Health & Medicine

Don’t write off the Canadian health care system

Denver Lewellen

The principles of the Canadian, single-payer health care system are not likely to be broadly applied in the US. This is due to deep historical, economic and ideological differences between the two countries. There are, however, many reasons we should look to Canada for the purpose of reciprocally transferring knowledge of successes and problems in their health care system as well as in our own.

For the uninitiated, here are some quick facts about our neighbor to the north: Relative to the US, Canada has strong systems of 1) health care, 2) finance, and 3) education. The country’s single-payer health care system boasts outcomes of higher life expectancy, lower infant mortality, and less cost per capita than the US system. Banking regulation in Canada has helped keep the Canadian economy stable even in these difficult economic times, and there is no real estate crisis in Canada that can even begin to compare to the foreclosure crisis in the states. Finally, many universities in Canada, although under stress, still operate much like the University of California did prior to its major loss of tax revenue. The field of education in Canada is highly respected and seen as vital to progress, sustainability, and economic growth.

Surprisingly, many US citizens are not aware of such successes in Canada, and they also cling to falsehoods about the country – if they ever think of it at all. I am reminded here of a discussion I had at a Canadian Studies event at UC Berkeley that drew in a handful of Canadians visiting the campus. When they found out I was studying their health care system, their expressions turned sour. They expressed surprise over the fact that Americans believed that Canadian health care was exemplified by “death panels,” those supposedly socialistic tribunals within which Canadian citizens are deprived of life at the whim of the government. My only response had to be that Americans have vastly different ideas about the role of government, taxation, and other civic issues, and – unfortunately – Americans are often subject to political “cons” such as the existence of Canadian death panels.

This experience has stayed with me, and I have thought deeply about the impact of such rhetoric on US discourse related to health care policy. On one level this discourse detracted attention from the fact that private health insurance companies in the US frequently make the kind of life and death decisions attributed to the “death panels” in Canada. Additionally, notions of “death panels” played a huge role not only in shutting down possibilities for a public health care option in the US, it also discouraged serious discussion of any kind related to Canadian health care as a potential model for health reform in the US.

This was a huge misstep, but not for reasons one might think. Even though I have already touted certain strong aspects of certain Canadian systems, I am not one of those “Canada=Nirvana” types. As an anthropologist who has lived and conducted research in Canada, I am well aware of the fact that there are cracks in the Canadian system, cracks that highly resemble problems in the US system. Canada – just like the US – faces pressures to reduce costs and to downsize programs, and these pressures are inevitable effects of continuing, neoliberal economic aspects of globalization that result in the erosion of the public sector.

Such problems in the Canada, however, make it only more important that we at least examine and consider their health care models. This is because the impact of reduced expenditures plays out differently in Canada than in the US, due to the mandate of the Canada Health Act to uphold provisions for universal health care. Whereas in the US the health care crisis translates into millions of people simply being left without health insurance, Canadians still have their coverage, albeit coverage that looks and feels different from previous generations. In this context, the benefit of having a comprehensive health care system such as Canada’s is that there are people, policies, and procedures in place that make it easier to create new models of care, particularly at the outpatient level where resources are scarcer but more necessary. In the province of Nova Scotia, as just one example, various community-based agencies have rallied to create evolving systems of outpatient care that can bridge the gap between a past system of services and a present reality of reduced resources.

For some reason, the US has insisted on creating its own unique response to the health care crisis, which, so far, means that we continue to face an enormous problem. An increasingly popular Libertarian movement here insists that health care remain in the private sector and that the “magic hand” of the free market will inevitably equalize the playing field. This theory has several problems, not the least of which is the fact that the determination of effective health care policy does not appear to derive solely from free market driven economies. Rather, sensible policy is based on hard work stemming from the nexus of research, experience, and smart thinking.

Rather than continue to let health care deteriorate, wouldn’t it make sense for the US to relax its defenses, put away the rhetoric of “death panels” and begin to look at the nuts and bolts of successful and highly ranked health care systems in other western countries? Wouldn’t Canada, our friendly neighbor to the north, be a good place to start? This move would not be about “bringing socialism home.” Rather, it would be about realizing we have a flat tire, and that in this case there is no need to reinvent the wheel. The transfer of knowledge could be reciprocal, as Canada has much to learn from us as it slowly attempts to introduce privatization of auxiliary health care services and systems of patient co-pays in select areas. Subsequently, hybrids of public and private models of health care may well be the answer to a lot of questions in both worlds. Working with Canada, as a neighbor and a friend, can be a good start towards approaching the coming, inevitable age of major health care policy transformations.

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Comments to "Don’t write off the Canadian health care system":
    • Rod Pederson

      The pressures to downsize and cut programs in Canada are rooted in the failure of the American economic system to function properly, not to any “neoliberal” urge. Our version of the Republicans, the Conservatives, ran up a huge deficit in a misguided effort to combat the local effects of a global crisis caused by Wall Street greed and irresponsibility. The very Conservatives who buried us in debt – and they took over with a surplus – are now hailing themselves as the rescuers of our economy. It’s a pathological pattern followed, it seems, by all North American right-wing parties. They first thrust us into debt to the point where the country is in some distress, then they rush to the fore claiming to be our saviours. It’s a form of “Munchausen By Proxy” and just as insane as it sounds.

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    • why sleep

      Sleep is an essential element to keep life going, nothing else matters. We spend about one-third of our lives asleep, nearly 3,000 hours per year. Unfortunately, one out of every four Americans reports getting sleep less than 7 hours per night daily during the work week, which works out to about an hour and a half less than a century ago.

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    • Charles

      Having done my own research, talked to many Canadians both inside and outside the healthcare industry, and having factored out the self-imperative to have someone else pay for one’s healthcare and never have to take personal responsibility for one’s outcome, I conclude that your article presents an inaccurate account:

      (Inter alia): http://www.city-journal.org/html/17_3_canadian_healthcare.html

      I’m sure there are things that we Americans could learn from Canada, but presenting an inaccurate account does not serve the cause of improvement.

      Finally, in close: “The wealthy would have whatever care they want…”. Well, gee, here’s a startling insight: the wealthy (and powerful) will always have whatever care they want.

      (Inter alia): http://www.thestar.com/news/canada/article/759760—danny-millions-williams-heads-south-for-heart-surgery

      We constitute governments to, among other things, regulate markets. Given the choice between direct, interventionist, autocratic government solutions, and access to a well regulated competitive market, the market will always, without exception, result in better outcomes for most people. The government-impelled solution, as already documented, will always and without exception result in the same mediocrity for all.

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    • juliaroberto

      Great article that makes some necessary corrections to American attitudes which do have these all type of stuff in their life. The Canadian system is far enough better off but still need so many improvements!

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    • KL

      Too bad many Americans do not have the adequate critical skills and patience to sit down and learn from other countries. Many of them just consider everything as socialism and then the conversation stops there and turns into unneccessary insults.

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    • Don McCanne

      This is an excellent article, and my comment here should not be construed as to detract from the major thrust of the message.

      The suggestion that the answer may be a hybrid between good and bad systems with regards to privatization and patient cost sharing should be challenged.

      Allowing Canadians to opt out of the public insurance system in order to buy their way to the front of the queue would inevitably lead to a two-tiered system with resulting diminished political support for the public system. The wealthy would have whatever care they want while low and middle income individuals would have to contend with a chronically underfunded public program.

      Although support for cost sharing is deeply entrenched in the U.S. political and policy communities, it actually has very little impact on total health care spending but it can have a significant negative impact by impairing access, especially for patients of modest means. Professor John Nyman has shown that in most instances the moral hazard of health insurance does not result in a welfare loss but actually results in a welfare gain. Erecting financial barriers to care is a flawed policy.

      As for the United States and Canada learning from each other, we can learn from Canada how to do health care financing mostly right, whereas Canadians can learn from the United States how to do it mostly wrong.

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