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Canada has socialized medicine and a government run, single payer insurance system.  I work in healthcare in the US and have heard several times that the US can’t go the way of Canada. I have also heard talk radio saying that the Canadian model doesn’t work.

I am writing this post to defend the Canadian healthcare model. Here are 5 positive and 2 negative observations about Canadian healthcare.

Positive.

1. In all my years of growing up in Canada, I have never once had a problem with getting quick primary and catastrophic care in Canada. Whenever I called my primary care physicians, I was in the doctors’ offices within 0-3 days. When a surgeon and I agreed that I needed elective surgery, that surgery was scheduled within 3 weeks. And whenever I went to the ER, I was seen within 1-2 hours, sometimes less.

2. Canadian healthcare is not free. Everyone pays a premium because fair and equitable premiums are automatically deducted from your paycheck. I think this is a good way of ensuring that everyone pays into the system – there are very few freeloaders in Canada. Also, premiums are automatically adjusted based on income, so poor families pay less. Making sure that everyone pays something into the system prevents the “entitlement” mentality (“I deserve care even if I don’t pay for it”).

3. If you get real sick in Canada, you don’t lose your home and risk bankruptcy.

4. If you require catastrophic care in Canada, you get it quickly. Last year my uncle had a massive heart attack. He was flown to Vancouver and in surgery with a specialist the very next day. He had follow up surgeries a few weeks later in a timely fashion. 

5. The story about the Canadian premier from Newfoundland who recently went to Florida for heart surgery that we keep hearing about was not denied heart surgery nor was he placed on a long waiting list in Canada. He was offered surgery in Newfoundland that would have saved his life, but he opted for an alternative, less invasive procedure by a specific physician in Florida who was recommended to him by someone else. So this is not a case of someone not being able to get decent care in Canada. It is a case of a wealthy politician shopping around for a specific doctor and procedure that was more to his liking.

Negative.

1. Last year I attended a healthcare conference where data were presented showing that the cost of healthcare is rising at an alarming rate in nations with socialized care. So Canada’s socialized medicine is not controlling costs very well. Obama’s insurance reforms will not, in all likelihood, bring rising costs under control. I believe that controlling rising costs can be achieved by changing the culture of healthcare delivery.

2. Canada does not have a co-pay system. Absence of co-pays leads to unnecessary visits at primary care and ER facilities. A co-pay is needed in Canada. It would force some Canadians with mild conditions like sore throats and coughs to think twice about whether they need to see a doctor, assuming they tend to run off to the doctor at the first sign of a cold .

So there you have it - one person’s viewpoint. Whether the Canadian model would work in American is unknown, but it works fairly well for Canadians.
 


Comments

Stan
03/24/2010 13:57

Nice post. Pro or con, it's nice to hear sensible voices in this discussion. I'm just guessing, but I don't imagine the Canadians sense a loss or restriction of basic freedoms due to their socialized medicine.

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Christine
03/24/2010 15:16

How is it fair that a person who earns more should pay more for the same service? How is it fair that a person who earns more should pay whether they use the system or not? That seems like an unfairness to me.

Who determines what is a "fair and equitable premium" in Canada? if it isn't the market, it must be someone who makes that call. What is the "fairness" based upon except for from each according to ability to pay to each according to need (with a nod to Marx)?

If the cost is going up, are the premiums going up to match the costs? Who covers the cost over and above what is paid by an undoubtedly lagging governmental response to raise premiums?

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Christine
03/24/2010 15:25

I wanted to ask also: what of those who are not employed? If premiums are deducted by force of law from paychecks, what about those with no paycheck?

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Dave C.
03/24/2010 15:46

Christine,

"How is it fair that a person who earns more should pay more for the same service? How is it fair that a person who earns more should pay whether they use the system or not? That seems like an unfairness to me."

- I agree, but that is the way it is. People who don't contribute in a meaningful way to the financial resources of Medicaid use up a lot of Medicaid resources. I suspect that the reason why I and my insurance paid $4.00 to the Hospital for my wife's Tylenol pills after she gave birth was that a bunch of people aren't paying for those same pills after giving birth.
Again, it seems unfair but that is the way it is.

"If premiums are deducted by force of law from paychecks, what about those with no paycheck?"
- They pay no premiums but are covered under the government insurance.

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Christine
03/24/2010 20:21

If folks get coverage whether they have a job or not, aren't there a lot that take advantage by not having a job and getting essential services anyway?

Don't you feel a loss of freedom of choice? I mean, you can't choose at what level you'll pay, whether you'll participate, what the plan is or who your carrier is. You can't choose to pay less for less or more for more. That seems like a fairly significant truncation of freedom to me.

Further, you're right about Medicaid. But the, two wrongs don't make one right. The free rider (translate that free loader) problem plagues American medicine because we all pay for folks who don't have coverage. Now we'll subsidize the coverage of those who don't pay.

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Dave C.
03/24/2010 21:24

Christine,

"If folks get coverage whether they have a job or not, aren't there a lot that take advantage by not having a job and getting essential services anyway?"
- No, I think most people want to work and take care of themselves financially. Living off the gov't dole is not a good lifestyle.

" you can't choose at what level you'll pay, whether you'll participate, what the plan is or who your carrier is."
- The premiums in Canada are fairly low compared to private programs in the US. Most employers in Canada pay your premiums as part of their employee benefit packages. I know there are some Canadians who would like to opt out and have no insurance at all, but then everyone else would be left paying for their bills if the need ever arose, so no dice for them.

"Now we'll subsidize the coverage of those who don't pay."
- We already are paying for their care through higher premiums and hospital bills. I despise redistribution of wealth, but in our modern society healthcare seems to be an exception to the rule.

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Mex Davis
03/25/2010 10:53

We live in Michigan and many Canadians work here and most like their system No system is perfect but Canada seems to have solved one of your big problems I. E. those that can't get insurance or the poor or unemployed are out of the loop but in Canada they are cared for. It is my understanding that there is some private insurance but if you opt for it and leave the government program you can't opt back in later. Anyway our new program isn't anything like Canada and is really in the early stages for good or bad.

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DavidH
03/25/2010 11:50

All right-thinking Americans know that Canadians don't like their socialized system. Just as the citizens of every other industrialized nation with universal health care are envious of the U.S. citizens and are prodding their representatives to move to systems where only the sick pay for their own care. No reason for the well to pay for the sick.

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Dave C.
03/25/2010 13:10

DavidH,

"All right-thinking Americans know that Canadians don't like their socialized system."

Wrong. In all my 25 years in Canada I never envied the American system neither did any of my friends or relatives. As a whole, Canadians are pleased with their healthcare.

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DavidH
03/25/2010 23:38

I was speaking tongue in cheek. I agree with you. If the opponents of universal health care are correct that the experience in other countries is so awful, then why is there no movement there to switch to the (former) U.S. system.

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Jay
03/26/2010 06:46

I used to work with a medical organization made up of U.S. and Canadian doctors. Even though the Canadian doctors said time and time again that they were happy with their system, the U.S. doctors simply refused to believe them. Even when the Canadian doctors said they would never give up their healthcare system, the U.S. doctors refused to believe them. I have never advocated a Canadian-style system for the U.S. but I think experience demonstrates how our obsessively America-centric view of the world often hurts us.

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Dave C.
03/26/2010 08:44

DavidH,
I suspected sarcasm, but was not quite sure. Cheers.

Jay,
Thanks for sharing that interesting observation. Here is a similar observation: Two of my brothers are primary care docs in Canada. They have received offers to move to the US but are content practising in Canada.

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Paul link
03/26/2010 09:24

Great post! It's great to hear a first hand report of the Canadian system. This rings true with the reports I have from my Canadian friends (many of whom just don't understand the US concerns).

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Anthony
03/26/2010 12:35

Negative point #2 about copays cannot be overstated! Many people in the US also don't have copays and it leads to increased utilization of resources and higher costs.

One of the selling points of healthcare reform in Massachusetts is that it would lead to less utilization of the emergency room. It hasn't. Having worked in the emergency room, I learned that you don't need to be uninsured to use the ER inappropriately. Many people with medicaid or private insurance without significant copayment used the ER in lieu of a visit to a doctor's office simply because it was more convenient for them.

Almost no system without some sort of copayment will be able to control cost.

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Deborah Collingridge
04/23/2010 17:28

Although this is purely anecdotal, my grandfather waited 18 months to have his kidney stones treated since Manitoba, Saskatchewan and Alberta were required to "share" ESWL one machine.

I also think of your mom, Dave, and the lack of clinical trials available in Canada. She had very few treatment options, and was basically waiting to die with no hope of extending her life or improving the quality of the remaining life she had left.

At least in this country, the funds are available for research, whereas in Canada funds are limited.

In Canada, if you need basic healthcare or urgent/emergency care it is available. If it is not urgent or an emergency, you wait and wait.

I know that healthcare in the U.S. needed to be reformed, but I think that it should have been done incrementally and with much more thought and care.

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Debbie Collingridge
04/27/2010 15:01

By the way, the premier of Newfoundland said the following regarding his decision to seek healthcare in the U.S.:
"This was my heart, my choice, my health. I did not sign away my right to get the best possible health care for myself when I entered politics." Rather "telling" don't you think, Dave?

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