Hate to (Br)eak it to you Walt, but it's pretty (Ba)d in Canada too

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Appeared in the Huffington Post, October 2013

The season finale of the popular U.S. drama Breaking Bad brought with it renewed interest in a viral internet meme that implicitly suggested that the entire story might not have taken place had the main character, Walter White, lived in Canada. The meme suggests that within minutes of being diagnosed with cancer, Walt's "free" treatments would begin the very next week.

The question of exactly how the story arc may have changed depending on which country it took place in, while surely fun, is ultimately moot. It is, after all, a piece of creative fiction. For all we know, Walt might have simply decided to retire in BC and start a marijuana grow-op instead.

However, addressing the meme's naïve and misleading allusion to the idea of timely access to "free", high quality healthcare in Canada is important especially for those relying on it for support of the status quo or in support of arguments to adopt a Canadian-style health care system elsewhere.

To begin with, healthcare in Canada is anything but free. The average Canadian family of two parents with two children (similar to Walt's family in the drama) pays approximately $11,320 in taxes for hospital and physician care through the country's tax system, in addition to the cost of private insurance for things like dental care and outpatient prescription drugs. While lower than the amount American's contribute on a per capita basis, it is certainly higher than in almost any other developed country that offers universal healthcare.

Next, comes the question of the scope and timeliness of medical services provided in exchange for this substantial expenditure. Surely such expenditure is justified if Canadians receive a stellar healthcare system in return for their tax dollars. Unfortunately, that simply isn't the case. Canada actually has fewer medical resources (physicians, beds, diagnostic imaging scanners for example), and performs fewer medical interventions than its American and European counterparts.

Canada's universal access health care system also fails to provide access to these services in a timely manner. The most recent annual survey of wait times in Canada revealed that patients have to wait approximately four and a half months on average to receive treatment for medically necessary elective procedures after referral from a General Practitioner (who many Canadians also have a hard time finding). While the wait is shorter for cancer patients (about a month), we also have to remember the long wait patients face for access to diagnostic imaging technologies like MRI's (over two months on average) and CT scanners (almost a month on average) which are vital for assisting in making the diagnosis in the first place. Such delays can have large impacts on cancer patients, with the possibility that the size of cancerous tumors double every four months.

Importantly, public health insurance plans in Canada also fail to cover the cost of many new medical options that could prove vital in surviving a bout of serious illness like Walt's. One of these costs is borne as a result of a lack of coverage for new prescription drugs. Public drug plans only covered about a quarter of the new drugs approved for sale in Canada between 2004 and 2010. Private drug plans, meanwhile, covered more than three quarters of the same set of new drugs. Even worse, Canadians also have access to fewer new and innovative drugs than their European and American counterparts and those they do have access to, are approved for use much later than they are in other jurisdictions. In fact, important new cancer drugs like Avastin and Jevtana were only available to patients in Canada more than a year after receiving marketing approval in either the United States or Europe.

These realities serve to dismiss the mythical notion that a Canadian-style health care system would have necessarily meant anything better for someone facing Walt's particular circumstances, either in terms of the cost of advanced health care or in terms of the ultimate outcome. Whether north of the border or south, Walt could just as easily broken bad.

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