Yeah, I know that some things are shunned in the consumer end of the health reform debate: don’t mention Canada because it’s been demonized as some kind of socialism (and it’s full of foreigners, eh?). And so-called single payer or "Medicare for All" are dead in D.C. But let’s violate both rules on a one-time basis. Here’s the best explanation of Canadian health care I’ve seen, by a Canadian who’s a long-time resident of the U.S. and obviously likes it here.
In this commentary from the Denver Post, Canadian-born Rhonda Hackett says "Frankly, both sides often get things wrong when trotting out Canada to further their respective arguments." So she gives us a myth-busting rundown of how Canadian health care actually works: choice, efficiency, taxes, costs, and so on. Read the whole commentary, (don’t miss the "Aunt Betty" story at the end) or just the list here:
Myth: Taxes in Canada are extremely high, mostly because of national health care.
In actuality, taxes are nearly equal on both sides of the
border. Overall, Canada’s taxes are slightly higher than those in the
U.S. However, Canadians are afforded many benefits for their tax
dollars, even beyond health care (e.g., tax credits, family allowance,
cheaper higher education), so the end result is a wash. At the end of
the day, the average after-tax income of Canadian workers is equal to
about 82 percent of their gross pay. In the U.S., that average is 81.9
Myth: Canada’s health care system is a cumbersome bureaucracy.
The U.S. has the most bureaucratic health care system in the
world. More than 31 percent of every dollar spent on health care in the
U.S. goes to paperwork, overhead, CEO salaries, profits, etc. The
provincial single-payer system in Canada operates with just a 1 percent
overhead. Think about it. It is not necessary to spend a huge amount of
money to decide who gets care and who doesn’t when everybody is
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.
What the American taxpayer may not realize is that such care
costs about $45 billion per year, and someone has to pay it. This is
why insurance premiums increase every year for insured patients while
co-pays and deductibles also rise rapidly.
Myth: Canada’s government decides who gets health care and when they get it.While
HMOs and other private medical insurers in the U.S. do indeed make such
decisions, the only people in Canada to do so are physicians. In
Canada, the government has absolutely no say in who gets care or how
they get it. Medical decisions are left entirely up to doctors, as they
There are no requirements for pre-authorization whatsoever. If
your family doctor says you need an MRI, you get one. In the U.S., if
an insurance administrator says you are not getting an MRI, you don’t
get one no matter what your doctor thinks — unless, of course, you have
the money to cover the cost.
Myth: There are long waits for care, which compromise access to care.There
are no waits for urgent or primary care in Canada. There are reasonable
waits for most specialists’ care, and much longer waits for elective
surgery. Yes, there are those instances where a patient can wait up to
a month for radiation therapy for breast cancer or prostate cancer, for
example. However, the wait has nothing to do with money per se, but
everything to do with the lack of radiation therapists. Despite such
waits, however, it is noteworthy that Canada boasts lower incident and
mortality rates than the U.S. for all cancers combined, according to
the U.S. Cancer Statistics Working Group and the Canadian Cancer
Society. Moreover, fewer Canadians (11.3 percent) than Americans (14.4
percent) admit unmet health care needs.
Myth: Canadians are paying out of pocket to come to the U.S. for medical care.Most
patients who come from Canada to the U.S. for health care are those
whose costs are covered by the Canadian governments. If a Canadian goes
outside of the country to get services that are deemed medically
necessary, not experimental, and are not available at home for whatever
reason (e.g., shortage or absence of high tech medical equipment; a
longer wait for service than is medically prudent; or lack of physician
expertise), the provincial government where you live fully funds your care.
Those patients who do come to the U.S. for care and pay out of pocket
are those who perceive their care to be more urgent than it likely is.
Myth: Canada is a socialized health care system in which
the government runs hospitals and where doctors work for the government.Princeton
University health economist Uwe Reinhardt says single-payer systems are
not "socialized medicine" but "social insurance" systems because
doctors work in the private sector while their pay comes from a public
source. Most physicians in Canada are self-employed. They are not
employees of the government nor are they accountable to the government.
Doctors are accountable to their patients only. More than 90 percent of
physicians in Canada are paid on a fee-for-service basis. Claims are
submitted to a single provincial health care plan for reimbursement,
whereas in the U.S., claims are submitted to a multitude of insurance
providers. Moreover, Canadian hospitals are controlled by private
boards and/or regional health authorities rather than being part of or
run by the government.
Myth: There aren’t enough doctors in Canada.
From a purely statistical standpoint, there are enough
physicians in Canada to meet the health care needs of its people. But
most doctors practice in large urban areas, leaving rural areas with
bona fide shortages. This situation is no different than that being
experienced in the U.S. Simply training and employing more doctors is
not likely to have any significant impact on this specific problem.
Whatever issues there are with having an adequate number of doctors in
any one geographical area, they have nothing to do with the
And these are just some of the myths about the Canadian health
care system. While emulating the Canadian system will likely not fix
U.S. health care, it probably isn’t the big bad "socialist" bogeyman it
has been made out to be.