Editor’s note: This commentary is by Lee Russ, a member of the Vermont Workers’ Center. He is a semi-retired legal writer and editor, who was the lead author of “Couch on Insurance.”
Canada, O Canada, how some Americans love to disparage you — especially your health care system. In an editorial titled “Decoding the Language of Green Mountain Care” almost a year and a half ago, John McClaughry informed readers that:
… an examination of the Quebec system can quickly lead to the conclusion – largely justified – that single payer health care will unavoidably result in rationing, waiting lines, maddening bureaucracies, demoralized doctors and nurses, shabby facilities, obsolete technology, declining quality of care, and, of course, much higher taxation.
Similar scare stories, usually involving anecdotes of some medical nightmare befalling a Canadian citizen forced to rely on Canadian health care, continue to make the rounds of our state, courtesy of the various groups opposed to Vermont’s planned system of universal, publicly financed health care. Many of them can be found on VTDigger, especially in the comments to articles about health care reform.
Are these dire warnings prophetic? Are they totally made up? It’s far easier to find the scare stories than it is to find any concerted effort to examine their truth. Which is both unfortunate in that it distorts our discussions of health care, and unnecessary in that many sources of legitimate, reasonably objective information about Canada’s health care system are readily available.
In fact, Canadian professor Antonia Maioni spoke at Lyndon State College in 2011 on the Canadian health care system, giving a lengthy review of the Canadian system’s nuts and bolts, including its flaws and its virtues. You can watch the entire talk yourself; it’s online (it lasts just under an hour). I watched it all, including the Q&A following the talk in which a member of the audience pressed Maioni about these horror stories. Her response: really not true. Not to say that there aren’t problems in Canada, but the horror stories … really not true.
And how do the Canadian people themselves feel about their health care system? If you believe the scare stories, Canadians are outraged. But I’ve talked to many Canadians about it and have yet to find one that doesn’t prefer Canada’s system to ours.
One of the most striking aspects of Maioni’s talk is her comparison of the billing departments at a major Canadian Hospital and an American hospital in Plattsburgh, N.Y. At the Canadian hospital, the billing department was in a relatively small room, and consisted of “maybe seven desks.” The billing department of the Plattsburgh hospital took up “a whole wing” of the facility.
Many of the scare stories thrown around in the U.S. concern claims that doctor are fleeing that nation. The facts? Well … Canada tracks its health care system very closely. The Canadian Institute for Health Information (CIHI) issues an annual report on the “Supply, Distribution and Migration of Canadian Physicians.” The 2012 report found that:
- There were more than 75,000 physicians in Canada in 2012, a 3.6 percent increase over 2011.
- Between 2008 and 2012, physician growth rates outpaced population growth rates threefold, resulting in 214 physicians per 100,000 population in 2012.
- During each of the five years profiled in the report, more physicians returned from abroad than moved abroad.
A 2009 “Survey of Primary Care Physicians in 11 Countries” also found that Canadian doctors tended to be more satisfied than American doctors:
- 75 percent of Canadian doctors were satisfied or very satisfied with practicing medicine, compared to 64 percent of American doctors.
- Insurance restrictions on medications or treatment posed major time concerns for 48 percent of American doctors, but only 19 percent of Canadian doctors.
- 58 percent of American doctors thought their patients often had trouble paying for care, compared to 27 percent of Canadian doctors.
The U.S. fared better in terms of waiting times to see a specialist and ease of access to specialized diagnostic tests. Both countries’ doctors thought their health care system needed work, but 15 percent of U.S. doctors thought the system needed to be “completely rebuilt” compared to only 4 percent of Canadian doctors.
A related scare story is that Canadians are flocking to the U.S. for health care because they are dissatisfied with their own system. The facts once again differ. The scare stories are usually based on anecdotal evidence about the number of Canadians treated by some medical practice in the U.S. But as long ago as 2002, researchers who took a serious look at the issue concluded that, despite the persistence of the myth of Canadian medical care refugees, “Surprisingly few Canadians travel to the United States for health care.” For example, in the 1996 Canadian National Population Health Survey (NPHS), ”Only 90 of 18,000 respondents … indicated that they had received health care in the United States during the previous twelve months, and only twenty indicated that they had gone to the United States expressly for the purpose of getting that care.” That’s a hair over one tenth of one percent who came to the U.S. specifically for care.
And how do the Canadian people themselves feel about their health care system? If you believe the scare stories, Canadians are outraged. But I’ve talked to many Canadians about it and have yet to find one that doesn’t prefer Canada’s system to ours. My personal experience is backed up by the recent Washington Post piece: “Canadians don’t understand Ted Cruz’s health-care battle” (Sept. 25, 2013), in which Matt Miller interviews two experienced Canadian businessmen on how the Canadian system works, and how Canadian businesses feel about it.
One businessman tells the author “how baffled he and Canadian business colleagues are when they listen to the U.S. health-care debate. He cherishes Canada’s single-payer system for its quality and cost-effectiveness (Canada boasts much lower costs per person than the United States). And don’t get him started on the system’s administrative simplicity — you just show your card at the point of service, and that’s it.” In fact, that Canadian is “amazed at the contortions of the debate in the United States.”
The second Canadian businessman, an “avowed capitalist” who has “experienced both systems first hand,” says that Canada’s lower spending, better outcomes and universal coverage make it superior by definition, and it’s “incredibly hassle-free.” Unlike in the United States, where his wife spent hours fighting with the health plan or filling out reams of paperwork every time his kids went in for an earache, in Canada, “the entire administrative cost is pulling your card out of your pocket, giving it to them and putting it back.” He also says that Canadian divisions of multinational firms love Canada’s system, and that his peers view the U.S. debate as “ideological and not based on economics.”
Even when commentators accurately cite criticism of the Canadian system, they often manage to leave out information even more critical of the U.S. system. Daniel McCauliffe, for example, in a commentary in June 2012, cited a Globe & Mail commentary for the proposition that “Even Canadians realize that their single-payer system is not working well.” While the Globe & Mail commentary did, indeed, talk about things the Canadian system needed to do better, McCauliffe failed to mention that the fourth sentence in the Globe & Mail piece says, “When it comes to health care, only the United States is morally bankrupt and economically inept.” Clearly the author of that commentary thought the Canadian system was working far better than the American system.
Canada’s system is not perfect; ours is far less so. At this point, the only thing that makes sense for all of us, including those who opposed reform, is to take a hard look at how to make our own publicly financed universal health care system even better than the system in Canada. We can do that by 2017 when the system takes effect. We can do it with facts; we cannot do it with fear.