There’s just one problem: The Canadian model of universal coverage is failing.
Assessing Canada’s Single-Payer System
The Canada Health Act (CHA), introduced in 1984, governs the complicated fiscal agreement between the provinces, who administer health services, and the feds, who manage their health-insurance monopoly and transfer funds to the local governments. Unlike in the United Kingdom, where health care is socialized and hospitals are run by the National Health Service, in Canada health care is technically delivered privately, although given the Kafkaesque regulations and restrictions that govern it, the system is by no means market-based. In fact, Canada’s government-controlled health-care system has become more restrictive than communist China’s.
Debates about health-care policy typically revolve around three key metrics: universality, affordability, and quality.
Canada passes the first test with flying colors: Every resident of the country is insured under the CHA, with covered procedures free at the point of delivery. While medical providers are independent from the federal government, they are compelled to accept CHA insurance —and nothing else — by a prohibition on accepting payments outside the national-insurance scheme so long as they wish to continue accepting federal health-transfer funds. The spigot of money from Ottawa thus ensures a de facto government monopoly in the health-insurance market.
The CHA provides and ensures universal coverage from the top down. In Canada, the government determines what procedures are medically necessary. Bureaucrats, not doctors, decide which procedures and treatments are covered under the CHA — based on data and statistics rather than on the needs of patients. While private insurance does exist — an OECD report found that 75 percent of Canadians have supplementary insurance — it applies only to procedures and services that fall outside the CHA — including dental work, optometric care, and pharmaceutical drugs.
When it comes to affordability, the Canadian system also passes, if just barely. Canadians pay for health insurance through their taxes; most never see a medical bill. But that doesn’t mean the system is affordable. Au contraire, it relies almost entirely on current taxpayers to subsidize the disproportionately large health-care needs of elderly Canadians in their final few years of life. Rather than pre-funding the system to deal with the coming tsunami of aging Baby Boomers, Canada’s provincial governments pay and borrow as they go — and rank among the most indebted sub-sovereign borrowers in the world. According to Don Drummond, an economist appointed by Ontario’s Liberal government to help fix its finances, Canada’s largest province is projected to see health-care costs soar to the point where they will consume 80 percent of the entire provincial budget by 2030, up from 46 percent in 2010.
In the meantime, to address scarcity in the health-care system, government central planners ration care and cap the number of procedures offered in a given year, leading to queues, longer wait times, and a deterioration in the quality of care. Speaking of which#…#
#…#When it comes to the final metric, quality of care, Canada lags behind most other developed Western nations. A 2014 report by the Commonwealth Fund ranked Canada tenth out of eleven wealthy countries (ahead of only the United States) in health-care quality, and dead last in timeliness of care. The report showed that 29 percent of adult Canadians who fell ill and needed to see a specialist waited two months or longer, and 18 percent waited four months or longer, compared with 6 percent and 7 percent of Americans, respectively.
Canada’s quality of care is poor, and it continues to deteriorate in the face of a looming fiscal crunch and further rationing. In Canada’s single-payer system, citizens cannot pay directly for procedures, and they cannot purchase private insurance to cover services provided by the CHA. They must instead wait in line or seek health-care services outside the country.
For full disclosure, my example is a story from about ten years ago. But it is one that has stuck with me and comes back to me every time someone says we should do like Canada. Because when people tell me that, I think to myself… then where will the Canadians go for surgery?
I had a police officer friend who lived in Canada and was caring for his elderly mother. She was in massive amounts of pain because of a hip injury. When she saw a doctor, she was told she needed a double hip replacement. At this point, she was completely unable to walk and was in chronic pain. My friend was devastated watching his mother cry on her sofa from the pain.
The doctor told her she had to wait 18 months for the surgery. I don’t remember what the reasoning was at this point, but I remember he said they had to wait 18 months. She agreed, and she dealt with this living hell for 18 solid months. When the time came for her appointment, she was again reassessed and the results were the same: she needed double hip replacement.
My friend asked the doctor to schedule the surgery and he was told… she had to wait 18 months. My friend, at this point, lost his mind. He told the doctors they had just waited 18 months and she had been told then that she’d get the surgery in 18 months. Now they were told they had to wait another 18 months. The doctor told him there was nothing they could do.
So, my friend wheeled his sobbing mother out of the hospital, put her in the car, and drove to New York. She had her double hip replacement surgery done within the month. He made arrangements to pay for it out of pocket on a payment plan. But his mother got her new hips and was on her way to healing and living life again.
Why is that? And how was what happened to him even fair? Was his mother going to be told in another 18 months that she had to wait another 18 months? Were they just hoping she’d die before they did the surgery? I have no idea what the motivation or reasoning was here. But every time someone tells me we need health care like Canada, I think of this friend of mine and his mother, and I look my mother with her double knee replacements and her spinal stenosis. Would my mother, on single payer, be allowed to get the acupuncture that is helping to relieve so much of her pain? Would she have access to the drugs? Would she get much help considering her pace maker and the drugs she is on for life from having contracted MRSA? And if not, where would I take her? My friend had the option to take his mother to New York to use the health care system so many Americans seem to loathe. But if we went the Canadian route, where would I take my mother?