With 10 out of 15 Democratic presidential contenders supporting some version of “Medicare-for-all” as of early April 2019, it’s important to separate the fuzzy myth of socialized medicine from the stark reality of a flawed system. In particular, those who extol the virtues of a Canadian-style government-run single-payer health care system need to take a look at some of its glaring shortcomings.
Admittedly, despite what some pundits will tell you, Canadians do not suffer under third-world health care. But neither is it the case that our system is anything Americans should aspire to emulate. Dr. David Gratzer put it best a few years ago when he wrote, “Canada has first-rate physicians and nurses — but a second-rate health-care system.”
Those who see the Canadian health care system through rose-colored glasses might start to disabuse themselves of their misconceptions by speaking to the family of Marianne Porter. The 58-year-old woman recently died of acute kidney failure after waiting 11 hours in a New Brunswick emergency room before being seen. Dr. Serge Melanson, president of the New Brunswick Medical Society and an ER doctor at the hospital in question, did not comment on the specific case, but he did lament the hospital’s ER beds being occupied by people who can’t be transferred out because of overcrowding.
The numbers don’t lie. While ER wait times vary from province to province, quick access to a doctor is not the norm. The Commonwealth Fund’s 2016 international comparison of 11 wealthy countries found that almost 30 percent of Canadian patients wait four hours or more when they go to an ER, versus just 11 percent in the United States. In the 2017-2018 fiscal year, in the province of Quebec alone, 212,000 patients waited more than 24 hours in an emergency room, and 30,000 waited more than 48 hours.
Canadians can also expect to wait for medically necessary treatment. In 2018, specialist physicians reported a median wait time of 19.8 weeks between a patient being referred by a general practitioner and receiving treatment from them, varying from 3.8 weeks for cancer treatment to 39.0 weeks for orthopedic surgery. That’s a whole nine months limping around on just one leg, if you have a knee problem.
In all, over one million Canadians waited some amount of time for surgery and medical treatment in 2018. This has a financial cost in addition to the physical and psychological one: specifically, a total of $2.1 billion in lost wages.
Canadians are also underserved when it comes to preventive screening tests. In 2017, the United States had 37.6 magnetic resonance imaging (MRI) units per 1,000,000 inhabitants, versus just 10.0 in Canada. (Similar discrepancies exist for CT scanners, mammography machines, and radiotherapy equipment.) Little wonder, then, that Canadians waited an average of 10.6 weeks for an MRI.
Some, though, choose not to wait, instead going abroad for the tests and treatments they need. Canadian patients made over 200,000 trips outside of the country specifically for health care in 2017, and spent $690 million on health care during those trips.
None of this is to deny that the American health care system has problems, especially in terms of affordability. Health care spending as a percentage of GDP in the United States was 17 percent in 2017, far ahead of Canada’s at 10 percent, or of any other industrialized country, for that matter.
All this spending of course buys excellent care for many Americans. In the Commonwealth Fund study, the United States scores highly on five-year cancer survival rates, and is ahead of the pack on 30 day in-hospital mortality rates following acute myocardial infarction or ischemic stroke, for example.
But some lower-income individuals struggle to pay for care, and the United States comes in dead last on affordability in the 11-country comparison. Presumably at least partly as a result of this, it also ranks last among these countries on such measures as infant mortality, life expectancy at age 60, and mortality amenable to health care. Still, as some have observed, these numbers aren’t nearly as bad once you control for segments of the American population that have been historically subjected to severe discrimination and who still bear the scars in terms of health status.
The 2010 Affordable Care Act has not solved the problem of unaffordable care. Many prominent Democrats now seem to want to go further down the socialized medicine road. But the serious defects and impediments inherent in a top-down bureaucratic health care system like Canada‘s, including the inevitable rationing and waiting lists that Canadians are forced to endure, should give Americans pause.
Michel Kelly-Gagnon est président et directeur général de l'Institut économique de Montréal. Il signe ce texte à titre personnel.