2008 is shaping up to be the election year that we finally get to have the Great American Healthcare Debate again. Harry and Louise are back with a vengeance. Conservatives are rumbling around the talk show circuit bellowing about the socialist threat to the (literal) American body politic. And, as usual, Canada is once again getting dragged into the fracas, shoved around by both sides as either an exemplar or a warning -- and, along the way, getting coated with the obfuscating dust of so many willful misconceptions that the actual facts about How Canada Does It are completely lost in the melee.

I'm both a health-care-card-carrying Canadian resident and an uninsured American citizen who regularly sees doctors on both sides of the border. As such, I'm in a unique position to address the pros and cons of both systems first-hand. If we're going to have this conversation, it would be great if we could start out (for once) with actual facts, instead of ideological posturing, wishful thinking, hearsay, and random guessing about how things get done up here.

To that end, here's the first of a two-part series aimed at busting the common myths Americans routinely tell each other about Canadian health care. When the right-wing hysterics drag out these hoary old bogeymen, this time, we need to be armed and ready to blast them into straw. Because, mostly, straw is all they're made of.

1. Canada's health care system is "socialized medicine."
False. In socialized medical systems, the doctors work directly for the state. In Canada (and many other countries with universal care), doctors run their own private practices, just like they do in the US. The only difference is that every doctor deals with one insurer, instead of 150. And that insurer is the provincial government, which is accountable to the legislature and the voters if the quality of coverage is allowed to slide.

The proper term for this is "single-payer insurance." In talking to Americans about it, the better phrase is "Medicare for all."

2. Doctors are hurt financially by single-payer health care.
True and False. Doctors in Canada do make less than their US counterparts. But they also have lower overhead, and usually much better working conditions. A few reasons for this:

First, as noted, they don't have to charge higher fees to cover the salary of a full-time staffer to deal with over a hundred different insurers, all of whom are bent on denying care whenever possible. In fact, most Canadian doctors get by quite nicely with just one assistant, who cheerfully handles the phones, mail, scheduling, patient reception, stocking, filing, and billing all by herself in the course of a standard workday.

Second, they don't have to spend several hours every day on the phone cajoling insurance company bean counters into doing the right thing by their patients. My doctor in California worked a 70-hour week: 35 hours seeing patients, and another 35 hours on the phone arguing with insurance companies. My Canadian doctor, on the other hand, works a 35-hour week, period. She files her invoices online, and the vast majority are simply paid -- quietly, quickly, and without hassle. There is no runaround. There are no fights. Appointments aren't interrupted by vexing phone calls. Care is seldom denied (because everybody knows the rules). She gets her checks on time, sees her patients on schedule, takes Thursdays off, and gets home in time for dinner.

One unsurprising side effect of all this is that the doctors I see here are, to a person, more focused, more relaxed, more generous with their time, more up-to-date in their specialties, and overall much less distracted from the real work of doctoring. You don't realize how much stress the American doctor-insurer fights put on the day-to-day quality of care until you see doctors who don't operate under that stress, because they never have to fight those battles at all. Amazingly: they seem to enjoy their jobs.

Third: The average American medical student graduates $140,000 in hock. The average Canadian doctor's debt is roughly half that.

Finally, Canadian doctors pay lower malpractice insurance fees. When paying for health care constitutes a one of a family's major expenses, expectations tend to run very high. A doctor's mistake not only damages the body; it may very well throw a middle-class family permanently into the ranks of the working poor, and render the victim uninsurable for life. With so much at stake, it's no wonder people are quick to rush to court for redress.

Canadians are far less likely to sue in the first place, since they're not having to absorb devastating financial losses in addition to any physical losses when something goes awry. The cost of the damaging treatment will be covered. So will the cost of fixing it. And, no matter what happens, the victim will remain insured for life. When lawsuits do occur, the awards don't have to include coverage for future medical costs, which reduces the insurance company's liability.

3. Wait times in Canada are horrendous.
True and False again -- it depends on which province you live in, and what's wrong with you. Canada's health care system runs on federal guidelines that ensure uniform standards of care, but each territory and province administers its own program. Some provinces don't plan their facilities well enough; in those, you can have waits. Some do better. As a general rule, the farther north you live, the harder it is to get to care, simply because the doctors and hospitals are concentrated in the south. But that's just as true in any rural county in the U.S.

You can hear the bitching about it no matter where you live, though. The percentage of Canadians who'd consider giving up their beloved system consistently languishes in the single digits. A few years ago, a TV show asked Canadians to name the Greatest Canadian in history; and in a broad national consensus, they gave the honor to Tommy Douglas, the Saskatchewan premier who is considered the father of the country's health care system. (And no, it had nothing to do with the fact that he was also Kiefer Sutherland's grandfather.). In spite of that, though, grousing about health care is still unofficially Canada's third national sport after curling and hockey.

And for the country's newspapers, it's a prime watchdogging opportunity. Any little thing goes sideways at the local hospital, and it's on the front pages the next day. Those kinds of stories sell papers, because everyone is invested in that system and has a personal stake in how well it functions. The American system might benefit from this kind of constant scrutiny, because it's certainly one of the things that keeps the quality high. But it also makes people think it's far worse than it is.

Critics should be reminded that the American system is not exactly instant-on, either. When I lived in California, I had excellent insurance, and got my care through one of the best university-based systems in the nation. Yet I routinely had to wait anywhere from six to twelve weeks to get in to see a specialist. Non-emergency surgical waits could be anywhere from four weeks to four months. After two years in the BC system, I'm finding the experience to be pretty much comparable, and often better. The notable exception is MRIs, which were easy in California, but can take many months to get here. (It's the number one thing people go over the border for.) Other than that, urban Canadians get care about as fast as urban Americans do.

4. You have to wait forever to get a family doctor.
False for the vast majority of Canadians, but True for a few. Again, it all depends on where you live. I live in suburban Vancouver, and there are any number of first-rate GPs in my neighborhood who are taking new patients. If you don't have a working relationship with one, but need to see a doctor now, there are 24-hour urgent care clinics in most neighborhoods that will usually get you in and out on the minor stuff in under an hour.

It is, absolutely, harder to get to a doctor if you live out in a small town, or up in the territories. But that's just as true in the U.S. -- and in America, the government won't cover the airfare for rural folk to come down to the city for needed treatment, which all the provincial plans do.

Mythbusting Canadian Health Care -- Part I | OurFuture.org

Good reference. I read the article and also the comments from readers. Put the two together and it's a damn fine read.

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I've seen the wild horses, I've heard the bull roarers

sounds nice to me, nice and expensive that is. If I could be convinced a universal health care system would not just massively increase deficits. I would be for it. However I am far from convinced. especially when your talking even paying their damn airfair and shit all on the governments dime.

I mean really how much is this all going to cost in real dollars per year. That is what I want to know.

please believe me when I say, If I could be convinced I would support it. God knows I went a good many years with no health coverage myself.

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Charles_Main

"Whenever a man has cast a longing eye on offices, a rottenness begins in his conduct."
Thomas Jefferson

"Dependence begets subservience and venality, suffocates the germ of virtue, and prepares fit tools for the designs of ambition."
Thomas Jefferson

Why bother with a national healthcare system, when Our Savior Barak will just walk up and down the streets, performing miracles with his messiah magic, laying hands on the poor and infirm? Sorry Kirk, I know you're a big Obama supporter, and I couldn't help myself...

My problem is this: the Chaoulli v. Quebec case. Canada's own Supreme court ruled (in an admittedly close decision) that a prohibition on the use of private insurance violates people's right to life and security of person.

I simply cannot support anything that limits an American's choice to take care of their health and the health of their family the way THEY see fit. I've even heard that one method the Canadians are considering, in order to gradually bring in the option of private insurance, is too demand that Canadian doctors provide a certain quota of work in the public sector. So now doctors have to be told who they can and can't see as well? I just don't trust that.

Furthermore, do you think anybody in America will seriously emulate a system where it takes over 6 months to get a hip replacement, when we've got this giant cohort of baby boomers leaving the workforce?

I'm not trying to make fun, I just would also like to know how this could possibly be feasible.

It ticks off the purists but in my country (Australia) we have a two-tier system that is officially frowned on in Canada. It's not perfect here but it works pretty well. But then we're a small population, only 21m people so what works for us may not work for the US.

Still, it's good to read an informative article that rebuts the myths attributed by some in the debate in the US to single-payer schemes. It's a shame when ideology - at either end of the spectrum - gets in the way of a decent health care system.

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I've seen the wild horses, I've heard the bull roarers

Silly me.. I thought we already have universal healthcare.. oh wait.. we do.. its just expensive, outdated and extremely inefficient... dont believe me.. spend a day in an emergency room... thats probably how long you'd have to wait...

Excellent post. There is no question Americans would want a similar system but spin will turn heaven into hell and truth will be confused by corporate conservative MSM which desires only more.

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"We have an obligation and a responsibility to be investing in our students and our schools. We must make sure that people who have the grades, the desire and the will, but not the money, can still get the best education possible." Barack Obama

How often do you seriously ask that question of our military budget?

You think this has to do with Obama?

I was under the impression tha tCanadians could also have private health care insurance if they choose.


If one see fit to have a doctor but one cann't afford one. Where's your choice?


Yes, I think they will. Many insured now still cannot afford medical care because their sharee of the costs exceeds their ability to pay. Throw in the 50,000,000 Americans with no coverage however bad, and I think you've got the political force to change things

Despite the fact that I have disagreeded with your every objection, I also thing that single payer universal health care, as currently proposed, is, in the long run, going to fail us.

A socialized payment system feeding the insatable greed of a "what ever the market will bear" private market?

The cost of health care will go so high, eventually, that having a card will be meaningless, just as we already see happening with medicade/medicare.

I'm NOT for the system we have now, but as yet, no solution that I think will work in the long run is out there.

We are paying 14% of our GDP for healthcare. A single payer system has inherent cost savings, and that is why other countries pay HALF per capita what we do for healthcare. Our system is expensive, bloated, and costs are going up faster than inflation. That is why every other Western country has universal healthcare. It makes sense and it is the right thing to do.

Yes, its appalling that we are the only developed country on the planet that doesn't have universal healthcare, and that our health metrics (longevity, etc) are among the worst in spite of spending the most money on healthcare.

However, I don't know why Canada always gets held up as the model of universal healthcare. They're not even ranked as one of the better universal healthcare systems. France is consistently ranked as the best healthcare system in the world. Maybe we should look at the French model.


World Health Organization Ranking of Healthcare Systems:

1 France
2 Italy
3 San Marino
4 Andorra
5 Malta
6 Singapore
7 Spain
8 Oman
9 Austria
10 Japan
11 Norway
12 Portugal
13 Monaco
14 Greece
15 Iceland
16 Luxembourg
17 Netherlands
18 United Kingdom
19 Ireland
20 Switzerland
21 Belgium
22 Colombia
23 Sweden
24 Cyprus
25 Germany
26 Saudi Arabia
27 United Arab Emirates
28 Israel
29 Morocco
30 Canada
31 Finland
32 Australia
33 Chile
34 Denmark
35 Dominica
36 Costa Rica
37 United States of America
38 Slovenia
39 Cuba
40 Brunei

]


All that really shows us in the inherent inefficiency of the market.

Yeah, that's right, capitalism in some kinds of markets is not the most efficient system.

That's why I still think any univseral health care insurance scheme that does not outlaw private insureance is bound to fail in the long run.

I mean I want to see universal health care, but I think the current proposals aren't going to work to out benefit, either.

midcan5 do I really have to post social spending compared to defense spending again....or can your dumbass remember like yesterday when it was posted on another thread? How many times must I post it for you?

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Be thankful we're not getting all the government we're paying for.
Will Rogers

Socialism is a philosophy of failure, the creed of ignorance, and the gospel or envy, its inherent virtue is the equal sharing of misery.

Winston Churchill

And so, my fellow Americans: ask not what your country can do for you—ask what you can do for your country.

JFK

No man's life, liberty, or property are safe while the legislature is in session. -- Mark Twain

A prime example of how well the government has served us through their socialistic programs; Social Security, Medicare and Medicaid....
http://www.gao.gov/new.items/d061077r.pdf
In 1992 GAO said: “The federal budget is structurally unbalanced. This will do increasing damage to the economy and is unsustainable in the long term. Regardless of the approach chosen, prompt and meaningful action is essential. The longer it is delayed, the more painful it will be.” These words are as relevant today as when GAO first published them.

The spending that drives the outlook is primarily spending on the large federal entitlement programs (i.e., Social Security, Medicare, Medicaid).


So basically Universal Healthcare proponents want to speed up the process at which America goes bankrupt.....

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Be thankful we're not getting all the government we're paying for.
Will Rogers

Socialism is a philosophy of failure, the creed of ignorance, and the gospel or envy, its inherent virtue is the equal sharing of misery.

Winston Churchill

And so, my fellow Americans: ask not what your country can do for you—ask what you can do for your country.

JFK

No man's life, liberty, or property are safe while the legislature is in session. -- Mark Twain

yeah, $450 billion is nothing at all. not even worth mentioning. and the extra-budgetary supplements for the iraq war ($170 billion in '07), chump change.

yes, social spending is expensive. but wont universal healthcare cut the costs of medicare and medicaid? or should we just get rid of health assistance for poor pregnant women, uninsured children, low income elderly, the disabled, etc?

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sealybobo thinks im a racist right winger. RGS thinks im a braindead liberal. I wonder which one I am?

the best view is from the middle

“Those who are too smart to engage in politics are punished by being governed by those who are dumber.” Plato

“Politics is the gentle art of getting votes from the poor and campaign funds from the rich by promising to protect each from the other” Oscar Ameringer

"I believe there are more instances of the abridgement of freedom of the people by gradual and silent encroachments by those in power than by violent and sudden usurpations. ... The means of defense against foreign danger historically have become the instruments of tyranny at home." James Madison