This year is shaping up to be the election year that we finally get to have the Great American Healthcare Debate again. Harry and Louise are back with a vengeance. I'm both a health-care-card-carrying Canadian resident and an uninsured American citizen who regularly sees doctors on both sides of the border. As such, I'm in a unique position to address the pros and cons of both systems first-hand.
1. Canada’s health care system is “socialized medicine.”
False. In socialized medical systems, the doctors work directly for the state. In Canada (and many other countries with universal care), doctors run their own private practices, just like they do in the U.S. The only difference is that every doctor deals with one insurer. And that insurer is the provincial government, which is accountable to the legislature and the voters if the quality of coverage is allowed to slide.
2. Doctors are hurt financially by single-payer health care.
True and False. Doctors in Canada do make less than their U.S. counterparts. But they also have lower overhead, and usually much better working conditions. A few reasons for this:
First, as noted, they don’t have to charge higher fees to cover the salary of a full-time staffer to deal with more than a hundred different insurers. In fact, most Canadian doctors get by quite nicely with just one assistant, who cheerfully handles the phones, mail, scheduling, patient reception, stocking, filing and billing all by herself in the course of a standard workday.
Second, they don’t have to spend several hours every day on the phone cajoling insurance companies about care for their patients. My doctor in California worked a 70-hour week: 35 hours seeing patients, and another 35 hours on the phone arguing with insurance companies. My Canadian doctor, on the other hand, works a 35-hour week, period. She files her invoices online, and the vast majority are simply paid — quietly, quickly and without hassle. There is no runaround. Care is seldom denied (because everybody knows the rules). She gets her checks on time, sees her patients on schedule, takes Thursdays off and gets home in time for dinner.
Third: The average American medical student graduates $140,000 in hock. The average Canadian doctor’s debt is roughly half that.
Finally, Canadian doctors pay lower malpractice insurance fees. When paying for health care constitutes one of a family’s major expenses, expectations tend to run very high. A doctor’s mistake not only damages the body; it may very well throw a middle-class family permanently into the ranks of the working poor, and render the victim uninsurable for life. With so much at stake, it’s no wonder people are quick to rush to court for redress.
Canadians are far less likely to sue in the first place, since they’re not having to absorb devastating financial losses in addition to any physical losses when something goes awry. The cost of the damaging treatment will be covered. So will the cost of fixing it. And, no matter what happens, the victim will remain insured for life.
3. Wait times in Canada are horrendous.
True and False again — it depends on which province you live in, and what’s wrong with you. Canada’s health care system runs on federal guidelines that ensure uniform standards of care, but each territory and province administers its own program. Some provinces don’t plan their facilities well enough; in those, you can have waits. Some do better. As a general rule, the farther north you live, the harder it is to get to care, simply because the doctors and hospitals are concentrated in the south. But that’s just as true in any rural county in the U.S.
The percentage of Canadians who’d consider giving up their beloved system consistently languishes in the single digits. A few years ago, a TV show asked Canadians to name the Greatest Canadian in history; and in a broad national consensus, they gave the honor to Tommy Douglas, the Saskatchewan premier who is considered the father of the country’s health care system. In spite of that, though, grousing about health care is still unofficially Canada’s third national sport after curling and hockey.
And for the country’s newspapers, it’s a prime watchdogging opportunity. Any little thing goes sideways at the local hospital, and it’s on the front pages the next day. Those kinds of stories sell papers, because everyone is invested in that system and has a personal stake in how well it functions. The American system might benefit from this kind of constant scrutiny, because it’s certainly one of the things that keeps the quality high. But it also makes people think it’s far worse than it is.
Critics should be reminded that the American system is not exactly instant-on, either. When I lived in California, I had excellent insurance and got my care through one of the best university-based systems in the nation. Yet I routinely had to wait anywhere from six to 12 weeks to get in to see a specialist. Non-emergency surgical waits could be anywhere from four weeks to four months. After two years in the British Columbia system, I’m finding the experience to be pretty much comparable, and often better. The notable exception is MRIs, which were easy in California, but can take many months to get here. (It’s the number one thing people go over the border for.) Other than that, urban Canadians get care about as fast as urban Americans do.
4. You have to wait forever to get a family doctor.
False for the vast majority of Canadians, but True for a few. Again, it all depends on where you live. It is, absolutely, harder to get to a doctor if you live out in a small town, or up in the territories. But that’s just as true in the U.S. — and in America, the government won’t cover the airfare for rural folk to come down to the city for needed treatment, which all the provincial plans do.
5. You don’t get to choose your own doctor.
Scurrilously False. Somebody, somewhere, is getting paid a lot of money to make this kind of stuff up. For the record: Canadians pick their own doctors, just like Americans do. And not only that: Since it all pays the same, poor Canadians have exactly the same access to the country’s top specialists that rich ones do.
6. Canada’s care plan only covers the basics. You’re still on your own for any extras, including prescription drugs. And you still have to pay for it.
True — but not as big an issue as you might think. The province does charge a monthly premium (ours is $108/month for a family of four) for the basic coverage. However, most people never even have to write that check: almost all employers pick up the tab for their employees’ premiums as part of the standard benefits package; and the province covers it for people on public assistance or disability.
“The basics” covered by this plan include 100 pecent of all doctor’s fees, ambulance fares, tests and everything that happens in a hospital — in other words, the really big-ticket items that routinely drive American families into bankruptcy. In B.C., it doesn’t include “extras” like medical equipment, prescriptions, physical therapy or chiropractic care, dental, vision and so on. You can deduct any out-of-pocket health expenses you do have to pay off your income taxes. And, as every American knows by now, drugs aren’t nearly as expensive here, either.
Filling the gap between the basics and the extras is the job of the country’s remaining private health insurers. Since they’re off the hook for the ruinously expensive big-ticket items that can put their own profits at risk, the insurance companies make a tidy business out of offering inexpensive policies that cover all those smaller, more predictable expenses. Top-quality add-on policies typically run in the ballpark of $75 per person in a family per month — about $300 for a family of four — if you’re stuck buying an individual plan. Group plans are cheap enough that even small employers can afford to offer them as a routine benefit. An average working Canadian with employer-paid basic care and supplemental insurance gets free coverage equal to the best policies now only offered at a few of America’s largest corporations. And that employer is probably only paying a couple hundred dollars a month to provide that benefit.
7. Canadian drugs are not the same.
False. They are exactly the same drugs, made by the same pharmaceutical companies, often in the same factories. The Canadian drug distribution system, however, has much tighter oversight; and pharmacies and pharmacists are more closely regulated. If there is a difference in Canadian drugs at all, they’re actually likely to be safer.
8. Publicly-funded programs will inevitably lead to rationed health care, particularly for the elderly.
False. In fact, seniors live longer, healthier, and more productive lives because they’re getting a constant level of care that ensures small things get treated before they become big problems.
9. People won’t be responsible for their own health if they’re not being forced to pay for the consequences.
False. The fact is that bad genes, bad luck, and the ravages of age eventually take their toll on all of us — even the most careful of us. The economics of the Canadian system reflect this very different philosophy: it’s built on the belief that maintaining health is not an individual responsibility, but a collective one. Since none of us controls fate, the least we can do is be there for each other as our numbers come up.
This difference is expressed in a few different ways. First: Canadians tend to think of tending to one’s health as one of your duties as a citizen. You do what’s right because you don’t want to take up space in the system, or put that burden on your fellow taxpayers. Second, “taking care of yourself” has a slightly expanded definition here, which includes a greater emphasis on public health. Canadians are serious about not coming to work if you’re contagious, and seeing a doctor ASAP if you need to. Staying healthy includes not only diet and exercise; but also taking care to keep your germs to yourself, avoiding stress, and getting things treated while they’re still small and cheap to fix.
Third, there’s a somewhat larger awareness that stress leads to big-ticket illnesses — and a somewhat lower cultural tolerance for employers who put people in high-stress situations. Nobody wants to pick up the tab for their greed. And finally, there’s a generally greater acceptance on the part of both the elderly and their families that end-of-life heroics may be drawing resources away from people who might put them to better use. You can have them if you want them; but reasonable and compassionate people should be able to take the larger view.
10. This all sounds great — but the taxes to cover it are just unaffordable. And besides, isn’t the system in bad financial shape?
False. On one hand, our annual Canadian tax bite runs about 10 percent higher than our U.S. taxes did. On the other, we’re not paying out the equivalent of two new car payments every month to keep the family insured here. When you balance out the difference, we’re actually money ahead. When you factor in the greatly increased social stability that follows when everybody’s getting their necessary health care, the impact on our quality of life becomes even more significant.
And True — but only because this is a universal truth that we need to make our peace with. Yes, the provincial plans are always struggling. So is every single publicly funded health care system in the world, including the VA and Medicare. There’s always tension between what the users of the system want, and what the taxpayers are willing to pay. But as many of us know all too well, there’s also constant tension between what patients want and what private insurers are willing to pay. At least when it’s in government hands, we can demand some accountability. And my experience in Canada has convinced me that this accountability is what makes all the difference between the two systems.
It is true that Canada’s system is not the same as the U.S. system. It’s designed to deliver a somewhat different product, to a population that has somewhat different expectations. But the end result is that the vast majority of Canadians get the vast majority of what they need the vast majority of the time.
Sara Robinson is a journalist who lives in Vancouver, B.C. This article originally appeared on TomPaine.com.