Canadian Health Care, Even With Queues, Bests US

Sept. 18 (Bloomberg) — Opponents of overhauling U.S. health care argue that Canada shows what happens when government gets involved in medicine, saying the country is plagued by inferior treatment, rationing and months-long queues.

The allegations are wrong by almost every measure, according to research by the Organization for Economic Cooperation and Development and other independent studies published during the past five years. While delays do occur for non-emergency procedures, data indicate that Canada’s system of universal health coverage provides care as good as in the U.S., at a cost 47 percent less for each person.

“There is an image of Canadians flooding across the border to get care,” said Donald Berwick, a Harvard University health- policy specialist and pediatrician who heads the Boston-based nonprofit Institute for Healthcare Improvement. “That’s just not the case. The public in Canada is far more satisfied with the system than they are in the U.S. and health care is at least as good, with much more contained costs.”

Canadians live two to three years longer than Americans and are as likely to survive heart attacks, childhood leukemia, and breast and cervical cancer, according to the OECD, the Paris- based coalition of 30 industrialized nations.

Deaths considered preventable through health care are less frequent in Canada than in the U.S., according to a January 2008 report in the journal Health Affairs. In the study by British researchers, Canada placed sixth among 19 countries surveyed, with 77 deaths for every 100,000 people. That compared with the last-place finish of the U.S., with 110 deaths.

Infant Mortality

The Canadian mortality rate from asthma is one quarter of the U.S.’s, and the infant mortality rate is 34 percent lower, OECD data show. People in Canada are also 21 percent more apt to survive five years after a liver transplant.

Yet the Canadian “bogeyman,” as U.S. President Barack Obama called it at an Aug. 11 gathering in Portsmouth, New Hampshire, may have “all but defeated” the idea of a public option in the U.S., said Uwe Reinhardt, a health-care economist at Princeton University in Princeton, New Jersey.

Senate Finance Committee Chairman Max Baucus, Democrat from Montana, introduced on Sept. 16 compromise health-care legislation that, unlike other House and Senate bills, omits a government-backed choice for the uninsured living in the U.S. who can’t afford private coverage.

Insurance Mandate

Private insurers, the pharmaceutical industry and the medical profession fear the “market power” of a public plan, Reinhardt said. They “deployed certain think tanks to find horror stories around the world that can be used to persuade Americans a public health plan in the U.S. would bring rationing.”

Given that Congress is likely to pass a mandate to cover the uninsured, Americans forced to buy policies will be left with no alternative to coping with “double-digit rate increases” on commercial premiums, Reinhardt said.

“Both systems ration medical care,” he said. “In Canada, they make people wait. In the U.S., we make people pay.”

Fifty-four percent of chronically ill Americans reported skipping a test or treatment, neglecting to go to a doctor when sick, or failing to fill a prescription because of the cost, according to a 2008 survey by the Commonwealth Fund, a foundation that focuses on health care, and pollster Harris Interactive. That was more than twice the number in Canada, data from those New York-based groups showed.

Payment Worries

As the price of health care in the U.S. has risen three to four times faster than the rate of inflation, surveys show that Americans have become concerned they won’t be able to pay medical bills. Forty-three percent of consumers in a June poll by the University of Michigan in Ann Arbor said they worried they might not be able to afford care, even with insurance.

“Canadians value fairness, and they cannot conceive of a system in which someone can’t get health care,” said Wendy Levinson, a Canadian who runs the department of medicine at the University of Toronto and worked in the U.S. from 1979 to 2001.

The U.S. spent $7,290 on health care for each person in 2007, 87 percent more than Canada’s $3,895, according to the latest OECD data. The U.S. also devoted the highest percentage of gross domestic product to health care, 16 percent, OECD numbers show. Canada’s expenditure was 10.1 percent.

Canada’s system consists of 10 provincial and three territorial nonprofit insurance plans that cover all citizens, including those with pre-existing conditions. It operates like Medicare, the U.S. program for the elderly and disabled. In Canada, the government uses taxpayer funds to pay claims by doctors, who mostly work in private practice or for a hospital and are paid fees for their services.

Effect of Technology

Care is free where it’s provided, as in a doctor’s office, except for dentistry, nursing home stays, prescription drugs outside hospitals, and rehabilitation services. The elderly and low-income residents get help with pharmaceutical purchases.

Technology partly explains the cost discrepancy between the two nations. There are 67 percent more coronary-bypass procedures in the U.S. than in Canada and 18 percent more Caesarean sections, OECD data show. In 2006, the U.S. had more than four times the number of magnetic resonance imaging units – – 26.5 for every million residents compared with 6.2 for every million in Canada — making Americans three times more likely than Canadians to get a scan, according to the OECD.

In the U.S., technology is “overused” because doctors have to justify equipment purchases with revenue, according to Gerard Anderson, a professor of public health and medicine at Johns Hopkins University in Baltimore. Canada in the 1960s was about as expensive as the U.S., he said.

No. 1 in Cost

“The real difference has been their ability to control technology costs,” said Anderson, who directed reviews of health systems for the World Bank and developed U.S. Medicare payment guidelines for the Health and Human Services Department. “The only thing the U.S. is consistently No. 1 in when it comes to international comparisons with Canada and other OECD countries is cost.”

Less technology and, according to a 2007 report from the World Health Organization, 20 percent fewer doctors in Canada than in the U.S. have led to longer lines north of the border.

In 2008, 20 percent of chronically ill Canadians surveyed by the Commonwealth Fund reported waiting three months or more to see a specialist. Five percent of Americans polled said they had to wait that long.

Television Commercial

Washington-based lobbying groups including Americans for Prosperity and FreedomWorks have seized upon the delays, arguing that Obama’s proposal for a public option would eventually put private insurers out of business and force everyone to live with government-paid coverage and substandard care. FreedomWorks is led by Dick Armey, a former Republican congressman from Texas.

An educational foundation affiliated with Americans for Prosperity paid $3.3 million to run a 60-second television commercial on U.S. stations in which Shona Holmes, a 45-year-old native of Waterdown, Ontario, accused the Canadian health-care system of almost causing her to die by delaying critical treatment, according to Amy Menefee, a spokeswoman for the foundation. The ad ran for three weeks and was repeated on Sept. 9 after the president’s speech.

The TV spot first aired in May. Holmes, a mother of two and a self-employed family mediator, said in the ad that she went to the U.S. for care. She traveled 2,237 miles (3,599 kilometers) to the Mayo Clinic in Scottsdale, Arizona, and spent $97,000 for treatment of a benign brain tumor rather than wait for insurance-paid care in Canada, she said in a telephone interview.

Bridge to Canada

“I felt strongly I could speak out because I’ve seen both systems,” Holmes said. “I have seen how government involvement plays very negatively.”

Obama administration officials are trying to use the public option as “a bridge” to a system like Canada’s since “they realize it isn’t politically acceptable to go directly to that,” said Phil Kerpen, the director of policy for Americans for Prosperity.

In Ontario, where Holmes lives, the average waiting time for surgery to remove a tumor was 99 days in the second quarter, according to the Ontario Health Insurance Plan’s Web site. If a patient was willing to go closer to Ottawa, the wait was 36 days at Pembroke Regional Hospital Inc. in Pembroke, 460 miles from Waterdown and 93 miles northwest of the Canadian capital. Closer to Waterdown, a patient could go to St. Joseph’s Healthcare Hamilton, less than 10 miles away, with a 56-day wait.

Ontario Appeal

Holmes began speaking out publicly, she said, after she couldn’t get Ontario in July 2005 to speed removal of her craniopharyngioma, a type of slow-growing cystic tumor that can put pressure on the brain or optic nerve. She is now pushing for the province’s insurance plan to reimburse her for the money she spent on surgery, tests and follow-up, she said in the interview.

Andrew Morrison, a spokesman for the Ontario plan, said Canadians need approval before getting care outside the country if they want to be reimbursed. He declined to comment on the Holmes case. Lori Coleman, registrar for the Toronto-based Health Services Appeal and Review Board, which handles complaints about the Ontario plan’s eligibility and payment decisions, also declined to comment.

Even with the waits, a majority of Canadians balk at the idea of turning government insurance over to private hands. In a July Harris/Decima poll, 55 percent of respondents said improvement should be made through the public plan, while 12 percent favored a private solution.

Doctor Visits

In both the U.S. and Canada, 26 percent of people interviewed told the Commonwealth Fund survey of chronically ill adults they got a same-day appointment with a doctor when they were sick — the lowest number in any of the eight countries polled by the foundation. Thirty-four percent of the Canadians said they had to wait six days or more, compared with 23 percent of the Americans.

Canadians visited their doctors more frequently: 5.9 visits per person compared with four for those in the U.S., according to 2005 OECD data.

The U.S. leads industrial countries in the portion of the health-care dollar devoted to processing claims and paying providers, the Commonwealth Fund said.

Private-insurance administrative costs in the U.S. are 12.7 cents of a dollar, and as high as 18 cents for some companies, said Karen Davis, president of the Commonwealth Fund. Government plans, including Medicare and Medicaid, spend 5.8 cents excluding costs of private drug plans, she said. In Canada 4.2 cents is spent on administration.

“If we lowered our administrative costs to that of the lowest three countries with mixed public-private health-care systems, we could save $50 billion a year,” Davis said. “This would go a long way toward financing coverage for the uninsured.”

To contact the reporter on this story: Pat Wechsler in New York at

Last Updated: September 18, 2009 12:22 EDT
By Pat Wechsler

Source: Bloomberg

4 thoughts on “Canadian Health Care, Even With Queues, Bests US”

  1. ATTENTION!! Congress Has The Votes Needed To Pass A Public Option – TODAY

    Why A Strong Public Option Is Essential – By jacksmith – Working Class

    Robert Reich explains the pubic option:

    It’s not just because more than two thirds of the American people want a single payer health care system. And if they cant have a single payer system 77% of all Americans want a strong government-run public option on day one (86% of democrats, 75% of independents, and 72% republicans). Basically everyone.

    It’s not just because according to a new AARP POLL: 86 percent of seniors want universal healthcare security for All, including 93% of Democrats, 87% of Independents, and 78% of Republicans. With 79% of seniors supporting creating a new strong Government-run public option plan, available immediately. Including 89% of Democrats, 80% of Independents, and 61% of Republicans, STUNNING!!

    It’s not just because it will lower cost. Because a strong public option will dramatically lower cost for everyone. And dramatically improved the quality of care everyone receives in America and around the World. Rich, middle class, and poor a like.

    It’s not just because it will save trillions of dollars and prevent the needless deaths of millions more of YOU, caused by a rush to profit by the DISGRACEFUL, GREED DRIVEN, PRIVATE FOR PROFIT MEDICAL INDUSTRIAL COMPLEX!

    It’s not just because every expert in every field, including economist, and Nobel laureates all agree that free market based healthcare systems don’t work. Never have and never will. The US has the only truly free market based healthcare system in the World. And as you all know now, IT IS A DISASTER!

    It’s not just because providing or denying medically necessary care for profit motivations is wrong. Because it is WRONG! It’s professionally, ethically, and morally REPUGNANT!, Animalistic, VILE and EVIL.


    The public option is ESSENTIAL because over 200 million of you are trapped in the forest of the wolves. Which is the forest of the DISGRACEFUL, GREED DRIVEN, PRIVATE FOR PROFIT MEDICAL INDUSTRIAL COMPLEX! With no way out except through needless inhumane suffering, and DEATH. While the wolves tear at your flesh, and rip you limb from lib. Then feast on your lifeless bodies like a dead carcase for transplant parts.

    At the most vulnerable times of your lives (when you were sick and hurting), millions of you have had to fight and loose cruel, but heroic battles. Fighting against the big guns of the DISGRACEFUL, GREED DRIVEN, PRIVATE FOR PROFIT MEDICAL INDUSTRIAL COMPLEX! in the forest of the wolves. All because you have no place else to go. You have no other CHOICE!

    But the PUBLIC OPTION will give you someplace safe to go. And it will give us someplace safe to take you. The public option will be your refugium (your refuge). Where the wolves cannot get at you when your down, hurting, and vulnerable. Where everyone who needs it can find rest, security, comfort and the care they need. Protected by the BIG GUNS of We The People Of The United States. THE MOST POWERFUL PEOPLE AND COUNTRY ON EARTH.

    This is why it is so critical that we do not lead another 50 million vulnerable, uninsured Americans into the forest of the wolves, without the protections of a Strong Government-run public option. We The People Of The United States MUST NOT LET THAT HAPPEN to any more of our fellow Americans. If healthcare reform does not contain a strong public option on day one. YOU MUST! KILL IT. Or you will do far more harm than good. And millions more will die needlessly. Rich, middle class, and poor a like.

    To those who would continue to obstruct good and true healthcare reform for the American people, and who seek to trap millions more vulnerable Americans in the forest of the wolves. We will continue to fight you. We are prepared to wage all out war against you, and will eagerly DESTROY! you. Time…is…UP! YOU HAVE BEEN WARNED! No Co-op’s! No Triggers! NO INDIVIDUAL MANDATES! without a Strong public option on day one.

    Healthcare reform can be the GREATEST! Accomplishment of our time and century. A time when future generations may say of us, that we were all, AMERICAS GREATEST GENERATIONS.


    I therefore call on all my fellow Americans and the peoples of the World. To join us in this fight so that we may finish becoming the better America that we aspire to be for everyone.


    I have been privileged to be witness as many of you fought, and struggled to take your first breath, and your last breath on this earth. Rich, middle class, and poor a like. Life is precious.

    Whatever the cost. WE! MUST SUCCEED.

    God Bless You My Fellow Human Beings

    jacksmith – Working Class

    Things You Can Do To Help NOW!

    No Triggers!


    Krugman on heathcare (

    Senator Bernie Sanders on healthcare (

    John Garamendi on the Public Option and the Grassroots:

    Howard Dean on the Public Option

    We’re Number 37! in quality of health care

    Twitter search (#welovethenhs #NHS #hc09 #hcr #healthcar #obama #p2 #topprog #) Check it out.

  2. This is bogus. We have more elderly that survive longer because we keep them alive. They are more apt to have something wrong with them, therefore. Also we count dead babies from abortions… in the infant mortality rate. Other countries DO NOT.

    Why is it that half million come here from Canada and UK to get treatments they can get in their own country?

    This is a bunch of world order communist propaganda and you should be ashamed.

    In Canada there is a shortage of doctors and the town clerk draws your name from a box. NICE!

  3. This article is dead on. Holmes was impatient and/or panicked. Nobody has come forward to confirm her claim that her country tried to kill her. Not the Mayo clinic, not her lawyers.

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