Posted on 04/28/2016 4:37:41 PM PDT by SeekAndFind
Conservatives are rumbling around the talk show circuit bellowing about the socialist threat to the (literal) American body politic. And, as usual, Canada is once again getting dragged into the fracas, shoved around by both sides as either an exemplar or a warning — and, along the way, getting coated with the obfuscating dust of so many willful misconceptions that the actual facts about How Canada Does It are completely lost in the melee.
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. If we’re going to have this conversation, it would be great if we could start out (for once) with actual facts, instead of ideological posturing, wishful thinking, hearsay, and random guessing about how things get done up here.
To that end, here’s the first of a two-part series aimed at busting the common myths Americans routinely tell each other about Canadian health care. When the right-wing hysterics drag out these hoary old bogeymen, this time, we need to be armed and ready to blast them into straw. Because, mostly, straw is all they’re made of.
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 US. The only difference is that every doctor deals with one insurer, instead of 150. 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.
The proper term for this is “single-payer insurance.” In talking to Americans about it, the better phrase is “Medicare for all.”
2. Doctors are hurt financially by single-payer health care.
True and False. Doctors in Canada do make less than their US 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 over a hundred different insurers, all of whom are bent on denying care whenever possible. 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 company bean counters into doing the right thing by 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. There are no fights. Appointments aren’t interrupted by vexing phone calls. 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.
One unsurprising side effect of all this is that the doctors I see here are, to a person, more focused, more relaxed, more generous with their time, more up-to-date in their specialties, and overall much less distracted from the real work of doctoring. You don’t realize how much stress the American doctor-insurer fights put on the day-to-day quality of care until you see doctors who don’t operate under that stress, because they never have to fight those battles at all. Amazingly: they seem to enjoy their jobs.
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 a 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. When lawsuits do occur, the awards don’t have to include coverage for future medical costs, which reduces the insurance company’s liability.
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.
You can hear the bitching about it no matter where you live, though. 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. (And no, it had nothing to do with the fact that he was also Kiefer Sutherland’s grandfather.). 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 twelve 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 BC 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. I live in suburban Vancouver, and there are any number of first-rate GPs in my neighborhood who are taking new patients. If you don’t have a working relationship with one, but need to see a doctor now, there are 24-hour urgent care clinics in most neighborhoods that will usually get you in and out on the minor stuff in under an hour.
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. The cons love to scare the kids with stories about the government picking your doctor for you, and you don’t get a choice. Be afraid! Be very afraid!
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 small 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% 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 BC, it doesn’t include “extras” like medical equipment, prescriptions, physical therapy or chiropractic care, dental, vision, and so on; and if you want a private or semi-private room with TV and phone, that costs extra (about what you’d pay for a room in a middling hotel). That other stuff does add up; but it’s far easier to afford if you’re not having to cover the big expenses, too. Furthermore: 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.
More preposterious bogosity. 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.
Also: pharmacists here dispense what the doctors tell them to dispense, the first time, without moralizing. I know. It’s amazing.
8. Publicly-funded programs will inevitably lead to rationed health care, particularly for the elderly.
False. And bogglingly so. The papers would have a field day if there was the barest hint that this might be true.
One of the things that constantly amazes me here is how well-cared-for the elderly and disabled you see on the streets here are. No, these people are not being thrown out on the curb. In fact, they 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.
The health care system also makes it easier on their caregiving adult children, who have more time to look in on Mom and take her on outings because they aren’t working 60-hour weeks trying to hold onto a job that gives them insurance.
9. People won’t be responsible for their own health if they’re not being forced to pay for the consequences.
False. The philosophical basis of America’s privatized health care system might best be characterized as medical Calvinism. It’s fascinating to watch well-educated secularists who recoil at the Protestant obsession with personal virtue, prosperity as a cardinal sign of election by God, and total responsibility for one’s own salvation turn into fire-eyed, moralizing True Believers when it comes to the subject of Taking Responsibility For One’s Own Health.
They’ll insist that health, like salvation, is entirely in our own hands. If you just have the character and self-discipline to stick to an abstemious regime of careful diet, clean living, and frequent sweat offerings to the Great Treadmill God, you’ll never get sick. (Like all good theologies, there’s even an unspoken promise of immortality: f you do it really really right, they imply, you might even live forever.) The virtuous Elect can be discerned by their svelte figures and low cholesterol numbers. From here, it’s a short leap to the conviction that those who suffer from chronic conditions are victims of their own weaknesses, and simply getting what they deserve. Part of their punishment is being forced to pay for the expensive, heavily marketed pharmaceuticals needed to alleviate these avoidable illnesses. They can’t complain. It was their own damned fault; and it’s not our responsibility to pay for their sins. In fact, it’s recently been suggested that they be shunned, lest they lead the virtuous into sin.
Of course, this is bad theology whether you’re applying it to the state of one’s soul or one’s arteries. 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.
The bottom line: When it comes to getting people to make healthy choices, appealing to their sense of the common good seems to work at least as well as Calvinist moralizing.
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% 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 signficant.
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. The balance of power ebbs and flows between them; but no matter where it lies at any given moment, at least one of the pair is always going to be at least somewhat unhappy.
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. It’ll be a good day when when Americans can hold their heads high and proudly make that same declaration.
” In socialized medical systems, the doctors work directly for the state. “
Do I really need to read the rest of this when the number one point is wrong?
Working directly for the state would be a communist system.
Simple economic definition of capitalism, socialism, communism:
Capitalism: Production and distribution controlled by private sector.
Socialism: Production - private, distribution - government.
Communism: Both production and distribution controlled by government.
And the 1 mlion dollar question... How homogeneous is the Canadian population (in culture in particular) compared to the US?
Obamacare is unavailable for enrollment most of the year.
And despite its formal name, its not affordable.
What good is private health insurance if you can’t afford it?
Canada experienced a “brain drain” in the 90’s, largely doctors seeking greener pastures in the US.
My friend died from a simple melanoma because his oncology appointment took months and months. And he lived in Montreal, Canada’s 2nd largest metropolis, not some prairie backwater.
I can remember a few years ago doing research on another topic in Google News Archives when I came across a 1982 article in the Ottawa Citizen. It was about a doctor from Ontario (can not recall where he was from specifically) who got fed up with the Canadian system and moved to Arkansas. I recall him commenting on how he could serve his patients in Arkansas in a more attentive and timely manner than he could under the Canadian system, all sort of things he really noticed that he could do so much more in his practice as a doctor in the U.S. than in Canada.
I cannot say how sorry I am to hear that. It is widely known that the survival rates for cancer are something like one third of what they are in the US in countries that have socialized medicine. The story is not the first such I have heard.
| Ethnic origin[Note 1] | % | Population | Area of largest proportion |
|---|---|---|---|
| Canadian | 32.16% | 7007105638050000000♠10,563,805 | Quebec (59.1%) |
| English | 19.81% | 7006650950000000000♠6,509,500 | Newfoundland and Labrador (43.4%) |
| French | 15.42% | 7006506569000000000♠5,065,690 | Quebec (29.1%) |
| Scottish | 14.35% | 7006471496500000000♠4,714,965 | Prince Edward Island (39.3%) |
| Irish | 13.83% | 7006454486500000000♠4,544,865 | Prince Edward Island (30.4%) |
| German | 9.75% | 7006320332500000000♠3,203,325 | Saskatchewan (28.6%) |
| Italian | 4.53% | 7006148842000000000♠1,488,420 | Ontario (7.0%) |
| Chinese | 4.53% | 7006148758000000000♠1,487,580 | British Columbia (10.7%) |
| First Nations | 4.17% | 7006136911500000000♠1,369,115 | Northwest Territories (37.0%) |
| Ukrainian | 3.81% | 7006125117000000000♠1,251,170 | Manitoba (14.9%) |
| East Indian | 3.55% | 7006116514500000000♠1,165,145 | British Columbia (6.3%) |
| Dutch (Netherlands) | 3.25% | 7006106724500000000♠1,067,245 | Alberta (5.1%) |
| Polish | 3.08% | 7006101070000000000♠1,010,700 | Manitoba (7.3%) |
| Filipino | 2.02% | 7005662605000000000♠662,605 | Manitoba (5.2%) |
| British, not included elsewhere | 1.75% | 7005576030000000000♠576,030 | Yukon (2.4%) |
| Russian | 1.68% | 7005550515000000000♠550,515 | Manitoba (4.3%) |
| Welsh | 1.40% | 7005458705000000000♠458,705 | Yukon (2.8%) |
| Norwegian | 1.38% | 7005452710000000000♠452,710 | Saskatchewan (6.9%) |
| Métis | 1.36% | 7005447655000000000♠447,655 | Northwest Territories (6.7%) |
| Portuguese | 1.31% | 7005429850000000000♠429,850 | Ontario (2.3%) |
| American | 1.13% | 7005372575000000000♠372,575 | Yukon (2.2%) |
| Spanish | 1.12% | 7005368305000000000♠368,305 | British Columbia (1.4%) |
| Swedish | 1.04% | 7005341845000000000♠341,845 | Saskatchewan (3.2%) |
| Hungarian | 0.96% | 7005316760000000000♠316,760 | Saskatchewan (2.8%) |
| Jewish | 0.94% | 7005309650000000000♠309,650 | Ontario (1.4%) |
Data from the same subject matter, though from 2001, is also grouped more geographically by Statistics Canada as follows:[18]
| 2001 | |
|---|---|
| North American (non-aboriginal) | 40.21% |
| British Isles | 33.64% |
| French | 15.89% |
| Western European | 12.78% |
| Eastern European | 8.50% |
| Southern European | 7.87% |
| 2001 | |
|---|---|
| East and Southeast Asian | 6.03% |
| Aboriginal | 4.45% |
| South Asian | 3.25% |
| Northern European | 3.22% |
| Caribbean | 1.70% |
| Other European | 1.28% |
| 2001 | |
|---|---|
| Arab | 1.17% |
| African | 0.99% |
| Latin, Central and South American |
0.82% |
| West Asian | 0.69% |
| Oceania | 0.16% |
Certainly you realize how pointless it is to post that here.
30 million population that can’t handle it....The TAX rate in Kanada is close to 40%.....on average. Screw socialist and government run insurance....This article is pure BS....
If it were true, Canada would be inundated with American doctors .... but alas, reality varies from the fictional spin. Several doctors in our local hospital are professional “refugees” from the Canadian Healthcare system. “Just across the border” American doctors have set up shop to get the “patients willing to pay anything” to get emergency or priority procedures.
RE: Certainly you realize how pointless it is to post that here.
No I don’t, tell me.
I have a neighbor with cerebral palsy who was effectively sentenced to death by the Candian government on their death panels, despite her having plenty of money to pay for her own treatment. Thankfully, she escaped that evil Socialist hellhole. I haven’t spoken to her in a while, but I suspect that Soetorocare is similarly trying to kill her off.
Awesome, thanks for that data. Would you be willing to post similar breakdown for the US. I’m on mobile and have no idea how to format it so nicely.
I’ve had OHIP, the Ontario socialized medicine. You know how, when you go to the post office, most windows are closed but you see postal workers standing around? And if you try to catch the eye of one, they leave? And the ones that don’t, look like you’ve insulted them? And when you do get to the front of the line, the clerk is bored and desultory? Change that from a post office to a medical clinic, and you’ve got Canadian socialized medicine.
As to the accuracy of the article, ask yourself this-—
How many Americans, a country with ten times Canada’s population, go to Canada for medical treatment? And how many Canadians go to the US for medical treatment? Overwhelmingly more Canadians come to the US for treatment they can’t get at home. There are reasons for that.
RE: f it were true, Canada would be inundated with American doctors .... but alas, reality varies from the fictional spin. Several doctors in our local hospital are professional “refugees” from the Canadian Healthcare system. “Just across the border”
This report below is either true or false, but I find it to be opposite to what you said above. Maybe you can tell me what’s wrong here ( The article was written in 2010 <— during the advent of Obamacare ):
SOURCE: http://www.canadaupdates.com/content/more-us-doctors-immigrating-canada-15730.html
EXCERPT:
Since, Canada is facing shortage of medicos in the nation, so, America’s loss seems to be becoming Canada’s gain.
Although, the number of US doctors leaving for Canada is growing significantly, the past few years has also seen a considerable decline in the number of doctors moving out of Canada.
As per the Canadian Institute for Health Information data for the last five years, the doctors immigrating to Canada is far greater than the number of doctors leaving Canada.
Way back in 1990s, Canada, too, had suffered a similar large scale exodus of doctors to America. This was largely due to several Canadian health reforms introduced by the Canadian government.
Doctors in the US feel that their immediate neighbor in the north is an attractive nation to live and work.
This is being attributed to US health reforms introduced by the US government. Moreover, Canada is an attractive place for several foreigner doctors including those from the US since it offers higher payouts to medicos.
CLICK ABOVE LINK FOR THE REST....
False. That's called communism. Socialism does not require ownership, only control.
Communism IS socialism.
As an Albertan, I find this whole article so full of crap, I don’t even know where to begin.
I can put it simply with these schemes:
They need public support, which means they need a lot of happy people. To do that, if you’re healthy, the system is a dream. But if you’re not healthy, things get tougher, much tougher. If you’re old, well, you get expensive.
Bottom line: Good Prenatal Care for 100 patients means a lot more support, and VOTES, than replacing granny’s hip...and they both cost about the same.
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