A bit more about Canadian healthcare, or The Truth About Canada

I’ve been trying to write about things other than healthcare, but it’s hard these days to keep my mouth shut when I hear some critics in the US pointing to Canada’s system as the doom and gloom scenario awaiting the US if Obama manages to accomplish his planned changes to the American system. This morning, I watched this video by Steven Crowder entitled “ObamaCare Yay or Nay? The Truth About Canada!”. What he finds is important and it points to some of the many problems currently being experienced in Quebec, especially by those people without a family doctor. What it does not prove in any way, really, is the failure of the Canadian system as a whole.

Here’s an expanded version of the comment I just posted on one of the many conservative blogs that is now using this video as their top evidence of how the last thing they want is for the US to look to Canada for inspiration.

As a Canadian currently living in the US, I watched this video with interest. I saw nothing that resembles my own many experiences with healthcare in Canada. As with the United States, the level of service one gets can depend greatly on where you live. For me, I’ve consistently had longer ER wait times in the US than I ever had in Canada (my son has asthma and I’ve visited emergency rooms on a number of occasions back in Canada). Just a few weeks ago, my wife and nine-year-old daughter waited 7 hours in our local ER in Burlington where she went because of chest pains and trouble breathing. All in all, though, I have to say that we’ve had fine service in both countries. In terms of service, access to care, and high quality of care, I’ve seen no difference. The big difference, though, is that my employer and I pay thousands of dollars per year for our coverage in the US. That works out to far more than the difference between the income taxes I paid in Canada compared to what I pay in the US. I pay slightly less in income tax here, but four times what I paid in property taxes in Canada, and my employer in Alberta paid under $200 a month for my family’s healthcare.

In the video, Steven Crowder, who if I recall correctly is a dual citizen, visits Montreal, Canada’s second biggest city and the place in the country that seems to be having the worst time of things by far. When I lived in Edmonton, if it were an urgent matter I could usually see my GP on the same day that I called. After-hours, there were a number of 24-hour clinics where the wait would be longer but I’d always be able to see someone. For urgent cases, we’d go to the ER and the wait was always understandable; the more severe cases always go first, as they should. Crowder goes on and on in this video about how in Canada they have to ration care because of the system. I’m sure my University of Vermont colleague down the hall, who is fighting with her insurance company here to get approval for some desperately needed spinal surgery, would be happy to talk about her experiences of care being rationed in the US. It’s rationed in the US all the time, not because of a lack of capacity in the medical system, but rather to increase shareholder earnings in the for-profit insurance system.

The major problem in Canada has, to my mind, very little to do with universal healthcare itself; there can always be greater efficiency in any system, but the system in Canada at the moment is underfunded, particularly in Quebec. Crowder’s video documents this underfunding very well with the clear problems in the Quebec system’s shortage of capacity at the moment. Despite this underfunding, the results in Canada are still superior to those of the US. Canada puts 30-40% less into healthcare than the US does and yet Canadians’ life expectancy is longer, patient satisfaction levels are similar if not higher in Canada, and no one ever goes bankrupt over medical bills. The question of higher tax rates in Canada, as I suggest above, is all relative. In Quebec, Crowder is right that with sales tax people do wind up paying the 8% provincial sales tax on the 5% federal sales tax, but there are other provinces that have solved this by “harmonizing” their sales taxes so that they are charged only one tax rather than two separate ones. In Alberta, there is no provincial sales tax at all and there never will be. Paying tax on tax is absurd, but one can’t say that happens in all of Canada.

While we Canadians, like people everywhere, wish our taxes would be lower, 85% of Canadians recently surveyed said that they wouldn’t dream of trading their healthcare system for that of the United States. Universal healhcare works. It’s more effective than what we find in the US in terms of its ability to treat everyone equally. It’s also, contrary to popular belief here in the US, far less bureaucratic than the US system. Just stop by a Canadian hospital or doctor’s office and look for the billing office. You won’t find one.
To see the problems Crowder found in Montreal as representative of all of Canada is as foolish as walking into one of the poorest areas in a major US city and describing the whole country as being rife with poverty and crime. The Canadian system needs to be improved and better funded, without a doubt, but overall it’s still very good and works well for most Canadians.

Finally, as Canadians, it doesn’t do us any good to be smug about how well our system works, because it doesn’t work anywhere close to as well as it should for many Canadians, and particularly First Nations people on reserves and the Inuit . Just because we’re ranked slightly higher internationally than the US doesn’t mean that we still don’t have a lot to learn and lots to improve. Because of our sometimes foolish and shortsighted preoccupation with what Americans think of us, it’s easy for us to get distracted by comments in the US about the good and the bad aspects of our system. What we really need is to start looking seriously (as they are doing right now in the US) about how we could do a much better job at providing better access and quality of care to all Canadians. Instead of focusing how much better our system might be than that of other countries we should start looking at how much worse our system is than that of the nations higher up the list.

Followup: This report from CNN offers a pretty balanced assessment of the state of things in Canada.