So, Canada

One of the most contentious issues of the current health care debate is how our health care system stacks up against Canada’s, or for that matter any nationalized, universal health care system.

I mean there are a lot to pick from. Canada, England, France, Norway, Germany, Sweden, Italy, Spain, Finland, Austria, Japan, Singapore, Australia, New Zealand, Israel, Iceland … well, the list goes on. Makes you wonder why all of those countries can provide universal care and we can’t. Oh, that’s right, socialism. That clears it right up.

Ok, sorry, getting a little snarky. But it is ridiculous, this to-the-death fight we have about which system is better. Take Canada. This is a country that has been one of our closest allies and a valued trading partner. There is probably no society—or economy, for that matter—in the world that more closely resembles ours. And yet this issue of health care has people in the US fuming that Canadians are a bunch of socialists. Come on.

In this country, when Canadian health care comes up, folks on the left and right assail each other with a blizzard of anecdotes, polls, testimonials, and opinions, but despite all the arguing, it seems that few minds are changed. So my collection of google search results may not impress you. But here they are.

One of the enduring claims on the right is that Canadian health care can’t be all that great since so many Canadians come to the US for health care. In “Phantoms in the Snow: Canadians’ use of health care services in the United States,” a report in Health Affairs, researchers looked at this issue. Here’s what they found:

“Throughout the 1990s, opponents of the Canadian system gained considerable political traction in the United States by pointing to Canada’s methods of rationing, its facility shortages, and its waiting lists for certain services. These same opponents also argued that "refugees" of Canada’s single-payer system routinely came across the border seeking necessary medical care not available at home because of either lack of resources or prohibitively long queues.

“This paper … depicts this popular perception as more myth than reality, as the number of Canadians routinely coming across the border seeking health care appears to be relatively small, indeed infinitesimal when compared with the amount of care provided by their own system.”

But Canadians and people in other nationalized systems don’t have the choices that we do here, right? That has to be frustrating. Well, maybe. But in a survey the Gallup company did (it’s a little old, 2003), Gallup found that Canadians and citizens of the UK were generally more satisfied with their access to affordable health care than were US citizens. However, citizens in all three nations rated the quality of care more or less the same.

For access to affordable health care, 57 percent of Canadians gave their system good marks. Sixty three percent of UK citizens gave their system good marks. And 47 percent of US citizens said they were satisfied with access to affordable care in their country.

For overall quality, 52 percent of Canadians were satisfied, 42 percent of UK residents gave a thumbs up, and 48 percent of US residents said they were satisfied. The US had the highest mark of “Very unsatisfied” at 26 percent. (Canada: 22, UK: 23)

As I mentioned, there are a million anecdotal stories about Canadians and how they either can’t wait to have a system like the US or think that our system is crazy. My personal anecdote is a trip to Canada in 2000 where I heard a health care conference by Canadian nurses on the CBC. The nurses were quite passionate about how they would never want to go to a system like the one here in the US. But I can’t claim to know firsthand how the Canadian system works.

One person who can is Rhonda Hackett , a Canadian psychologist who wrote an opinion piece in the Denver Post. The article, Debunking Canadian Healthy Care Myths, goes through the arguments one by one; government control, long wait times, higher taxes, etc. The whole thing is worth reading, but here’s one paragraph that I think is especially interesting:

“Myth: The Canadian system is significantly more expensive than that of the U.S. Ten percent of Canada's GDP is spent on health care for 100 percent of the population. The U.S. spends 17 percent of its GDP but 15 percent of its population has no coverage whatsoever and millions of others have inadequate coverage. In essence, the U.S. system is considerably more expensive than Canada's. Part of the reason for this is uninsured and underinsured people in the U.S. still get sick and eventually seek care. People who cannot afford care wait until advanced stages of an illness to see a doctor and then do so through emergency rooms, which cost considerably more than primary care services. “

Who picks up the tab for the much higher costs of health care in the US? Businesses, health plan enrollees, and hospitals through charity care. Of course the highest price of all is paid by the uninsured, though perhaps not always in monetary terms.