Wednesday, July 22, 2009

Health Care: Canada vs US

This was written by a Canadian who has been living in the United States for 17 years.

CanadaCare doesn't seem so bad, does it?

Myth: Taxes in Canada are extremely high, mostly because of national health care.

In actuality, taxes are nearly equal on both sides of the border. Overall, Canada's taxes are slightly higher than those in the U.S. However, Canadians are afforded many benefits for their tax dollars, even beyond health care (e.g., tax credits, family allowance, cheaper higher education), so the end result is a wash. At the end of the day, the average after-tax income of Canadian workers is equal to about 82 percent of their gross pay. In the U.S., that average is 81.9 percent.

Myth: Canada's health care system is a cumbersome bureaucracy.

The U.S. has the most bureaucratic health care system in the world. More than 31 percent of every dollar spent on health care in the U.S. goes to paperwork, overhead, CEO salaries, profits, etc. The provincial single-payer system in Canada operates with just a 1 percent overhead. Think about it. It is not necessary to spend a huge amount of money to decide who gets care and who doesn't when everybody is covered.

Myth: The Canadian system is significantly more expensive than that of the U.S.

Ten percent of Canada's GDP is spent on health care for 100 percent of the population. The U.S. spends 17 percent of its GDP but 15 percent of its population has no coverage whatsoever and millions of others have inadequate coverage. In essence, the U.S. system is considerably more expensive than Canada's. Part of the reason for this is uninsured and underinsured people in the U.S. still get sick and eventually seek care. People who cannot afford care wait until advanced stages of an illness to see a doctor and then do so through emergency rooms, which cost considerably more than primary care services.

What the American taxpayer may not realize is that such care costs about $45 billion per year, and someone has to pay it. This is why insurance premiums increase every year for insured patients while co-pays and deductibles also rise rapidly.

Myth: Canada's government decides who gets health care and when they get it.

While HMOs and other private medical insurers in the U.S. do indeed make such decisions, the only people in Canada to do so are physicians. In Canada, the government has absolutely no say in who gets care or how they get it. Medical decisions are left entirely up to doctors, as they should be.

There are no requirements for pre-authorization whatsoever. If your family doctor says you need an MRI, you get one. In the U.S., if an insurance administrator says you are not getting an MRI, you don't get one no matter what your doctor thinks - unless, of course, you have the money to cover the cost.

Myth: There are long waits for care, which compromise access to care.

There are no waits for urgent or primary care in Canada. There are reasonable waits for most specialists' care, and much longer waits for elective surgery. Yes, there are those instances where a patient can wait up to a month for radiation therapy for breast cancer or prostate cancer, for example. However, the wait has nothing to do with money per se, but everything to do with the lack of radiation therapists. Despite such waits, however, it is noteworthy that Canada boasts lower incident and mortality rates than the U.S. for all cancers combined, according to the U.S. Cancer Statistics Working Group and the Canadian Cancer Society. Moreover, fewer Canadians (11.3 percent) than Americans (14.4 percent) admit unmet health care needs.

Myth: Canadians are paying out of pocket to come to the U.S. for medical care.

Most patients who come from Canada to the U.S. for health care are those whose costs are covered by the Canadian governments. If a Canadian goes outside of the country to get services that are deemed medically necessary, not experimental, and are not available at home for whatever reason (e.g., shortage or absence of high tech medical equipment; a longer wait for service than is medically prudent; or lack of physician expertise), the provincial government where you live fully funds your care. Those patients who do come to the U.S. for care and pay out of pocket are those who perceive their care to be more urgent than it likely is.

Myth: Canada is a socialized health care system in which the government runs hospitals and where doctors work for the government.

Princeton University health economist Uwe Reinhardt says single-payer systems are not "socialized medicine" but "social insurance" systems because doctors work in the private sector while their pay comes from a public source. Most physicians in Canada are self-employed. They are not employees of the government nor are they accountable to the government. Doctors are accountable to their patients only. More than 90 percent of physicians in Canada are paid on a fee-for-service basis. Claims are submitted to a single provincial health care plan for reimbursement, whereas in the U.S., claims are submitted to a multitude of insurance providers. Moreover, Canadian hospitals are controlled by private boards and/or regional health authorities rather than being part of or run by the government.

Myth: There aren't enough doctors in Canada.

From a purely statistical standpoint, there are enough physicians in Canada to meet the health care needs of its people. But most doctors practice in large urban areas, leaving rural areas with bona fide shortages. This situation is no different than that being experienced in the U.S. Simply training and employing more doctors is not likely to have any significant impact on this specific problem. Whatever issues there are with having an adequate number of doctors in any one geographical area, they have nothing to do with the single-payer system.

25 comments:

dave said...

Great article - unfortunately, many Americans and their media don't really want the truth, thy prefer to rely on the 30-second sound bytes, and the urban mythology - the same mindset that allows 30% of them to still believe Saddam was behind 9/11, and Obama is a Muslim.

Elvis lives!, the moon landings were fake! katrina was God's punishment! Canadian-style Health Care is the devil incarnate!

Thank god I live in a country where getting medical treatment doesn't rely on how weathy I am, where being healthy is recognized as a basic human right, not as a byproduct of a social lottery based on my means.

Since I had (and beat)colon cancer,(without having to lose my home and savings) I most likely would not be able to get coverage in the States, because that constitutes a "pre-existing condition".

Finster said...

I live in Eastern Canada. I'm a healthy 27 year old male, who will go see the doctor twice yearly for checkups, various things like flu, blood checkups.

My family has had to go through some not-so-serious operations , and some serious, and they never have had to wait for anymore than 3 months. If it is very serious, they go in right away.

There's even a lot of fuss here sometimes in the media about poor healthcare, but it's always a story about somebody with loads of health problems. And everyone admits it's not perfect, but it is 99% to being perfect.

There are huge benefits to having the government pay for healthcare, because it ties everyone socially as a whole to one health standard.

So consider that in Canada, a product that harms the population ends up costing the Government more money, so thus the Government wants to prevent such products from being sold.

Whereas in the US, products that harm the population actually make people money.

Mia said...

Having lived in both places myself and by NO means applauding either system entirely because it would take a FOOL to believe that either is per se "better", I would have to vehemently diagree with the poster.

NO, I am NOT disillusioned to believe that that the American System is without problems...in fact it had PLENTY and most inposed by greedy government types, big corporations and money-mongering insurance companies. And, in my not so humble opinion, both countries have taken the dignity and honour out of being a doctor, making it more about meeting quotas and making the big bucks.

Anyway, I will say, that just like anything else, "you get what your PAY for" and the health care in Canada is not living up to what should be expected. A young woman died giving birth because no one acted on her imminent complaints of pain, but rather dismissed her as over-reactive. My father-in-law, unlike my grandmother who received care in the U.S. was not given any follow-up consistent care after his stroke, and I know for a FACT that regular blood work and health monitoring that is simply standard protocol for MY family in the U.S. isf "optional" in Canada. In fact, we just got word that an uncle seemingly had an ongoing heart condition that is serious and potentially life threatening, but was not previously detected. And, why,...because follow up care is "negligent" and most elderly are dismissed and their conditions deamed as irrelevant. Not to metnion that this irreverant health care system sent my mother-in-law home without treatment, and simply of her own recongizence after a series of bouts with a serious mental disorder. And, don't even get me started on her regular doctor who opted to take her off meds, twice prior, after having put her on meds for similar erratic behaviour. Let me also stress that she was "advised" to seek mental health counseling, to which after two or three visits was given the option of continuing or not, and all this was HER decision, not including the family or the doctor. GOOD choice for a woman who had lost her grib. This only to be followed by a week long stint in the waiting room for my husband's dad following his stroke, provoking me to call local government officials (from here in the U.S.)to help get the wheels in motion for his care, which was minimal to say the least. I can't tell you how many times he fell out of his hospital bed becasue he was not being looked after properly. But, of course, professionals there don't care becasue there's little, if any threat of being held accountable or being sued.

I have one of the least favoured insurances here in The States and it is often burndensome and cumbersome getting to see the practitioners I want and trust and who have an impeccable rep. And, some I have to pay for out of pocket...but at least I have that options. And, I will always take being "in control" of my health rather than allowing others to control it...and that's my primary gripe with the Canadian System.

May you all be well anyway.

P.S. Why are Canadians so defensive when confronted with the obvious when it makes things "back home" seem somewhat antiquated. Things are what they are...embrace the truth...for IT shall set you free.

Anonymous said...

Mia,

Why do you think that you get what you "pay for" in the US? Look, you have a crappy doctor here, or the US, what do you do? You look for a new one...

Except, in the US, if your insurance or HMO says "no, you have to see this one" then you're screwed.

In Canada, you can go see whatever doctors you want. Ours are all to the same levels of expertise as American ones. And just like the US, we have good ones and bad ones. But nobody here will tell me I can't see the doctor, except the doctor himself.

I feel your pain in regards to the elderly care, but I would bet that you'd get better service in a completely private institution in Canada... Which is ALSO an option.

So, lets see.

- Canada has more choice for doctors
- Canada has private options in many cases
- As long as options aren't elective, they're covered by health care
- Canadian doctors are subject to the same good/bad issues as the US

Why are we defensive? We're not. Why are Americans defensive of their obviously inferior system which costs a whole hell of a lot more?

Simple. You feel like you have the CHOICE of NOT paying for medical insurance, should you so choose. You don't like that the money goes to government, you rather it go to some private corporation...

Government isn't evil. Its run and staffed by the people, for the people. Why the hell would you rather give your money to a business who's sole purpose is to make money?

Crazy. Simply crazy.

Yours faithfully,
Concerned Citizen 128

koovle said...

To Mia - Granted the Canadian system is faulty, it is definitely in the patients hands with this system - a strange caveat emptor type of awareness. With a little research to the condition and a firm back bone will get you what you want, without paying a dime from your pocket, albeit some time and energy. But to call yourself not 'in control' of your health is ridiculous. Our Doctors are worked to the bone. They're human and make mistakes. You have to know how to put your foot down and say that's not right to your doctor and find another clinic or advocate or someone who can help. I know this from experience. Maybe if you weren't in another country you could be a little closer to your family's medical problems to deal with it more carefully than having to call 'the local government officials', whatever that means.
I'm proud of Canada for it's health care. No matter what Yankee looking in from the outside says. I find your statement ill informed. Every situation is different from province to province, town to town. To blanket Canada's health care system from another country isn't fair. Please use more consideration in the future.

Anonymous said...

he ultimate purpose of a health care system is to keep you alive and well. On that basis, to compare the US system to the Canadian system, is absurd. The Canadian system is so far ahead of the US system any comparison is asinine. A more meaningful comparison would be between the US system and that of Wallis and Fatuna, an overseas French colony in the Pacific. Go here: https://www.cia.gov/library/publications/the-world-factbook/geos/wf.html

dave said...

and mia, you said

"some I have to pay for out of pocket...but at least I have that options"

What, the option to choose, or the option to pay. There's the rub.

In both countries you have the option to choose. In the States, many (35 million)don't have the "option" to pay, they can't afford it.

Count your blessings that you can afford what you perceive as the options available to you in the States, and be comfortable in the knowledge that may of your fellow Americans will die unneccesarily because they couldn't afford the free-choice highly competent American service, while their aging counterparts in Canada live longer and healthier with our horrible, oppressive system.

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jj said...

From Wisconsin. I have most likely come to this discussion late but was surfing the Canadian health system after viewing Sicko last evening. I did not need the movie to tell me that the name 'health care' is a misnomer for what passes for health care in the U.S. I have far too many experiences with this but the most recent is perhaps indicative of why I would be surfing the Canadian system. My husband and I were in an auto accident two weeks ago. Not our fault. Fortunately we were not seriously injured. Still I had need to query our medical insurance regarding an aspect of the claim. I needed to sort out chiropractic care reimbursement. (The fact that I had to call the insurance people before I called the chiropractor should make clear a significant part of the problem here in the States.) My insurance company told me that if the doctor was in the 'provider network' we would pay a $50 deductible and then have the charges reimbursed at 70%. If we chose someone outside the network we would have to satisfy a....ready?....$15,000.00 deductible after which the insurance would pay 50%. This is a choice? It is not a choice, it is a faulty dilemma, a box, a non-choice in sheep's clothing. We don't have choices here....we have these constant faulty dilemmas. We don't have preventative care, we have symptom relief by urgent or er care. And then we have huge bills due instantly. And we have land shifting beneath our feet and disappearing benefits and higher premiums and an unhelpful so-called debate about socialism. Maybe you can guess why I am surfing the Canadian system. Meanwhile, good for you, it sounds like a human system, with problems and vigilance needed by citizens, but it sounds like a very good system. If only we would wake to the obvious down here.....private companies will always extract immense sums of money from the people at the same time not providing compassionate, excellent care than a government which is connected to its people. By the way, our insurance provider (through my husband's work place) is Humana....a giant out there with Kaiser and Cigna and Blue Cross Blue Shield. $15,000 deductible? I am sure they need the money.

Queenbuv3 said...

Just like jj, I am now researching possibly moving my family to another country after watching "Sicko". My hubby watched it today and we are both interested in researching the option of moving to another country not just because their healthcare is better but because some countries also have more positive qualities when compared to the U.S. It's nice to hear from Canadian citizens that their healthcare is indeed as good as we think it is based on our research so far.

Proud FA said...

I would like to add: The leading cause of death and injury in the US is our medical system. Here is a link with all the sources like the CDC, NIH, WHO US Surgeon General and even the AMA.

US doctors are the highest pain in the world making 2.5 more than ALL other doctors. US MDs make more medical blunders than all other doctors.

One million Americans die each year as a result of medical errors and only 5% ever get reported.

Canada is ranked 30th for health care and he US is rated 37th.

Canada has a doctor shortage because Canadian doctors come to the US to ride he gravy train and get away with murder.

*

.1 percent chance of a serious adverse drug reaction (186,000) 1
*

5 percent to 6 percent chance of acquiring a nosocomial [hospital] infection (489,500) 9
*

4 percent to 36 percent chance of having an iatrogenic injury in hospital (medical error and adverse drug reactions) (1.78 million) 16
*

17 percent chance of a procedure error (1.3 million) 40

All the statistics above represent a one-year time span. Imagine the numbers over a 10-year period. Working with the most conservative figures from our statistics we project the following 10-year death rates.

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Anonymous said...

I am a Canadian who has lived here my whole life. I now live in the most socialist province of the country, Quebec.

I would take U.S. healthcare over Canadian healthcare any day of the week, although if the U.S. continues down the government healthcare route that may change.

Although, I find the American healthcare system to be much too socialist as well. Oh and the limitless litigation (sueing of doctors and hospitals) is going to bankrupt the Americans whatever the system of healthcare.

I moved to Quebec three years ago, I am still on a government wait list to have a doctor appointed for me. I am married and have a little girl, they have not been appointed a doctor either.

Furthermore, it is surprizing how often you find that doctors are rude and demeaning here, but hey it's a doctors market. If you find a good doctor, they do exist, you fight to keep them.

At work if one person tells a story about how bad the healthcare is in Canada, the whole office starts with a round of horror stories from personal experience here.

If things get really bad I've known of people re-mortgaging their house to get healthcare south of the border.

Anyway, you Americans can do what you want. Remember though, that if the government owns it good luck getting it back.

Buh, buh.

P.S. The average Canadian pays more for taxes each year than for food/clothing/and shelter COMBINED.

P.P.S. Sorry for yelling.

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