Canada's healthcare system through American eyes

The US media alternately likens Canadian medicare to a beacon of hope
or a red menace. "O say can you see, Canada's higher life expectancy?"

By Peter Woodford

LAST BEST CHANCE?
It's been over a decade since then-president Bill Clinton tried and failed to bring universal healthcare to the US. Back in 1994 the stars all seemed aligned for reformers hoping for a Canadian-style system: a Democrat in the White House for the first time in 12 years plus a Democrat-controlled Congress. But a funny thing happened to the healthcare reform bill on the way to Capital Hill — millions of dollars were funnelled into a TV ad campaign by anti-national health insurance lobby groups. Their tactic worked.

Enthusiasm for universal healthcare among those already insured quickly fizzled amid fears that a 'Soviet style' system would mean that some bureaucrat would choose each patient's doctor and unspeakable abominations would ensue. Soon thereafter centrist Democrats, already lukewarm to the plan, abandoned the president in droves and the bill died. And the loudest voice opposing universal healthcare, Georgia Republican Congressman Newt Gingrich, would lead his party to victory later that year, gaining control of the Congress which they still hold to this day.

LEFT BEHIND
Since then the ranks of the uninsured have swollen to an estimated 45 million, according to the US Census Bureau. But with a Republican Party fully satisfied with free market health controlling the White House and the Congress, shouldn't this issue be lying dormant? Well, it isn't. Unbelievable as it may seem, these days you're as likely to hear an American commentator bemoaning the crisis state of his healthcare system as you are a Canadian, maybe even more.

American critics of the Canadian system like to call it "socialized medicine," conjuring up images of forced collectivization and communist-style queues. On the other hand, US proponents prefer to call it a "single-payer" system — which smacks of bureaucracy-busting good sense. People somewhere in the middle just call it what it is — "national health insurance."

PAPER TIGER
One of the key differences between the American and Canadian systems is the existence of competition in the US model. Competition is nearly always seen as a good thing for consumers, though some think healthcare may be an exception, as it creates excess capacity, which in turn is marketed to create more demand. This leads to huge amounts of money being spent on frivolous use of technology like MRI scans for a mild case of tennis elbow. Not to mention the vast mess of red tape. According to an investigation in the San Francisco Chronicle, the bureaucracy of any large health insurance company in a mid-sized state has about the same operating costs as the entire Canadian system.

TALKING HEADS
Lately, there's been a rash of American newspaper editorials coming out both for and against adopting a Canadian-style system in the US. Washington Monthly commentator Kevin Drum wrote recently, "I've long thought that the spectre of 'socialized medicine' is the greatest con ever perpetrated on the American public." He added "Over the years we've jury rigged a bizarre system that Rube Goldberg would be ashamed of, but somehow we're convinced that America has the best healthcare in the world." While in the March 22 Boston Globe, columnist Jeff Jacoby launched a broadside against the Canadian system, saying "socialized medicine guarantees only the right to stand in line." He finds the argument for converting US healthcare to a universal system rather simplistic, calling it "an impatient demand for the drastic transformation of one-seventh of the US economy."

Jim Spencer of the Denver Post wrote an impassioned defence of the Canadian system for his April 14th column. He predicted that it's only a matter of time before US taxpayers get wise to the fact they pay much more for healthcare and get worse results than fellow industrialized nations in key areas like life expectancy and infant mortality. Economist Paul Krugman has been writing a series of columns for the New York Times on the 'healthcare crisis' in the US. Using the 2002 data (the latest that's comparable) he found that out of the $6,459Cdn per person the US spends on healthcare, the government ponies up $2,899. Here in Canada it's $3,594 per person with the government taking care of $2,511. "We have lots of MRIs," he wrote "but on more prosaic measures ... America is only average, or below average."

MUDSLINGING
A recent episode of the Fox News current affairs program The O'Reilly Factor hosted a typically heated debate on healthcare that inevitably focused on Canada. Dr Steffie Woolhandler of the group Physicians for National Health Program (PNHP) praised the bureaucratic efficiency of Canada's system and the fact that Canadians have a three year life-expectancy advantage over Americans. Michael Cannon of the right-wing Cato Institute faced off against her, attacking Canada's waiting list woes, suggesting Bill Clinton would've had to wait as long as anyone else for his quadruple-bypass had he been a Canadian. The show's host, Bill O'Reilly, dispensed with all objectivity and joined Mr Cannon in castigating our system. Mr O'Reilly was scandalized by the fact the affluent cannot circumvent the system, concluding "I don't want to live in the fascist state that Canada is evolving into."