Sicko and Canadian Health Care


Sicko and Canadian Health Care


Michael Moore’s latest documentary Sicko and it is already causing a stir. His latest is a damning indictment of the American health care system. I am normally repelled by Moore’s tactics even if he makes decent points now and again.

For all my American readers I’d like reflect on the Canadian system and Moore’s claims about it. I’ve been through two lung surgeries and observed close family members deal with bad knees, seizures and even brain surgery.

Is health care in Canada free for the end user?
Most of it is but not all. We pay out of pocket or have private insurance for dental and vision care, drugs, medical equipment and some miscellaneous things like massage therapy. There are no deductibles or co-pays for everything covered under medicare. You are not denied care because of pre-existing conditions.

Can an American cross the border and get health care?
No you need a health card. If you get a student visa and enrol in a university you do receive the same health care as other Canadians. Be careful though once you come you’ll want to stay…unless you have real issues with cold winters.

Is health care the same across Canada?
No. Each province is responsible for delivering health care so there are differences in each system. Health care is governed by the federal Canada Health act which ensures the delivery of a health care is publicly administered, comprehensive, universal, portable, and accessible. I’ve had experiences with hospitals in a handful of places. I prefer to stick to the larger hospitals in cities.

Can you choose your own doctor and hospital?
Yes. In places like my home city of Saskatoon the 3 major hospitals have areas of speciality, so you tend to take a sick child to the hospital with the paediatrics ward. In some areas of the country general practitioners are in short supply.

Are there really long waiting lines?
It depends on what you are waiting for. Urgent or life threatening conditions are treated quickly. If you need treatment for something that is not urgent but is complicated you could wait a long time to see your health problem resolved. I’ve seen people get referred to a specialist and that takes months, they order tests which take months and then you have to see the specialist again and that takes more months. This aspect of the system is maddening because some people end up suffering for months.

Is the result of these long waiting times because of under funding?
Yes and no. In 1995 the government got its fiscal house in order by slashing government spending. This caused a serious problem for the delivery of health care. All of that funding has been reinstated but the waiting times haven’t decreased to the point where they were before.

The problems in Canadian health care cannot be fixed with just more funding. Some reform is needed.

Do some people get so frustrated with the weaknesses of the Canadian system give up and pay for care in the United States?
I know of people who were frustrated with problems that weren’t being resolved in Canada. They paid out of pocket for what they thought was better treatment in the US. It is rare but it does happen. It is more common that people will pay out of pocket for diagnostic services like an MRI and bring the results back to the Canadian doctor.

Is the quality of care from doctors and hospitals better in the US?
The short answer is probably yes, although I couldn’t back up this assertion. Much like in the US some hospitals are better than others. Canada has world class doctors, specialists and facilities but not as many as the US.

Are Canadians happy with their health care? Would they want to switch to a US style system?
Canadians are generally happy. We have shed the idea that our system is the best in the world. However most Canadians wouldn’t want to go to an American style system. In Canadian society we think it would be inhumane to deny people medical care because their inability to pay. This idea deeply disturbs us. The care that most people receive most of the time is more than adequate.

Is Universal health care cheaper?
Yes. The cost of health care in Canada per-capita is $2500. The cost in the US is $4600.

Does Canada get more bang out of their health care buck?
Yes. We pay $2500 per person and we insure everyone. America pays $4600 and 1/6 of the country has no care at all. Life expectancy in Canada is ranked 13th in the world at 80.35 years. In the US it is 78 years, ranked 44th just behind Jordan, Puerto Rico and Bosnia! The World Health Organization ranks the Canadian system 30th and the American system at 37th. Neither country gets bragging rights on this one when both countries lag behind Morocco, Saudi Arabia and Colombia. To put it plainly America is paying for a Lexus and getting a Hyundai. Neither country gets what they pay for but Canada pays a lot less.

Is universal health care (a.k.a socialized medicine) going to corrupt the free market? Is it the first step towards communism?
Universal health care is a boon to most businesses as it removes a lot of hassle for employers who never have to deal with health plans for their employees. One of the great benefits of the system is its simplicity for everyone involved. There is much less bureaucracy in a system with few rules and a single payer.

Should the Americans adopt the Canadian system?
No. It is plain to see that the Canadian system has its problems. I’d look more towards Europe or Japan. The countries that consistently show the best outcomes are ones with a public and a private system. I don’t necessarily believe that Canada needs more private delivery of health care but we need to be honest about the failings of our own system. In America a blind allegiance to free market delivery of everything serves as a straight jacket in reforming their medical system. In Canada left-wing politicians and pundits are in an ideological straight jacket as well. Health care is a pawn in partisan politics and the losers are the people that need care.

Don’t you pay a lot more taxes in Canada?
We pay more taxes but not a lot more. According to OECD revenue statistics American taxes make up 29.6% of GDP whereas in Canada it is 35.8%. We pay about 20% more tax.

  1. #1 by Kuri on July 10, 2007 - 6:07 am

    We already combine a public and private system. Doctors aren’t salaried – they’re in private practice, just paid by the government. If we had a totally public system doctors and other health care professionals would be salaried. Also, as you note, dental, optical, etc. are private practice with professionals setting their own fees. So when you say, “The countries that consistently show the best outcomes are ones with a public and a private system.” to exclude Canada you are being misleading.

    Yes, reform is needed, but this endless focus on public vs. private is the wrong question. Alberta’s done a lot to reduce waiting times without privatizing. And if we want to reduce costs, we should be asking questions about prevention vs. treating after the fact (we really don’t do very much for prevention). For example, the British doctor interviewed in SiCKO receives a bonus based on how many of his patients he can convince to quit smoking. Incentives that reduce the need for care (not that just reduce care full stop as in the USian system) instead of rewarding more illness should be considered.

    Your entry does not say whether you have in fact seen the film or not, I’m assuming not based on a few of your points here, which “address” issues that are already addressed in the film, such as that yes it’s illegal for USians to use the Canadian health system for free. That’s established in the film.

  2. #2 by Linea on July 10, 2007 - 7:06 am

    I think the greatest thing about our health care system is the universality of it.

    I would beg to differ about the quality of health care. I guess it depends on if you are looking for higher quality technology and greater access to it. IMHO that is only a small part of quality care and the US system may have more of that but in our system where not all doctors have to be fee for service, there is provision for the treatment of maladies that require a doctor’s time and expertise that no insurance company is going to want to pay for.

    And I am still old fashioned enough to want a doctor that is empathetic enough to listen to me and smart enough to figure out my medical problems.

    Sometimes waiting in line is frustrating but I would rather do that in non-urgent situations knowing that I can refer even the poorest of the poor of my patients to a medical doctor without wondering if they can afford to go.

  3. #3 by LT on July 11, 2007 - 10:15 am

    Linea:

    My comments about the quality of care are largely an a guess as to who is going to have the best equipment and the best doctors. Given that so many of our talented doctors move to the US and we are forced to import our doctors from other countries it does look like we are one rung down on the ladder, but one up from other places.

    Kuri:

    Many of your points are well taken.

    My comments about other countries with a public/private blended system refer to countries where you can pay for private care or use the government service for the same kind of care. I acknowledge that in Canada we have private delivery of government funded health care. I suppose you could argue Canada has a private/public system because our government system doesn’t cover vision or dental care. The distinction I was attempting to make is that the countries with the best outcomes are ones that permit citizens can choose to use either system to receive care for the same thing.

    I do give come weight to the Romanow Commision’s finding that we needn’t privatize anything to reform the system. Unfortunately most provincial governments have done little but ask for more money. Here in Saskatchewan we have the longest waiting times yet health care makes up half our budget. We are facing yet another health care strike and a friend of mind, who has been languishing in the queue might have to wait even more months to see a specialist.

    I don’t see expanded private delivery of publicly funded health care as a problem. If provincial governments won’t fix the system let someone else.

  4. #4 by Linea on July 11, 2007 - 8:28 pm

    LT,

    It is true that some Dr’s move to the US. But the reasons are mixed – specialtys that require a larger population base, the lure of more money as well as philosophical differences with our socialized system. That they are better doctors is debatable. And Saskatchewan has a particularly difficult time recruiting physicians and getting home grown ones to stay for all of the above reasons but our small population plays a huge role.

    One of our major concerns for health care right now is not a shortage of doctors – nurses are more scarce. If a hospital can’t staff its wards and its operating rooms, the doctors can’t practice at the levels they would like to – so they move on.

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