Canadian Healthcare Vs. American Healthcare

A quick rundown of the reality of poor healthcare in Canada

Ok, so there’s a widely accepted idea that universal healthcare is better. It’s something many Canadians like to hold over American’s heads, and a mark of shame for left leaning Americans. I get the feeling that many feel like they’re behind their Canadian and European counterparts. In some ways one can argue that when you look at success stories like Switzerland, but you also have to look at their median wealth when gauging success. I think the COVID-19 pandemic has really brought to light the differences between the US and Canadian system, so for my friends down south and anyone in Canada, here’s a brief overview of what our healthcare system is really like in Canada, and how it stacks up against the US.

First is a brief overview. Canada has a federally funded, but provincially run universal healthcare system. This covers necessary procedures, diagnostics, GP visits, specialist visits, x-rays, MRIs, the works. There are some things that aren’t covered like doctor’s notes, private hospital rooms, stitches, waterproof casts, and these can vary by province as well as the prices. Generally speaking though, if you walk into a doctor’s office or hospital, you will leave without opening your wallet. Sounds good right? Well that doesn’t include outpatient prescriptions, dental, eyecare, or psychiatric care (unless deemed needed to make you a functioning member of society, more on that later). I am extremely myopic and wouldn’t be able to get a job without glasses, but for some reason this isn’t necessary. Also oral cancer medication (because it’s outpatient), diabetes strips and medication (even type-1), and anything else you would pick up at a pharmacy is out of pocket. Because of this, private health insurance is still a big part of job hunting. This already doesn’t sound like it’s universal or even very fair, but lets continue.

The US has two federally funded programs, Medicaid and Medicare, but a completely privatized system of care. Medicaid is an assistance program for low-income people that closely reflects our insurance system in Canada in the sense that it varies from state to state. Then there is Medicare, which is an insurance program for those over 65 and the young and disabled who qualify. This is similar to our government health insurance in Canada, and also varies state to state. Together, these two systems operate as a safety net for those who cannot afford private healthcare. These systems have their downsides, people fall through the cracks as in any government run system, and because the coverage varies very widely state to state based on the US having more of a focus on personal responsibility than Canada. This leads to more people going without care because they can’t afford it. So how do these two imperfect systems, Canada with a mandatory insurance program, and the US with a low-income support program and an insurance program for the old and disabled? I’ll try and explain as best I can.

Now into the belly of the beast. First off is wait times, this is something you hear a lot about if you’re familiar with complaints about our healthcare at all. They vary wildly because it’s a public system, with some provinces having non-profit private hospitals, and some having public hospitals. All doctor’s clinics are privately run so they’re generally not as bad for wait times in Canada. As you can see here, we rank 11th for elective (non-emergency) surgery among this list of developed countries, and the US is third. The most staggering difference is the greater than 1 month and less than 4 months category, where a whopping 25% of Canadians have to wait more than 4 months, and the US comes in at only 7%. Now for emergency room waits. These are more varied by province or state, but as shown here in an article from iPolitics: “CIHI’s National Ambulatory Care Reporting System numbers for 2018–19, released Thursday, show that patients in Canada spent a median of 3.2 hours in emergency departments per visit. But for 90 per cent of those visits, patients were there for 10.9 hours or less.” With Quebec coming in as the worst at a median of 18.1 hours. The US seen here on the CDC website, has a median of wait time of 30 minutes, with total visit, with wait, being only 2 hours. These stats vary by year, but consistently the US outperforms Canada. Our wait times also lead to deaths, as this study from the Fraser institute shows. Outside of deaths, there are countless complications that arise from them as well, which is why this is such an important and often overlooked flaw in Canada.

Another issue is what doctors get paid for a visit or procedure is government controlled. There is no escaping this. This leads to less scrupulous doctors here in Canada to rush their job in an effort to make more money within a smaller amount of time. This issue can be seen in the US as well with hospitals and doctors that take Medicare/Medicaid patients. While in the US, advocates say that the poor deserve better, I would argue that everyone getting the same poor treatment, regardless of whether they can pay extra or not, is not any better. This is the whole argument against socialism in a nutshell, do you want the poor to suffer with a chance of things getting better, or do you want everyone to suffer equally? You will never remove the human aspect of people valuing their time differently. This is almost inescapable in Canadian healthcare though because it’s very difficult to convince a doctor to give you a second opinion, especially if it requires costly tests and treatments, because they will be concerned you are just wasting taxpayer money, which is valid. Although valid, the issue in Canada is that if you are seriously concerned, there is no amount of money that will buy you the second opinion you want, so people can have undiagnosed issues go on until it’s too late.

Another issue with the Canadian system is that you can only get government approved medical treatments. Much like your insurance provider or Medicaid/Medicare in the US might not cover an experimental treatment, our government mandated insurance works the same way. This leads to Canadians going to the US for treatments they can’t get done up here, because every professional up here only does treatments covered by our system. This creates a very conservative atmosphere to approving new treatments, drugs, etc. because it’s then a part of our single payer health insurance program. If you want cutting edge medicine in Canada, you will only find it in labs, not available to the public.

The next issue is that because the government is fiscally responsible for what care you get, there are a lot of issues that arise out of that. One is paying for medical treatment you think should not be publicly funded. Abortions and more recently gender reassignment surgery are both covered by the government. Not only are they both funded, but a doctor who disagrees with the reason for someone getting either of these treatments, whatever that reason is, cannot decline. The irony is that psychiatric care for gender dysphoria is not covered. This gets into an important flaw in our system, is that it’s basically based on “Can you function at your job? Are you going to live? Great, move along, we aren’t going to pay until you completely break down.” Doctors weigh if a treatment or a visit to a specialist should be done with the idea that everyone pays for it in mind. You can’t just walk in and go “I’ll pay whatever you want, I want this done.” in a lot of cases when it relates to physical health. It’s actually one of the more subtle and less talked about issues in socialized healthcare, that the government has a huge say in if and when you are worthy of treatment.

So now getting to COVID-19, after explaining all these problems, you can see where problems will arise. First, we have had to postpone elective surgeries because of our bare bones, “hallway healthcare” system. We simply didn’t have the staff in the first place for any sort of pandemic. This makes wait times even worse than before, and with no profit interest to drive growth, it remains up to the government to solve that issue. The second part of that is that we must lockdown solely to protect our hospitals from being overrun, and have to rely on the government again to solve that issue. Our hospitals themselves don’t really have much of a say in expansion of capabilities.

This leads to the final, bottom line reason why I personally disagree with a socialized system, which is you can spend your whole life taking care of yourself, eating right, paying your taxes, and almost never see the inside of a doctor’s office. Once you grow old, and finally need healthcare, at the end of the day you will not receive the best, quickest care. Your contribution means nothing. You still may end up having to go to another country to pay full price for a procedure that isn’t covered here. There is no incentive to live a healthy or responsible lifestyle. This is why I always favour a system where the most urgent care is covered by the government for the poor, but there is some sort of inherent sense of personal responsibility built into the system. I think the US system in most states is close to that, so as much as the US system is rated poorly because there is no national system (like ours in Canada), I find it is more effective at providing the best care to those who need it, even though some people will fall through the cracks. Here people fall through the cracks as well through government incompetence and sluggishness, so there seems to me no distinction in that regard. I hope this has been eye-opener to the flaws of the Canadian system.