Exposing Lies About Canadian Health Care

Common Myths About the Canadian Health Care System Exposed

By Victoria Foe / The Rag Blog / August 5, 2009

I am a dual U.S./Canadian citizen. I am American by birth. I became a naturalized Canadian in my early forties and Canada was my primary residence for eight of my 63 years. Though I now live and work in the U.S., I still return yearly to Canada. I currently have medical insurance through my employer here in the U.S., and in the past, when self-employed, I purchased health care insurance as an individual.

I have first hand experience with Canada’s single-payer health care insurance program, to which I continue to subscribe. For-profit health insurance companies here are intentionally spreading misinformation about the Canadian system to frighten people away from a not-for-profit, government-administered insurance plan being added to the insurance options available to Americans. Here I correct five lies about Canada’s medical insurance program.

Lie #1. Canada has socialized medicine, putting the federal government, rather than doctors, in charge of medical decisions.

In fact the Canadian federal government plays only two roles: 1) it provides an eight page document — the Canada Health Act — outlining the attributes that Canadian medical insurance must meet (coverage of all “insured persons,” for all “medically necessary” hospital and physician services, without co-payments, transportable throughout Canada, and stipulates that the insurance program must be administered on a not-for-profit basis by the provinces) and 2) it transfers federal tax dollars to provinces whose medical insurance coverage meets these standards.

Except for complying with the Canadian Health Act, each province has autonomy in administering and delivering health care services and in determining how to finance its share of the cost of its health insurance plan. Financing can be through the payment of premiums (as is the case in Alberta and British Columbia), payroll taxes, sales taxes, other provincial or territorial revenues, or by a combination of methods.

In British Columbia I pay a premium of 640 Canadian dollars per year. In 2007 the total annual medical insurance cost, including provincial plus federal contributions, was $3,895 USD per Canadian, and everyone was covered; this contrasts with $7,290 per year in the US, while still leaving 44 million Americans uninsured (OECD Health Data, 2009; the World Health Organization data for 2006 shows a similar Canada/US health expenditure ratio).

Whereas the provinces manage the insurance component on a not-for-profit basis, and fund major facilities such as hospitals, healthcare itself is provided by physicians, most of whom are in private practice. Canadian doctors generally work on a fee-for-service basis, as in the U.S., but instead of sending the bills to one of hundreds of insurance companies, they send it to their provincial government.

Medical peer review (not the government) establishes best medical practice. Specifically, in each province a College of Physicians and Surgeons prescribes the diagnostic procedures and treatments shown to have the best outcome, provides advice on emerging diseases, preventative care etc.

Contrary to propaganda here, Canada’s version of national medical insurance is characterized by provincial control, physician autonomy and consumer choice. It is not the practice of medicine, but the business of insurance, that has been socialized in Canada, and the change from for-profit to non-profit insurance, plus low administrative overhead, has resulted in enormous cost savings in Canada.

In summary, Canadian medical insurance distributes risk over the entire population, is administered on a not-for-profit basis by the provinces, with oversight as regards fairness by the federal government, but with the actual medical services largely provided by private entities and with medical peer review prescribing best care practice.

Lie #2. Canadians have no choice of doctor and medical care is rationed.

In Canada the majority of physicians are in primary care practice. Canadians can go to any primary practice doctor who has an opening, in any Canadian province, whenever and wherever they need to.

It is true that before we can go to a specialist we need a referral from our primary care doctor, but many private insurance companies in the U.S. require the same. And here again, in Canada we can choose from among the relevant specialists, seek second opinions, and change doctors etc. The average number of physician visits per capita per year is about 6.0 in Canada, vs. 3.8 in the United States — hardly evidence of rationing and inverse to the yearly cost per person.

When in Canada this June I went to one of the three doctors who live and work on the island I used to live on, seeking a physician’s perspective on Canada’s medical insurance system. I asked how often the government had intervened in his practice. He was surprised by the question, and said “never.” He also claimed he has never been denied reimbursement for tests or treatments he prescribed, and his only complaint was that the wait time for diagnostic MRI is longer than he would like.

I asked what percentage of his time was spent on paperwork. He initially misunderstood my question to mean time spent documenting the medical needs and care of his patients in their charts. When I clarified my question to mean dealing with insurance coverage and payment, he snorted dismissively and said he did not spend any time at all on that, that billing was a small routine job his receptionist performed for him and for the two other doctors with whom he currently shares a clinic. I asked whether he felt cheated having to practice in Canada given that he could make more money in the U.S. He denied any envy and went on to opine that better medicine was practiced in Canada than in the U.S.

Lie #3. Public-funding of health insurance leads to second-rate medicine.

The proof of the pudding is in the eating thereof and World Health Organization analyses show that Canada consistently, and significantly, outperforms the United States in life expectancy, years of disability-free life, and infant mortality.

One might attribute this to the high number of uninsured Americans dragging down the national average. However, a systematic review comparing health outcomes in the United States and Canada among patients treated for similar underlying medical conditions (including cancer, coronary artery disease, and various chronic illnesses and surgical procedures) found that Canadian outcomes were more often superior to U.S. outcomes than the reverse.

Of course, there are outstanding and mediocre doctors everywhere, and of course, errors or malpractice by individual doctors can have tragic consequences anywhere. But there is no evidence that the 87% higher per-capita expenditures on health care in the United States systematically buys superior outcomes for the sick, or better preventative care.

Lie #4. Long wait times for medical care in Canada are routine.

In Canada, I have never needed to wait more than a day or two to see a primary care physician; in the U.S. I have never gotten to one that quickly. In Canadian cities, walk-in clinics supplement primary care doctors by attending to non-catastrophic urgent care that in the U.S. clogs emergency rooms. Life-threatening illness gets Priority 1 attention throughout the system.

Of course, Canadian doctors, like doctors everywhere, have preferences about where to live and raise their families. So, in the vast sparsely-populated country that is Canada, there are under-served communities, just as there are in the U.S.

The one common complaint I do hear from Canadians is that wait times are too long for diagnostic MRI and for those surgical procedures that the provincial Colleges of Physicians & Surgeons have designated non-urgent. Most complaints concern hip and knee replacements (in BC the median wait time for knee replacement is currently 13 weeks and 10 weeks for hip replacement).

Rather than add facilities that will be under-utilized, patients are queued, and patients needing emergency surgery and those in most urgent need of elective surgeries are moved to the head of the line. This practice annoys those waiting in line, but it has helped Canada hold per capita health care costs to just a little above 50% of what Americans pay for medical insurance, while still covering everyone, including for elective surgeries, long-term care and all hospitalization.

However, one consequence of having heath care administered by a government is that it becomes responsive to voter satisfaction. Reducing wait times is currently politically urgent in Canada, new funds have been targeted to increasing operating room capacity and MRI machines, and wait times are now shorter than a few years ago. (Wait list information by year is posted by each of the provincial Ministries of Health Services; e.g. www.health.gov.bc.ca/cpa/mediasite/waitlist/median.html).

One feature of Canadian health care that I think would amaze and delight Americans is the utter absence of paperwork for the user. When I go to my doctor, or for a test, or to a hospital I show my BC health card and that is the beginning and end of my part of the paperwork!

Lie #5. Given a choice, Canadians would choose the American system of medical insurance.

Access to good medical care as a universal right is a value that unifies the geographically vast and ethnically heterogenous country that is Canada, allowing citizens to move or change jobs while retaining health care coverage. Canadians are justifiably proud of their medical insurance program and value it so highly that Tommy Douglas (the colorful Baptist minister, premier of the prairie province of Saskatchewan and father of Canada’s universal health Insurance program) was voted “the greatest Canadian of all time” in a 2004 CBC poll.

Debates on how best to afford new medical technologies and the increasing medical cost of an aging population are ongoing north of the 48th parallel, just as they are here. But, as Saskatchewan physician E.W. Barootes, originally an opponent of universal health care, put it, “today a politician in Saskatchewan or in Canada is more likely to get away with canceling Christmas than… with canceling Canada’s health insurance program.”

President Obama’s Public Health Insurance Option vs. Universal Single-Payer Insurance.

Americans generally know little about the superior insurance programs other modern democracies give their citizens. And conservatives here have assiduously promoted distrust in, and disdain for, governmental programs. Thus, I think the Obama proposal of offering a not-for-profit government-administered insurance plan as an option, on a trial basis as it were, is a smart way forward. But, unless people rise up in huge numbers to support it, even that is going to be blocked by the for-profit insurance companies.

Friends, if good and affordable health care insurance is something that matters to you, we have August to make our opinions known, in every way we can. By the way, check out, add to, and pass along stories.barackobama.com/healthcare/.

The Rag Blog

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8 Responses to Exposing Lies About Canadian Health Care

  1. I have 3 Canadian friends, and all of them have said pretty much the same thing that this post confirms.

    Glad you took the time to summarize this – it’s handy information for anyone who grabs it up like I did.

  2. I am a physician advisor in Dallas, and I have become an activist in writings, blogging and social networking/commentaries about the deplorable state of U.S. healthcare. The reason we are doing this at our firm is that 1) we wholeheartedly believe in the sanctity of healthcare, i.e., the relationship between physician and patient, 2) we are increasingly appalled by the lies, deceit and misinformation that is being spread about by self-interest groups in the States (both political and corporate)who wish to maintain the status quo of a viciously avaricious and selfishly profitable private sector, and 3) we are concerned about the morale of U.S. physicians (notably primary care doctors) who are concurrently being systematically robbed of the best attributes of medicine, i.e., interacting and caring for patients, and are under increasing financial pressure. Unlike the uninformed naysayers and those who choose to spread lies and hearsay, we have taken it upon ourselves to study the Canadian system. Our inquiries have been cordially and warmly welcomed by the Canadian Medical Association in Ottawa, and by the University of Manitoba Centre For Health Policy, when we have asked questions about Canadian healthcare. We have been given open and candid evaluations about the issues and challenges in Canadian healthcare (there has been no sugarcoating), and we have been apprised of Canada’s initiatives e.g., The Wait Time Alliance and the Canadian evaluations of European models for potential reform guidance.

    We have an honest and informed view of Canada’s challenges – e.g., long waiting time for MRIs, hips, knees etc. But we do NOT have an impression that Canadians are dying in their homes or in hospital corridors waiting for life-saving care.

    Likewise, we are aware that Canada’s per capita costs for healthcare, while increasing, are well below the U.S. and that Canada may well be viewed as focusing more peer review oversight to utilisation. In the U.S., one of our leading universities (Dartmouth) has published studies which have shown that the U.S. is wasteful and many of our increasing costs are due to overutilisation and outright fraud (esp Medicare). In fact, one of the worst offending areas in the U.S. has been identified as Dallas, Texas. Our firm (which includes a well-know physician in Dallas and the U.S.) wholeheartedly believes that public/private payer systems (no matter who “wins” the debate-debacle currently raging in the States) will not provide a solution, and that whichever payer system prevails, U.S. healthcare costs will crush the American economy UNLESS a massive effort is devoted to the redesign and restructuring of how healthcare is delivered on a cost-effective new spectrum that is lashed together by a sound system of healthcare information technology (EMR/EHR).

    From one American, Canada, I apologize for the lies and smear tactics that have been used against you by self-serving and self-motivated bureaucrats and corporations in the States, who wrongly wish to scare people with fabricated and overblown facts.

  3. From Texas and currently living in Berlin, Germany, I sure appreciate the thoughtful and careful article about a “foreign” health system.

    While there are many complex issues, in my experience the Germans certainly take their health care system seriously, work on improvements, and have much here that is much better than in the US.

    I will certainly pass the article along to other Americans with experience in Germany, and get some information from over here back home.

  4. Carolyn Prescott says:

    I appreciate this clear summary of how the Canadian system works. I have had some harrowing experiences in the U.S. health care system, including the very common one of losing insurance after getting sick and being unable to work for over six months and thus losing my job. I was offered insurance under Cobra, but it would have been around $900 for our family per month (in 2001) and was just out of the question with only one person in the family working. So this was a major factor in our deciding to move to my husband’s home country, Germany, where we now live and have health insurance. In the German system, we have all received excellent care–no wait times, very, very low copayments, no deductible, access to medical technology, etc. One of the most amazing aspects of the system here for me is the lack of fear that I feel about all insurance matters. In the States, illness didn’t mean just illness; it meant you might have to fight for care or you might go broke. I’m deeply saddened by the lies being spread in the U.S. now about systems that have universal coverage. We all have to keep explaining and clarifying the truth, and Victoria Foe has done that so well.

  5. dospesentas says:

    Canada has about the population of Texas. A better comparison would be our old competitor Russia. Russia’s had public healthcare for decades, a closer population to ours and it’s own medical schools and research programs. I don’t think you will be hearing proponents making any comparisons to Russia – for good reason.

    It’s easy to do healthcare on a small scale when you have low welfare demand, a healthy, well paid population and the vast majority paying into the system. It’s also nice to benefit from billions in research and development paid by your southern neighbor. The use of Canada as a point of reference is very misleading and dangerous. America’s illegal immigrant and perpetual welfare population is larger than the entire population of Canada! We have 50% participation in our income tax system, Canada’s is over 80%. Canada in addition to national and provincial income taxes, has a national sales tax, and VAT (Value Added Taxes) called GST (Goods and Services Tax) and HST (Harmonized Sales Tax). Depending on provence VAT can exceed 15%. As if that wasn’t enough they have Property taxes, Payroll taxes (the Employer Health Tax alone is 1.95% of total payroll), Excise taxes (on all tobacco and alcohol sales), Estate taxes and a specific Health and Prescription Insurance tax than runs $300 – 900/yr per person depending on income.

    At the end of the day FUNDING and DEMAND make a world of difference. No one is talking about THAT!

  6. My goodness, the comments were as helpful as the article – what articulate and informed readers all of you are!

    I think all the comparisons have been exceptional; thanks to the comment section, I’ve learned much much more than I ever expected. How I wish all of you who took the time to add your lengthy remrks, would also duplicate them to your representatives and local newspapers in your area. These are ‘talking points’ of considerable value!

  7. P.S. – Tried to find dospesentas’ blog, but the profile is kept private….. …..too bad – I’ve read a number of his/her comments today, and they are all exceptional and intelligent.

    I’d just say: “Please, don’t be shy – if you’ve got a blog or web-site, would you leave it the next time you post?”

  8. MMC says:

    More than a little late to the party here but, Dospesentas please get all your facts straight:

    Canada in addition to national and provincial income taxes, has a national sales tax, and VAT (Value Added Taxes) called GST (Goods and Services Tax) and HST (Harmonized Sales Tax). Depending on provence VAT can exceed 15%.

    Firt of all we don’t have a national sales tax AND a VAT – the national sales tax IS a VAT and depending on the province you live in it is called EITHER the GST or HST. I live in the province with the highest HST (which combines the provincial sales tax with the natinoal VAT) and the rate is 15%. But that is the highest rate in the country and we are the only one province with a rate that high.

    As if that wasn’t enough they have Property taxes, Payroll taxes (the Employer Health Tax alone is 1.95% of total payroll), Excise taxes (on all tobacco and alcohol sales), Estate taxes and a specific Health and Prescription Insurance tax than runs $300 – 900/yr per person depending on income.

    As far as I can tell only two provinces (Ontario and Quebec) levy an employer health tax, I’ve never heard of that in any other province. Ontario is also the ony province with a Health and Prescription Insurance Tax too. Just for the record, we don’t all live there.

    You might want to check out your own estate taxes (which are basically very similar to ours) and, by the way, I see that some states also impose an inheritance tax on beneficiaries. We have no such tax in Canada. Nor do we have any gift taxes or a tax on lottery winnings. None, zip, zero. Nor do our employers pay social security or medicare taxes. And are you about to tell me you don’t have property taxes?

    Please, if you’re going to compare the two systems, at least make the effort to be a little more accurate and try to keep it fair.

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