Why is Bernie the top photo? What concrete step for health care has he ever achieved? He knows how to say "Single Payer" but still doesn't have a plan to get there. Like Trump, he thinks sitting in the Oval Office is all it takes to get his way.
He knows he gets applause from his minions for non-stop criticism of President Obama for the Affordable Care Act. 10 years ago when it was under discussion, his only contribution was blocking the "Public Option" for not using the words "Single Payer". As we see in the anniversary photos of ACA, didn't stop him from photo bombing when it finally passed. Thanks for nothing Bernie!
4
All I used to read about was Canadians complaining about their healthcare system and tales of them crossing the border to the US for procedures. It was this whining and complaining that gave a national health system a bad name - Brits did it too. Guess no one is ever happy but it has prevented a big movement in the US for a national healthcare system, even though medicare works really well for the over 65's.
3
Hi,
Thank you for your perspective! I could not access the full Lancet article. Are you permitted to share it?
Thank you,
Janet
1
There are reasons why the U.S. system persists. Many doctors here value their right to be self-employed entrepreneurs. I don't begrudge them that, though some abuse the privilege. (In Canada, as I understand it, a doctor cannot legally moonlight.) Second, many Americans won't abide a system where they perceive themselves to be subsidizing care for minorities who aren't paying equally or may even be undocumented. Third, patients deserve choice. Not all MDs are great doctors (just as not all writers, carpenters, programmers, chefs, barbers, etc. are experts). If you reside for many years in a small city or town, you eventually discover whom you can or should trust with your body and mind.
In Canada, we work as "self-employed entrepreneurs" (so yes we can moonlight; I have worked as many as four different jobs at a time); but we finance our offices 100%, right down to providing the toilet paper for the patients and paying for the plumber to unclog it when someone decides to flush a diaper! And the government "price fixes" so we only get $30 per patient, regardless of how complex their problem is, or how many problems they want to try to squeeze into their visit! (Now you know why your doctor is in a rush). In Ontario, we've been without a contract for 5 years, but our last contract (which awarded us $33/visit) was too much for the government to handle, so they broke the contract, unilaterally dropped the fee to $30, and then to boot cranked up minimum wage so we could lose more from both ends! There is no government pension, no paid sick leave, no paid drug plan, nothing. Just $30 per patient. I don't know a single doctor who is encouraging his children to go into medicine. My daughter is in medical school in Ireland and I'm strongly recommending the US for her career.
4
Thank you. That's all news to me. BTW, by moonlight, I meant moonlight as a doctor and serve affluent private patients for cash on the side. That's what some doctors in Costa Rica's public health system do to supplement their incomes.
1
Dr. Wang,
What you describe sounds punishing for the medical profession. However, in the U.S., many doctors have risen to the higher reaches of the society's income levels and choose medicine for that reason. The practice of medicine is a "career", rather than a service to society. Neither the Canadian nor the American systems is a desirable norm for medical professionals.
1
I don't agree with the doctor's reductive analysis, which is more pep talk more than debate. Canadians don't look to US healthcare so much as a boogeyman, but where it works, as a model to emulate, as it does with EVERY OTHER healthcare system in the world. Neither do we have ANY qualms about benchmarking and pointing out weaknesses in each of our MANY systems. Fixing what's broken involves looking at what works : the doctor's own work and words support this view.
Canadians DO get tired of being served up huge helpings of humble pie in every form by industry lobbyists out to make a buck though. Because it's so nearby, that usually means American industry shills and yes, it does get old, and yes we see through them and their domestic proxies. (Yes, Canadians are more well educated than Americans on average, but that's another discussion.)
No system is perfect, but by design some serve populations better than others. The French system certainly has its weaknesses, but it has already saved my life. I'm convinced that would not be the case in Canada (comprehensiveness problem for drugs, treatments & practitioners, &income loss) nor the US (same problem due to affordability). Not sure how the NHS would perform, but I wouldn't pick either Canada nor the US.
For most people as for myself though, where you live is less a choice than a given, so it's more realistic to try to fix what's broken than try to move where it works. And that's my takeaway from the good doctor's pep talk.
3
The practice of medicine in the US is characterized by the cartel of service providers who limit the number of practitioners and indulge in conflict-of-interest services (labs, MRIs,). Individual doctors may live up to the Dr Marcus Welby personification, but the industry as a whole is riddled with self-aggrandizement.
The point is simple. Our politicians and uninformed citizens blame the insurance companies for denial of services that cannot be justified economically or by actuarial standards. Insurance is simply math applied over large numbers. When the numbers don't work, the insurance doesn't work.
The fundamental issue is whether or not universal health care is a human right. Nations like Canada, Japan, and those of Europe believe it is. The US republican party believes otherwise. Just as the republican agit-prop plays the 2nd Amendment game with common sense about guns, it also plays the "death panel" game with healthcare. Too bad for us that so many Americans are that gullible.
7
I don't know anything about wait periods for treatment in Canada. I do know that here in the US my wife has to wait months to see many specialists. I'm not sure where this myth of superior access came from, but it seems largely false in my experience.
7
Superior access in the US is a myth. Have you tried to get a appointment to see you own doctor? For me, it takes about a month. To get an appointment with a doctor that is not your personal doctor takes about 1.5 months.
3
To me, the difference would be that, if you live in a well-populated area with many doctors, you can shop around and see if another specialist has a shorter wait time. I don't think that sort of thing is an option in some universal health care system.
Yes, in New York City, the wait is generally quite short, unless a highly specialized medical expertise is required.
The waiting period for hip-replacement surgery is no better here in the U.S. As an American citizen, covered by Medicare, a dozen years ago I had to wait four months to get on an operating table. No faster than Canada, just more expensive.
7
Hip hip hooray. Let's have a follow up article in this series. The stuff Canada gets right -- why/how does it get it right?
1
"More than two months to see a specialist.....more than four months to have elective surgery"? This is clearly a "downtown Toronto" perspective. Where I practice in Kitchener, a mid-sized city of 300,000, I warn patients to please NOT start calling me back about their specialist appointment until two months have passed, which is the average time to even hear back from them. The wait for hip and knee replacement is 18 months, which is the same wait to see a dermatologist or an allergist (so pray you are not itchy in Kitchener). Dr. Danielle Martin once again glorifies the Socialist Dream, which in reality means that every Canadian qualifies for the same second-rate care at the local Gulag clinic.
3
Canada has a better class of health beneficiaries than the U.S.
The Comments to this article prove the adage that "comparisons are odious."
The author neglected to mention the increase in euthanasia in Canada. Of course, this occurs in the US, as well, but we aren't as honest about it. There have been several cases in Ontario, where the Canadian (or provincial) courts have approved this.
1
As a Canadian, I take exception to the first sentence of this article. Almost nobody in this country is concerned about your health care system. It exists to make the rich richer not to make the sick well. Who wants any part of it, other than the folks who own stocks in your health care companies?
8
The phrase that was used was "negatively fixated." I don't know if you're fixated, but certainly sounds like you're negative about it.
to me outcomes are dependent on funding. the british nhs is grossly underfunded and hence we have these intolerable waitjng lines. canada is on a similar wave length. stick more resources into the system and hey presto the problems mostly disappear. you know it is not really magic. when you get into the better systems(french, german, swiss and dutch) guess what they are better funded.
Here in Maine, a fall caused a Baker's cyst to dissect (knee to toes black and blue and very painful).
It took three months to see my first orthopedist. He was a patronizing, incompetent jerk so I asked for another referral.
Two months later, a second orthopod gave me an appointment for surgery... two months after that.
When the surgery turned out to be futile (arthroscopic scraping when I needed a Total Knee Replacement), I finally had a TKR. Total elapsed time? Ten months.
The other knee also needs a TKR, but first I must see a gastroenterologist to help me cope better with the post-surgery meds this time. "Oh, you haven't been seen here for three years! I have to count you as a brand-new patient. I'm scheduling three months out..."
*After* that 3-month wait I'll phone the orthopod, who told me his wait-time for TKR #2 will be 2 months.
Total time from initial injury and diagnosis of severe bilateral arthritis to the second knee replacement = 19 or 20 months of pain.
I heartily wish I could move to Canada.
5
The provincial plans have some variation in them, but this is what your experience would be if you moved to Ontario. Happily, you wouldn't pay for the doctor, but you would wait about 9 months to see the Ortho for the first time, during which interval you are expected to be doing physio (self-pay). Then you will be seen by the Ortho and his physiotherapist, and they will tell you the risks/benefits of surgery and send you away to think about it, saying "Call when you're ready." (If you said Yes today, it would be another 9 month wait). But if you take longer than 12 months from your initial referral, then it has "expired" and OHIP won't pay the doctor again, so you must go back to your family doctor (or if you are one of the 1 million Ontarians without a doctor, then you go to a walk-in clinic or the ER) and start from scratch. Are you so sure you want to move now?
1
Maybe you should move to New York. I've seen orthopedists in a matter of weeks from the time I requested the appointment. I never needed surgery, but I had x-rays on the same day as my appointment and MRI's soon thereafter.
1
Of course health care should be a right, and that means single payer. The reason I don't see it happening in the US is because it would cut out the insurers, who add nothing of value to actual health care.
6
So how much do prescription drugs cost in Canada's various provinces vs the US? I recall reading that Bernie Sanders once escorted a bus full of American cancer patients across the Vermont border to Canada to get the lower price they could afford on their needed cancer drugs.
What's blocking prescription drugs from being included in Canadian's insurance? Where does the your Prime Minister Trudeau stand on that ?
Is your conservative party as tight with the corporations as our GOP is here?
Americans pay the highest costs for drugs and medical care in the world.
Our system is the most profitable in the world.
Our insurance and drug donate big to our election campaigns. How do Canadians finance their elections? Do Canadians' taxes subsidize high insurance profits like Obamacare does? Or are they regulated like European countries?
Have any of your drug company CEOs been sentenced to prison like here? Just wondering.
I read Canada started universal health care in the 1960s. The US still doesn't have it in 2018. We are behind the rest of the modern world.
Interesting op ed but we need further comparisons.
4
I grew up in the United States and have lived in Canada for many years. It is simple. The Canadian system is designed to provide quality health care for everyone. It's weakness is the lack of coverage of prescription mediation, but those medications are much cheaper than in the US. The American system is designed for the rich, and those who receive high quality insurance through work, clearly a very significant minority. If you are part of that minority than you can often get quicker access to non-emergent treatment. If money is no object, you will have gold quality insurance and surely recieve high quality treatment and wait for less time for knee replacements, hernia surgery etc. If you are part of the vast majority you and your family are permanently at risk of bankruptcy or otherwise preventable death from a serious medical problem. There is a great deal of research to show that the very, very wealthy and their insurance companies have a far, far greater impact on government policy than ordinary people. It is time for the majority to demand that elected officials put their interests first, especially regarding health care. Unfortunately Citizens United has severely damaged the fabric of society by enabling dark money to legally bribe congressmen and women, especilly Republicans, and buy endless ads to con ordinary people.
9
Statistics records show CANADIAN med costs are 70less than the USA as %of gdp,and a commentator advises our mortality is higher and outcomes better than the USA. If correct the numbers speak volumes of success. I had quadruple bypass in CANADA at no cost and mortality rate in CANADA 1% whereas in MINNEAPOLIS, where I sought a second opinion it was 2.5%. And I’m happy to pay a higher tax for universal coverage. Not only is that social justice but results in healthier more productive citizenry. But I admire the USA, I don’t criticize because USA spends ions on defence which lrotectsus and the world
1
I am a Australian/US citizen and have thereby experienced both universal and US style health care. Let's just say this, if I ever have a dire disease, I am gonna make sure I am in Australia. Hands down. Universal healthcare works. Does it has blips that need refining, like is currently the case in Canada and UK? Yes. But still Canada's issue is not majorly chronic. America's is chronic, expensive and against their own national self interests. And the kicker to me is, with such a large population base, any US universal healthcare system would have AMAZING economies of scale. They could actually end up with the greatest system in the world - but instead they are misinformed
.
24
Finally, an article that expresses the crux of the issues with Canadian healthcare "Instead of talking about how to make our system better, we’re talking about how much worse things are in the United States.". Canadians consistently compare our healthcare to the system that is the anomaly in wealthy Western countries- the US Health Care system. Perhaps we as Canadians should set our sights on understanding other similar health care systems that function better. While I appreciate many of the comments regarding emergency care in Canada - has anyone recently attempted to get a family GP in Ontario or Quebec (particularly outside of a major centre)? Not all provincial systems are equal in delivering care. Emergency healthcare is one thing, but long term preventative health care is quite another. Our system is currently not good enough. We must not fear discussions on how to improve our system even if it may risk the quiet, smug, superiority we feel when we compare our health care system to our southern neighbors.
8
Mike,
Things are never good enough but here in Quebec we are seeing incredible changes in the healthcare is managed and the way healthcare providers are
educated and trained and run research facilities . Our major universities like Laval , McGill, Sherbrooke and Universite de Montreal are running their local Health Education and Welfare systems. It is 2018 and complete integration is efficient and practical. Our universities decide everything from how laundry is treated to world class brain research.
The greatest problem is how to stop the political corruption when a party is too long in power.
4
The problem that both nations face is a fiscal one; we cannot afford to, or are not willing to, tax ourselves sufficiently to provide universal care. The alternative for both countries would be to reduce the reimbursement rates but, perhaps not understandably, doctors, hospitals and drug manufacture do not want to appreciably reduce their incomes.
A tax increase with reduced reimbursement rates would work from a fiscal perspective but then both provider and taxpayer would oppose such a solution.
Something or someone has to give so that all may have reasonably minimum care at affordable prices.
Schneiderman,
You are taxing yourselves too much! You are paying much more than anyone else for healthcare and the results are still below average and much of your population is uncovered.
This is a problem of a complete distortion of what government is there for. America is going down the tubes because it has stopped believing in government of the people's ability to know when change is needed.
For most of us or at least from my experience both systems work really well but if you are on the wrong side of the equality gap it may as well be the 1960s.
2
both your ideas would make the situation worse.
reduced reimbursement would decrease the supply of medical providers. for a look at how this works in practice check out the wait times to get physician appointments if you have medicaid insurance. medicaid may work good for emergency care (the most expensive care) but doesn't function well for routine medical care unless you waiting for an appointment in a public clinic.
as far as tax increases many physicians (especially well off ones in the later part of their careers) would decrease work or retire early if faced with a progressive tax system a la Bernie Sanders.
reducing burdens on physicians such as onerous electronic record demands, as well as stopping the malpractice lottery (while still providing care for people who suffer from medical mistakes/errors) would go a long way to increasing the supply of medical care.
1
My wife passed away from cancer in 2012. She was in treatment for 4 -5 months and in hospital for three of those months, the last two weeks in palliative care. The quality of care and consideration shown by the medical professionals was exceptional. There were no delays in diagnosis or treatment. The cost to my family: Zero (apart from donations to palliative care volunteers). If we had been in the US, in all likelihood I would now be bankrupt.
I think for all national medicare systems, perfection is impossible. When people talk about long wait times in Canada for example, this is often true, but most of these people are suffering from non- life threatening symptoms and, in many ways, the wait times serve to reduce the level of spurious complaints.
It is clear that there is a political driven effort in the US to diminish Canadian Health Care. Most Canadians view this as an overt attempt to somehow try and justify the horrendous cost of treatment and drugs south of the border, driven by rapacious medical insurance, pharmaceutical companies and political lobbying. But in the end, only by banishing commercial competition in these areas with a true Medicare for all, will these costs come under control. Crass Capitalism and political payoffs should have no place in the protection of our lives by the state.
11
It's worth noting that Canadian healthcare is severely negligent of mental healthcare. Unlike the U.S., where most insurers, including Medicaid and Medicare, cover outpatient psychotherapy for people who have psychological distress, the Canadian provincial health systems do not. Psychological specialties like child psychology or neuropsychology are non-existent in a lot of areas in Canada. It's always interesting to me when Bernie Sanders, who I generally like, touts the Canadian system at the same time he claims to value mental healthcare, because you won't find much mental health care in many parts of Canada.
3
You should provide data to back up any claim that mental healthcare access, costs, or outcomes are better in the US than in Canada or any other universal healthcare system. Otherwise you raise my suspicion that you work for a private insurance company. Anyone with cursory knowledge of mental healthcare in the US knows that insurance benefits are very hard or impossible to use, that well over half of American psychiatrists don't accept insurance at all because of impossibly low reimbursement rates and bureaucratic barriers to payment, and that a jarring number of people with chronic mental illness have been shunted from mental health systems to correctional facilities because of funding cuts for mental health services.
9
You can not compare Canada with Norway or Germany.
Norway has very high taxation and oil wealth and Germany has a much larger population in a much smaller geographic area.
Yes, Canada can do better but we may never be able to have a best in the world health care system.
3
The advantage of being the only developed country in the world which doesn't ensure universal access to health care is that when we finally do, we get to learn from everyone else's mistakes. I lived in the UK for several years and can say that there are some great things about the NHS, and some things that I believe we could do better. Where's Yankee ingenuity when you need it?
4
In the interest of providing fodder for ALL of my fellow commentators to prove OR disprove ANY point of view, here are some numbers from the World Bank (data.worldbank.org), showing Healthcare expenditures (% of GDP) from 1960 --> 2016 and rates of change. My goal is to show that some countries we ASSUME have tighter controls don't, while others do:
Canada (1960-8.9% of GDP --> 2016-10.4%) %change: 16.9 %
Denmark (8.1% --> 10.8%) change: 33.3 %
Germany (9.4% --> 11.3%) change: 20.2 %
Netherlands(7.4 --> 10.9) change: 47.3 %
U.S. (13.1 --> 17.1) change: 30.5 %
The bottom line: Healthcare, like the economy itself, has its winners and losers. Since I happen to be fortunate enough to have Excellent, mostly Free coverage, I see nothing wrong with spending a lot of money on research (and profits for drug researchers.) Others who are less fortunate may express their disagreement by clicking "Reply."
3
You provided pointless numbers. Thanks?
3
The largest discrepancy between Canadian and American health care is that Canadians want to be sure that everyone is covered. We pay taxes for this right. Not so with the US where it seems that the government, at least the present one, would rather cover only those who can afford insurance. They don't care that others aren't covered. There is a huge difference between self indulgence and being "all about me", vs the Canadian system that includes the other.
14
I don't think health care coverage is high on Trump's priority list, but we do still have Medicaid and Medicare which provide coverage from the government for some who don't otherwise have health insurance.
Another aside, I needed a hip replacement State side, prior to 2014 and Obamacare, my BC/BS said it was pre-existing, when I move from NYS to SC. Had to quit working and wait 8 months for medicaid to pick it up. $56,000. I almost went to India to get it done $11,000 flight and medical visa all in. Or come back to Canada $18,000. You need to be in Canada 3 months for your coverage to kick back in. I have since moved back to Canada mostly because of aging issues, and orthopedic problems. Many Canadians with duel citizen ship or Green cards do just that. Much easier, less stressful to get old in Canada.
16
"Fear of an American-style market-based system inhibits a national conversation about how to expand the breadth of coverage and increase the timeliness of services." That fear is well justified because some Canadian medical professionals would prefer an American-style market-based system that expands the income of doctors and increases the timeliness of their pay checks. For example, several years ago a pro-American orthopaedic surgeon came within a few votes of becoming president of the provincial medical association in British Columbia. He is one of the principals in a lawsuit challenging the limits on private medical care (and private payment for surgery). Many Canadians worry that any process used to reform our public health care system will be used by people like him to create a back door to private for-profit care. Our close cultural connections with the US (including the exchange of health care professionals in both directions across the border) make this fear legitimate.
8
What is wrong with people who can afford to get timely medical care receiving it? Are you worried that someone might get something better than you?
1
If you have a two their system then the ones who can pay are drawing on the same resources that are needed for universal health care.
The major problem with the Canadian system are political interference and corruption.
In Ontario it started with Mike Harris who drastically reduced the number of nurses and doctors just so he could win votes from people who did not understand the impact of his cuts.
It has continued with our current premier who wasted millions of dollars paying outlandish prices to her cronies to build wind farms and solar systems that we did not need and then cut essential services like health.
The other problem in our system is we are paying far too much for administration and for corrupt operations like orange and computer systems that do not work.
2
@Driven
Yours is a typical American response that frets over the possibility that someone might be trying to freeload or, motivated by envy, taking from "hard-working" people what's "rightfully" theirs.
Actually no one is trying to freeload or stop anyone from getting anything out of envy. The concern is that a private system will pull funding and resources from the public system, leaving the public system too weakened to provide care for the millions of poorer and average Canadians who might not be able to afford private coverage. There are arguments in favour of more paid-for care as there are those against it, but those who fear privately paid care will hurt the public system are motivated not by envy or resentment, but primarily by a desire to keep good care available to all.
Many of us who support a public system (including me) are high income earners who pay high taxes and might personally benefit from some aspects of a private system. But much more important to us is to ensure that our Canadian society can provide the best care to the most Canadians. In Canada most of us still believe we're in it together and have a duty to help out our less fortunate neighbours. In America . . . well just look at your divided, angry, and increasingly miserable society. Assuming the worst of your fellow Americans isn't helping, it's dragging you ever deeper into the mire.
6
Anyone looking for a probing insight into the problems with American health care and its “for profit” capacity should read “Crooked” by Kathryn J. Ramin. As I said in an earlier comment, I’ve had 3 discectomies under the Canadian system and, having read her book, can only express my deepest sympathies for those in the States who have generally the same symptoms as mine but who have suffered grievously at the hands of surgeons who have such inducements to over-intervene ($$$) with corresponding frequency of complications.
3
These discussions overlook a fundamental issue. How exactly does one have a "right" to a service that requires the labor of others? Who determines what is fair pay and fair working hours ? Only those who want to pay the least possible for the service? Further, note physicians are not allowed to unionize on the US. How does the call for "universal access" ignore the working rights of MDs? There is a reason foreign physicians come to the states to practice, and a reason the bulk of biomedical innovation is centered in the US, and it isn't price controls.
4
Bernie Sanders has *never* presented a budget for his theories.
Res ipsa.
2
They don't have a right to a service--they just want it that way.
Foreign physicians come to Canada as well. And there is no shortage of Canadians that want to go to our medical schools; admissions are very competitive.
Perhaps the high pay attracts a better calibre of professionals in the United States. But if part of the population doesn't have access to them, what has the US accomplished?
6
There is much political profit in creating bogeymen and then propping them up in a nationwide circus tent to scare the bejeezuz out of the nation's voting citizens. Dr. Martin suggests that "both [Canada and the US] can engage in more meaningful debate about how to fix our systems."
The problem stateside, at any rate, is that a critical mass of political pressure has no interest in fixing anything. It needs monsters under its citizens' beds to generate the fear and loathing on which its political success depends. If we wanted to fix anything, we would have taken Obamacare, strengthened its benefits and fixes its flaws.
As it has happened, however, we have been so incompetent that we can't even get rid of the health care system that politicians take such glee in vilifying. All we can muster up to the spine do is to damage it beyond repair and to let it sputter along ineptly, unable to fulfill its original mission.
5
Try to get a appointment with a specialist in the states. You'll be lucky to get a appointment period, much less wait two months.
10
Depends on your insurance. If you have great a great provider that pays well and the specialists are in network, you go to top of the list. Medicare, medicaid it is as you describe.
This commentary is quite to the point, however, our Canadian system is supply based, the provincial gov. controls the supply, and you have to be pro-active, have a family doc, and know how to get services, way ahead of time. Squeeky wheel gets the grease. Many people are told that they are too young to have a joint replacement, and then as time passes you are too old to have a joint replacement. With limited supply you have to know how to advocate yourself.
3
The heart of the problem in the US is a refusal to accept the nature of insurance: pooled risk. By letting healthy young people opt out of the system -- and letting insurers cherry pick how and who they insure -- we create an unsustainable system that works for nobody. Add in the all the unnecessary treatments that US doctors order up for the insured out of fear of litigation and the challenges here seem much more daunting than anything north of the border.
18
The best healthcare I experienced was when I lived in the UK. It was a two-tiered system where you could choose to go public or private depending on whether you had insurance or the means. This system alleviated the public system and provided better care for all. For example, I was able to get a GP within 2 days, whereas in Quebec you wait more than 2 years to get a GP, if you're lucky.
In my time there I had a medical emergency, although it was not life threatening, it was incredibly painful. After seeing my (public) GP she gave me the option of continuing in the public system - where I would wait up to two weeks to be seen - or use my insurance to go private and be seen the same day. That choice is rarely available in the Canadian system.
As a Canadian I believe healthcare is a right but, I also see that we're blindly holding on to an outdated system based on an 'ideal'. We should be striving to provide better care for all by allowing a parallel private system to exist.
6
We left the US for Europe 20 years ago. The difference in quality of healthcare is nothing less than astonishing:
- you are not harassed for payments before treatment
- even in some cases where we had to pay out of pocket, we were charged AT COST for everything and it still came to pennies compared to what we would have paid in the US,
- people become doctors here because they care about helping others, not because they want to make big bucks,
- emergency procedures are scheduled accordingly. I've waited for non-acute procedures but frankly I don't mind,
- the entire system here isn't permeated by greed and practicioners looking to line their own pickets as in the US.
Would I go back to the for-profit system? NEVER.
14
None of what you listed is related to the quality of healthcare, just money and time. My understanding is that the actual quality of care is inferior to the US where doctors are incentivized and the best rise to the top.
1
Objective metrics of well-being, such as longevity and maternal/infant mortality, don't seem to support your understanding that other countries have worse care than the US.
According to the CIA World Factbook, for instance, the US maternal death rate (2015 estimates) is 14 women per 100,00 births. Canada's rate is half that at 7, while Sweden is just 4.
The Texas death rate (as reported by the Texas Dept of State Health Services) was 32 in 2015, worse than Sri Lanka and Romania.
The US spends a huge chunk of its GDP on healthcare, yet our outcomes are inferior to many other countries.
8
I've lived in both countries, and found the quality of care similar. There are certainly situations where you get less care in Canada (fewer colonoscopies and less prostate screening are examples) but incentives to provide more services don't necessarily lead to better health care.
4
Turf protection, by professional groups and corporations, knows no international boundary, I suppose. I know plenty of Canadian nurses who emigrated to the US for higher wages and more professional opportunity (anesthesia). On the other hand, for many Americans healthcare is simply unavailable because no entity wants to pay for it and providers won't work for free.
4
Actually they're recruited rather vigoursly.
6
I think you are discussing the Detroit/Windsor or Niagara Falls/Buffalo thing where grads. would prefer to live at home and go to work every day without having to move to another major metro area. In both cases the US locales don't
graduate enough folks to take are of their own.
1
I'm not terrified of the Canadian health system; I'm jealous.
26
George, hold the artillery fire.
Martin is a professor of medicine at U. Toronto and a hospital administrator with responsibility for evaluating and improving the system. Every well-managed health care system around the world is committed to identifying its problems and correcting them. She doesn't want to oversell her system, and wants to remind Americans that Canada isn't perfect (if Rob Ford hasn't taught you that). Of course, 99% of Americans wish they had a health care system with Canada's problems.
If you want to read reasonably objective news coverage of the health care system in the New York Times, I suggest you follow Aaron Carroll and Paul Krugman. Austin Frakt is right about half the time, which is pretty good.
Unfortunately, the news media very seldom leaves the Overton Window of covering health care according to the perspectives of the wealthy, powerful interest groups like the "centerist" wing of the Democratic Party and the Republicans. Try to catch Democracy Now or Thom Hartmann on Youtube.
8
Its strange that Americans would want to be the bottom of all happiness and quality of life indices. Good health, wellness, well being of the citizens is the basic indicator of a country's own health. America lags way behind all the developed world. Just because of its stubborn ness, like a kid who throws a tantrum each time someone suggests gently let us get universal health for all. Americans can fool themselves all they want and find excuses of all kinds but the truth is, America is no longer a healthy nation.
11
Its strange that Americans would want to be the bottom of all happiness and quality of life indices.
---
Those European countries you cite: mostly white, and immediately jail "undocumented" immigrants.
Is that what you want? Pity.
4
Bing Ding, what has this got to do with color?
Singapore is not white. Nor is Japan.
Bing Bing ow, your comment is not supported in fact. Look at reputable international statistics or just get out and see the world for yourself because your "alt right" echo chamber doesn't carry over into the real world.
1
Americans are not "terrified" of the Canadian health care system. Many of us are envious of it.
10
I will not deny the problems we have in Canada: doctor shortages, long waiting time and limited ER capacity as SteveRR wrote in his comment. But nobody in Canada has to go bankrupt because of medical bills or to be refused care because he do not have money or insurance to pay for it. In other words I prefer to live with our problems that the one you have in your country. As my family doctor whom is an American and practiced medicine in the USA before moving to Canada told me: "I earn less money in Canada, but it is less stressful to practice medicine in Canada."
11
Free enterprise loving America
As no problem forcing hospital to threat EVERYBODY in an EMERGENCY
But do not care to pay for those unpaid tresments
This being utterly unfair to the hospitals left on the hook (All of them)
And totally anti capitalists and anti free-market
It's (very bad) socialism by decree ! ! !
1
Most hospitals are still tax-exempt (on their income and their property). It isn't unreasonable to expect them to provide emergency care in return for their freedom from taxes.
A certain level of socialism is what makes this country prosperous and a place so many people want to live, despite our problems. How successful do you think this country would be without free schooling that results in an educated workforce? Transportation infrastructure that we all pay for even if we don't use it? Police and fire services?
5
Free schooling? Where do you get free schooling? Nothing is free.
Teachers, police, and fire are bankrupting city after city in the US.
As a licensed MD practicing for 30 years in both the US (Texas) and Canada (Nova Scotia) I see merit and deficiencies in both systems that require attention. Much debate can be had comparing the two systems. My conclusion is both systems utilize nearly the same standards-of-care, medical technology, diagnostics and treatments. The glaring main differences occur in the manner of funding, insurance coverage and payment, and health systems management (bureaucracy).
In Canada, the prioritization of funds allocated among required services often leads to conflict among the physicians and their government funding controllers. Neither yet seriously evaluate value-based outcomes in patients or communities. Little practical or rigorous effort is made to understand - and prioritize paying for - what works best, cheapest, most efficiently. Emphasis remains on seeking more funding for healthcare without really restructuring how the health coverage/payment can incentivize value-based care. We need to pay for what works best - but can't and don't - because we aren't looking rigorously & realistically at value in health outcomes.
In the USA, excessive bureaucracy management costs saddle health systems with myriad impenetrable fee structures negotiated willy-nilly. Likewise, little practical effort occurs to identify & prioritize value-based outcomes in patients and communities.
We must prioritize & incentivize real, practical, rigorous value-based care in both Canada & US healthcare.
15
My work has been in Minnesota and Ontario, and I have drawn the same conclusions. Moreover, I would argue that entrenched interests (different groups in each country) run circles around rational and disinterested proponents of change.
6
The author glosses significant doctor shortages, long waiting times and limited ER capacity. All of these are tracked ans well reported regularly in the Canadian news.
By refusing to recognize a Tragedy of the Commons problem, Canada is simply continuing to make promises its medical system can't deliver.
Yesterday from the CBC - the national broadcaster:
"On the night he nearly died, this man resorted to leaving the ER to call 911 for help - David Doucette was diagnosed with Stage 4 lymphoma hours after fourth attempt to be admitted to Halifax ER"
2
I would like to see guaranteed comprehensive universal coverage with low copays and generous prescription drug coverage than the current American non-system in which we tolerate millions without health insurance and drug prices that have been going through the roof. With its faults and inter-provincial differences, the Canadian system, on balance, is still much fairer and far more successful in fulfilling the social contract than America's.
6
MUCH FAIRER !!!???
The American system is just NOT fair
Not even close, does not try, and is not even sure what "fair" means
1
What social contract? Take care of yourself and your family without intruding on others.
1
Taxes are a social contract too. Just think of taxes as insurance - a national insurance, or state insurance; without a pool of resources (similar to health insurance) how would you ever get roads built? schools built, children educated, water systems built just for yourself...? Think about it. It is a way to spread the load of the cost of our nation-wide infrastructure. It is more civilized.... meaning civil, to share the load amongst the populace. I pay my taxes because I do not want to empty my sewage in the river.
Be grateful that our civic-minded forebears didn't think like YOU! They've done the math and realized nobody can do everything alone.
2
Government spending on healthcare is massive in both countries, but the way monies are spent has created an elaborate system of incentives and disincentives with entrenched beneficiaries and rent-seekers. Insurance companies, big hospital systems, big pharma and the AARP have a vested interest in the current system in the US. In Canada, it is the provincial medical associations and nurses' unions that present immovable obstacles.
Whatever tinkering or systemic remedy is considered to improve access or reduce cost, it must first and foremost identify and engage those that regard change as existential threat.
2
When I grew up in the 1950s and '60s in Los Angeles my family belonged to a group health care plan owned by group of doctors who essentially self-insured by providing ample preventive care and having contracts with local hospitals to cover specialty cases, surgeries, and emergencies. Their incentive was to keep us healthy (lowering their costs) and keeping our family's premiums low (keeping them competitive in the marketplace) and the result was lower costs all around.
Along came the "health" insurance companies who persuaded Congress to outlaw physician-owned health-care groups and that was the beginning of the end of low-cost, affordable insurance in the United States. Canada's health system flaws are well-known (no drug coverage, longer waits for less essential surgeries) but they aren't that bad: my emergency appendectomy was done within hours of my complaint of a mild but inexplicable stomach pain and my hernia operation wait was about five weeks (I don't know if that's considered a long time or not).
In years my income was lower my monthly premium ($70 or so) was waived and when you turn 65 it gets cut in half. Each province has its own systems and in my case the agency is run by govt appointees but is not 'government run'.
Three words explain the difference between Canada's provincially-run and the American health system: profit, profit, and profit.
16
No drug insurance in Canada? I only have to pay $6 for prescriptions, to cover the filling of the prescription by the drug store, not the drug itself.
"Hospitals account for 28.3 per cent of health-care spending in Canada, at a per capita cost of $1,871 per Canadian. Drugs cost $1,086 per Canadian when averaged across the population, making up 16.4 per cent of total health costs. Physician costs round out the top three spending drivers, at 15.4 per cent per Canadian, or $1,014 per person. "
CBC news.
It only took a few seconds for me to find this....
may as well get it right, eh??
1
healthcare will never be perfect, because there is so much we can now technologically do and not enough money to pay for it. Americans who disparage canada's health system ( a smaller and smaller group each year i suspect) are foolish if they don't believe that there are waits for specialists and elective surgery. its just that they are not always the ones that have to wait. And certainly those that complain about canada have never been bankrupted over medical care, never had to choose between medical care and rent or food.
obviously, the perfect health care system is one in which I have all kinds of medical care just waiting for me in case i need it. short of that, complaints listed about both systems are likely to continue.
2
I have a mathematical question
Let's say you have a one year wait for hip surgery
.... going back ? 20 years
Are you not operating the same number of hips
Whilst maintaining the existing "ONE YEAR WAIT" ??? (20 years +)
Really how much money and how permanent would it be
Of knocking 9 months on this never ending waiting list ?
However hard it might be to reform Canadian healthcare it has to be a lot easier than reforming American healthcare. Canada is at least somewhere close to the right track. United States is nowhere near it.
14
First, it is important to state that, unless the US health care system, the Canadian system is not at the verge of a complete collapse, or desperately needing reforms. Yes, there are always room for improvement, but I believe it is misleading to say it is hard to introduce reforms into Canadian system. And yes, getting all provinces on board to approve a change is not easy. But that has been done in the past and will be done in the future, "The canadian way." The complications, if any, come from outside, thanks to constant undermining of the Canadian health care system by US Insurance and Pharma companies.
The same way that during the cold war all US administrations were horrified to see a prosperous, successful socialist country anywhere on the globe, these companies are petrified to see a successful socialized health care system next door. As we have seen in previous elections, US public always wants to know why the US can't have a healthcare system similar to that of Canada. The politicians facing that question normally undergo many twist and turn to come up with a remotely plausible answer. Typically, their answers can be translated into one sentence: we want the Market govern the US health care system. That is another way of saying that the Insurance and Pharma companies have become too strong for the US government to impose any restrictions on how much money they can make off the US public.
9
Given the disparity in economic opportunities for most Canadians compared to Americans, the least that Canadians ought to have is some free health insurance for most of their immediate health needs. If Americans had the kind of high Canadian unemployment in some of its eastern and northern provinces, coupled with fuel costs and taxes beyond anything like Americans would pay, we, too, would demand their national health insurance for most of our immediate health needs.
But in either country medical demands always exceed the curve of health provision, whether under national health insurance or ours. The question for both countries is this: which country provides the most accessible health services for the population most acutely in need of it, either under our mixed care insurance and pay-for-service or under Canada’s? Canada does not offer free national health insurance for a number of health needs, dental, vision, eye and podiatry. But hospital emergency treatment is free. Finding a physician for regular exams is not easy. On the other hand, most single people under 25 could not afford to pay for most Canadian emergency or medical disabilities. And unemployed single people under 25 could not pay for even routine medical exam services.
Americans have been fortunate to afford the medical care most of us receive for most of the healthiest years of our lives. Our economic opportunities, even as we seek to perfect our system, is what attracts medical tourists from Canada.
1
My Goodness, you make Canada sound down right 3rd world countryish. And what on earth are medical tourists that seem to be pouring over the border? And, what is a "northern province?" I leave in the province of Ontario. There isn't another province north of us. If you are going to speak so knowingly of Canada's high unemployment and low wages, at least have the decency to get your facts straight.
16
Amen Ref! There is a significant lack of knowledge of Canada on display there.
7
Ref: ask some of the young people in and around the Canadian side of the Great Lakes, say Toronto, or Hamilton, whether the cost of pharmacy prescriptions and other health related purchases are covered under the National medical insurance. Ditto for youth in Nova Scotia, New Brunswick and British Columbia. A large number of Canadians disliked Donald Trump’s administration at first because they believed that he was going to a) tighten visa restrictions for snowbirds and their V1-B visa holders at the border; and b) that he was going to really impose stiff tarriffs on Canadian exports here. What a relief it must have been there that he did not. Nor that he had no plans to build a wall along the US-Canadian border.
Argue therefore as you will that those assertions are not true, but they are supported by the lines of Canadian shoppers from Toronto and elsewhere crossing our border each day for less expensive gas, liquor, cigarettes and groceries than in Canada. Some also come across the border for hip replacements and treatment of other health problems.
This opinion is truly an oxymoron, how to compare tweaks to an existing well run National health care to none. If Obamacare could even possibly survive the onslaught of dismantling is totally unknown. In reality, the United States had a good beginning. Canada has a much better functioning health care system that requires some review and updating.
5
"What’s different is that in Canada, doctors and hospitals have a high degree of autonomy..."
Translation: "Get down, doc, they're coming for you." The Govt. vs. AMA; this I would PAY to see.
1
I am afraid that you will be disappointed. There are ongoing discussions between provincial governments and the provincial medical associations about what is to be funded, how much funding should be directed toward particular issues, how best to deal with particular issues and so on. Very little excitement, some positive results.
2
AMA, of course, stands for AMERICAN Medical Association. Canadian doctors have the option of moving to America, which some of them (we can argue over the numbers) take. Few American doctors seem interested in the reverse trip.
The most important aspect of our health care system versus those of Canada, Great Britain, France, Germany, Switzerland, Spain, Italy, Israel, etal, is that bankruptcy, foreclosure, the wiping out of family life savings and then death are an inherent part of our present day system. How so many Americans can blindly overlook this integral and disastrous part of our system, is beyond words, and beyond me. Who knew that so many Americans actually believed that health care is a human privilege, against the backdrop of gun ownership being a human right? For this to distinguish us amongst other civilized nations is sad, indeed.
12
they dont think it is a privilege, they just dont understand how close they are to insolvency and no care unless it has happened to them or someone they love.THEN they understand.
6
Health care is not a right as you are asking someone else to help you. You have no right to the time, education, or money of another.
1
Well, we do have a right to life, liberty and the pursuit of happiness. I do not see any way an individual can have any of these three without access to medical care when needed. Indeed, adequate medical care is necessary to citizens in order to maintain life, liberty and the pursuit of happiness. Understand?
1
I think the best course of action for Canadian health care (or anything, really) is to ignore what Americans are thinking and doing. Maybe a small daily synopsis of the madness down south. Support and defend institutions of your own democracy. Protect fact from propaganda. Then do your own thing.
8
You sound very sane, dear Kate in Georgia!
Truthfully it would be extremely difficult to try to ignore you! But such a kind thought.
The daily shouting and screaming, finger pointing and lying are crowding out common sense, and honestly, I don't think it so common any more.
I’ve been involved in medicine & healthcare, Now in retirement the geriatric patient with multiple concerns towards life’s end. $53 billion spent annually on Healthcare in Ontario, with initiatives like the Universal Patient Record, $1.2 billion which could have measured trends (disease) and outcomes (ROI) failed. 5 month wait CV spine MRI 4:00 AM. “Severe degenerative disc disease”, attending neurologist relocates refers to a neuro surgeon. Phone, “I haven’t got time for you, I’ll call you back”, never does. Phone again, long recorded message, leave message, never hear. Toronto’s worst Winter storm in history, stay overnight at a hotel for first-up surgery, at 4:00 PM still in my patient OR gown. Witness a patient from out of town, hotel stay and travel, told that their surgery will not proceed, overtime not permitted (cost cutting). Those shiny new tall buildings on University & College are not changing the internal short comings. Ontario’s Healthcare needs re-engineering, it is fragmented. I’d look at incorporated consolidation, institute QMP (Quality Management Process) leading to ISO certification. I’d put a Call Center in the institute I’ve been describing and get rid of all those individual answering machines. The agent taking the patient call would own it to timely resolution. There is a synergistic effect to bring together Engineering and Medicine. On that CVS, I have restriction and pain, eating, shaving, brushing my teeth, but I’m lost in the shuffle.
3
Canadians are stupid thinking they have anything close to a decent system. The system is the worst amongst rich nations in terms of access and cost. They are obsessed comparing with the American system as they are obsessed with everything American. Reality is some systems in Europe are universal and are so much better in every aspect than the Canadian system. Examples: Dutch and Swiss systems.
3
You can not compare very small but well off countries with a country like Canada that is is larger geographically than the USA but has the population of California.
What terrifies Canadians far more than the U.S. healthcare system is the U.S. President. His selection of John Bolton for National Security Advisor says it all.
U.S. healthcare? Not so much.
3
Well I have to say that two to four months for a hip replacement. My good friend, now deceased, had to wait so long he ended up dead, from the pain through self medication. Two years, and still no appointment.
I lived in Sweden in 1973-1974, what an eye opener. Certain elective plastic surgeries could take two years, but all other treatments were weeks or two months at most for things like hip replacement.
90% or more of US citizens could be bankrupted by cancer, etc., says something is wrong with our system in the US.
That paragon of Europe, Germany, has national health, what is wrong with the US.
us army 1969-1971/california jd
6
Was your hip replacement done through the VA?
The story is fair, clarification on at least one point about wait times. The averages given seem fine, but in fact are just that, averages. In areas where retirees are numerous in growing communities, wait times for them, at a critical time of need in their lives, are much, much longer. Six to 10 months for example is NOT unusual for a hip replacement. Seniors have less time left, and that time should not be spent in pain and lack of mobility and autonomy. This reflects the lack of awareness of the problems of the aged, physical and mental. It also reflects a possible lack of empathy for them. It may also reflect even subconscious tendencies on the part of medical personnel to put aged people "second" in their personal priorities. One cardiologist for example told my 90 year old friend that he was "lucky" ! the inference being of course that he should not be seeking major treatment to prolong his life.............
1
As a recipient of our Canadian health care system’s intervention for three herniated discs (with associated leg function impairment), I have absolutely no complaints. I did not get trotted in to a specialist’s office until I had undergone “conservative” treatment and found it to be unproductive. If there had been no waiting period, I expect I may have entered a system where “back pain = MRI = discovery of herniated discs (seemingly ubiquitous in our sedentary population) = surgical intervention” and, if there were a sufficient number of surgeons to handle the entire population of folk with back problems, don’t they need a constant stream of patients needing their highly-skilled intervention to justify (and pay for) their existence? Whoever suggests “no waiting” is a sustainable health care model is entirely unrealistic.
3
In America too many of us don't bother to go for the care we need until it's too late. That doesn't seem to be a problem in countries with universal coverage. And while specialized care may be harder to get in Canada, in America it's care that's difficult to get. More and more of the "health" insurance plans offered have high premiums, high deductibles, high co-pays, and narrow networks coupled with a great many loopholes so that payment can be shifted to the patient.
Canada has a health care system. America has a wealth care system. That makes all the difference in the world. The other difference is that in America our politicians have no real skin in the game. They are courted and funded by the companies they are supposed to regulate. Those interests matter more than the needs of American patients. Therefore we have a system that doesn't serve us. It serves the wealthy corporations, their CEOs, and those rich enough to afford the care they need.
12
With all due respect, as a family doc in the USA I have been morally and politically committed to a public policy of universal health services for 50 years and long admired Canada's accomplishments. Nonetheless, last Christmas while visiting Vancouver, BC I was admitted to hospital with massive GI bleeding. I went into shock and almost died as it was 19 hours before my admitting physician showed up. Even though I protested my deteriorating condition, I was so ignored by all the staff that I felt I was in a concentration camp! I made a detailed complaint to the local health authority and have yet to get any response. In the abstract ideals, morals, and epidemiological data are well and good, but in the particular, care and caring may need to be augmented by monetary incentives.
8
Like your experience doesn't happen here in the US everyday. People routinely die in ER waiting rooms, for example.
Why? No profit in fully staffed humanitarian health care, run by corporation whose only goal is maximizing profits.
I would just as soon take my chances with government run facilities.
us army 1969-1971/california jd
us army
us army 1969-1971/california jd
2
You don't say whether you are talking about being in Emergency or admitted to a ward unit. As a retired Nursing Supervisor who has worked in several hospitals across Canada, I can say unreservedly that had you been in Emergency, you would never, ever have waited 19 hrs. If you were admitted into a unit hospital bed, 19 hrs is less than one day for your Dr. to visit you. Going into shock simply means your BP lowered & since you're still with us, I guess that intervention occurred.
6
I like the article, but as a Canadian, one controversial issue (here in Canada) not addressed is that unlike most European countries we have a one tier system. IT IS ILLEGAL TO PROVIDE PRIVATE PAID HEALTH CARE IN CANADA. I believe there should be a robust debate in this country of having a 2 tier health care system in Canada along the lines of the systems in Finland or Sweden. On the plus side, people who can afford it will take a load off the ever rising cost of health care. On the negative side, the minority of people who would rely on a public system won't have the political clout to ensure the quality of the public system is maintained.
Unfortunately, because of the reasons outlined in this article, debate of 2 tier health care is anathema in Canada.
5
Having to wait a few months for appointments with specialists or surgeries doesn't seem to be a big problem to me. I'm currently waiting a month to get an appointment with a specialist I need to see so no, America isn't automatically treated to immediate visits with needed care givers. America's system may have a lot of high quality providers but after a certain amount of success many providers kick insurance to the curb meaning you can only see the best if you're rich. That's a travesty. Also we still fail to insure tens of millions of people at all and many of those who are technically insured lack access to the best doctors because their insurance coverage is substandard. The fact that I even have to consider insurance panels in which doctors I can and can't see (again, unless I'm willing to pay a higher non-negotiated price) and also whether or not my insurance is going to pre-approve me, discourages me from getting care that is needed or at least to delay it while my problems get worse. American health care is a dumpster fire unless you're rich.
6
The author says: "More than a third of Canadians wait more than two months to see a specialist, and 18 percent of Canadians wait at least four months for elective surgery." This is not too much different from the situation in the U.S. where health insurer tactics include delays, denials and refusals.
Here is my summary of the situation....... I have yet to meet and talk with a Canadian who would trade their health care system for ours---- and that includes Canadian doctors.
We need to ask why Americans pay 18% of GDP for health care while all other OECD countries (with universal coverage) pay an average of 11%. If we only paid 11% GDP for health care and had universal coverage the savings would amount to nearly $1 Trillion annually!
33
"More than a third of Canadians wait more than two months to see a specialist." This is also common here. I am on Medicare, with an Anthem Blue Cross supplement. I have to wait two months to see a cardiologist, because there are too few of them, and they only work 3-4 days a week. I'd gladly take the Canadian system, which Medicare is similar even if I have to wait a bit for care, and as you say, in my European countries not only is the health care system better than in the U.S. the waits for care are shorter. Our Republican lead government has made it clear they do not care for anyone but the 1%. That's the problem in the U.S.
11
Medicare is almost identical to Canadian single payer, so obviously that's why waits are longer -- doctors don't want Medicare patients because they get such low reimbursements for them.
1
There's no question that both countries have issues that urgently need addressing in their health care systems - if the American one can actually be called a "system". The non-partisan Commonwealth Fund's latest comparison of health care systems in 11 developed countries based on a number of metrics places Canada 9th in overall effectiveness. But, of course, America even with the real improvements in coverage from the Affordable Care Act is placed 11th. It really is all a matter of degree. Canada's system is undoubtedly flawed but ours is a veritable disaster and no amount of right-wing Fox generated propaganda can conceal that simple fact.
Interestingly the highest ranked health system was the United Kingdom's, another one that is government run and with universal care. The Fund found that the UK spent less than half per person on health care ($4094 compared to $9364 in the US) with superior overall performance, even after years of austerity imposed by a Conservative government.
7
You would be wise to Google BBC NHS news to see how well the UK is doing. Not.
1
Dental, drug and optical is not covered in Canada hence the "low" score vs Europe.
2
The best way to gauge how well a system is doing to to ask a democratic people to select thru elections to have a "socialized" medical program removed. Both in Canada and the US that will never happen. Medicare for all its problems is still very popular for the elderly here in the US and the medical program in Canada is dearly loved (with all its issues) by Canadians. Working to make each system perfect is the goal but removing it, is out of consideration. As an American with many relatives in Canada I wish we had something similar to what they have in Canada.
6
What is the reason for this article? Canada provides health care for all, we do not. Any system can be improved, and should be, but this again looks like a swipe at Canada. We would do well to achieve what Canada has done. Again, your point in this? We have an administration that could care less about anything but the 1%. Write about that.
6
Canada’s health system, like its economic opportunities and government jobs, including union ones, discriminate against its native tribal communities in nearly every respect. Please note that endorsers of the Canadian health care system here (including author Danielle Martin) go quiet vague when they mention almost sotte voce style the lapses in the national health insurance regarding natives and immigrants. Why the absence of specific native health shortfalls?
Well, they would have to start with the historical European settler confiscation of nearly every government power for tribal economic sufficiency, starting with control of tribal property, of tribal mineral resources, fisheries, tourism, marine, border security, law enforcement, judiciary, education and health services. Most importantly, there would have to be tribal control of taxation of tribal members.
None of those so-called “portfolios” in any Canadian government are available to native tribes for self-development as “sovereign” nations, individually or severally in a national confederation. It’s an insult that Franco-Anglo Canadians admit that native tribes share with them the official status as “First Nations” in the country’s creation, (how else, given the history, could they not?) but natives share none of the real governmental powers of the immigre French speakers in Quebec or the English in the rest of Canada. The result is that even the so-called tribal province of Inuit is a dependent ward.
4
There is no province called Inuit. Are you perhaps thinking of Nunavut?
More false equivalencies.
Are we patently unable to have a genuine conversation about anything?
The Canadian health care system is so much better than ours.
Not going bankrupt because a family member gets sick is the 1st, best thing Canada offers followed by the fact that all Canadians have health care.
Those 2 facts along set it on a level high above the USA system.
15
I live in the US and I have health care. Good health care. Where do you live?
1
Who are you kidding?
As an American citizen, I transferred to our Toronto office for eight excellent years in every respect. I lived in Oakville where I suffered a heart attack and received an outstanding level of care at OT Hospital.
I'm retired, 70 years old now and live in greater Hartford. I was just referred to a arthritis specialist and the first appointment I could get is a full five months into the future. Who is kidding whom?
Friends and family in Ontario and Quebec continue to receive far better care and support than do the same here in Connecticut and elsewhere. Simply, it is in favor (favour) of far too many in the USA to spread outright lies about the quality of care practiced under the Canadian system.
43
It certainly wasn’t by choice, but I’ve thoroughly tested the Canadian health-care system. American by birth, I’ve lived in Canada for roughly half of my 65 years, during which I’ve been treated three times for lymphoma, undergone two bowel resections and been managed for congestive heart failure. Have there been frustrating delays? Occasionally. But mostly the treatment has been timely and always it’s been first-rate. And all this without the additional worry of how to pay for it. Everything – including sophisticated procedures such as a stem-cell transplant – has been covered.
It’s really no contest: I’ve experienced both the American and Canadian health-care systems and the latter is infinitely superior. Analysts point to higher life expectancy at a lower cost under Canada’s single-payer system – but patients just know they can focus on their illness, not their wallets. I regularly see an oncologist and cardiologist, both attentive and talented. I’m on IV nutrition because of radiation-induced problems with my esophagus and intestines, getting nightly visits from a home-health nurse. I’ve been provided with a cellphone, scale and blood-pressure cuff that allows a hospital cardio team to monitor me remotely through Bluetooth technology. I don’t pay a dime for any of this.
To American politicians intent on denigrating the Canadian system, I can only say this: You are clueless, or dishonest, or both. I’ve lived it. I owe my life to it.
66
We Canadians can't help but be terrified of American healthcare, I am sure Americans can get the best healthcare in the world...if they are billionaires.
8 years ago I had a minor heart attack. I was able to make my own way to the hospital ER. The triage nurse took my blood pressure and care came very quickly after that, a week spent in the Ottawa Heart Institute, a renowned institution, and several months of twice-weekly rehab at the same place. Regular follow-up appointments. And I never had to touch my wallet once, I never had to fill out or sign any forms or papers, never had to make phone calls to insurance companies etc. My out-of-pocket expenses for this whole ordeal was $0. Whether I was employed or not, or had credit or money in the bank was a moot point. I was lucky that I live in our capital city with easy access to first rate medical care, someone in Northern Ontario would have had a slower time getting the same level of care, but would still get it.
I am confident most Americans would love this.
We DO have higher taxes, and a very large proportion of our taxes goes to healthcare. Sometimes, taxes are worth paying.
74
Although greatly over-hyped and exaggerated in right-wing media in the US, it is a fact that Canada does have an escape valve when it's system fails to deliver - and that is Canadians coming down to the US to have non-emergency procedures done when the wait for in Canada is unbearable. And this is often if not primarily done at provincial expense.
4
Daoud, I work for an international company. Not counting sales and property taxes, my Canadian colleagues pay 3.5% more in total taxes than I do. After I take out my share of health insurance premiums, the difference is even less. For that 3.5%, universal health care would be well worth it.
5
Canada's health system may have problems, as does England's, but both provide health care for all, with outcomes at least as good if not better than in the U.S. That alone makes them superior to our "system."
Yes we need more (honest) dialog, but the tragedy in the U.S. is the reliance on a market-driven, for-profit model. Until we agree on there's a universal right for health care, we will never create a fair and decent system.
And the obstacle to universal health care, as to so many things, is the Republican party and their wealthy donors. And the willingness of a sizable part of the country to vote for them, against their own interests.
15
Only two months to see a specialist? Where do I sign up? I have decent health insurance and live in a city with a medical school. This week I called for an otolaryngology appointment for a non-emergency condition and was offered an appointment in July. Three to four months wait to see a dermatologist to check on a couple of questionable spots....weeks to see a primary care physician if you are a new patient. Hip replacements might be quicker here (they are much more profitable than skin spots), but folks who might need one know for years that the day is coming, and a couple of months to get on the schedule is not actually unreasonable.
13
When I was a child growing up in the U.S., we almost lost our house to pay for my father's heart surgery. The terrible burden of financial ruin on top of the dealing with a life threatening illness is a nightmare unknown to Canadians. My elderly mother, still in the U.S., was sent home by ambulance after hip surgery since the rehab part is not profitable to the hospital, so we have to take care of her privately. I also paid for decent palliative care for a cousin in the U.S., telling my grief stricken relatives that I was using the money that the Canadian system saves for me. I am happy to grow old here with the Canadian medical system despite any flaws is much more humane.
18
I recently broke my arm and leg while vacationing in P.E.I. The service I received from the Canadian health care system was different than I would have gotten in Maryland, it cost one helluva lot less and the orthopedist used surgical procedures not seen in MD in 40 years. I mended just fine.
I have used socialized medicine in Canada, Great Britain, France, Germany, Australia and New Zealand - all of them work so much better than anything we've got going in this country I am ashamed to be an american.
47
Having lived in both Canada and US over the last 50 years, I find both systems worthless.
In Canada, its top 1/3 crop of Doctors, Engineers, Businessmen head for the lucrative US market, leaving the riff-raff behind. Misdiagnosis is common (no place or time for plethora of personal examples). The current joke in Greater Toronto Area is the for quick, competent, and cheap medical advice, call a taxi as most highly qualified immigrant doctors are prevented by the guild to join the system, and end up driving cabs.
In America, medical care is excellent, but be prepared to bankrupt yourself.
A 4000 years old Egyptian hieroglyphic wisely says - "one fourth of what you eat goes to feed you, the rest to feed your doctor". Good advice then, good advice now. The best healthcare is prevention. Over the years, by changing lifestyle, I have learnt not to fall sick. Both systems can go to hell.
4
Fact check:
Less than 0.5% of Canadian doctors leave for the US, according to the latest statistics.
This is according to Aaron Carroll, who now writes for the NYT and was then writing for the Washington Post https://www.washingtonpost.com/blogs/wonkblog/post/meme-busting-doctors-... Meme-busting: Doctors are all leaving Canada to practice in the U.S. Canadian doctors actually get paid pretty well https://www.theglobeandmail.com/life/health-and-fitness/health/how-much-...
Carroll also wrote the article, "Phantoms in the Snow," which debunked the false claim that Canadians are coming to the US for health care.
6
You are kidding yourself if you don't think misdiagnosis is common in the US. It is such common problem that the medical industry has made it almost impossible to sued for damages.
us army 1969-1971/california jd
4
Yes, you are right about US misdiagnosis. Bit it is kept in check in the US with malpractice suits and insurance, an impossibility in Canada.
Buyer beware. You pay nothing, you get nothing. Both the systems are inefficient, not giving value for your money.
Three years ago, my 40 years old son started non feeling well in the morning, He went to a doctor who sent him to the hospital. After tests during the evening, he was operated on à 2 .00 AM.
He spent one week in intensive care and another in a regural hospital bed. How much did it cost him? Zero cent.
Not such a bad system after all.
12
http://independentbloggersalliance.blogspot.ca/2009/11/americans-filchin... and the same conclusion this experiences may draw. So may busloads of pharmatourists where showing up at border towns they voided/drained local pharmacy inventories that Ontario now forbids the filling of foreign scripts. Nor will they now correct the problems arising from treatment Stateside where wonder, immediate cures can been seen on TV out of the US. Provinces have their own systems but the actual systems are privately managed though universally subscribed. The concept of elective/cosmetic surgery care vs..needed must not be confused in an overview of the two systems.
Healtcare in this modern age of medicine is a human right, but Canada and the US have different logistic issues and political systems. The delivery of universal healthcare will reflect that. So US people, don't fear that your love of choice and individuality will be reduced. You will develop an access for all system that works for the United States.
As an example of how the two systems work in their own way and can be adapted to work in each country - I have been treated in both countries. The emergency care system in the US for non-life threatening injuries is excellent. The clinics are cost effective, fast, accessible (at least in Baltimore area) and keep people out of emergency (chronic problem in Canada).
Canada could adopt such a system addressing the problem of over use of the emergency care in hospitals.
But I had excellent, fast, free care for a more serious medical issue in Canada. There is nothing more relieving than not worrying about paying the bill when you have no choice but to seek medical help. The hospital care was no different than what I see in the Baltimore area hospitals.
My cousin was vacationing in Ontario and had a heart attack. He left the hospital with a stent and a bill for $3000. The hospital discharge nurse said here is the bill but we really don't expect you to pay it (apparently not many Americans do).
The US doesn't have to lose good care just because it shows compassion for all its citizens.
4
When my son was around one year old, he needed to see a pediatric gastroenterologist in Chicago metro area. The wait time was six months, half of his life at the time.
Why all the cherry-picked statistics comparing the United States and Canadian systems?
11
The US health care system is a mess. The biggest single difference between the US and Canada and the other OECD countries is that we simply pay more per service on and unit basis than anyone else in the world. Plain and simple.
Hospitals have almost no incentive to become more efficient. Physicians make more in the US than other countries often by huge amounts particularly for specialists.
Hospital markets have consolidated both vertically (owning physicians, their own health plans and freestanding outpatient facilities) and horizontally (merging of multiple hospitals into huge systems) without the presumed benefits of this activity not being realized (e.g. more efficiency).
Everybody blames the insurers - who deserve some of it for sure - but how does an insurer go up against the only academic medical center in town? There is no alternative. The hospital has all the leverage.
And these "non-profit" hospitals are raking in the cash and behave no differently than their for profit peers.
But even the thought of the federal and state governments, insurers, and providers banding together to address this problem would be considered anathema. Why? It is all about the money folks, it always is.
12
In Canada who decides what doctors can charge? Are all doctors paid the same amount by the state for the same examination/procedure? Does experience or location factor into the fees? Does the Canadian government decide where doctors can practice, distributing them where they are needed? Americans wonder the answers to these an questions, and how they might apply to a 'single-payer' medical system here.
4
Donna:
1) Fees for various medical services are set by the provincial health plan. So doctors charge the same fees for service - they bill the provincial plan not the patient. The fees may be different province by province.
2) No, I don't believe experience or location are a factor.
3) To my knowledge the doctor can practice anywhere in the province from which they graduated. If they change province they have to pass that provinces medical board exams. Because 80% of Canada's population is within 50 miles of the US border (in the south of Canada), provincial governments have a hard time recruiting/convincing doctors who want to practice in Toronto or Vancouver to go to a remote northern community. Northern communities, especially aboriginal communities are under-served and often patients have to be flown south to bigger facilities at high cost to the province. I hope this helps.
4
The provincial ministries of health typically set a list of covered procedures and the fee paid to the doctor/medical practice. (sex change, yes; eye exam, no) Delivering a baby pay very little so many OBGYN's will serve patients in the day but remain off-call after office hours.
There are often billing caps so a physician can be only paid a specific amount by the ministry each year (Bad press to have physicians getting paid huge bucks)- a friend who is a surgeon would cap out billing by the end of May if he undertook a full weekly schedule.
Physicians are encouraged to establish practices in areas that are under served, often with financial incentives. Without a practice partner, they often burn out after working without relief.
One of the great challenges in Canadian health care is primary service. After 5-7 years of university (undergrad then med school) a physician will opt for a 1-2 year of specialization and thereby multiply their potential income above that of general practitioner.
The key of the Canadian system is that everyone with acute conditions gets immediate and equitable attention. Feeling "off" is not a potential life-and-death decision based on an ability to pay to get yourself assessed. Many Canadians are enraged by the seemingly endless stories of lingering deaths in America because a timely visit to a medical office could not be afforded by the working poor.
8
Thanks for the information regarding Canada's health system. It would be great for US health care consumers (all of us) if doctor fees were set by the government, along with hospital costs, and those were freely available. Then we would know costs before we use the service. Even with a insurance (I have Heatlhcare.gov) it is a crapshoot as to .
1
Canadian health care is socialized medicine, plain and simple, which has its pluses and minuses. It has its defenders and detractors, just as the US healthcare system does, but it is free. Both systems could benefit from more flexibility. The road to improvement in Canada is to increase the role of private healthcare providers, the road to improvement in the US is to increase the role of the public sector.
Plus healthcare should not be free in Canada, and in the US it should be less expensive. In Canada, I would include drugs in the public healthcare system, and every physician visit and every prescription filled would be subject to a flat fee, say $25. The rest of the cost would be covered out of general tax revenues. People living in poverty would be assisted with their fees. The government would control costs, including drug costs. Any service which could be supplied by private providers at equal or better cost would be.
2
Health care in Canada is not "free," as you would have it. Canadians pay for it with their taxes.
The Canadian system is not perfect, but it's much better than the American way. And I don't believe that health care or education are well served by profit-seeking companies.
18
Of course nothing is "free". there is always a cost which someone must pay, even if it is by foregoing compensation that could have been charged, and of course taxes pay for healthcare, in Canada, but for medical services there is basically no charge, except for parking your car at the healthcare facility, and for persons over 65 there is no charge for drugs, regardless of the number of visits/prescriptions.
As for whether the Canadian or US system is better, that depends. For those who have full access to the US healthcare system, there is no better healthcare system in the world. If one was facing what could be a serious medical condition and was given the choice of anywhere in the world to go to deal with it, at no cost, the US would be at the top of the list - the speed, the skill levels, the technology and facilities are all tghe best.. If the factor of cost is introduced, the decision may well change depending on the individual. Wealthy Canadians facing major medical challenges go the the US for treatment and procedures.
3
I am a Canadian living in Toronto who has had the misfortune to need our health care system frequently since being diagnosed with Mixed Connective Tissue Disease 30 years ago. My disease was tricky to diagnosis and during that period I was poked and prodded and tested and tried...urgently and frequently. Access was no problem. In fact I was frequently asking them to slow down as I tried to balance my new situation with my busy life. Now quiet, its most devastating consequence was the death of both my hips with my left one needing replacement and, 15 years later, a revision. I was on a wait list for both surgeries and was very fine with that. I needed the time. Fellow hip sufferers I talked with often had the same feeling. It continually surprises me that it is the Hip Replacement wait time that is being trotted out as evidence of a failing in our system. Hip replacement is frequently required as the creeping result of arthritis or a vascular necrosis (my issue), or some other form of degradation. This means doctors and patients see it coming, often months/years ahead. I have talked to many as they struggled with the decision of when to have it, if to have it, and they are rarely chomping at the bit to get it done quickly. There are, of course, more dramatic examples, e.g. the elderly with a break, but they can, and do, rightly jump the wait list and those of us with the creeping variety just wish them well. Time to pick a better example for the problems with our system.
18
The single biggest problem I see with the US healthcare system is that we actually have two systems: One is socialized medicine for the elderly (Medicare), poor (medicaid), and veterans. The other is privatized medicine for everyone else. Unfortunately, these two systems are working against each other. Privatized medicine has to subsidize socialized medicine through higher costs and/or taxes, while socialized medicine suffers because of mandated prices for treatments, which causes doctors to prefer patients with private insurance. The solution is to move to one form or other (preferably single payer socialized medicine) and scrapping this mess we currently have. Or, possibly a more slimmed-down hybrid healthcare system like in Singapore. The current system here in the US is not sustainable.
5
Reading too many American newspapers perhaps but I also wondered how good the Canadian system was.Then before Christmas a friend arrived in Budapest from Canada.Aged 71 he had been born in Canada,lived there for six months before his Hungarian/Australian parents moved on to other countries..he returned to Canada when his mother died in 2009. He had recently developed Prostate problems and been hospitalised with operations over Christmas.
Returned to Canada he was taken straight to hospital had more operations and then removed to aspecial hotel where he was to recover before deciding on further treatment including a possible kidney transplant...all this costing nothing.His treatment so far has lasted about two months and is still continuing.He hasnever worked in Canada or paid any kind of income tax. His financial resources are limited.He does have adistant relative who is well known in the world of culture It is remarkable what the Canadian ealth system has provided for this person compared with the viciouness of the backward primitive American ^system^
My only doubts are how are the indigenous and really poor sections of society are treated. These are really the ones who need free healthcare the most.
Its interesting the writer makes no real mention of this never explaining is the ^expansion^ is to be free and government funded but leaves it open. It must of course be free..otherwise well done Canada .America is a medical gangster nation compared to it
17
Good post. "Medical gangster nation" seems about right. Before any trip for healthcare I spend at least an hour on the phone with my insurance company determining just how much it's going to cost me.
3
We emigrated from the UK to Canada nearly 50 years ago, and 30 years ago to the USA, returning to Canada after just 2 years, partly because of the US medical systems, but also because of different social values (education, guns, violence, militarism, etc.). I understand that the US perfected corporate law, and together with their national attitudes, their medical system seems to fit, somehow. In Ontario we personally have benefitted from 18 years of complex cancer treatment in Guelph, Toronto (PMH, TGH, MSH) and Buffalo (Roswell Park). We are grateful for having been treated by the best informed, skilled and knowledgeable of experts. Our experiences have mostly been perfect, as in a heavenly dream world, but all places certainly have difficulties. My exposure leads me to believe that less than half of the problem, if any, lies in the facilties, very little if any in the medical personnel, and the other half definitely in the attitude of the patients themselves. We ourselves find it helpful to develop an intelligent, knowledgeable, informed, anticipative, attentive and co-operative patient attitude. We try to be thoroughly prepared. It works.
10
I often ses the supposedly long waits to see a specialist or for elective surgery as a criticism of the Canadian system. Well, I don't know how common it is her ein the US, but if I want an appointment with my Gastroenterologist, it's going to be a good 8+ weeks unless there is an acute problem. Dermatologist? Try six MONTHs.
No system is perfect, but ours in the US doesn't even see perfect on the horizon. It is too expensive for results that are not good enough and cover too few people.
35
Yup -- wanted my elderly father to see a psychiatric neurologist (depression and dementia). First, had to take him out of the Medicare Advantage plan and return him to original Medicare -- there was no one in the network remotely qualified. And then had to make the appointment more than two months in advance. US issues with long waits for specialist visits are just as bad as Canada's.
8
Dr. Martin bemoans the long waits to see specialists here but 2 months is about what it takes here as well. MRIs can be gotten quite promptly, even for back pain, where they often find things that do not matter but all too often get operated on anyway, which also all too often does not help and leaves the patient with chronic pain which the surgeon blames on the patient and abandons them to the tender mercies of pain specialists who specialize in 'walletectomies' via multiple courses of often ineffective injections. Round and round it goes and where it stops is when the patient runs out of money.
12
Specifics?
This is a PR blurb, that doesn't confront, or even acknowledge the existence of, real issues.
3
Sound advice. We need to learn from international examples rather than simply compare US and Canadian models.
5
I am lucky to live in Canada. Having recently gone through major battles with cancer with both my parents (one in Edonton, Alberta & one in Toronto) I can say first hand our system works. Neither parent had to wait for treatments or MRI's, and had access to current drugs and treatments and a collection of brilliant specialist Doctors. However there is much room for improvement. We need a national strategy for the delivery of elder medicine and care. When I tried to get my Mother into a care home during the later stages of her treatments, there was not a room to be had ...years long waiting lists. She was lucky she had money to hire private care herself, but most won't. It is a urgent need and needs to be addressed.
20
Canada's Healthcare systems are run by the provinces. Here in Quebec change is something that happens constantly as medicine evolves. Change comes with liberal democracy and change has been part of healthcare since 1947.
It seems everything in the USA is in danger because of an inability to evolve. Reaganism worked for a while but now the country seems to be in its death throes. Conservatism is a losing philosophy in a country designed to lead in evolution. America's diversity and experimentation in better ways to things was what made it great.
I have known both systems and the healthcare providers are the same except insurance provided care is bottom line profit where here in Canada we are all in it together and health is job one.
America has abandoned its core values and is a danger to the world. Jefferson and Franklin were scientists and Jefferson understood evolution , he was a plant breeder.
13
As an American with long knowledge of and some experience with the Canadian health care system, I can state that this column is on the mark. Despite what too many lobbyists in this country yell at our representatives, most of the Canadian care is good and the results prove it. In any civilized country, health care should be, as it is in Canada, a right.
That being said, the system does need work. While most Canadian drug prices are remarkably lower than in the U.S., there still is not adequate insurance coverage for those in the lower income bracket.
The U.S. needs to go to a single payer system getting private insurance carriers out of managing and profiting by it. The ACA was a small start. Until the present makeup from the President on down through both houses of the Congress is changed, we will still have millions of our citizens without care.
36
Certainly an essential change needed to improve our health care system would be, as you say, "getting private insurance carriers out of managing and profiting by it." But there is no way that will happen unless and until the Supreme Court is composed of justices willing to overturn Citizens United, which permits corporations to make political contributions. Our elected officials are utterly dependent on corporate money to fund their campaigns. The system is inherently corrupt and health insurance companies (and drug companies) profit mightily by that corruption.
If you want the system to change, if you want single payer health care, you'll have to work to elect candidates for federal office who are unequivocally in favor of working toward overturning Citizens United. There is no other way.
3
I’m a Canadian and my wife is a doctor, specifically a rheumatologist. The Canadian health care system is the greatest asset any Canadian has. No one anywhere should be deprived of high quality, free, accessible health care. We have it here in Canada. Try it stateside, you’ll love it.
That being said, here’s the rub, healthcare spending here, like education spending, acts like a political safety valve. In times of plenty, governments pour money into both because they’re politically popular. In times of drought, money is sucked from them and reserved for other things, which is politically popular among conservatives, less so among liberals. The result is that the quality of healthcare is indeterminate, the patient’s prognosis more or less tied to the economy, which is appalling and inhumane.
The provinces retain the lion’s share of control over healthcare spending, which is part of the problem as Canada’s traditional boom and bust economic model affects different parts of the country at different times. The result is uneven delivery of care which makes some hawks screech for a private option offering “choice.” This is balderdash: given a choice, I’d rather go with socialised medicine, albeit funded from a federal source that is adequate and guaranteed to provide consistency. Private options will only lead to exclusionary health options which benefit the rich. We have those in Canada too.
56
A totally Socialized healthcare system is constantly starved of cash and staffing resources. Look to the England NHS for what could happen in Canada. We do not want to go down that road. And we already have private healthcare in Canada in the form of Dentists and prescription Drugs. The healthcare system in many Provinces is not financially viable any longer, so we should look at a public-private system when catastrophic illness (cancer, heart disease, etc...) is covered by the public system and lesser illnesses and injuries are covered by a private employer-funded system. The unemployed and the destitute would be covered by the Gov't for both.
2
Marcus Brant, while largely funded provincially, health care is one of 4 federal funding equalization mechanisms. That funding is significant and in fact the reason there is nation wide universal health care system. Alberta for example, can't just sign away universal health provision and go with 2 tier public for the poor, private for the rich system because it would then forsake funding it can't afford to give up.
So the system you wish for exists today and the political problems are slightly more complex and entrenched than you describe.
If you're not getting even this basic information as the spouse of a physician, take a political science 101 at your local college or university. You seem interested and articulate enough to benefit from learning how the Canadian political system works when you look "under the hood".
Regards.
I’d rather wait 4 months for a hip replacement than not ever get one because it’s too expensive. I’m sure that there’s lots of room for reform of the Canadian system, just as there is for our own form of socialized medicine known as Medicare. Unintended consequences, perverse outcomes and cheating are the hobgoblins of every large government-run program.
You know that going in, and you manage as best you can—and private enterprises such as GE or Facebook are prone to the same hobgoblins. I just can’t vote out Mark Zuckerberg if I don’t like Facebook.
Sweden, Japan, Germany are run by professional career bureaucrats who are responsible to the government in office. As with Canada and the U.S., governments rise and fall routinely over an administration’s failure or successful management thereof. Sounds good to me.
58
Yes, for a lot of Americans, the waiting time for a hip or knee replacement is "however long it is until they qualify for Medicare."
2
National health care failed where ever it was tried because it always mushrooms to an enormous financial beast that is difficult to control. The tendency is to get something for nothing. If the name Obamacare will be changed to Trumpcare it will be abolished in Congress instantly.
4
Wonderful idea as long as the abolition includes Trump himself, hopefully to a no bail stay on Riker's Island where, given the interminable waits to go to trial, he will live out his days in this purgatory.
7
Please see https://fixithealthcare.com.
National healthcare has succeeded everywhere it's been tried, from japan to France to Sweden to Canada.
The United States has the most expensive, most inefficient system on earth. It costs 50-100% more than other countries spend, as a function of GDP. Each year it wastes $1 trillion, and condemns 50,000 Americans to die from untreated treatable illness. Millions more suffer from lack of access to a doctor or because the can't afford their prescribed medication.
All that, in the name of private enterprise.
There is a paternalistic myth that democratic societies can't control social welfare spending, or government spending generally. A myth because experience demonstrates otherwise, else social security (for one) would be more than enough to retire on. Paternalistic because it implies we can't govern ourselves, 200 years of evidence to the contrary.
Government spending is controlled by the voters. Everyone wants services; no one wants taxes. The balance is decided by elections, and no one is totally satisfied. You would think that after a couple of centuries that would be obvious. It should be.
25
'National health care failed where ever it was tried...' Really? Care to provide a few examples? There must be lots to choose from.
6
Once you teach people that they're entitled to free stuff and earning things is only for (Boo!) Americans, they get really upset when you can't afford to keep giving them their free stuff.
1
Once people like you (re)learn that we are all in this together, rich, poor, white, colored, man and woman, gay, straight, able, disabled, perhaps you would be less "upset". The Golden Rule is: "Do unto others as you would have done to you" and not, as you apparently belive: "He who has the gold makes the rules."
30
I personally don't consider something paid for through taxes, co-pays and other means "free."
18
There's nothing free about Canadian health care. I pay for it with my taxes, which are higher than in the US. It's an insurance policy I'm happy to pay for.
53
How do you trust anyone with your health when profit is the main motive.
Also try to remember it’s called a medical practice.
11
When we talk about healthcare we talk about life and death. You mentioned the Canadian systems' strengths and weaknesses. Here are a few weaknesses in the American system:
1.If you or somebody in your family gets sick there is a good chance that you could lose everything, as even the most routine surgery and shortest stay in the hospital can run into the hundreds of thousands.
2.people put off going to the doctor because they can't afford it.
3.Emergency rooms are jam packed with people who have no health insurance. leading to long waits, bring a pillow you will be there a long time.
4. Our Hospitals are awash with greedy doctors who come from countries with socialized medicine to make a killing over here ( figuratively and literally)
5. Our Doctors have no sense of community or national involvement, many ( not all) are just in it for the money, and you will get kicked out of a doctors office if you do not have health insurance. ( see point # 3 to see what you do when that happens)
6. You have to stay at your job, even though you might want to retire, because if you leave your job you will lose your health insurance. So you become a slave to your job.
7. Your employer swell person that he is will hold your health insurance over your head at every new contract negotiation, and you will see any pay raise eaten up by higher health care premiums.
8. An inequality in health care designed around who has health insurance and who doesn't .
I could go on but have run out of space..
115
while you are half right about greedy doctors;consider their student loan repayment with interest rate of 8.75%(generally $250000 in principal),and mal practice expense AND the army of hungry lawyers and litigious patient and family!
4
Great points, Thomas, especially the first one. When my wife retired before age 65 (pre-ACA) I insisted that she purchase health insurance on the open market, which I referred to as "house insurance."
2
There is no arguing with any of this. What I fail to comprehend is why there is such opposition from so many people in this country to a system that would solve all this.
1
A few years ago I had a heart attack in a rural area of Nova Scotia. I got immediate help at the local hospital, then an ambulance transfer to the cardiac unit at a major Halifax hospital. After a stent and several days of observation I was sent home. My bill? Zero.
Any Canadian would get the same prompt care with no concern about cost. Our heath care is not perfect but it’s so much better than the US.
112
The immediate bill is zero, but you have paid 5 times more for that procedure with your taxes. Glad you are feeling better.
1
Sorry. Look at the pie graph as a percent of US GDP, the health care complex represents. Major main contributors are the AMA, For profit Hospital corporations, Insurance companies and Drug corporations. These players have no interest in Universal healthcare. Universal health care if adopted in the US would drive taxes into the stratosphere . I've used the Canadian system it works well if your in a major metropolitan area. Canadians market their system as free. Point is all universal healthcare systems are heavily supported with hidden taxation. Our US system will never change too much influence of the major benefactors. Medicare is already eating away and retirees benefits, it is broke.
1
The army is broke too. Have you looked at its trust fund? Zero!
Medicare for All would save Americans $1 trillion and 50,000 lives a year. Our current system is a national shame and tragedy.
Medicare per-patient spending has been flat — flat! — for several years. It is curbing costs even without the advantages it would have if universal, such as negotiating drug prices.
It's not Medicare that's broke. It's the current, for-profit system. And it's breaking the rest of us with it.
34
Hidden taxes? Have you ever looked at how much you're paying for insurance through your employer-provided insurance--if you're lucky enough to have it? People in the U.S. pay more per capita than do the people in any other country in the world, but, even when the ACA was working fairly well, still did not cover everyone. In addition to the amounts that a company pays in premiums for their employees, many people also contribute to the cost of the premiums with payments deducted directly from their salaries, and they still have deductibles, co-pays--which can be hefty. Prior to the ACA there were also both annual and lifetime caps for many people (I think both were done away with by the ACA, but don't know what's happening due to the Trump budget machinations.) In addition, many things that people believe are covered services are not in fact covered. I used to do insurance administration for a company and spent a fair amount of my time on the phone fighting with the insurance company about our employee's coverage. Later, my husband's company suddenly announced AFTER his surgery that it wouldn't be covered. Turns out that they did cover it but that was a scary experience.
There are also a lot of hidden costs. For example, any company or organization that offers its employees health insurance has to pay people on their staff for the work done to provide that coverage.
We could and should do better.
3
I moved to the US from Canada when I was 40 - I've been here 13 years. In my 40 years in Canada I never once heard a health Care horror story, not from friends, family or friends of friends of friends.
In my first year in the US I was inundated with depressing stories from my new American friends and colleagues who were struggling through their godawful system trying to stay alive and healthy.
One friend fighting for her life, who's insurance company kept refusing to grant her the treatment she desperately needed, was invited (after a relentless campaign) to argue her case in front of a 4-member insurance company panel. She was allowed to bring someone to observe and offer support and she asked me. I sat in the back and watched with horror at how my new country treats its sick who have no, or less-than-gold health insurance.
They peppered her with questions, bringing up reports casting doubt on her and the treatment she needed. But she had been a nurse and was able to counter everything they threw at her.
At the end, she explained she had three young children who would one day have children of their own. Her greatest dream was to be the best, most loving grandmother. Her appeal was so emotional and so well argued that she brought tears to two of the panel members. In the end she was given the treatment and is alive and well today - with 4 grandchildren who she loves more than anything.
I don't have her skills. Like many, I would not have not have survived that panel.
94
The Japanese have the world's longest longevity rates. Why not ask them about their medical system?
3
i lived in japan off and on for 19 years.
many don't have a family doctor, but go to the hospital for their problems. i'm not sure it's just a cultural reason for that fact.
some years ago, 20?, the government raised the individual's share of costs from 20 to 25%. drugs, dental and medical were included in that.
when i went to the dentist, the charge was about $12. drugs were cheaper than in my native Canada. waiting times were less.
as for the longest life expectancy. i guess it's true, but there was a story not so many years ago that many families were not reporting their grandparents' deaths--japan still has many homes with three generations living together--because they needed the meager pension money to sustain themselves.
3
They also have a tightly knit society, with no underclass.
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They probably have healthier lifestyles. They eat less processed food, walk around a lot more, etc.
The above statement is from anecdotal evidence. I haven't researched it enough.
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The discussion about wait times is actually a red herring. Any system can be made to function poorly if it is underfunded. The Canadian system was much better years ago when it was better funded, and it has always been less expensive than the US system.
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Our representatives act as if anything less than perfection isn't worth putting in place. Perfection does not exist. People will always complain, and there will always be plenty to complain about. But sickness should not be compounded by financial suffering.
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This is an important Op-Ed. The data shows that overall, universal government run health care systems such as Canada's are vastly more efficient than our complicated mess of a system. They get at least as good care for much, much less cost, and the wealthy countries get substantial better care. The OECD has the statistics.
But we aer talking about 30 different systems. You cannot expect perfection in every system. The NHS in the UK is starved of funding by a conservative government. We pay 127% more per person for health care than the UK. You might expect some problems with that level of funding. Yet in spite of that, they lead us in many of the bottom line public health statistics such as life expectancy, and infant & maternal mortality.
Furthermore, many of the complaints you hear about their systems are just plain lies. During the health care debate, there was a TV ad that showed Dr. Koop, the surgeon general under Reagan, who said that he was 93 and listed several medical procedures he had that he claimed he would not have been allowed to get if he lived in the UK because they do not offer expensive procedures to old people. One of the was the insertion of a pacemaker. When asked if this was true, a spokesperson for the NHS said she didn't have figures for people of that age, but 104 people over the age of 100 received pacemakers in the UK the year before.
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Germany, the Netherlands, Switzerland and Japan all have high quality, universal, affordable health care that is highly rated by their citizens. They are not single (I.e. government) payer systems. Instead they all rely mainly on multiple, well regulated private insurance providers. Insurance for the most part is purchased by individuals or employers.
We should be comparing and contrasting the pros and cons of that type of model with the Canadian single payer system and the UK's fully "socialized" system in which the government owns the hospitals, employs the providers, etc. Instead our media treats this issue as a binary choice between our mostly for profit system and a single payer system, so Americans are grossly uninformed on this critical issue we have been debating for decades. That lack of an informed public has made it all too easy for dishonest propagandists to manipulate the public to vote against their best interests.
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Infant and maternal mortality is higher in the US than in any other civilized country, western or eastern. Why? Because greedy doctors in the US who also don’t want to get out of bed at 3 pm to deliver a baby, much prefer to do a ceaserian operation. They get paid much more for this because it’s an “operation” and of course they can do it in daylight. Studies have shown the countries that encourage and use natural childbirth and use of Lamaze techniques have a vastly lower mortality rate. And don’t get me going about the greedy healthcare companies paying GOP lackeys to protect the higher cost of drugs in the US. It’s a sick system that encourages death by gun and the necessity to pay to get the bullet wounds sewn up.
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Theodora, while you are correct about Switzerland, the situation in the other countries is not as simple as you think. For example:
Health care in the Netherlands is financed by a dual system.
Long-term treatments, especially those which involve (semi-)permanent hospitalization, and also disability costs such as wheelchairs, are covered by a a state-run mandatory insurance. This is laid down in the Algemene Wet Bijzondere Ziektekosten.
For all regular (short-term) medical treatment, there is a system of obligatory health insurance, with private health insurance companies. These insurance companies are obliged to provide a package with a defined set of insured treatments.
For those who would otherwise have insufficient income, an extra government allowance is paid to make sure everyone can pay for their health care insurance.
A key feature of the Dutch system is that premiums are set at a flat rate for all purchasers regardless of health status or age. Risk variances between funds due to the different risks presented by individual policy holders are compensated through risk equalization and a common risk pool which makes it more attractive for insurers to attract risky clients.
Children until age 18 are covered for free. Those on low incomes receive compensation to help them pay their insurance.
So it is part single payer and part heavily regulated private insurance.
I agree we should carefully consider what kind of universal, government run system we should adopt.
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As an American who now lives in Canada, I've experienced the best care both systems have to offer. I had serious heart and lung problems that were treated successfully in Boston at Lahey Clinic and Massachusetts General Hospital. My wife had cancer that was treated successfully in Toronto at Mt. Sinai, Princess Margaret, and Credit Valley hospitals. And I've also experienced some poorer quality care in both countries.
I am no medical expert, but I get the sense that the huge scale and rich funding of the US system may make it better equipped to treat the most complex cases—but only if you're lucky enough to be covered and to find the right providers. The Canadian system seems to me to do a better job coordinating care and guiding people to the best local resources, and I've found more quotidian types of care actually more accessible in Canada than the States (my primary care doctor has walk-in hours six mornings a week, no appointment necessary). Wait times vary in both systems—they can be short or long in either country. Health care is, like any resource, limited and the best specialists are often booked for months, whether in Boston or Toronto.
The big difference, though, is in risk—the risk of not being covered, the risk of unmanageable cost—and the stress of dealing with bills while ill. The Canadian system removes those risks and stress from individuals. The US system dumps them squarely on the ill and their families. This alone makes the Canadian system better.
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Excellent summary, particularly your mention of the Touchiest part of the problem: doctor-patient relationships. (Remember, it was no accident that what derailed the Clinton's first stab at healthcare was the Harry+Louise ads that claimed the program would prevent you from choosing your physician.) The bottom line, which no politician is crazy enough to come out and say, is that in order to have universal healthcare, some people's coverage must get worse in order for others' to get better.
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No country can afford all of the health care that its citizens think that they need.
So there have to be limits on care. Hopefully those limits are based on science and not bean counters in their administrative offices.
If physician autonomy means physicians have their patients best interests at heart then I am all for it.
I believe Canada does subsidize medical education so they have some leverage over physicians' choice of specialties by limiting the number of specialty trining slots.
In this country the soul crushing costs of medical education drive young physicians into specialties that are lucerative enough to pay off their student loans.
As any reader of this note may have surmised I have not offered a solution for presently in the USA because there is not one viable option on the table today nor is there the political will to augment a plan.
I would be in favor of Medicare for all of those who wish to switch or join if that is accompanied by subsidizing medical education and limiting drugs, tests, procedures and devices based on science and not lobbying by corporations and patient advocacy groups.
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Of course, no mention of "supply management" in medical education. The number of spaces for specialist training is limited and many positions are allocated to well-connected non-Canadians.
Premier Wynne has squeezed the health care budget, leading to a substantial reduction in the number of nurses and other professional personnel. The good news for administrators is that health admin. is a growth industry.
One can agree with the implication of the author that resource allocation is not efficient, but if people choose to live in remote areas, it is a choice that is made in respect to access to many other services besides health care, includind education and police protection.
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I, like many Canadians, shake my head in disbelief every time we read some American warning that the Canadian medical care system is "communist" and raise the spectre of Soviet-style, grey, autocratic health care. Our system has it's problems. In some part of the country there is a problem finding a family doctor. ER and specialist wait times can be long,. but generally medical care is available, first rate and there is no charge. I support paying taxes so that health care is universally available although it's not perfect. I can't understand why anyone would think this is not a good and reasonable system where money goes to health care, not to profits for the insurance industry.
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If you think medical care is readily available in Canada, you are mistaken.
For instance in Quebec, many thousands still don't even have a family doctor. They can wait many years to get one.
Here are some other facts:
You can wait months, even years to see a specialist;
You can wait years for some operations;
You still pay out of pocket to see some specialists, as many quit the state sponsored system;
You will even pay some extras with specialists within the system;
You will probably go to private practice ($$) for tests, MRIs, CT scans, ultrasounds, etc as you can wait months, maybe years if you rely on public care to get one of those.
If you are sick and want to see your or another doctor now, sorry...you will have to go to the emergency. Wait time: average of over 10hours. It was actually 44 hours during peak flu season;
If you or an elderly parent has to be hospitalized, you will probably wind up in the hallways for many many hours, probably days.
And the doctors: specialists were awarded $66 extra for each time they put on a gown to visit a hospital patient.
They were given a bonus to get to work on time.
The list of extras goes on...
Their salary: look it up. It's an eye opener!
The worst part is that we don't even know really what their REAL salary and perks really are.
The Prime minister in Quebec is a doctor.
The healthcare minister is a doctor!
Go figure.
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Most Americans who are familiar with your system, and even more so that which exists in northern Europe, agree with you. Our medical insurance system -- like our electoral college system, our two senatorial votes per state regardless of population, and our gerrymandered House of Representatives -- is very poor by comparison. Unfortunately we have many non or semi-literate voters who easily are conned into believing otherwise.
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I suspect that in the US, race is the issue (I don't want my taxes to support Those People (I glean that from Paul Krugman's Op-Eds). Even if I am a poor southerner who pays very little in tax.
Whereas in Canada I think we understand that it helps if everyone stays healthy. After all, bacteria and viruses don't check a person's income before infecting them.
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I must tell the truth. Most Canadian's believe they have the best health system in the world. Until they actually try to use it.
The entire system is centered around cost cutting. Appointments with specialists are frequently less than five minutes long. In you go, they start talking before you do based on some incomplete referral they received, they tell you there is nothing wrong with you, and out the door you go. The time for thoughtful exploration of complex problems is nearly nonexistent. So people just live with their ailments.
There are entire programs designed around reducing tests to reduce cost, because most of them come back negative. The right way to look at it is: if a doctor isn't doing enough tests that most come back negative, they aren't doing enough tests. We want to find the problems. That takes testing.
Wait times for MRI's, knee surgery, anything other than critical life-threatening treatments, are months and sometimes years long.
Doctors have become accountants.
The system needs major improvement. Where it is hugely better than the US system is we don't go bankrupt and then die because we can't afford life saving care. True. But this has made us complacent. We need to move from a cost reduction focus to a patient centered, health enhancing focus. We can and must do better.
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Nonsense. I spent 38 years under the Canadian health care system and I have spent 34 years trying to figure out the hideously expensive U.S. medical industry. In America, unless you are able to spend big for your medical care, you better pay very close attention to your diet and exercise regimen. In Canada, the cost is little, so that doesn't matter so much, however, if Canadians aren't willing to spend money to improve delivery of their healthcare benefits, they will have to endure these wait times. In a way it's a Catch-22 I suppose, but one factor that does make the Canadian system better than the U.S. system is the absence of insurance companies in the mix. That's why Universal Health Care should be added to our American system, the insurance companies are reactionary and do no good at all for Americans.
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As a Canadian abroad (and thus familiar with both Canadian and German health care systems) I would say that this kind of statement doesn't ring true if only by virtue of the fact that Canadians only have that kind of pride about hockey and curling. I think most Canadians are aware of the shortcomings that one encounters (wait times) but should also be more aware that their system exists without any of them ever paying a premium monthly or yearly for its use. It is funded via taxation. (In Germany I pay a monthly premium.) So there is a degree of fairness in place on that level (no one is excluded from coverage), that is exemplary. The German system does not have such long wait times - but that is a whole other matter. If one were to compare systems one would have to compare Germany, Canada, Norway and England to see the variety of models as regards funding (with or without monthly payments), status of medical profession (as private businesspeople billing the government or as government employees), degrees of coverage (including or excluding dental care, medication, psychological and preventive treatment etc). It is not just about the Canadian system vs. the American system (where there is no doubt in my mind that the former is better and fairer than the latter), but rather the question of how different universal health care systems function.
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"What’s different is that in Canada, doctors and hospitals have a high degree of autonomy, and don’t always participate in efforts to reduce waits. At times they have opposed attempts to have other professionals care for patients or to shift resources into needy communities.
And we have been slow to adopt virtual care, group-based care, and other models that would reduce waits. The solutions to delays in Canada lie in changing how we deliver health care services, not how we pay for them."
These statements are not factual. We have far too little input from frontline medical personnel. The problem lies with the bureaucratic level which acts to resist any form of progressive evolution.
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Harping on wait time is a red herring, when, in the US 90% of the citizens can be bankrupted by cancer, or worse, die from no ability to pay for care.
us army 1969-1971/california jd
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The American system's number one goal isn't patient care, it's profit. The public is convinced that a Canadian or European system is a terrible idea and is socialized and, therefore, evil. But what have they got for all the capitalist, free market system they so embrace? Lots and lots of their money going to corporations and people that do absolutely nothing toward patient care. They push paper not expanse and are rewarded handsomely for it. And the Republicans fear universal healthcare because they see it as another "Social Security" type system that will "bankrupt" the country. The real question should be: You are going to pay the money one way or another. Where do you want the money to go? Health care or corporate care?
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Fact: Bernie Sanders' Vermont will not pass his "single payer" theory.
https://www.forbes.com/forbes/welcome/?toURL=https://www.forbes.com/site...
And fatal flaw in the op-ed writer's rationale: Canada, USA, and Europe are not alike. Europe is mostly white and urban, and jails "undocumented" immigrants. Canada is very rural. And the USA has been paying trillions to defend Europe and Canada, paying the majority of medical research costs, and a "people's president" can profit $400,000/day for a speech.
Medical doctors are not experts on economics and engineering. This has been proven again, in this op-ed.
Canada, Europe, and Asia should pay their fair share of medical research costs. They have been "free-riding" for decades. That needs to end. Now. Today.
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I think Canadians and Europeans should pay - by setting up medical research centres in Asia. It will be far cheaper than paying American researchers.
Canada is very rural? About the same as the USA
https://en.wikipedia.org/wiki/Urbanization_by_country
As for defending Canada - would the US prefer that Canada became a nuclear power, capable of defending itself?
The idea that most of the worlds medical research comes from America andnot other countries is insane....Most comes from Europe Japan and above all Britain incidentallymost American cos dom much of their research in the UK where they havehuge Labs
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Let us stop imagining that it is all that easy to see a specialist. For some it is easy - I needed an orthopedist after I dislocated my right elbow. Low risk in the larger scheme of things.
But it took me almost 4 weeks to schedule an appointment with the neurological practice that saw me in a hospital after what appeared to be a seizure (with no history). And the appointment was almost 2 months after my hospital stay. So yes, let's be fearlessly honest about both health systems. Oh - the hospital where I stayed for 2 days and the neurology practice were both In-Network!
And by the way, my employer based insurance and income make me an ideal patient for any doctor.
So maybe it is all very complicated. I know it is far to complicated for our president.
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