Does Canada's Health Care System Need Fixing?

fromKQED

Amid the debate about reforming heath care in the United States, it's tough to turn on your television these days without hearing a political ad condemning the Canadian health care system.

One such ad from Americans for Prosperity features a woman talking of her experience with getting treatment for cancer.

"I survived a brain tumor, but if I'd relied on my government for health care, I'd be dead. I am a Canadian citizen. As my brain tumor got worse, my government health care system told me I had to wait six month to see a specialist," the woman says.

The ads are provocative, but just how accurately do they portray Canada's system?

At a small doctor's office in the gritty working-class neighborhood of East Vancouver, Dr. Larry Barzelai meets with John and Bessie Riley, who have been his patients for more than 20 years.

John Riley was recently diagnosed with colon cancer. Contrary to the woman in the TV ad, he says his experience getting in to see specialists has been "nothing but good" so far. "Everything's gone bang, bang. I've had no waiting times for anything," he says, adding that his only out-of-pocket expense has been the cost of getting to the doctor's office.

Socialized Insurance, Not Socialized Medicine

Canada has a universal health care system that's paid for through income taxes and sales tax. All Canadians are covered, and they can see any doctor they want anywhere in the country with no copays or deductibles. Some things aren't covered: optometry, dentistry and outpatient prescription drugs. Many Canadians have private insurance to cover those services, though some struggle to pay for them out of pocket.

U.S. critics of Canadian health care like to call it socialized medicine, but it's more like socialized insurance — meaning the risk is pooled together. And while the individual provinces and territories set their overall health budgets and administer the health plans, the delivery of medical care is private. Doctors run their own businesses and then bill the government.

Barzelai says physicians in Canada earn a good living and aren't faced with the same administrative hassles that American doctors gripe about. "Medical costs here are half of what medical costs in the States are," he says. "At the same time, our infant mortality is lower, our life expectancy is longer, our rates of obesity are a lot less. So there's got to be some positive aspects of living in Canada and with the Canadian medical system."

The Commonwealth Fund, a respected and nonpartisan U.S. health research organization, looked at deaths that could have been prevented with access to quality medical care in the leading 19 industrialized countries. In the latest survey, the United States ranked last and Canada came in sixth.

Professor Bob Evans, one of the grandfathers of the health economics field, has been studying the Canadian and U.S. systems since they were founded around the same time in the mid-1960s. He says that what many Americans hear about Canada — rationed care, long wait lists and a government bureaucrat who gets in between a patient and doctor — is "absolute nonsense."

"Are there cases of people who wind up not getting the care they need at appropriate times? Yes, of course there are," says Evans, who is with the Centre for Health Policy Research at the University of British Columbia in Vancouver. "This is a huge system and it's a very complicated one and things do go wrong. But as a general rule, what happens here is that when you need the care, you get it." But that wasn't always the case.

'The Most Frustrating Moments In Our System'

When federal spending on Canadian health care declined during a recession in the 1990s, lines for non-urgent procedures — and some urgent ones — grew. A few years later, Canada's Supreme Court found that some patients had in fact died as a result of waiting for medical services. Stories of the deaths and of residents traveling to the U.S. for medical care dominated Canadian news coverage.

In response, Canada's government poured billions of dollars into reducing wait times in the five medical areas deemed most troublesome, including cancer care, cardiac care and joint replacement surgery. And wait times for these services has dropped: Most provinces now report those times on publicly available Web sites. Such data — and public accountability — don't exist in the U.S.

But that's not to say there still aren't frustrations with waiting for medical care in Canada.

Jocelyn Thompkinson is a peppy 29-year-old who was born with a neural tube defect similar to spina bifida. "I haven't been able to walk since I was 8, and I've had lots of surgeries, lots of medical interventions of various types," she says at BC Children's Hospital, in a leafy Vancouver neighborhood. "But beyond that, I hold a job, I have a pretty much normal life."

She credits an army of Canadian doctors and physical therapists for giving her that normal life, though there have been roadblocks. "Of course there were some times when I had to wait for care, and those are always the most frustrating moments in our system," Thompkinson says. Several years ago, when she was on a long waiting list for a pain clinic in Vancouver, she traveled to Seattle and then Texas to get care. The visits and tests cost her $1,800.

Few Canadians actually go south for medical care, though. Canadian researchers say it's a bit like getting struck by lighting — it's extremely rare, but when it happens, everyone talks about it.

Provincial governments do pay for Canadians to receive specialty care in the U.S. in some cases. For example, a shortage of neonatal beds means a small number of women with high-risk pregnancies are sent to U.S. hospitals to deliver their babies.

It doesn't happen often, though, and public opinion polls continue to show strong support for publicly financed, universal health care in Canada.

An Option To Buy

Keith Neuman of Environics, a long-standing Canadian polling group, says, "It's not something that everybody is completely satisfied with or complacent about. There are concerns about waiting and that sort of thing. But when you ask people about their experience and the experience of people they know, the vast majority think the system's pretty good."

At the same time, he says, about half of Canadians say they would like the option to buy a private health insurance plan. Currently, that's not allowed.

In many ways, Canada is confronting some of the same problems as the U.S. — anxiety over how to pay for its aging baby boomers, a shortage of primary care doctors, and too many people who overuse hospital emergency departments. But what Canadians don't worry about is losing their health insurance or going bankrupt because of an injury or illness.

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