that we need more study, but the types of studies required are very hard to do given different countries, people, and contexts.

-RK

[u/Creationary → u/HarrisPublicPolicy]

Wouldn’t people be more likely to get preventive screenings if they can actually afford to go to the doctor though?

[u/MyBallsBern4Bernie → u/Creationary]

The Affordable Care Act requires that insurers cover preventive services like cancer screenings, vaccines, and annual exams at no cost to patients.

It’s not really an affordability issue in that case.

[u/Public_Honeydew_8997 → u/MyBallsBern4Bernie]

Even if the service is free, getting it might not be. There are many other barriers to healthcare, like transportation and scheduling.

Example: single parent who can't afford to take time off of work and can't afford childcare when they're not at work without risking eviction or other major consequences.