Health Care: Go Canadian

The U.S. should adopt its northern neighbor’s system of state-paid medical care for all its citizens. Pro or con?

Pro: Follow the Maple Leaf

I find Top 10 lists are a useful way to quickly distill large and complicated issues down to the bare essentials. So here are my Top 10 reasons the U.S. should adopt Canada’s single-payer health-care system.

1. All Americans would have health insurance. This is the right thing to do because it reflects and promotes core values and notions of citizenship: equality, compassion, and social solidarity. Sickness doesn’t discriminate. Neither should health care.

2. Health would improve. On almost every critical measure (life expectancy, infant mortality, etc.), Canada rates higher than the U.S., and we’re among the best in the world.

3. It would cost less. Canada spends 9.8% of GDP on health care, while the U.S. spends more than 15%. A single-payer system is the less expensive way to go.

4. Patients would have more choice. In Canada, patients can choose whatever doctor, specialist, and hospital they want. Treatment decisions are left to patients and their doctors. No insurance companies meddle in our choices.

5. Quality of service would improve. In Canada, health providers never have to choose between their wealth and a patient’s health. Our system forbids that choice. The vast majority of Canadians are highly satisfied with the quality of care they receive. In Canada, patients rarely sue physicians.

6. It would reduce the bureaucracy. Patients in Canada show their health card and get care. Health providers bill the government directly and get paid. It’s that simple.

7. Fewer Americans would go bankrupt because of health-care costs. This is a major problem for many U.S. families. It rarely happens in Canada.

8. It would benefit business. Companies in Canada have a competitive advantage because they don’t have to provide basic health-care coverage for their workers.

9. It would diminish labor strife. Health care is incidental in labor negotiations in Canada. It’s a large and growing pitfall in contract negotiations in the U.S.

10. It would serve democracy. Most Americans want major, not incremental, health-care reform. Many Americans support a single-payer system. It is about responding to the wishes of the people.

Con: Take a Cocktail Approach

It’s not that I think Canada’s national health-care system is a bad one. But I don’t think we should lift any one country’s health-care system to replace the one in the U.S. that is so damaged and dysfunctional.

Canada’s system is not without its detractors. The complaints range from long waiting times to dramatic inconsistencies of care depending on the province one lives in. There are so many caffeinated critics of changing to “socialized medicine” in the U.S. that, even if the system we convert to isn’t actual socialized medicine, Canada’s well-chronicled complaints would provide ammunition for the status quo crowd.

Instead, a new Administration in Washington should put together a bipartisan commission to study, with a deadline, the systems around the world that spend less on health care than the U.S. but get better results. In the end, there would be a “best of all worlds” solution that both major political parties would have played a part in building.

The biggest complaint, and often the myth, of nationalized systems is that everyone has inordinate waiting times for surgeries and treatments. In some countries, this has held true. At one point in Canada, residents of Saskatchewan waited two years for an MRI. But in Japan, there is virtually no waiting. In Germany, wait times for surgeries can be a few weeks, just like in the U.S. In Britain today, hip and knee replacements happen within three months of the asking. That’s faster than I was able to get one in the U.S.

The U.S. system needs four major overhauls, and we should cherry-pick from Britain, Germany, Japan, Switzerland, and Taiwan, to name a few, to find the right structure for each fix.

1. Medical insurance must convert to a nonprofit enterprise.

2. Prices for medical procedures and drugs must be negotiated each year, and fixed at one price by the government, insurance companies, and health-care providers.

3. Medical malpractice awards must be limited and set the same way drug and treatment costs are, rather than battled out in court one by one.

4. Medical records and billing must convert to “smart cards” to spare patients unconscionable administrative costs and paperwork.

It will take leadership and courage in Washington to stand up to special interests like trial lawyers and global drug companies and medical-device makers who are invested in the skyrocketing costs of U.S. health care as a way of subsidizing the sounder, fairer systems around the world.

Opinions and conclusions expressed in the BusinessWeek.com Debate Room do not necessarily reflect the views of BusinessWeek, BusinessWeek.com, or The McGraw-Hill Companies.

Reader Comments

Dante

I'm all for it. Just like the Canadians now come down to the U.S. for treatment (read: only the rich Canadians can afford timely medical treatments), the poor stupid U.S. folks who would vote for this should also have the option of going down to Mexico for timely treatment.

Dickson

I don't think trying to copy Canada's recipe for national health care is realistically going to work for the United States. The government spending priorities of the United States are different from those of Canada.

The U.S. government could offer federally backed comprehensive umbrella medical insurance that would activate once your primary medical insurance limits are exceeded. You would need your own private (government-approved) medical insurance in order to qualify for the government umbrella, ensuring that those who pay into the system get protection. Private medical insurance would need to be regulated to ensure certain standards and minimums so the government doesn't end up with 95% of the bill. U.S taxpayers might be able to support it and keep families from going bankrupt and the drug companies happy.

oliver

We already have a form of national health insurance: Medicare, Military Tricare, Military Medical, Medicaid, and even inmate coverage. What is lacking is coverage for the uninsurable and the population that cannot afford it. Active duty military people do not get to choose their physicians, and to get an appointment they dial a central appointment number and get an appointment in days or weeks. Seems to work. The problem is for-profit medicine. Until we delete that bit, which we won't, due to lobbyists, it will not matter who the President is--our system is doomed to failure. And fail it does.

Alan

We traveled and stayed in Canada for four months last year. My wife had an ailment that had to be treated there. The quality was good, the price was o.k., but on the whole we'd much rather have our system after going through all the hassles. We love Canadians; we just don't care for their health care system. Been there, done that.

bobmarley

I personally have had no problems with health care in the U.S. I learned that a lot of people don't know about all the government's free health care programs. A lot of young Americans having babies end up with huge hospital bills and no insurance for their babies' 1-to 2-year checkups when they can easily qualify for Medicaid.

eyedoc812

It may surprise most readers that many physicians are unhappy with the present system and would welcome significant change. I know that I would. The present system enriches the middleman (e.g. medical insurance company execs) at the expense of virtually everybody else, including providers. If a single-payer system would eliminate the excruciating paperwork, insane malpractice awards, and the constant hassle of dealing with insurance company bureaucrats, while providing a fair negotiated reimbursement to providers, then I am all for it. Disgust with the present system is almost universal among physicians and is resulting in the premature retirement of experienced physicians and fewer qualified applicants to medical schools. However, don't expect our calcified politicians to effect significant change. Not as long as they have their own gold-plated system around to look after their health needs.

Dickson

Even the poor should pay their share. Canadians have complained for years how their poorer citizens use the healh care system nonstop while paying relatively little or no tax. So instead of buying $20 worth of cold-relief medicine, they'll show up at the local hospital, asking to see a doctor because its free.

paranoid

Do you know the former Prime Minister of Canada came to the U.S. for treatment? Do you know there are more CT Scanners in Cleveland than Canada? Do you know that you can get a CT scan for your dog faster than for a person? Do you want to pay for every drug addict, drunk, illegal, homeless, etc., to have exactly as good care as you? I don't.

Harry Singh

I am from Canada and do not live in the U.S. and can tell you the Canadian system is not even half as good as it seems. The only good thing is that the rich pay for the not so rich for everything--just like it should be in a socialist democracy. The waiting times for critical care are insanely long--something Americans will never accept, having never dealt with that before. It can take up to eight months for an MRI scan and six to 10 months for mammograms even after one is diagnosed with cancer. Here is a recent case of abnormal delays http://tinyurl.com/6yxvvf. The best bet for the U.S. is to expand its Medicare and Medicaid programs to cover more of its citizens and children who presently cannot afford health insurance, and the way to do that is in steps by giving them catastrophic coverage to begin with. Although Canada is a great country with tons of things that may be better than the U.S.--like the low crime rate--health care sure is not one of them.

Brown

Whether it's the Canadian, German, British, French, or Japanese system of social medicine is not the issue. The U.S. should take the best from everyone else's system and then build its own that addresses the most serious issues. The U.S. people need and deserve a social health care system that is what any democracy would naturally provide for its citizens.

Robert Laughing

Could anything be worse than the U.S. system? The only people getting in on the gravy boat Congress gave them are the insurance company CEOs. Doctors charge $325 and either the government or insurance company approves $47. And the doctor has to have three people on staff just trying to figure out all the ambiguous paperwork, each one specific to each insurer? Madness. All of which is designed to obfuscate and "create" value for each CEO's company. Congress must mandate one uniform system.

Dan Frith

The U.S. system needs dramatic changes, but it will not happen in my lifetime (51 years old). Why? Because the medical industry (Big Pharma, corporate nursing home chains, medical insurance companies) is making too much money. You know the golden rule: He with the gold rules.

D

Ask any Canadian which health care system they would rather have: the American vs. the Canadian model. The vast majority will say they would rather stick with the Canadian approach, thanks very much. Would a large majority of Americans say the same thing?

Healthy Canadian

Complaints regarding waiting times for health care in Canada are grossly exaggerated. I recently had a series of tests performed, and I did not wait very long (less than 90 minutes) and I had an MRI scheduled within two weeks. I'll wait two weeks, especially if it isn't serious, rather than pay thousands of dollars for one in the U.S. By the way, Canada also has private clinics where you will find CTs and MRIs with costs covered by employers or else it is back charged to Medicare. Bet you didn't count the equipment in all of those clinics, "Paranoid." By the way, U.S. Congressmen have been to Canada for medical treatment also.

Dominic

Let's clear through some propaganda here. Alan, are you Canadian? If you are not, probably is reasonable that you went through some hassles to get you wife treated, and I'm sorry for the inconvenience.

I'm Canadian citizen, other than being American and Italian, too. An Italian couple visiting Florida got caught in a robbery in a store, and the guy got shot in the arm, breaking the bone. He got treated and once back in Italy he got a $30.000 bill. Do you prefer that?

I lived in Canada, and their health care system is good, not super excellent but very good. And guess what, Canadian doctors still can afford BMWs and second vacation homes. Here in the States, I have very good insurance, and you know how long I have to wait to see an endocrinologist? Two months.

Some rich Canadians want to get treated immediately even for a non-life-threatening issue? Hey, come here to the U.S. and pay up. I assure you that an average American (translation: not rich) cannot get immediate treatment as well, in my and some of my friends' and relatives' experience.

For serious problems and life-threatening conditions, people get treated immediately in Canada as far as I know.

Alan, what happens here in the U.S. if you lose your medical coverage because of a layoff and get some serious illness like cancer? Are you happy to lose your house and savings before you can qualify for Medicaid? I bet the Canadian system would sound damn good then.

Many Canadians refuse to visit the U.S. even for one day without insurance, because they are scared to death of potential medical bills in case of an accident.

I know personally of people who moved to Canada because of unexpected medical emergencies that, here in the U.S., would have wiped out the little saving and wealth they had.

Dickson hit the nail in the head: "The government spending priorities of the United States are different from those of Canada." Foreign military adventures for a starter.

I agree with David Kiley that we should pick and choose what is the best. The Canadian system is not the best for sure, but beats the monstrous system we have here in this country. Wake up, people and smell the coffee. Stop being hoodwinked by the scare tactics of the "socialized medicine" propaganda. Follow the money.

Numbers

It all boils down to life expectancy and the infant mortality of a country. Countries that have better numbers on these parameters have surpassed us. If they spend less doing so, they are doing even better. So figure out what we should do.

Dominic

Harry,
Where do you live in Canada? I lived in B.C., and I have never heard of someone waiting 10 months for a mammogram even after being diagnosed with cancer. And I know people who had cancer in Canada. This information about biblical waiting times in Canada for serious conditions is a bit suspicious. Is the Canadian system perfect? Far from it. There are some serious issues. Is it better than the U.S. system? Sure it is, in my humble opinion.

Petras Vilson

I'm a Canadian in a major urban center, Ottawa, with lots of good health care experiences especially for my young son. But my family has had its share of nightmares. With no emergency treatment for my Dad when he suffered a stroke (sent to the wrong hospital, later died) and my daughter's waiting 10 months to remove a misdiagnosed cancerous tumor. She may never have kids, so we've seen good and bad.

On the flip side, my best friend's wife had a malignant tumor removed from her leg in North Carolina within three days of detection that would have killed her in Canada. Some major Canadian flaws IMO:
- Outside major centers in Canada, doctors are rare because they are private contractors and work where they please, unlike in Britain.
- Health care is a money pit and the fastest-growing portion of government revenue.
- The special interest groups in Canada fight over authority, pay, and who does what (doctors rule, and malpractice doesn't really exist up here--likely the only reason costs are lower).

I've heard France has a much better mix of public and private care (read premium care).

Bottom line: All systems have flaws, be careful, watch what you wish for.

Tom Hagan

The question is a bit of a red herring, because one alleged fault--long waiting times--of the Canadian system often cited to oppose the proposed single-payer system in the U.S. (HR 676) wouldn't happen. As for those famous Canadian waiting times: What would happen to them if Canada doubled per capita health care spending to the level we now spend per capita in the U.S.? Obviously, they would disappear.

HR 676 would maintain per capita spending at the present U.S. level--twice that of Canada. So much for the reason so often given for not going, like Canada, to single payer. Waiting times would not arrive automatically with single payer. For more, see http://whatsnotso.blogs.com.

Nick

Though it doesn't seem to be a permanent solution, I took the health tourism approach in getting myself treated for a knee replacement surgery, using the services of Value Medicare in India.

Wayne

Problem: Many of the responses are ignorant of the facts. Sure, there are some wait times in Canada and some do cross the border for quicker service, but it's still an option for them. Most Americans are ignorant of the fact that they pay way more for drugs than any other country in the world. They buy into the BS the government feeds us about needing to stop the cheap imports from Canada due to safety concerns. Fact is, they are protecting their profits on the back of ignorant Americans. It's a sick, corrupt system here. We're being ripped off and taken for a ride. We pick out isolated cases in other countries and say that represents their whole system. No wonder we're laughed at all over the world and score so low in just about every world survey on education, IQ, best country to live, etc. Face it, fellow Americans, we're not at the top of these lists. Wake up.

charles

I am against national health care--mostly because nobody has given me an explanation about how "we" are going to "pay" for it. With deficits running at all time highs--and still going up--the unstable dollar, Social Security partially in the tank, and the politicians who can't practice fiscal responsibility, etc., just where in Hades is this money coming from?

Dean Fang

Dominic, I back your statements up 100%. I am 27 and have lived in Canada my whole life. My mom had cancer, my sister lost her first child because the egg was trying to grow in the tube, and my dad had a heart attack soon followed by a stroke. This is just my immediate family. Uncles and aunts have had numerous medical issues over the years. And you know what? The concern of the doctors was that of my family, that of their patients. It never cost us anything either. Nothing except for $44 a month. I don't think for a second--gee, I don't want to pay for all the alcoholics and druggies and so on. You know less than you think. We are all one people and with the population in the U.S. being 10 times what it is in Canada--hypothetically, you guys could pay $4.44 a month each and afford a wonderful system like we have in Canada. There is no perfection in life, love, religion, politics or health care. So see things for what they are and not for what they ought to be.

I don't want to imagine what we as a family would have had to go through living in the states, emotionally and financially. My mom survived cancer even though it spread to most of her insides. My dad had quadruple bypass surgery within the week of his condition. My sister is working on having another child. We are emotionally stronger now and financially secure (or at least I'm getting there). But would the story be the same with the very scary system you guys have in the U.S.? Dominic is dead on when he says Canadians won't travel to the states for a day without worrying about getting insurance. I've seen it and heard it my whole life from numerous parents telling their children. It is interesting, too, that my dad was a doctor. He practiced in New York, then went to Halifax and ended up in Edmonton, Alberta. He swears by it here, problems and whatnot. Bottom line: Americans, you seriously have nothing to lose. I would fight hard for our system to be adopted in the U.S. I personally view your pharmaceutical and insurance system as embezzlers of the average families' health in the U.S. Money over health? Not for me. Not ever.

HAhmad

With deficits running at all time highs--and still going up-- the United States should quickly turn attention to their war vs. the world. Fact is, billions of dollars that fuel the war can tackle the deficit. Using the deficit as an excuse to forgo nationalized health care is just wrong.

Now whether or not wait times are longer under the Canadian system is irrelevant. Ask the 50 million uninsured Americans if they prefer nationalized health care, and there will be a resounding yes. It's about what is fair and equitable for everyone, and if that means waiting in the back of the line to get treatment, so be it. The right to health care should not discriminate based on age, sex, or wealth.

Damian

I currently reside in the U.S., after living in Canada for close to 20 years. My mother is an American, and recently has had to get a tumor removed, and I have seen the bills that their insurance (a large insurance company from a Fortune 500 company) as well as dealing with doctor network issues. The system is not perfect in Canada, but I assure you it is much better.

David Kiley

BusinessWeek's David Kiley Responds:
The question of who pays is easy. Take all the money that workers and employers pay to insurance companies now. Medical insurers become non-profits. Then, administrative costs come way down because the whole thing is centralized and standardized. Then, costs of procedures, medical devices, and Rx drugs get negotiated downward and standardized. Malpractice judgments get standardized and lowered as well.

While all of that may sound far-fetched in our ridiculous system, they are precisely the measures taken by foreign countries with better systems and open access. All that saves a lot of money and provides a lot of funding for universal access.

neodoc

I think it is foolish to compare the U.S. (and its health care system) with any other country in the world, because there is no other country that is this big, diverse, and also rich.

We should remember that the U.S. is at the cutting edge of modern medicine. In fact, the budget of NIH (National Institutes of Health) is bigger than the national budgets of half the countries of the world. As a result, we are always faced with the latest and the best technological advancements in the world. However, it doesn't come cheap. And there's the fact that we are subsidizing the health care systems of all the nations mentioned (Canada included). So, health care is never going to be cheaper in this country. That doesn't mean we can't have administrative reforms. I am fully with the suggestions of the con argument. We should reform the tort system, cut through the bureaucracy and expand Medicare and Medicaid. In fact, the VA (Veterans Administration) has by far the best system in the country. But we should be careful not to provide anything free. As a pediatrician serving Medicaid patients in Texas, I have seen whole families waiting for four hours to collect some Tylenol and cold medicine for their kids, because they don't have to pay anything for the visit (and they don't want to spend $3 and buy the same OTC). So, anything given free is valued only as much.

Dominic

Neodoc, I'll answer your message with just a few facts:

- Best health care in the world: France (which is by far the most advanced country in the treatment of cancer and infectious diseases. Yes, some wealthy Americans go to France for treatment).
- The United States is in the upper mid-30s.
- The vast majority of all other OECD countries fare way better than America at every possible health care statistics: life expectancy, infant mortality, obesity, cancer, heart problems, etc.
- Maybe you should ask yourself where all that enormous NIH budget goes to, because definitely, it doesn't show in any measurement of health and well-being.
- The notion that the U.S. "subsidizes" all the other nations is just plain ridiculous.

P.S. You said, "because there is no other country that is this big, diverse, and also rich." The "rich" part is highly debatable nowadays.

random

I'm going to agree with Mr. Kiley in using a best practices model rather than copying the Canadian health care system. Just being able to standardize paperwork and reduce the number of forms one must fill out over and over again with every visit to a different doctor's office and update every year, would do wonders for lowering the costs of health care.

Leslie

I think the tenor of the comments posted here indicates a great deal of thoughtfulness. The Canadian system can, I believe, be improved by increased investment in staff and infrastructure, which would probably reduce waiting times where they exist and make the system more efficient. This has been worked on quite seriously since the basic goals of the system--universality, accessibility, and equality--are still as applicable today as they were at the start of the program. It should be noted that Canada does not have a national health care program but one composed of 13 interlocking provincial and territorial health insurance plans. The U.S. system, on the other hand, would be far more challenging to fix. I believe that something like 48% of U.S. health care costs are already covered by Medicare/Medicaid but without real cost advantages (i.e., no competitive bidding on pharmaceuticals). Multiple billing practices and malpractice suits add exponentially to costs, and vested interests would make it politically difficult to dismantle the system to address the needs of the uninsured or those unable to pay. A best practices model that combines more efficient private/public arrangements, as used in Switzerland, might be the best for the U.S. It remains a puzzle why the United States, alone of OECD countries, has no universal health care--although it was proposed for Iraq under U.S. occupation.

Joe

We already have a single-payer system, and it is called Medicare. Everyone must pay into it, and everyone is enrolled. Simple as that. Having said that, it should have nationwide standards but be run by the states. The states will negotiate best prices for everything from drugs to hospital beds.

Mazen

Americans are so fixated on not wanting the same health care as Canada or any other country, and I cannot for the life of me, understand why. Having lived in Canada and had health care there, I know it is far superior to that of the U.S. Having a for-profit health care system is horrible. I continuously hear of long lines and other nonsense on the national news; I never experienced that. The pro side of this is that in the U.S, cutting-edge technology produces new medications and treatments but greed does not have to be the motive. I am sure the "greatest" country in the world can figure something out.

neodoc

Mr. Dominic,
To answer your comment about OECD, so here you are, comparing Iceland, with a population of 300,000, with the U.S., with a population of 300 million, with 4 million to 5 million entering the U.S. as immigrants from the Third World. So, please have some perspective before throwing statistics around. I don't have any experience with France, but I will believe you. But wait until the current contagion (economic) hits that part of the world and the mighty Euro comes crashing.

Joe Lee

People who don't have health insurance should go to Canada for treatment. That way, we don't have too much burden on our health care system. The Canadians welcome anybody for treatment.

Joe Lee

Dear Dean Fang:
You can keep your Canadian health care system. We like our system.

iguatemi

neodoc,
Rather ridiculous to use Iceland. Why not Germany (82 million people), France (60 million), and the UK (60 million)? All of them have large numbers of immigrants and deal with all sorts of "big country problems." All of them offer universal health care (in different ways, though), and all of them are paying 30% to 50% less (as percentage of GNP) for health care then the U.S. That has also nothing to do with the euro or the current financial crisis as all the systems have been working like that for decades.

Some of them have not been as good in the past (e.g., UK), but additional spending has significantly improved them (still spending 50% below U.S.).

The big difference is that doctors are usually not millionaires (still good income, though), that insurance companies don't make billions in profits, and that generally less administration is needed.

By the way, France, Germany, and other rich European countries all are on the forefront of health care innovation. So while all of them have individual problems, they are all still far better for the people as a whole than the U.S. system.

Dominic

Neodoc,
Iguatemi pretty much responded for me. I would add another country, Italy, whose World Health Organization statistics rank it as second-best health care system in the world after France (it is a mix of public and private, a two tier system).

Italy has a huge immigration influx and problems associated with it from Third World countries, especially from the North Africa area. Same for France, which, as I posted before, is No. 1 accordingly with the WHO--very serious immigration issues.

France's status as a health care powerhouse, by the way, predates the euro by several decades, and I suspect it will remain that way for a long time. In my opinion, the biggest problem with the main health care mind set here in the U.S. is: "It will not happen to me." Then when the "chocolate" hits the fan (no insurance and a sudden huge health issue), that mind set shifts quickly.

I personally know of well more than one case of people who were staunch opponents of public health care and, after having their entire savings wiped out or losing their home because of an unexpected medical problem when they were not insured (mostly because of losing their jobs), they become advocates for a change in the system.

In one particular case, a gentleman tried to immigrate to Canada because his wife contracted a serious illness. Sad, if you ask me.

neodoc

Iguatami wrote: "By the way, France, Germany, and other rich European countries all are on the forefront of health care innovation."

When I read this, I went to the Nobel committee's Web site and tallied the Nobel Prize in medicine for the last 20 years (1988-2007). Here are the results:

USA--30
UK---6
Germany---3
France---0
Italy---0

I am concluding that all these 30 scientists who won Nobel Prizes for the U.S. just made up something out of thin air (and therefore didn't use all the health care dollars we are "wasting" in this country). I further conclude that these research findings are of no use to anyone in the countries that are "not subsidized" by the U.S. taxpayer.

Terence O'Connor

I have lived in the UK, U.S., and Canada and have had the opportunity to compare all three health care systems. I've had good care in all three but was always concerned about the lack of universality in the U.S. system. The U.S. system works well until there is no employer-backed system. Also, there is a large amount of clerical staff needed in U.S. doctors offices just to handle insurance concerns, which is not necessary in the Canadian system. Also, obtaining health insurance for self-employed individuals is a real challenge. Of the three, I'd take the Canadian system any day.

ScottD

You don't have true pros and cons here but a debate on the method of the U.S. adopting a socialized or semi-socialized health care system. I'm in favor of Mr. Kiley's general approach, but I'm concerned that it is the long way to get there, and we need to get there quickly.

I'd also ask what happens to Medicare and VA programs under nationalized health care. It would make sense to eliminate those programs and have one unified program serving veterans and the retired as well as working citizens.

There should be a focus on lower cost. I'm very skeptical of proposed plans that increase my costs or taxes. Why? We already spend nearly twice what other nations spend on health care, for poorer outcomes. I don't see a need for increased cost.

Last, I hate the partisan arguing. What we have is broken. It costs too much and provides poor comparative outcomes. Critics will constantly point to waits and anecdotal issues with other "socialized" systems, but no system will result in perfection. The only question to ask: Is it better and more cost efficient than we have today?

Dominic

Neodoc,
You are comparing "grapes with lettuce" here. Yes, apples and oranges are too similar for this example. We are talking about health care here, not Nobel prizes. Having won more Nobel Prizes doesn't translate to better health care or medicine. Just for starters, from the idea, or scientific discovery, is a long way to go before becoming a workable solution. By the way, about France in the recent past, the Professor Luc Montagnier and his team at the Pasteur Institute first discovered the retroviral causes of the AIDS.

The Pasteur Institute is at the forefront of the research for infectious diseases. The first facial transplant, an incredibly difficult surgery, was conducted in France two years ago. If you can buy fresh milk at the supermarket and it lasts quite a while, it is because of the work of the founder of the Pasteur Institute. Ever heard of Pasteurization?

The German multinational Siemens is the producer of the most advanced medical equipment in the world. And maybe other countries just buy what they need from the U.S. and other nations, it doesn't necessarily mean the U.S. "subsidizes" them. Neodoc, you have a bit of too much of a U.S.-centric vision of the planet. The world is a big place, you know.

Dominic

Scott,
You are right--no solution is perfect. But the fact that the U.S. system is the worst of the bunch is pretty much clear to the entire industrialized world. I do not think that much is debatable. Otherwise, someone else would have followed our "lead."

FI

As a Canadian, I am happy with our system. It has its flaws and drawbacks, but generally one gets good care at no up-front cost. Although I can't tell anything about the U.S. system, it seems that there is no consensus as to the cause and solutions to the U.S. health care problem, except that it's broken. The Canadian system, on the other hand, has problems and everybody agrees that it just needs more money. In life, I would always prefer a system where the problem and solutions are known vs. a system where we can't even figure out what the problem is, let alone solutions.

neodoc

Dominic,
Grapes and lettuce have more in common than you think. Contrary to your thinking, most of the Nobel Prizes in medicine in the last 20 years have been awarded to discoveries that have already changed medicine unbelievably. (Just go the Nobel committee's Web site and check it out for yourself.) The Nobel Prize is like the infant mortality rate or life expectancy. It is objective (with a denominator), unlike some complicated surgery or the latest machine. And the simple fact is that France (or Canada, for that matter) has not a single one to show for it. So, when the U.S. spends a lot of money on research (part of health care allocation), it will obviously make the system look inefficient comparatively. I am not arguing that our system needs no fixing. But it would be naive to blindly go with a one glove fits all approach as the issue at hand is far more complicated than you think. I was just providing one such example by pointing out all the research dollars we spend. FYI: Louis Pasteur, 1822-1895. We are talking about 2025.

Dominic

Neodoc,
Even if it seems so, there is not necessarily a direct link between Nobel Prizes won and amount of resources used for R&D. A lot of R&D spending is done to generate workable solutions out of pure research. Some companies/countries may be particularly well-versed in acting as collectors or recipients of others' ideas and discoveries and generating actionable results (see Japan, for example). However, overall R&D spending, as a percentage of GDP, is higher in Japan, France, Sweden, Finland, and some other countries, compared to the U.S. (2007 data).

That said, I totally agree that we should not blindly dive into a specific "model" or "one size fits all" solution. But our system is seriously broken, and it needs dramatic overhaul. It is well beyond the point of patching and quick fixes.

iguatemi

Neodoc,
Yes, of course, all that money goes to research and not to doctors and insurances. Just have a look at the numbers for health care expenditure as a percentage of GDP (2005):

Germany: 10.7%
France: 11.1%
UK: 8.3%
USA: 15.3%

If the USA would spend only 11% of GDP on health care (between Germany and France) it would save more than $600 billion USD (4.3% of GDP) while offering universal health care to everybody.

Are you saying that these $60 billion should go into more research? It is, by the way, undisputed that the U.S. has a great infrastructure regarding research and universities, and it very often attracts the best researchers from around the world. This, however, is in my opinion--not linked to the health care system in general.

Ananth Shankar

There are three components of health care. First there are the physical infrastructure, the hospitals, clinics, and the technology. Nobody can argue that the U.S. has some of the best. Second, there are the providers--doctors, nurses, technicians. Here, too, the U.S. has some of the best-educated and best-trained professionals. Where the U.S. fails, and fails miserably, is the third leg--how health care is distributed to the citizens.

The hodgepodge of insurance companies, HMOs, and thousands of other entities make this the most cumbersome, expensive distribution system in the world. We pay more for health care on a per capita basis that every other developed country, and our health ranking is among the lowest. Every civilized industrial country has figured out that a single payer system is the most superior. Here we let ideology with terms such as "socialized medicine" turn opportunities into fear. For all the things that Margaret Thatcher privatized Great Britain, she did not dare to touch the National Health Plan.

Here in the U.S., government already pays for about 60% of health care--through Medicare. What private companies do not want is to have the added burden of finding health care for its employees. Health care is a fundamental right of citizens living in any civilized country, and the "free market" cannot be allowed to jeopardize the health of the citizens. What people do not realize is that you and I are paying far more for other people's health care now, under the current system. The U.S., in this regard, has no courage and is gutless.

Mel

The biggest challenge in changing to a government system is that politicians will promise to do it without anyone paying the bill. Just look at the mess Medicare is in. If the government wants to bring down the cost of insurance, it should simply make Medicare pay doctors at the same level of the federal employees' health plan. That would stop cost shifting and reduce the cost of care, thus reducing the cost of health insurance.

Darryl Steele MD

I come to my stand on adopting the Canadian or any other socialized medical plan from three rational and experiential hats. As a physician, I practiced under socialized medicine in Canada in the late sixties. The only advantages were accrued to maternal child health patients and immunizations to prevent communicable diseases. I was able to access surgeries, diagnostic testing, and dialysis care because I was a faculty member at a major medical school in Ontario. Other physicians had long waiting times for any special treatment for their patients. No one over 65 gets triple bypass, laser eye surgery, or renal dialysis.

They must wait for limited resources, and many die or come to the United States for treatment. I can get all major all diagnostic testing and specialist appointments the same day or within one week. When my longtime friend needed triple bypass at age 62, he waited 18 months because in Toronto, only one hospital performs this procedure. When my daughter-in-law needed a colonoscopy annually, my son had to drive her 185 miles to the only hospital in Toronto (hotel, one to two days, lost work time for both of them). She also had to travel 300 miles to get an elective C-section delivery, because the government selects 12 obstetricians.

In Ontario, patients are assigned physicians and hospitals. No freedom of choice. As a son, I had to watch my mother's last six months of life, suffering with bone and lung cancer pain, because she was allergic to Demerol and morphine. Fentanyl by patch was the next choice. Her oncologist informed me Canadian manufacturers could not keep making enough Fentanyl patches for Canadians to use. I wanted to kill somebody over her pain. Finally, she got a subcutaneous drip going to ease her last week of life.

One month before her death, I spent 10 days, as her son, with her. The day I was to return to the DFW Metroplex, I collapsed, and was transported to North York General Hospital's emergency room. I had shortness of breath, chest pain, cratering BP, and a very slow heart rate. The ER doctor would not treat me or order blood tests until my sister paid him $200 in cash. This medical behavior is outlawed in this country.

I spent 48 hours in the coronary care unit. No diagnosis was made. I flew home to see my nephrologist. But first I reviewed the typed medical progress notes. An MD oncologist was the only specialist making rounds in the cardiac unit. Oncologists do not attempt to care for such a disease state here. Upon reviewing my intake and follow lab tests, I a family physician, made the DX of my Canadian illness. I had protein poisoning and very high potassium levels. Nowhere on my medical chart did any nurse or physician make a comment on, or treat, that condition. I could have easily died as a result. My nephrologist confirmed the diagnosis two days later. High potassium is the lethal substance in a lethal injection execution. Also the administration in the hospital hounded me for a $2,000-a-day guaranty. Nowhere in the USA do administrative goons enter an ICU to demand money from a sick patient. I had given them my Medicare card plus a Blue Cross supplement card IDs. They refused to bill the USA for services.

I am also a Medicare patient here in the USA. The government and Blue Cross spend $32,000 a year on my prescription meds. I spend $6,500 for the deductible and copays. Canadians do not get paid prescription benefits (unless on welfare or workers compensation.) They must purchase both travel and drug insurance out of pocket.

National health care here will bankrupt the USA within two years and will cause long waiting lists and rationing of dialysis, cardiac procedures, MRIs, CT scans, and all other high dollar diagnostic tests.

Dominic

Darryl, I have no reason to doubt your bad experiences. Frankly, what you described sounds more like Angola than Canada. But I doubt your medical professionalism when you label the Canadian system or other national health care programs "socialized medicine."

All the OECD countries, minus the USA, have a universal national health care plan in place. You know why? Because it works better than what we have, simple as that. I moved a lot for professional reasons during my career, and I personally experienced the health care system of Italy (my native country), Australia, England, and Canada before the USA.

During my time in Canada (British Columbia), people were and are very happy with their system. Again, it is not perfect. You can definitely improve upon it. Maybe Ontario has serious issues I'm not aware of, but the Ontarians I know have never complained. As you did about Canada, I can list several bad American health care experiences for me or my friends and family, but I do not want to write too long of a message.

Just a simple recent example here in Seattle: I have very good health insurance, and still I had to wait almost two months to see an endocrinologist. Enough said. You said, "National health care here will bankrupt the USA." The present system will bankrupt the country anyway.

Ananth Shankar

What is bankrupting this country is the current health care system in the U.S. Take the price of manufacturing a car--a full $1,500 of the cost goes to health care costs. The majority of Americans say the system is broken. The wait times for procedures in other countries are vastly exaggerated by fear-mongers. The truth is that the majority of Canadians and the British and the French would never give up their health care plans. Forty million uninsured and growing--in the richest country in the world. What a shame.

FI

Darryl Steele, M.D., I am sorry you had such a negative experience in Ontario. I live in Toronto and can tell you that hospitals and physicians are not assigned here. One is free to choose any family doctor. This applies to hospitals as well. Specialists are, however, referred by the family doctors.

Tori

I am an American living in Ontario for the past two years. Canada is a nice country, for Canadians, just like America is a nice country, for Americans. I think that we should all just stay in our own countries of birth and mind our own business.

I'll be out of here by the end of the month, and I've already re-enrolled in my former American health plan (which was excellent). No hard feelings, Canada, but I prefer our system over yours, and I really think that Canadians should adopt a new pastime other than the current one of a total obsession with all things American.

Please try to accept that we do not consider you as an equal. We do not consider you to be inferior. We do not consider you at all. The sooner you get that through your American-obsessed heads, the better off you'll all be.

America has many, many problems. But so does Canada. Before I moved here, I had no idea that Canadians spend more time focusing on us than themselves.

I have no intention of ever returning to live here again. However, if I ever find myself with severe and expensive health problems, I will hightail my American ass back up here so fast so that you Canadian taxpayers can foot the bill for me.

Al

Ya'll are forgetting that when you hand over all your money to bureaucrats, you also hand over all your power. As it is, Canada is talking about making Vitamin C illegal without a prescription. If you think Big Pharma has a choke hold now, just go ahead and centralize it (Communism). Then see if alternative treatments are even allowed. We will then have all the bean-counters and politicians deciding who should be paid what for what service, and if it is even acceptable.

And before ya'll think social Communism is the way to go--has anyone tried to remodel or build a house in this day and age? The degree to which life is controlled for us has reached a level of ridiculousness. Enable the propaganda bilge of a socialist not-for-profit system, and we will have long waits, mandated prescriptions, and waist measurements like in Japan and further erosion of liberty.

Dominic

Al,
Who told you the Canadian health care system is not for profit? Big Pharma has more power here where legislation prevents the government from negotiating bulk prices with pharmaceutical companies under the Medicare scheme. No solution is perfect, and what they have in Canada is definitely not one of the best around. But in terms of coverage and public availability, it beats what we have here by a mile. As I said before, whoever praises our way of running health care never got caught in a serious medical emergency without coverage. Be careful--if you get sick, you are only one layoff away from financial disaster.

outsider-with-thoughts

Honestly I'm of the opinion that it doesn't matter that America feels it might lose its pride, or that they don't need Canada, if it's all for the greater good of the people, then no offense but obviously they should accept the idea. I mean health care for all Americans is absolutely fantastic if you think that there are actually people who can't afford health care, then again, the need for doctors would increase because of all the people with health care coming in for treatment, which would lead to more hospitals, thus leading to more employees, which again leads to fewer unemployed people, which is good.

Michael L

I believe it would be worth a try. If Canada is flourishing with it, who's to say we won't? I think it would be much easier through the government, and patients would be treated much faster by flashing a card rather than filling out paper work. If it proves to be horrible for us, we can always change back at anytime; it's not like it's set in stone. Our health ratio would most likely increase, more money in our pockets would stay there, and we have more authority about who operates on us. Plus, it is cheaper for the government and us.

Pierre

Darryl Steele MD is a total fraud. Pretty much everything he claims about health care in Ontario is pure bogus. We are not assigned our doctor. We can go to any hospital. There are numerous hospitals in Toronto. The government doesn't select ob/gyns. There are way more than 12. Bypass surgeries, laser eye surgery, and renal dialysis are performed for those over 65. And your claim about having to pay an ER doc $200 makes it all more obvious that you are full of it.

Walter

I've lived in Canada and the United States and have used both health care systems. I overwhelmingly prefer the Canadian system. The stories you hear in the States about wait time for surgery and tests is grossly over exaggerated. I think the stories are made up by the U.S. health care company CEOs. They don't want you to know how good we have it with our system.

Alfredo

I was transferred to the US in the 80s and lived there for 5 years. The company had a very expensive health insurance. In my experience I can tell you that the system in Italy is far superior to the system in the US and far less expensive.

Phil Eyler

The U.S. government spends more money per capita on health care than Canada and treats only a portion of its citizens. If the U.S. converted to the Canadian system, the government could save money and serve everyone.

It won't happen, of course. The U.S. is mired in corruption where Congressional votes are regularly bought by well-healed lobbyists offering "campaign contributions" to compliant Congressmen.

howard

Lets as Natasha Richardson. She got the standard treatment of care in Canada. No heli or CAT - those would have been given in the US.
There arent options in Canada and, if not needed--no CAT scan. Yes--we may do them after whiplash here--and even if a 10:1 ratio--isn't a life worth it?

I found the thoughts of Alan Greenspan--kind of line up well with the concerns:


Even absent the inflation threat, there is another potential danger inherent in current US fiscal policy: a major increase in the funding of the US economy through public sector debt. Such a course for fiscal policy is a recipe for the political allocation of capital and an undermining of the process of “creative destruction”--the private sector market competition that is essential to rising standards of living. This paradigm’s reputation has been badly tarnished by recent events. Improvements in financial regulation and supervision, especially in areas of capital adequacy, are necessary. However, for the best chance for worldwide economic growth we must continue to rely on private market forces to allocate capital and other resources. The alternative of political allocation of resources has been tried; and it failed.

Mike

There may be some good things about the Canadian system, but apparently also some major problems that threaten the whole program. See following.

http://www.google.com/hostednews/canadianpress/article/ALeqM5jbjzPEY0Y3bvRD335rGu_Z3KXoQw

Marcia

"1. All Americans would have health insurance."

False. Many people in Canada are without health insurance. Indeed, some are kicked out of the system for violating some silly rule here and there. And the current health care legislation being bandied about, even its supporters are admitting that millions will go without health care insurance.

"2. Health would improve. On almost every critical measure (life expectancy, infant mortality, etc.), Canada rates higher than the U.S., and we’re among the best in the world."

False. For example, cancer survival rates are number one in the United States. And cancer survival rates is a better measuring stick.

"3. It would cost less. Canada spends 9.8% of GDP on health care, while the U.S. spends more than 15%. A single-payer system is the less expensive way to go."

We pay more, yes. But in return we get more. Its the old adage: You get what you pay for, and in Canada, they get very little care for their money.

"4. Patients would have more choice. In Canada, patients can choose whatever doctor, specialist, and hospital they want. Treatment decisions are left to patients and their doctors. No insurance companies meddle in our choices."

This is altogether false. Oh sure, they can choose where they want to go, but depending on where you live in Canada, one can't choose their physician -- there's too much of a shortage, and some people are lucky to have one at all. So, the one you choose ,ight not be able to see you, as a result, you have to go to another physician that you dont want.

"5. Quality of service would improve. In Canada, health providers never have to choose between their wealth and a patient’s health. Our system forbids that choice. The vast majority of Canadians are highly satisfied with the quality of care they receive. In Canada, patients rarely sue physicians."

Quality would improve? Ha! Again, number one in cancer survival rates in America. And its true that patients rarely sue physicians. But thats because cases are heard by judges, not juries. Damages for pain and suffering are capped. Punitive damages are rare. And if patients lose their lawsuits, they have to pay the doctors' legal bills. In America? Theyre heard by juries, damages are not capped, and patients who lose their cases dont have to pay the legal expenses of the people they sued.

"6. It would reduce the bureaucracy"

Thats a big laugh. Recently I did a google search on NHS bureaucracy and two articles on the same page caught my eye. One was from 5 years ago in 2004 in which it said how steps were being taken by the government to reduce the bureaucracy. It said that they would see positive results by 2007-2008. And a more recent article only days old which said that the health care bureaucracy has increased over 25 percent over the past 2 years!

"7. Fewer Americans would go bankrupt because of health-care costs. This is a major problem for many U.S. families. It rarely happens in Canada."

Falsehood. This is a myth invented by the left. No one ever goes bankrupt because of health care costs.

"8. It would benefit business. Companies in Canada have a competitive advantage because they don’t have to provide basic health-care coverage for their workers."

No, but they have to pay exorbitant taxes. Which is being proposed by the current legislation.

danny

"But in Japan, there is virtually no waiting"?

Yeah right! That is if you don't get refused medical attention by the paramedics or doctors first! Have you guys even read about how ambulances or doctors can (and are allowed) to refuse treatment in Japan?

Surely you won't want to be in this person's shoes --> http://tokyorave.wordpress.com/2010/02/15/very-bad-experience-with-doctor/

frank

I live in one of the economically poorer provinces in Canada, and a family member was diagnosed with breast cancer from a routine yearly mammogram (no waiting time). She was operated on in 4 days, began treatment in the next 7 days. Hospital stay, scans chemo, radiation (20 some treatments) consultations with 8 specialists, MRIS, CatScans and on and on and on cost a whooping $0.000 (U.S.).

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