Canada's medical system is a model -- and that's a fact

Theodore R. Marmor & John Godfrey

July 24, 1992|By Theodore R. Marmor & John Godfrey

CRITICS of Canada's medical-care system contend that it is no model for America and that its good reputation vastly exceeds its mixed performance.

Their claims that Canada's program is less effective and no less costly than America's, and that it is beset by horrific waiting lists and unhappy doctors, are caricatures.

This myth-making is predictable. Because Canada has restrained its health care costs more successfully than we have, those who feed at America's $800 billion medical feast are frightened.

Hence, Canada-bashing by special interests like the American Medical Association and Health Insurance Association of America, a trade association.

After all, cost control means reducing the medical providers' income -- the one unassailable axiom of medical economics.

Actually, Canada provides an attractive model for American reform. Canada (like most industrial democracies) combines universal health insurance with clear political accountability for raising and spending money for health services, and for the quality of the care the money buys.

Yes, Canada has its problems and, no, its national health-insurance program (known as Medicare) cannot be directly transplanted.

But Canada balances access, cost and quality in ways the United States should find instructive.

Primary and emergency care, universally insured, are readily available. No financial or administrative barriers prevent patients from seeking the services of any family doctor.

Canadians are not assigned doctors from approved lists, but rather choose them: It is that simple.

Canadians visit physicians more often than Americans do and are highly satisfied with the service and the system. With a single insurer, the provincial government, there is far less paperwork for patients and doctors.

More important is the widespread sense of security that comes from knowing that illness, however catastrophic, never results in financial disaster.

Are some high-tech items in shorter supply in Canada than in America? Undoubtedly.

Were America to disappear, Canada would have the world's most ample supply of intensive-care units and diagnostic machinery.

The real question is whether the United States is oversupplied with marginally effective high technology, not whether Canada is in the medical stone age.

Are there delays and waiting lists? Some, particularly for non-emergency heart surgery and hip replacement.

The waiting is, however, hardly serious: Government statistics show that 96 percent of Canadians over the age of 15 get their care within seven days of requesting it. Nevertheless, critics in conservative American think-tanks such as the Heritage Foundation propagandistically tell stories of endless waiting in Canadian medicine.

The reality is far less worrisome, but the media communicate the misinformation by repeating its anecdotes.

Is Canadian care as expensive as ours? In 1991, Canada spent about 9.2 percent of its national income for medical care, while the U.S. spent 12.3 percent; the proportions for 1971, the year Canadian Medicare became universal, were 7.3 percent and 7.4 percent, respectively.

So over two decades Canada learned how to insure everyone while spending less.

Doubters will object that Canada achieved this result by faster economic growth, not by less medical spending; this is partly true, but so what?

Controlling costs means living within one's means. Canada, with a health budget, decides what to spend for care. Budgetless America learns about its health costs only after the fact; few celebrate the result.

Some say Canadians' social circumstances are so different from ours that nothing can be profitably learned by looking north. Such arguments are wildly exaggerated or simply inaccurate.

We are told Canada has proportionately fewer costly patients -- the old and the poor. In fact, 11 percent of Canadians and 12.2 percent of Americans are over 65, a trivial difference, especially when contrasted with statistics in Germany and Sweden, where the figures are 16 and 17 percent, respectively, and where medical care is less expensive than in the United States.

Yes, there are proportionately fewer poor Canadians. But the implication that our exploding medical costs are caused by treating the poor -- millions of whom are not insured and receive little care -- is mistaken.

We read that the Canadian medical system works well because of the country's disciplined parliamentary democracy. Yes, it does work well, but not primarily for that reason.

Canada's supposedly disciplined government has a budget deficit comparable to ours, and its federal system is in danger of collapse from Quebec separatism. Most Canadians love their Medicare but view government no more favorably than we do.

Canada is the country closest to ours in wealth, geography, ethnic diversity and patterns of medical practice.

If we cannot learn from Canada, we cannot learn from any country.

Theodore R. Marmor, co-author of "America's Misunderstood Welfare State," is a fellow in the population-health program of the Canadian Institute for Advanced Research. John Godfrey, former editor of the Financial Post, a Canadian newspaper, is institute vice president.

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