Health Care, Canadian Style

Reforming America’s health care system has become a defining domestic issue in the presidential race.

Democratic presidential hopeful John Kerry wants the federal government — that is, the taxpayer — to become the country’s catastrophic insurer. Other Democrats openly assail any private involvement in health care.

“Does this mean that the American way is wrong and that we should switch to a Canadian-style single payer system?” writes New York Times columnist Paul Krugman (search). “Well, yes.”

Before Americans embrace those who advocate joining the Canadians in government-dominated health care, they ought to take a look north. Just as American pundits and politicians are calling for us to adopt policies that put us on a path to a Canadian-style system, Canadians fed up with rationed care are questioning their own.

A July poll conducted for the Canadian Medical Association (search) found that 40 percent of Canadians now grade their health care system as a C or worse.

“Year over year, Canadians have identified that their confidence in their health-care system is eroding,” said former CMA president Sunil Patel.

The reason is simple and the problem is structural.

In theory, Canadians enjoy an almost ideal system — the government pays for all necessary health care, which is delivered by private practice physicians and independent hospitals. The day-to-day reality is starkly different. When Canadians need care, they face a series of waits: one for access to a primary care doctor, another for access to scarce diagnostic equipment, and another for the necessary procedure.

Between 1993 and 2003, the median waiting time from referral by a general practitioner to treatment increased by 90 percent, from 9.3 weeks to 17.7 weeks, according to an annual survey of physicians by the Vancouver-based Fraser Institute. For cancer patients, the waiting time for medical oncology more than doubled from 2.5 weeks to 6.1 weeks, and the waiting time for radiation oncology increased from 5.3 weeks to 8.1 weeks.

That’s the experience of 58-year-old Don Cernivz, who noticed blood in his urine in fall of 2003. He waited three weeks for his first diagnostic test and then another month for an MRI (search). Actual treatment for his cancer of the pelvis didn’t commence until May of the following year.

“The waiting time is ridiculous at the hospital,” his daughter complained to the Calgary Herald. “He is in pain.”

The waits for care are not aberrations, but the logical result of the incentives of a government-supported system. To the government, health care costs are merely the checks it must write. To the patients like Cernivz, however, costs are broader, including the value of lost or diminished work while waiting for care and the diminished quality of life, while waiting in pain.

Government planners control monetary costs by shifting non-monetary costs on to patients. The system then prohibits Canadians from avoiding those non-monetary costs by paying out of pocket for their care, unless they leave the country.

That’s exactly what former champion figure skater Audrey Williams did. After waiting two years for a hip replacement in Vancouver, B.C., she traveled to Washington State and paid $25,000 to stop the pain.

“I couldn’t wait any longer,” the 71-year-old Williams told the National Post. She could barely walk, wasn’t getting enough sleep, and pain pills had upset her stomach. “I wanted a life.”

Canadians are finding they now have to wait for primary care, not just advanced procedures.

One Canadian tells of a 5-year wait to see his wife’s general practitioner. Nearly 4 in 10 Canadians reported waiting longer than they thought reasonable for access to a family physician in a poll conducted for the CMA in the spring of 2004.

"At the moment," writes CMA president Dr. Albert Schumacher, "millions of Canadians would love to find just one family physician, let alone choose from among several."

Nearly half of doctors and nurses polled in July reported that their patient’s conditions had worsened while waiting for care.

And the waits only promise to get longer, as a stagnating pool of physicians struggles to serve an aging population that isn’t allowed to pay privately for care. That’s the reality of a health care system dominated by the government, and the reality Americans need to be wary of when considering options for health care reform.

Sally C. Pipes, a Canadian residing in the U.S., is the president & CEO of the California-based Pacific Research Institute. She is the author of "Miracle Cure: How to Solve America’s Health Care Crisis and Why Canada Isn’t the Answer," with a foreword by Milton Friedman.