To health-care reformers in the United States, the Canadian government-financed medical system seems to be just what the doctor ordered.
With universal access, low costs, and good results, a Canadian model has been touted as the cure to the American system, which is overpriced, restrictive and produces some of the worst results for an industrialized country.
A recent study of six industrialized countries, sponsored by the Harvard Community Health Plan, a Massachusetts health maintenance organization, found that the U.S. ranked last in infant mortality rate, infant immunization and life expectancy. The other countries in the study were Canada, Great Britain, Germany, Sweden and Japan.
Along with other health-care reform measures, Congress is now considering a bill that would establish a Canadian type of system in which all health-care costs would be paid by federal and state governments.
However, a Canadian insurance representative warns Americans that they should take a hard look at his country's health system and decide whether they want to give up some of the flexibilities and luxuries of the current system.
"You can't just say the Canadian system must be imported," says Ian Callaway, the regional vice president in Canada of the National Association of Health Underwriters of Vancouver, British Columbia. The NAHU is an organization of people in the health insurance industry.
The Canadian system is "not, on the surface, that bad," Callaway told a meeting of the Maryland Association of Health Underwriters last week.
But Callaway, an expert in disability insurance, said the system is hampered by long waits for some medical procedures, is subject to government budget battles and would not necessarily produce the same sparkling results in the United States.
Despite its claim of universal access, Callaway said, the Canadian system rations its services with long waiting lists for surgical care. He said one study reported a 245 percent increase the number of patients on waiting lists during the last five years. This has been worsened when the country's largest province, Ontario, decreased the number of hospital beds by 4 percent over the last two years, he said.
In one case, a doctor in British Columbia mixes his own cancer medication for his patients, because of government cutbacks, Callaway said. There are also cases of doctors leaving the country for better pay and patients crossing the border to get more immediate care.
Health care must compete with other government budget considerations and it can often mean politicians decide between health care and bridges, he said.
Callaway also said the supposed savings of the Canadian system, which consumes 8.5 percent of the country's gross national product, compared with 12 percent for the U.S system, may be mostly illusionary. He said that when the two amounts are adjusted for inflation, rates of economic growth, population growth, and currency exchange, the numbers are nearly even.
Additionally, American costs are boosted by a larger elderly population and more research and development, Callaway said.
A Canadian-style system may not produce a healthier population, he said, pointing out that Americans use more tobacco, use seat belts less and have more extensive poverty. "We are a different society and have a different culture," Callaway said.
He also questioned whether Americans are ready to increase government interference with their lives, reduce their freedom to select their medical treatment as well as wait longer for service. "Not a chance," he said, about increasing Americans' patience. "They want it today or yesterday."
In response, supporters of the Canadian system say its faults pale in comparison with the problems of the American system.
He said that for the most part "Canadians have immediate access to essential health care service," according to Bradley D. Lint, the acting director of Maryland Citizen Action Coalition, a group that supports a Canadian-style system for the United States.
While there may be stories about waiting lines in Canada, millions of Americans without insurance have no access to health care, he said. "There is no line for them to get into," Lint said.
As to restrictions on surgery in Canada, Lint said the same thing is happening in the United States with the rise of managed care, which allows the insurance companies to refuse to pay for treatment it considers medically unnecessary. Many Americans are also limited in their choice of health-care options since many insurers will not cover people with pre-existing conditions.
"Put everybody in the same system and we would all fight for a top-notch system," Lint said.
Various studies have shown that the American system of private insurance -- one of the few among developed countries -- gets low marks on basic health-care measurements.
However, a Louis Harris poll done for the study found that 55 percent of Americans rate their personal health care "very" satisfactory. Of the six countries, only Canada got a higher rating, with 60 percent saying they were very satisfied.
The survey of Americans broke down along insurance lines, with 57 percent of those with insurance being very satisfied and only 29 percent without insurance saying they were similarly pleased.
But in other studies, Americans are found to disapprove of the overall health system by a higher percentage than in other industrialized countries. The difference in responses stemmed from the people's personal experience vs. their opinion of the overall system.
"As is often the case, it's how you ask the question," said Alan Raymond, a spokesman for the Harvard Community Health Plan.