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The Facts About Canadian Care


Heard on National Public Radio
These days, we can hardly turn on our TV's without seeing political ads telling us how horrible Canadian health care is.

Now, just so you know, no one in Congress or the White House is suggesting that the US adopt the Canadian design. [Though why they aren't, I don't know--it's a great system. Oh--that's right--the insurance companies don't want it. I forgot.]

Sarah Varney, reporter for NPR member station, KQED, decided to check out health care north of the border. See what you think.
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Varney opened her piece with a visit to a doctor's office. She interviewed John Riley who was being treated for colon cancer in a small doctor's office in a gritty, working class neighborhood. He and his wife have been seeing the same doctor for over twenty years. They are allowed to choose their own physician.

Varney asked John if he had been required to wait for treatment. "Nothing but good. Everything has been going bang, bang, bang."
Did he have out-of-pocket expenses? "Other than gettin' there. No. Everything is good. I'm covered. I'm covered."
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So, how does the Canadian health care system work? It's paid for by income tax and sales tax. All Canadians are covered and can see any doctor they want, anywhere in Canada with no co-pays or deductibles.

Some things aren't paid for: optometry, dental care or prescription drugs. Some people carry additional insurance to pay for those--others pay out-of-pocket for them.

American opponents to a new health plan like to call Canadian health care "Socialized Medicine [HORRORS!]." That's not an accurate description. Actually, it's socialized insurance--meaning that the risk is pulled together and paid for by the government.

While individual provinces and territories set their own overall health budgets and administer the health plans, the delivery of the actual care is private. Doctors run their own practices and bill the government rather than the patient or a 3rd party provider.

A physician Varney interviewed [Dr. Barsalai] told her that doctors earn a good living in Canada and don't have to handle the hassles involved with dealing with hundreds of different insurance policies--each with its own rules.
The article didn't say so, but I would imagine the issues of pre-approval or preexisting conditions don't come up.

Barsalai said that medical costs in Canada are half of what they are in the US. Infant mortality is lower. Life expectancy is longer. Obesity is lower and accessibility is higher.
Canada must be doing something right.

The Commonwealth Fund, a respected and non-partisan health research organization surveyed the 19 top industrialized countries in regards to deaths that could have been prevented had appropriate care been available. Canada rated 6th in positive outcomes while the US rated last.

Steve Morgan, a health economist at the University of British Columbia in Vancouver, said, "I think a lot of it has to do with access. Canadians who need to manage a chronic condition or are faced with an urgent situation don't think about their pocketbooks. They seek the care and, more times than not, they get the care they need."

Varney met with Morgan and his colleagues at the UVC Center for Health Policy Research to find out what the data they've collected over the years reveal about the Canadian health system. Varney advised them of what the American public is told about the Canadian process: that health care is rationed, there are long waiting lists and a government bureaucrat gets between the patient and his/her doctor.
Professor Bob Evans, one of the grandfathers of the health economics field, said, "An illusion has been created that there are long lines of people who are near death waiting for care. That's absolute nonsense!"
Evans has been studying the two systems [Canadian and American] since they were founded about the same time during the 1960's.
He went on to say, "Are there people lined up not getting the appropriate care they need in appropriate times? Of course there are. It's a huge system and a very complicated one. And things do go wrong. But, as a general rule, what happens here is: when you need the care--you get it. We're not a third world country! [He sounded downright incensed.]

When federal funding for health care declined when a recession occurred during the 1990's, lines for nonessential services [and even some urgent ones] grew. The Canadian Supreme Court did find that, in some serious cases, patients had, in fact, died as a result of waiting for medical services. Stories of the deaths and of people traveling to the US for medical care dominated Canadian news. As a result, the Canadian government poured billions of dollars into reducing waiting times in the areas that were the most critical including cardiac care, cancer and joint replacement surgery.
As a result, the amount of wait time has been dropping. Most provinces now report waiting times on publically available websites. No such data or accountability is available in the US.

That's not to say there aren't frustrations regarding waiting for health care in Canada. At BC Children's Hospital, Jocelyn Tomkins, a young woman born with a condition similar to spina bifida, stated, "I haven't been able to walk since I was eight. I've had lots of surgeries and interventions but, beyond that, I hold a job and I live a pretty much normal life."
Jocelyn credits an army of doctors and physical therapists for that normal life but she admits there have, on occasion, been roadblocks.
"Of course there were some times when I had to wait for care and those were always the most frustrating moments."
A few years ago, when she was on a wait list for a pain clinic, she traveled first to Seattle and then to Texas. The care she required cost $1,800.00. Very few Canadians do go south for health care. It's a bit like getting struck by lightning--it's rare but, when it happens, everyone talks about it.

On some occasions, provinces pay for people to receive specialty care in the US. One such instance is the fact that a shortage of neonatal beds in Canada leads some women with high risk pregnancies to travel to the US [at Canadian expense] to deliver. It doesn't happen often and polls show that the vast majority of people are happy with their health care.

A few people would like to purchase private health insurance. Currently that is not allowed.

Canadians share some anxieties with their counterparts south of the border: a concern regarding their aging baby boomer population; overuse of emergency departments and a shortage of primary care doctors. But what Canadians don't worry about are: losing their health insurance or going bankrupt because of a health crisis.

14 Comments

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If I could vote, I would vote for a single payer system at least based on those that exist and are working well. I see not option but to keep fighting for single payer healthcare.

I still believe it is a strategic mistake to have left this option out. The insurance and pharma companies will spend tons of money to defeat the democrats and help the republicans regain power so that their outrageous profits will not be threatened.

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This article is short on facts. Google 'wait times canada angioplasty' for instance, see how the report that wait times are 6 weeks or more. Read the articles about the one year wait times for mammograms or MRI's. I spend a lot of time in Canada, and I can tell you plenty of people complain about their system. And plenty of doctors move south to work in our system. Their system is not the utopia you portray it to be.

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For more on intolerable wait times, check out this article.

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You forgot to mention something.

Wait times are only for those who are able to wait. Critical cases get immediate care.

It wouldn't surprise me to find that a system serving over 30 million people in the second most extensive country in the world doesn't screw up sometimes, but anecdotes do not equal data.

Neither does criticism of the system equal a desire to change to anything like the broken and pathetic American one. We criticize because our system is under control of a government that has to win elections every few years. It's in their best interest to listen. Try that with an insurance company and they'd give you the finger.

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Life Expectancy at Birth:

U.S. 77.89

Canada 80.36

Source: Wolfram Alpha


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You do realize Canada has one tenth the population of the United States, right? Many of the industrialized nations so often discussed in this conversation have populations lower than many US states. There's a size and magnitude adjustment that has to be considered in this conversation.

The poverty rate in Canada is about 40 percent lower than the US. So taxable income in Canada is more available than in the US. And the average tax rate in Canada is 6% higher,and there is a national 5% goods and services tax. There is more money available to the government for these programs, and the burden is not just placed on the wealthiest, but on all taxpayers, and because of the sales tax, on all citizens. Everyone pays for the system -- something that has not be proposed here.

While the NPR report may have claimed no rationing, as the father of premature twins, the shortage of neonatal beds certainly sounds troubling. As does the exodus -- mass or not -- of doctors. Med school is long and expensive -- doctors aren't out of line to expect some sort of payoff for it. If that payoff is reduced, the number of people choosing to go through the process might reduce as well, which would lead to fewer providers of service. Which would, invariably, lead to a greater denial of services.

Canada may have made the right decision 50 years ago going to a single payer system, but throwing it out as an example to the US is disingenuous. Converting the US system to a single payer is a process that must take decades, not months, and needs to the subject of a sincere debate. Part of that requires accepting the faults and limitations of that system, as well as the current one.

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I've never understood the excuse that we're a larger country, so it's harder for us. A larger population should provide more opportunities for efficiencies, not less. (That's one of the complaints of the insurance companies, by the way. They think that it's unfair to compete against the government since presumably more people will sign up for the government plan. Again, note that the increase in size contributes to greater efficiencies/bargaining power. Personally, I don't care how fair it is to the insurance companies if we end up paying less for health care.)

As for the poverty statement, interesting how that works. Maybe one reason they have lower poverty is that they haven't seen the cost of health care double in the last decade like we have. At the very least, that's no doubt a contributing factor.

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Would I rather pay slightly more tax, knowing it's directly funding health-care providers -- or pay outrageous premiums to insurance CEOs, and still have to worry that it won't guarantee I get the care I need when I need it?
It's a no-brainer, isn't it?
Canada's got a conservative government at the federal level right now, but even they aren't stupid enough to try to dismantle Medicare. Surest way to electoral defeat!
If Americans can be talked, lied and bullied into keeping some version of the profit-based system you have now, it will be the final piece of evidence that the Iraq War was no fluke.
Wake the fuck up, folks. Fight the right-wing crazies and corporate shills. Your lives literally depend on it.

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I don't know why a shortage of neonatal beds should bother you, since if you were Canadian, the Canadian government would pay for you to be treated wherever necessary -- including in the United States, despite its outrageous overcharging. The concept of a system that does whatever is necessary to serve its clients is evidently foreign to you.

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Hi all
I've lived both sides of the border; born in Canada, I emigrated at age five and grew up an IBM brat in NYS and had the benefit of IBM's major medical through my undergrad at Vassar. Returned to Canada in 1974 but stayed in close touch---worked for Obama in the last elxn.
A former CBC TV and print investigative journalist, I know stuff about the Canadian healthcare system---in fact, I did serious research for a piece in HARPER's examining the funding behind the successful campaign to derail Hillary Clinton's 1994 health care initiative. HARPER's didn't get the importance of the story in predicting what would happen the next time around. Wellll...the research was right: the wheels are coming off the US system and profit rules.
Point blank? The Canadian system works. Period. Yes, there's an outmigration of Canadian medical and nursing talent but that's not---as is often posited---necessarily solely because of income. Many physicians relocate for research and career reasons, not simply hard cash. The US has a massive R+D lead on Canada in many healthcare disciplines. Simple fact.
I live in Stratford, Ontario, home of the Shakespeare Festival. I have three kids and no major medical or dental or drug plan since leaving a corporate dayjob to write my first commissioned feature film script.
We get superb care from a family practice group that's a 15 minute drive from our house, which has two afterhours clinics and no user fees except for physicals for job app.s. Dental is a far bigger issue for us, frankly. And all of us have compromised immune systems (allergies, serious asthma), so we spend $1800 or so a year on drugs and eyeglasses. That's doable.
There are no personal bankruptcies here because of medical costs; there are no horror stories (my stock in trade as a former journalist) beyond those attributable to human error that I can see in the daily press. Wait times used to be an issue but everyone I know heads north, where the wait times are minuscule, for prosthetic joint surgery and the like. Cardiac care is world-class; likewise pediatric ICU.
I have excellent contacts in the health ministries, both provincial (state level) and federal. Their biggest worry is identical to every health care bureaucrat in the west: a demographic nightmare.
But we'll muddle through. Canadians, with a far stronger social safety net, aren't in permanent crisis. (Our much-maligned financial services sector---we get user fee'd to death up here---didn't implode either last fall. Regulatory oversight works.)
You folks are enduring a calculated propaganda war. Start looking to see who's funding the propaganda (the guts of my abortive HARPER's piece) and you'll find serious money.
At a recent bar mitzvah, I met the AMA's lead negotiator with the HMOs. This is the guy who goes into the small room to cut the deals. He gives the US system three or four more years to find a solution before the thing cracks wide open. His words, not mine.
Final note: I know stuff about the US insurance industry, because I investigated the insurance scandals stemming from unpaid Holocaust-era life insurance policies.
Every state has an insurance commissioner. Ask around: see whose pocket your state commissioner is in...and you'll start to get the picture.
Good luck. You're gonna need it.

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This story, this narrative should be shouted from the mountaintops. They do documentaries. Good doctors chime in on the subject and confirm your points.

And there are CEO's heading insurance companies and taking home a billion dollars a year.

Bet that does not happen in Canada.

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I waited a month in the U.S. to see an orthopedist when I broke a bone in my leg. Just this spring I waited two months in the U.S. to get an appointment with a specialist to whom I was referred by my PCP.

As for Canada, you are allowed to have private insurance, or at least you were 25 years ago when I lived there. I'm not sure whether what we had was supplemental to the public plan or a totally private policy.

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hi, synchronicity--
I agree with your view. as to why single payer was left out-- the insurance lobby won this round.
we need to get what we can this time and try again in 4 years or so.
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Karen09--
you are too right. our system is badly broken.
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thecleverbulldog--
what utopia? the post certainly didn't paint that picture, imo.
still-- when The Commonwealth Fund, a non-partisan organization looked at deaths that could have been prevented had appropriate care been available and Canada rated 6th in positive outcomes while the US rated last -- well, I have to wonder.
Do you?
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nebton--
people keep bringing up wait times -- just as if they didn't happen here.
and just as if people who can't pay aren't waiting and waiting and waiting and waiting and either dying or going bankrupt.

at least in Canada, it will be paid for. they will get care. generally speaking, urgent matters are taken care of immediately.

the system did have problems during the 1990's during their recession. and the gov't worked to close those holes.

closing the holes -- that's what our proposed plan hopes to do, too.

and, yes, I agree with you about the size issue.
still, the bottom line is-- our system is broken. we need to fix it.
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hi, sagesource--
exactly. we gripe about our government, too. still, if China suddenly decided to go democratic and the nay-sayers came up with the argument that the people in our country gripe about our gov't so they should maintain their status quo--- would that argument make sense?

and your point about the neonatal beds is exactly right. Canada pays for women with high-risk pregnancies to come south if needed.
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hi, msa3
so your argument is:
their system is better so they should have good health care.
our system is worse so we shouldn't.

how about if we work to make our system better rather than settling for ranking 19 out of 19?
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acanuck--
I wish I'd said that. eloquently put.
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hi canuckjourno
thanks for your insights. we need em.
yes, it's obvious serious money is behind all the propaganda. it's so sad that pushing fear works so well.
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dickday--
bet that if such a thing DID happen in Canada, the scandal would split the country wide apart.
it would be the CEO's, not the politicians that got hanged in effigy.
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I'm sorry that happened to you FDRdog-- a month
to get a broken bone treated??? that's criminal.
and TWO to see a specialist? I hope the condition wasn't serious and that you're better now.

the piece I heard on NPR said that general insurance outside the state-provided program isn't allowed. people can carry insurance for the things the state doesn't cover: optometry, dental care and prescription drugs.

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