In an effort to provide health insurance to all Americans, President Barack Obama appears eager to give government a greater role in health care insurance. But before doing so, he would be wise to consider Canadians' struggles with government-run health insurance, where delays within the Canadian health care system have grown to the point that some Canadians have turned to the courts in hopes of gaining better access to health care.
Let's start with the facts about Canada's Medicare program.
First, it is not cheap. While less expensive than the U.S. health care system, Canada maintains, on an age-adjusted basis, the second most expensive universal access health insurance system in the developed world (of 28 such systems).
Yet Canadians endure service that ranges from mediocre to terrible. Physicians are in short supply, as are medical technologies like MRI machines, CT scanners and lithotriptors. Canada is also slow to invest in medical technology, while many pieces of medical and diagnostic equipment in Canada are outdated and in need of replacement.
Wait times for health care in Canada also rank among the longest in the developed world. A recent study published in Health Affairs found that Canadians, compared with patients in Australia, New Zealand, Germany, the Netherlands, the United Kingdom and the United States, were most likely to wait more than one month for elective surgery, six days or longer to see a doctor when ill, and two hours or more for access to the emergency room. Consider also that in 2008, the median wait time for orthopedic surgery, from mandatory GP referral to treatment, was nearly 37 weeks. It was nearly 32 weeks for neurosurgery. While wait times for cancer treatment were shorter at 4.6 to 5.8 weeks, they were hardly what you might consider prompt treatment.
Canada's health care system is also a study in decline. Once the home of one of the developed world's highest physician-to-population ratios, Canada now ranks a miserable 26th among 28 developed nations that maintain universal approaches to health insurance. And the decline is firmly set to continue. Largely due to government restrictions on physician training, Canada's physician-to-population ratio will fall in coming years without a significant intake of foreign-trained physicians.
Worse still, recent government attempts to save the public system have shown little initiative and therefore little result.
For example, provincial governments across Canada have attacked the waiting time problem by announcing long wait time benchmarks and selective wait time guarantees along with large increases in funding. Neither the benchmarks nor the guarantees are what you might call ambitious, at four to eight weeks for radiation therapy to as long as 26 weeks for hip and knee replacement and lower urgency cardiac bypass surgery.
Government inaction and poor service have brought some Canadians to the realization that the courts may provide the only hope of recourse.
In a landmark and controversial ruling in 2005, the Supreme Court of Canada found that Canadians suffer physically and psychologically while waiting for treatment in the public health care system, and that the government monopoly on essential health services imposed a risk of death and irreparable harm to health.
Ultimately, the Supreme Court determined that the government of Quebec's prohibition on private health insurance violated citizens' right to life, personal security, inviolability and freedom, as guaranteed by Quebec's Charter of Human Rights and Freedoms.
Three additional cases, in the provinces of British Columbia, Ontario and Alberta are seeking to expand that finding to other provinces.
The realities of what Canadians endure on a daily basis are far from the paradise many believe to exist. To the contrary, Canada's health care system is one of low expectations cloaked in lofty rhetoric. It fails Canadians on a regular basis. It is a system that some Canadians are fighting in the courts.
It is obviously up to Americans to decide what kind of health care system they want. But know this: Canada's system is in a bad way because of too much government involvement. Americans would be well advised to look elsewhere (and away from government control and intervention) for their solutions. They should also hope Obama heeds the lessons that can be learned from Canadians' hardships and does the same.