My Personal Perspective on Canadian Health Care

Robert has asked for my perspective on some of the comments being thrown around about Canada's health care as the American government continues to debate health care reform. As I am rather busy right now, I have not had a chance to do any proper statistical research, so my response here will be motivated by personal experience and anecdotes (in defense of my personal anecdotes, I have lived at various times in my life in two provinces in Canada (British Columbia and Ontario) as well as four years in the United States (Pennsylvania). While I recognize that such experience is not equal to statistics and other forms of hard fact, it can at least help explain where some of my perspectives come from). I have numbered and put in quotation marks the remarks Robert picked out of the media and sent me, and then written my responses beneath them.

1.) "In Canada, if you are old, but have a treatable illness, the government will deem you not worth the investment in health care dollars, and will let you die."
- I really have no idea where this claim comes from. I would have to see some pretty strong evidence showing age-based discrimination for treatment in Canada. I have a number of well-aged relatives (my mother's side of the family seems particularly robust), and I have never known any of them to be refused treatment. As one example, almost fifteen years ago, my grandfather (a retired school superintendent) suffered a rather devastating heart-attack. He was flown to Vancouver and operated on, resulting in a quintuple bypass that saved his life. I think that disproving this claim, though, is rather difficult, as it depends a lot on definitions (such as what is old, what the treatments being talked about are, and so forth). This is one of those fear-mongering statements that is slippery enough to retreat under scrutiny rather than admitted incorrect.

2.) "In Canada, if you have cancer, you have to wait 6 months or more before getting a bed to be treated, time that will of course cause the cancer to spread and kill you."
- Once again, I am not sure what this claim is based on. For one thing, many cancers don't require a hospital bed for treatment (or, if they do, it is on a rotating basis... you need to spend a couple nights in the hospital every few months). There is also no set time course for treatments (treatment once again depending on the cancer and its stage), but everyone I have known has had treatment options proposed as soon as cancer is diagnosed. Some of those treatments might be delayed somewhat due to the availability of facilities (such as surgery or imaging equipment), but I doubt it would be in a manner which would seriously endanger one's health without some unforeseen circumstance (such as a miss-diagnosis as to the cancer's initial severity or aggression).

3.) "In Canada, you cannot see whichever doctor you would like to."
- Well, neither can you in the States... doctors have finite amounts of time and resources, just like all parts of the medical system. There are systems in place for requesting a new doctor or a consultation visit, however. This actually factors in to the availability of medical resources in Canada in general, which I am going to talk about at the end of this post.

4.) "In Canada, you cannot choose your treatment option."
- A ridiculously worded statement... I'm not even sure what it means. In the United States you cannot choose whatever treatment you desire, either. When multiple treatments are available, Canadian doctors usually outline them and go over the various advantages and disadvantages between them. Of course, some doctors have personal biases which might influence their decisions, and not all doctors are good at communicating available options to their patients. Rather than a national thing, I think the number of treatment options one ends up with is more dependent on the individual doctor and the given ailment. Also, many treatment options are not always a good thing. While it gives the patient a better sense of control, I would rather doctors ignored dubious treatments (particularly things like "alternative medicine"). If there is only one treatment option supported by evidence, then there is only one treatment option I want my doctor giving me.

5.) "In Canada, a government bureaucrat stands between you and your doctor, and that bureaucrat often determines that you do not need the health care that your doctor prescribes you."
- Much like the first claim, this is a misleadingly slippery statement. How often is often? It is not as though every medical decision needs to be approved by a bureaucrat. There are oversight committees to ensure that doctors are not making uncalled for treatments, but for the most part the doctors prescribe what they feel is necessary. In general, I believe, bureaucrats design general guidelines for healthcare practice (and determine the allocation of funds for equipment and other health facilities), but within that framework doctors are relatively free to act (it is not like every treatment decision must be scrutinized and approved). In many ways, having the "government bureaucrat between you and your doctor" makes things run more smoothly, since the doctor is aware beforehand what resources are available for treatment and there is little worry of finding out later that it is not covered (which is the situation with having a private bureaucrat between you and your doctor). Whenever I have dealt with the more privatized forms of health care (while living in the States and with dental care in Canada), I have found it much more confusing and bureaucratic. Every insurance group has their own sets of policies and coverage plans, so there is often a great deal of confusion as to how payment should be made and what will be reimbursed. When there is a private insurer, it is in their interest to not cover as much as possible, and thus there is always a bureaucrat involved in treatment decisions.

6.) "In Canada (this claim was actually made on the floor of our House of Representatives...sorry about this) 1 out of 5 people DIE because of the health care system."
- Of all the claims being thrown around, this one confuses me the most. What the hell does it mean for a person to die because of the health care system? In order for such a statement to be supported, one would have to be very careful about defining what it means to die from a health care system. As Colbert pointed out, five out of five people die... 20% of deaths being caused by our health care system seems just plain ridiculous. To make such a claim, I imagine it would have to be a fairly loose set of rules for assigning blame, and so I would be interested in what proportion of deaths in the United States were caused by the American health care system under that same definition of blame.

7.) "The Canadian government will only allow so many operations per year. Once this figure is reached, they will stop paying for them."
- This seems like a horribly twisted statement. There are a finite number of surgeons in Canada, and thus they can perform a finite number of surgeries every year. The government pays the salaries of those surgeons, so yes, the government pays for a finite number of surgeries each year. However, it's not as though, if somehow surgeons across the country started finishing operations extra fast and thus reached a set number of surgeries by mid-October, the government would say, "No more surgeries!" and the surgeons would all go and have a nice two and a half month vacation (at least, this would be news to me). Also, this statement suffers from the same ludicrous vacuity as the cancer statement. Not every surgery is equal in either time or resource requirements, making this statement not only obtuse and twisted, but also overly simplistic.

8.) "Because of the socialized nature of the health care, in Canada, people do not innovate, and Canada's health care is not as advanced as America's."
- This statement is stupid in so many ways... for one thing, our two countries do a lot of intellectual sharing. Also, innovation is done for more than just profit, and other than theoretical science I don't think that is more true anywhere than in medicine. People are motivated to innovate for prestige, for the betterment of society, and simply for the joy of solving a difficult problem. For an example of not only intellectual sharing but also innovation not motivated by profit, insulin was first isolated as a treatment for diabetes at the University of Toronto by Banting and Best, who then sold the patent for a dollar to the university as they trusted it to disseminate the treatment for the betterment of humanity rather than for monetary gain. As a result, insulin is a widely available treatment around the world (yes, this is a fairly old treatment, but it did not require research on my part). Finally, the "socialized nature" of our health system does not completely remove monetary rewards, although it does possibly diminish the factor that they play (something which I think can easily be argued to be a good thing).

Finally, Robert asked me a few questions of his own:
"Those are some specific claims. What is your impression of the Canadian health system? Do you like it? Have any horror stories? Do you pay 60 percent in taxes to get that health care?"

If it hasn't become clear from my responses, yes, I do like our health system. I think it is a decent system which does a good job of providing care for as many people as possible. This does not always translate to the flashiest care or even the fastest (and no one likes to wait several hours in the emergency room, but that happens in the States too). I cannot really think of any horror stories, but perhaps people reading this will chime in. This has actually gone on longer than I intended, so I just want to make one last point about the Canadian health care system. Canada is a large and sparsely populated country. While we do have regions of fairly dense population (like southern Ontario), a lot of the country is decidedly not dense. This makes providing specialized health care very difficult for certain things. My grandmother, for example, has Parkinson's disease. While she has a general practitioner in my hometown, getting specialized advice from a neurologist is more of a challenge. The nearest center larger than my hometown is about an hour and a half drive away, but even that town only has a population of 20,000-30,000 people (depending on how you define the town boundaries, like always). Thus, to get a consultation, my grandmother has two main choices: go to Calgary (a six hour drive) to see one of the neurologists there, or wait for a traveling neurologist to come through the area (I think the traveling neurologist is still a two hour drive away, but that is closer than six). Going to Calgary provides the most flexibility in appointment times, but six hours is a long drive. Seeing the traveling neurologist generally leads to the long wait times that are so often touted as failings of our system in the U.S. Really, though, many of those long wait times are actually caused by our geography and population distribution. Likewise (from question 3), assuming the drive to Calgary was impossible for my family to execute, my grandmother would only have the option of seeing the traveling neurologist, and in that way she would not have the option of picking her doctor. But once again, that is not a direct outcome of our medical system, but is actually a result of our geography. In a similarly isolated region in the United States, it would not make individual economic sense for a specialist to go there, so she might not have any option.

Anyway, like I said, this got a lot longer than I intended, but it is an issue I feel strongly about. While Canada is certainly not perfect (health care is expensive, and we do therefore have perpetual budgetary issues and a certain level of unpleasant bureaucracy), I think the maligning that takes place is overly simplistic, disingenuous, ignorant, and rhetorical fear mongering. Perhaps when I get more time I will go and dig up some proper statistics on the matter, but I encourage others to look into these things as well. If you feel I have made mistakes, left anything out, or would otherwise like to add something, be sure to let me know.

P.S. I realise I did not answer the tax question... long story short, I pay very little tax as a student. I'm sure my dad, who actually makes a decent amount of money, has a different impression of the tax situation in our country, but I don't want to put words in his mouth. I have a lot of thoughts on taxes, but those are for another time.