Here’s a basic truth about the complex issue of medical care in the U.S. and in Canada: both systems have real strengths and glaring flaws.
In general, Canadians across the political spectrum like the principles of their health care system. They are genuinely baffled so many Americans seem to fear something as simple as each province providing health care for nearly all residents.
In terms of cost and outcome, the Canadian system delivers pretty good results. (For facts and figures, here’s more on spending and outcome by country in this PBS Newshour article from 2012.)
In terms of peace of mind, it is a solid foundation Canadians count on, with the responsibility being shared on a societal basis.
Speaking personally, after spending close to four decades in the American system, the Canadian system strikes me as humane and civilized. No worries about having no insurance if a job is lost. No such thing as being denied coverage for pre-existing conditions. Basic needs are covered, full stop.
Businesses in Canada can offer employees and their families supplemental health benefits – like dental, drug or vision plans. But businesses here have a significant competitive cost advantage by not having to provide basic health care plans for broken arms, cancer, etc.
Ah, but let’s be honest. There are some pretty big flies in that ointment. Depending on where they live, Canadians can find it very hard to find a personal physician. It can take many months to see a specialist. And simple diagnostic tests can take a long time to schedule.
You might think big cities would be the best place to get procedures done, but sometimes they have the longest lines. Here’s an article about wait times in Ottawa from the Ottawa Citizen:
For example, province wide, patients in need of a hip replacement will get one in 188 days, nine times out of 10. At the Ottawa Hospital, these patients waited 426 days, according to Ontario Ministry of Health figures for April, May and June.
A patient in need of a knee replacement waited 300 days for surgery at The Ottawa Hospital, compared to 214 days across the province.
There’s a not-so-funny joke in Canada that it’s easy to get an MRI right away – if you’re a dog or a cat with an owner who can pay. Canadian humans, rich or poor, have to get in line and wait.
This recent story out of CBC highlights cross-border medical traffic where Canadians who can’t (or won’t) wait head to places like Alice Hyde Medical Center in Malone, New York for routine joint replacements.
Some of the wait times in Ottawa make alternatives like Alice Hyde very tempting, according to the CBC story:
The online and Ottawa newspaper ads boldly claim, “Pain-free knees and hips are just 30 days away.”
“It’s really all about looking to our neighbours who are not far from us to our north and saying, we are an alternative, and you should look at all of your options before you decide whether it makes sense to wait for access through your current health-care provider,” said Doug Divello, president of the not-for-profit Alice Hyde Medical Centre.
Go ahead and quiz this official “wait time” site from the province of Ontario. Wait times vary by location and procedure. But the day I wrote this post, the target wait time for an MRI was 28 days. Actual wait times ranged from 29 to 78 days. Province wide, 9 out of 10 patients could expect to get an MRI in 62 days.
Now, emergencies and those with the greatest need do get seen faster. And not all tests or treatments are urgent. But still. Waiting a month for a mere diagnostic test can seem excessive.
Medical tourism is one result. Going to India, or Mexico or New York to pay for what can’t be had quickly at home. The Canadian system knows some who can pay more to be seen faster are doing so. And there’s debate about if those patients should or should not get follow-up care in Canada for un-regulated services provided outside the system.
Do less-than-optimal statistics and experiences mean Canadians are ready to abandon their decades-long relationship with provincially-provided medical care? Hardly. Most just wish their system had fewer bottlenecks.
Remember, it could take a year or more to get that new hip. But the high-quality procedure will be close to free, meaning even poor people can get that relief, eventually. (How many poor or uninsured people in the U.S. can hope for a free hip or knee replacement?)
Of course, “free” isn’t really free. It all comes from the tax coffers. But Canadians see a good chunk of those taxes come right back as direct health care, without the expense and duplication of the U.S. insurance layer with its maze of claim form paperwork.
Many Canadians would welcome the option of twin tracks: public care for all and the option of private care for those who can afford it or can’t bear to wait.
Many Americans wish the U.S. would adopt a Canadian-style system.
I feel both systems have vast room for improvement – keeping in mind that providing the very best health care to everyone – right away – would probably bankrupt any nation. Sometimes it comes down to imperfect choices.