STEVE INSKEEP, host:

Thanks to the health care debate in the United States, it is hard to turn on your television without hearing a political ad condemning the Canadian health care system.

(Soundbite of ad)

Unidentified Woman #1: I survived a brain tumor, but if I had relied on my government for health care, I'd be dead. I am a Canadian citizen, and as my brain tumor got worse, my government health care system told me I had to wait six months to see a specialist.

Unidentified Man: The government runs health care in Canada…

INSKEEP: That's an ad questioning health care changes in the United States. Now, to be clear, no Congressional leaders are even debating establishing the Canadian system in the U.S., But still, the question is there.

So, reporter Sarah Varney, from member station KQED, wanted to know how accurately these ads portrayed Canada's health care system. She also wanted to know what Canadians thought about it. She traveled to Vancouver, Canada and brings us this story.

Unidentified Woman #2: Hi, thanks for holding. Can you tell me what she needs to come in for to…

SARAH VARNEY: This small doctor's office is on a bustling street in East Vancouver, a diverse and gritty working-class neighborhood. In one of the exam rooms, Dr. Larry Barzelai(ph) is talking with John and Bessie Riley, patients he's been seeing for more than 20 years.

Dr. LARRY BARZELAI: John has recently had a cancer diagnosed, colonic cancer, and he's seen various specialists.

Mr. JOHN RILEY: As far as the cancer goes, I've been going through the so-called treatments as they scheduled.

VARNEY: When Dr. Barzelai steps out to check on something, I tell John about the TV ads.

How have you been dealing with this when you've been trying to see specialists? What's been your experience of getting treatment?

Mr. RILEY: Well, nothing but good. Everything has gone bang, bang, bang. I have had no waiting time for anything.

VARNEY: And how much have you had to pay for all of this? Have you been in and out of the doctor's and getting surgery?

Mr. RILEY: No, I'm covered. I'm covered.

VARNEY: No out-of-pocket expenses whatsoever?

Mr. RILEY: Well, either than getting there - no, not.

VARNEY: So, how does Canada's health care system work? It's paid for through income tax and sales tax. All Canadians are covered and can see any doctor they want anywhere in Canada with no co-pays or deductibles. Some things aren't covered: optometry, dentistry and outpatient prescription drugs. Many Canadians have private insurance to cover those services, and some struggle to pay for them out of pocket.

American critics of Canadian health care like to call it socialized medicine. That's not actually true. 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 health care is private. Doctors run their own businesses and then bill the government.

Dr. Barzelai says physicians earn a good living here and they aren't faced with the same administrative hassles American doctors gripe about.

Dr. BARZELAI: Medical costs here are half of what medical costs in the States are. At the same time as our infant mortality is lower, our life expectancy is longer. Our rates of obesity are a lot less. So, there's got to see some positive aspects of living in Canada and with the Canadian medical system.

VARNEY: Canada has enviable health outcomes. The Commonwealth Fund, a respected and nonpartisan American 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, Canada came in sixth.

Mr. STEVE MORGAN (Health Economist, University of British Columbia): I think a lot of that is attributable to access.

VARNEY: Steve Morgan is a health economist at the University of British Columbia in Vancouver.

Mr. MORGAN: Canadians who feel that they have a need to manage a chronic condition or to manage an urgent situation, don't think about what the impact on their pocketbook is going to be. They seek the care - and more times than not, they get the care they need.

VARNEY: I met with Steve and his colleagues at the UBC Center for Health Policy Research to find out what the data they've collected over the years reveal about the Canadian health care system. I told them what most Americans hear about Canada: care is rationed, there are long waitlists, and a government bureaucrat gets in between a patient and her doctor.

Professor BOB EVANS (Health Economics): The allusion has been created of lines of people, kind of near death, waiting for services in Canada. It's absolute nonsense.

VARNEY: Professor Bob Evans is one of the grandfathers of the health economics field. He's been studying the Canadian and U.S. systems since they were founded around the same time in the mid-1960s.

Prof. EVANS: Are there cases where people wind up not getting the care they need at the appropriate times? Yes, of course, they are. It's 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? We are not a third-world country.

VARNEY: 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, the Canadian Supreme Court found in some serious cases, patients had in fact died as a result of waiting for medical services. Stories of these deaths, and of Canadians traveling to the U.S. for medical care, dominated Canadian news coverage.

In response, the Canadian government poured billions of dollars into reducing waiting times in the five areas deemed most troublesome, including cancer care, cardiac care and joint replacement surgery. As a result, wait times for these services have been dropping. Most provinces now report those waits on publicly-available Web sites. That kind of data and public accountability doesn't exist in the U.S.

That's not to say there still aren't frustrations with waiting for medical care in Canada. At B.C. Children's Hospital in a leafy Vancouver neighborhood, I met Joycelyn Thompkinson(ph). She's a peppy 29-year-old who was born with a neural tube defect similar to spina bifida.

Ms. JOYCELYN THOMPKINSON: I haven't been able to walk since I was eight. And I've had lots of surgery, lots of medical interventions of various types. But beyond that, I hold a job, I have a pretty much normal life.

VARNEY: Joycelyn credits an army of Canadian doctors and physical therapists for giving her that normal life, but there have been roadblocks.

Ms. THOMPKINSON: Of course, there were some times when I had to wait for care, and those were always the most frustrating moments in our system.

VARNEY: A few years ago when she was on a long waiting list for a pain clinic in Vancouver, she traveled to Seattle then Texas. The visits and tests cost her $1,800. Very few Canadians actually do go south for medical care though. Canadian researchers say it's a bit like getting struck by lightning - it's extremely rare, but when it happens everyone talks about it.

In some cases, provincial governments do pay for Canadians to receive specialty care in the U.S. 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. It doesn't happen often, though, and public opinion polls continue to show strong support for publicly-financed universal health care in Canada.

Keith Newman is with Ottawa-based Environics, a longstanding Canadian polling group.

Mr. KEITH NEWMAN (Environics): It's not something that everybody is completely satisfied with or feeling complacent about. There are concerns about waiting and that sort of thing. But when you ask people about their experience and experience of people they know, the vast majority think the system's pretty good.

VARNEY: At the same time, says Newman, about half of Canadians say they would like the option of buying a private health 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.

For NPR News, I'm Sarah Varney.

(Soundbite of music)

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