Debunking Canadian health care myths

By Rhonda Hackett
Denver Post


As a Canadian living in the United States for the past 17 years, I am
frequently asked by Americans and Canadians alike to declare one health
care system as the better one.

Often I'll avoid answering, regardless of the questioner's nationality.
To choose one or the other system usually translates into a heated
discussion of each one's merits, pitfalls, and an intense recitation of
commonly cited statistical comparisons of the two systems.

Because if the only way we compared the two systems was with statistics,
there is a clear victor. It is becoming increasingly more difficult to
dispute the fact that Canada spends less money on health care to get
better outcomes.

Yet, the debate rages on. Indeed, it has reached a fever pitch since
President Barack Obama took office, with Americans either dreading or
hoping for the dawn of a single-payer health care system. Opponents of
such a system cite Canada as the best example of what not to do, while
proponents laud that very same Canadian system as the answer to all of
America's health care problems. Frankly, both sides often get things
wrong when trotting out Canada to further their respective arguments.

As America comes to grips with the reality that changes are desperately
needed within its health care infrastructure, it might prove useful to
first debunk some myths about the Canadian system.

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 percent.

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 covered.

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
should be.

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 single-payer system.

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.

It is not a perfect system, but it has its merits. For people like my
55-year-old Aunt Betty, who has been waiting for 14 months for
knee-replacement surgery due to a long history of arthritis, it is the
superior system. Her $35,000-plus surgery is finally scheduled for next
month. She has been in pain, and her quality of life has been
compromised. However, there is a light at the end of the tunnel. Aunt
Betty — who lives on a fixed income and could never afford private
health insurance, much less the cost of the surgery and requisite
follow-up care — will soon sport a new, high-tech knee. Waiting 14
months for the procedure is easy when the alternative is living in pain
for the rest of your life.

Rhonda Hackett of Castle Rock is a clinical psychologist.


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The modern GOP is little more than an army of moral absolutists led by a
gang of moral nihilists.