Our Health Care is Nothing to be Proud of: Others do it Better

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Appeared in the Montreal Gazette and the Fredericton Daily Gleaner, 8 December 2004
On November 29, Tommy Douglas was selected as CBC’s “Greatest Canadian,” over such luminaries as Sir John A. Macdonald, Frederick Banting, and Terry Fox. This result suggests that viewers of the CBC are proud of the Canadian health care system. This result however also suggests they may be misinformed on the realities of our universal access health care program.

First, it is important to note that Canada is not the only country in the developed world that guarantees access to care regardless of ability to pay. Though it is true that we have the only such program in North America, fully 28 of the 30 most developed nations on this planet (including Canada) have programs that similarly ensure access to health services regardless of ability to pay. In many cases these programs outperform Canada’s in terms of access to health services and quality of services delivered, while none (on an age-adjusted basis) costs more than our own.

Canada’s health care system is not the envy of the world either. In fact, most other nations have realized that the Canadian health care model, which was originally based on the now failing British National Health Service, is not one that should be emulated. A number of European countries are in fact moving further and further away from Canada-type health policies.

Why are these nations moving away from the Canadian model? To put it simply, the monopolization of comprehensive health insurance and the monopolistic provision of hospital services have meant a more expensive and lower standard of health care in Canada than would otherwise be possible. As a result, Canadians pay for the most expensive universal access health care system in the world (we’re tied with Iceland on an age-adjusted basis), and receive in return some of the worst access to physicians and technology, some of the longest waiting times in the developed world, and only mediocre health outcomes.

Countries with more competition in health services have done a far better job at delivering universal access to health services. Australia, Austria, Belgium, France, Germany, Japan, Luxembourg, Sweden, and Switzerland all have private hospitals delivering publicly funded care, all have cost sharing arrangements for publicly funded care, and all allow individuals to seek care privately. As a result, all of these nations manage either better health outcomes from care, or access to care without waiting lists, or, in the cases of France and Japan, both. In addition, not one of these nations spends more on an age-adjusted basis to deliver that level of care to all its citizens.

It is also important to note also that the Canadian health care system was not one of the first universal health care systems in the world. Compulsory health insurance was first introduced in Germany as early as 1883, while the British National Health Service was introduced in 1948 (just 4 years after Tommy Douglas became Premier of Saskatchewan and 20 years before Canada’s Medical Care Act). The Canadian health care program was being developed around the same time that the Swedes and the Belgians were introducing universal access programs, though their programs had much earlier origins than our own.

The one truly unique feature of the Canadian health care system is not the direct result of Tommy Douglas’s actions. Canada is the only developed nation that denies individuals the right to seek health care on their own terms when the government program is unwilling, or unable, to deliver services in a time frame that provides comfort and peace of mind. That unique feature is more the legacy of the 1984 update of the original Act, which was passed 40 years after Tommy Douglas first took power in Saskatchewan.

Though the CBC’s contest clearly suggests that a number of Canadians are proud of the Canadian health care program, a program that guarantees all Canadians access to medically necessary services regardless of ability to pay, the evidence tells us that the system itself is failing. Canadian taxpayers foot the bill for the most expensive universal access health care system in the developed world, and manage to buy access to physicians and technology that ranks among the worst in the developed world for those who fall ill.

If the heath care system is such a great source of pride to the participants of this contest, then improving that health care system should be job number one for them. If the naming of Tommy Douglas as the “Greatest Canadian” helps these individuals and others realize the need for improvement, and leads to an honest and informed discussion of what other more successful nations have been doing, then it is a genuinely good thing. If, however, it leads to more uninformed discussions of how Canadians are uniquely defined by the Medicare program, and how the status quo must be maintained at all cost, then nothing positive will come from this recognition of the importance of Medicare to those who voted for Tommy Douglas through the CBC.

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