Published August 12, 2009
When it comes to the health care reform debate, Canada's single-payer system often is held up as an example of success by supporters -- and by opponents as a warning of the pitfalls.
Answering questions at the Summit of the Americas on Monday, President Obama seemed ambivalent about Canadian health care.
"I don't find Canadians particularly scary, but I guess some of the opponents of reform think that they make a good bogeyman," he said.
Obama went on to say the Canadian system wouldn't work in the U.S., but many American doctors believe it does some things better.
"Our health care system delivers probably the highest specialty quality care in the world but our primary care infrastructure is not good," said Dr. Joseph Ross of the Mt. Sinai School of Medicine.
Canadians have a longer life expectancy, lower infant mortality rates and lower rates of obesity and diabetes than people in the United States. Canadians' primary care doctors get paid more and spend more time with their patients than doctors across the border to the south.
But Canadians also wait twice as long for non-emergency care and sometimes come to the U.S. for specialized treatment.
Dr. Scott Gottlieb, a resident fellow at the conservative American Enterprise Institute, says the single-payer edifice is starting to crumble.
"What you're starting to see in Canada is that it is falling apart, and you're seeing the growth of a private market for a lot of essential services," he said.
That private market was born after a 2005 Canadian Supreme Court ruling ended the government's monopoly on some health care services.
But since people have to pay out of pocket for them, Canada's public system is still overloaded.
"The average wait time to get an appointment with a new primary care physician is 17 weeks and for specialty care it is even worse," he said.
Canada lacks America's high technology, with about a third of the MRI machines per capita and far fewer specialists. But Canada also spends 50 percent less than the U.S. on health care as a percentage of its economy.
Some doctors say Canada's long waits are the equivalent of our 47 million uninsured and are morally more defensible.
"We just have moved waiting lines to a different place," Ross said. "There's no perfect health care system. Every system has lines somewhere."
But the president wants to squeeze savings out of Medicare to cover part of the cost of insuring the uninsured, and some experts fear that will ultimately lead to Medicaid-like coverage limits.
"Medicaid in many parts of the country is hardly offering any insurance coverage at all to patients," Gottlieb said. "It is paying providers so little that patients who are on Medicaid have a very hard time getting access to services."
Gottlieb says the U.S. and Canada will both have a mix of public and private health insurance. The president's goal is finding the right balance, so the public plan doesn't crowd out employer provided insurance.