In August 2002 I visited Toronto for the World Science Fiction Convention. At one panel discussion the Canadian national single-payer health-care system came up and I asked whether anyone saw any downside to it. The panelists (Canadians of various ages) looked at each other, and all shrugged and said, “No” – appearing faintly surprised the question would even be asked. I got the same answer from several random Torontans I sounded out during my visit. But that’s just Toronto; maybe its people are not representative of the whole country. If you’re a Canadian, are you satisfied with your health care system? Do you see any downside? Would you rather have an American-style system where health insurance is provided by private companies? Or, conversely, would you rather have a British-style system where the doctors are government employees?
And, looking at the U.S. from the outside, do you see any reason why single-payer health care wouldn’t work here? (Assuming we decided to try it, and disregarding for the moment the enormous political obstacles to our ever reaching that decision.)
Health insurance here IS provided by private companies, to a large extent. The single payer system covers only essential medical services, as long as they have nothing to do with your teeth. Dental work is a wide open free market, and drugs will run you big buckolas unless your employer has a drug plan. A lot of non essential services are pay-as-you-go, too. If I want a letter from my doctor for some reason I pay for that. Many types of extra tests, I pay for. If I want a nicer hospital room, I pay. (Well, in my case, my employer pays; I have a really good benefits plan.) The hospitals and clinics themselves aren’t run by the government for the most part.
The system works reasonably well, but the cost is running high and waiting lists for some things are longer than they should be, and there’s always a bit of a shortage of GPs.
But why the false dillemma? The solution, as I see it, is to allow private practice to sop up some of the excess demand. This is already being done on a large scale in Quebec, where private medicine is becoming very popular, and to a lesser extent in other provinces. My province, Ontario, is actually one of the slow movers in this regard.
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And, looking at the U.S. from the outside, do you see any reason why single-payer health care wouldn’t work here? (Assuming we decided to try it, and disregarding for the moment the enormous political obstacles to our ever reaching that decision.)
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It would work about as well in the USA as it does here, with the caveat that it’s possible the waste and overhead would be greater, since the population is so much bigger and the bureaucracy would be much larger.
It’s also important to note that each province runs its own health care system and treatment can vary, as well as services and costs. Some provinces charge a monthly premium – here in Alberta, I pay $44/month. I suspect that a child’s premium is much less but not having any, I’m not totally sure. Some provinces cap drug costs per year, although you have to be quite sick for it to kick in – in the thousands of dollars per year for Saskatchewan the last time I was in that system.
On the other hand, private health plans are quite cheap and the concept of a “pre-existing condition” doesn’t exist, because Blue Cross et. al. aren’t forced to cover those things. private health care is mainly for dental, opthlalmic, drug costs, etc. I’ve never had to fight with an HMO for payment or to get covered and I like it that way.
I think Americans are a bit confused and think that our health care is totally free. As others have pointed out, it’s not. Unless you have private insurance, you pay for a lot of medical services and for your own drugs. And many of us pay a monthly fee for the public health care system. And of course, we pay higher taxes.
The services that ARE free are rationed through waiting lists. My mother has lost some of her vision because she had bleeding in her eye, and it took her six months to get in for laser surgery to stop it. In fact, it took her two months just to get in to see a doctor for an evaluation.
The people who have a hard time in Canada’s health care system are the ones who need treatment for non-life threatening conditions. Psychiatric help, hip replacements, arthroscopic surgery, etc.
Here’s a PDF which lists some of the waiting lists in Canada for various procedures. Here are a couple of examples:
For othopedic surgery in general, the median time to treatment after a referral from a GP is 32 weeks. In Saskatchewan, it’s an astounding 72 weeks. So, if you break a hip or tear a knee ligament, you could be hobbling around for a year and a half before getting surgery to repair the damage.
And you don’t want to get cancer in Saskatchewan, because after a GP refers you for radiation treatment, you’re going to have to wait 17 weeks. I have a friend with cancer in the U.S., and after she was told she needed radiation treatment she had the first treatment I believe the same day or the next day.
It’s also telling that the very rich in Canada routinely travel to the U.S. for treatment. That includes one of the people who helped create Canada’s health care system, the ex premier of Ontario who travelled to the U.S. for his cancer treatment.
Middle class people taking out second mortgages and spending their retirement money to get treatment. Doesn’t sound ‘free’ to me. And according to this article, the problem is getting worse.
Then there’s the perception of favoritism and cronyism:
So while you’re contemplating moving to a Canadian system, Canadians are becoming increasingly dissatisfied, and are willing to consider moving back towards a system with more private treatment. Until I read this today, I wouldn’t have thought that was the case, because it wasn’t that long ago that overall Canadian sentiment for single-payer was very high.
And here’s what the Canadian medical association has to say:
The other thing to keep in mind is that having a huge private health care system across the border helps offload stress on Canada’s system. We benefit from your R&D, your drugs, and a lot of people who need complicated treatment travel to the U.S. to get it. From the same article above:
If the U.S. socializes its health care system, there won’t be any place to offload patients to, for us for for you.
Also, don’t extrapolate Canada’s health care costs into the U.S. The population in the U.S. is very different.
Our health care is, overall, decent, although some provinces are really struggling and certain types of treatment are in trouble. But would it be better if we could take the same amount of money and put it in a private system? I think so.
Despite Sam’s claim, the difference in per capita health spending between the two countries is, as near as I can divine (and this is not easy stuff to figure out independently) more or less nil. My best estimate is that U.S. FEDERAL health spending, including directed grants to states, is about $500 billion a year, or about $2000 per capita. That’s pretty darn close to what’s spend in Canada; Ontario forks out about $2800 per capita, which adjusting for inflation is what, $2400 US?
I see from Muffin’s cites that it’s possible we spend LESS; I’m just going by the numbers I can find myself.
So in truth, Canadians DON’T spend much more in taxes than Americans do on public health care. It’s Sam’s standard mantra that health care kills our taxes as compared with the United States, but frankly that does not hold up to scrutiny.
I work with Americans and this subject always comes up, and I’m not even convinced they really pay fewer taxes, either. The folks I talk to seem to pay less income tax, sometimes, but pay exorbitant property taxes, slightly higher payroll taxes, get absolutely jacked up by insurance premiums if they have a family, and seem to get screwed by the county a million other ways. Inheritance taxes, less favourable capital gains taxes… I dunno, it’s like the death of a thousand cuts down there.
Where did I say that? I was under the impression that per-capita health care spending was significantly higher in the U.S. It was a few years ago.
But it’s an irrelevant comparison for determining which system is more efficient. There are too many other variables. Just like life expectancy figures. Life expectancy is different all over the world for all kinds of reasons. A better measure would be things like cancer survival rates, average life expectancy of patients with cardiac trouble, infant mortality, waiting lists, and other measures that are a direct reflection of health care services.
I think RickJay meant “the difference in per capita health spending [by the government] between the two countries is, as near as I can divine (and this is not easy stuff to figure out independently) more or less nil”. That is, per capita government spending on health care in the US is as or nearly as high as in Canada, and then they spend masses in private funds on top of that.
Given that the US spends a lot more (in total) per capita on health care and yet doesn’t clearly have any edge at all in outcome (I agree Canada’s going to have a spotty record on some of Sam’s suggested criteria, but that has to be balanced against people with no coverage at all in the US), I find the argument that free market medicine is inherently more efficient than socialized medicine to be rather unconvincing. That’s not to say that I’m necessarily imposed to using market-like mechanisms to improve the delivery of health care here. I just don’t have any a priori faith that market-driven medicine will solve the problems that exist in our system.
For the record, in all my personal encounters with the health care system, delivery of services has been entirely satisfactory. That’s an anecdote, not evidence.
I’m a fan. Here in Quebec, we pay independently or through insurance for medication (although I’m told the prices are lower than in the States), dental things and glasses. Everything else is covered.
I’ve never used private carriers (at least, no one who hasn’t accepted a Medicare card and only a Medicare card for payment), neither I nor anyone I know has had to wait for any treatment, and my family and I have always received excellent care.
In Quebec in election years, or when the provincial government is particularly unpopular (as is the case now), the anti-privatization rhetoric gets pumped up a lot, though in practice private clinics that provide certain diagnostic tests (MRI, CAT-scan, etc) for fees are becoming popular because given the choice of paying $600 for a clinic scan or waiting six+ months for a free hospital scan, many people are opting for the former. Similarly, the provincial beaurocracy has imposed a number of foolish and short-sighted rules on medical practitioners, prompting many to leave the province or “opt-out” of the Medicare system entirely. I’m personally hoping that private medical care will come to Quebec to give citizens the choice of getting treatments expensively and fast, or freely and slow. Competeition among clinics (once there are enough of them) can help keep prices under control and the burdens lifted from the public system can give it a chance to get its act together.
Or maybe a man will have a baby. Who knows when Quebec politics is involved?
I was just thinking the same thing - I was in Toronto a few months ago, and one thing that struck me was that although Toronto is roughly similar to my hometown (Chicago) in terms of ethnic/socioeconomic position, types of activities taking place, etc., I did not see a single morbidly obese person. In fact, I drove to Toronto from Chicago, and I didn’t see a single morbidly obese person once I crossed the Canadian border, and Canadians in general were thinner than Americans. And we all know what effect excess weight has on susceptibility to a variety of medical problems.
My personal experiences, through friends and family, has been very favourable. In the cases I’ve witnessed firsthand, the system works. The worst I’ve seen is one friend who had dibiltating wrist pain. She was booked in for surgery 7 months away. She bitched an awful lot about the wait to me, but after two months they called to see if she wanted the surgery the next week, but the pain had gone away by then.
On a less anecdotal note, it seems to me that a system where there are many many HMOs and other organizations administering the system, each developing their own way of doing things, each with shareholders looking to make as much profit as possible, is going to be inherently more expensive to the patient than what we have here.
That said, the system is in trouble, and does need help, but moving to an american style system, IMO, would be a very bad thing.
Don’t forget sales taxes. Have you got those in Canada? In the U.S., most state governments are financed primarily by retail sales taxes. In Florida, we pay the state 6 cents on every dollar of purchase price. (For other state taxes, see .) Basic necessities like food and medicine are exempt. Nevertheless, it’s a very regressive tax, falling hardest on those with the lowest incomes.
OTOH, “inheritance taxes” are negligible here – no estate worth less than a million dollars is taxable.
!!! Why is that? When I think of Canadian cuisine I think of peameal bacon and baked beans with maple syrup – not exactly diet food. And the Quebecois, I understand, eat rather like the French, with lots of cheese and cream sauces. And there’s lots of junk food and fast food, isn’t there? And a widespread fondness for beer and whiskey? And I presume Canadians, like Americans, spend a lot of time in their cars instead of walking – there are mass-transit systems, but only in major cities like Toronto and Montreal. So what makes Canadians thin?
Local governments, OTOH, are financed mainly by taxes on real property. Since “local governments” includes not only counties and cities but special-district governments such as school districts and water-management districts (whose boundaries, except for the school districts, do not always coincide with the county boundaries), reading your tax bill can be rather boggling. This page – http://www.hcpafl.org/padb/tax_estimator.htm – will provide you an entirely unofficial estimate of your property tax in Hillsborough County. It uses a default millage rate of 25 ($25 for every $1,000 of appraised property value), so I guess that’s a rough estimate of what should expect to pay, but it varies depending on what special districts your property falls under. Is it any different in Canada?
We have a federal 7% sales tax which all Canadians pay on most goods (food items not sold in convenience stores are exempt). In addition, every province except Alberta has a provincial sales tax of between 7% and 8%.
A 14-15% sales tax is bound to hit the lower income brackets pretty hard! (And people call Canada a “socialist” country!) IMO, you’d be better off phasing out the sales tax and increasing the income tax.