Canada would be better off being America’s 51st state because Canadians would have “much better health coverage,” Donald Trump said last week.
There are probably some Canadians who would concede the point, having travelled to the States and found themselves able to pay for necessary treatment not available at home.
But by almost every objective measure, America’s health-care system is a disaster. The U.S. spends more than any of its peers: 16.5 per cent of GDP, or more than US$15,000 per person in 2022. Yet, U.S. life expectancy is more than four years lower than the average of 10 of its high-income peer countries and it has the highest rate of preventable, treatable deaths. If you were drawing up a national health-care system from scratch, you wouldn’t touch the American model with a 10-foot pole.
The link to affordability is inextricable: 26 million Americans are underinsured and nearly half of citizens have skipped or delayed care because of cost. U.S. health-care costs are the nation’s highest cause of non-business bankruptcy.
The federal government’s Medicare program covers people 65 and older, some people with disabilities, as well as some children, government workers, the unemployed and veterans. But coverage varies greatly according to race, ethnicity, income and education.
The conclusion of a comparative study by the Ross University School of Medicine is that Canadian medicare performs considerably better than the U.S. health-care system, offering better outcomes for less cost.
However, this is not a paean to Canadian health care.
If America annually comes a distant last in the Commonwealth Fund’s respected “Mirror, Mirror” study of 10 international systems, Canada has tended to come second last.
There is some considerable irony in the fact that in 2024, Canada rose to the heady heights of 7th place — irony, because a study by the Fraser Institute released last month suggested that wait times for non-emergency surgery have reached 30-year highs.
The quality of care and outcomes once people see a doctor are considered world-class. But the biggest problem for Canada is consistent: access to care, where it regularly ranks near the bottom.
Every year, peer countries like Australia, the Netherlands and even the U.K. are ranked higher than Canada, despite spending less than our health expenditures of 11.2 per cent of GDP or $8,119 per person.
How many patients with a reversible illness have seen their condition deteriorate to become chronic and irreversible because of these waits?
The Fraser Institute study is particularly damning. The median wait time between referral to a specialist by a general practitioner and receipt of treatment at 30 weeks is the longest in recorded history, up a staggering 222 per cent since 1993.
The Fraser study suggested that patients are waiting six weeks longer than physicians would consider to be clinically reasonable, and that the total number of procedures that people are waiting for is over 1.5 million.
A paper released this week by the same team at Fraser said patients could expect to wait 16.2 weeks for an MRI and 8.1 weeks for a CT scan, largely because Canada has far fewer machines than do other rich countries (for example, Canada has 14.6 CT scanners per million people; Australia has 78.5 units per million).
Even after the $46-billion extra injected into the health system under the accord signed between Ottawa and the provinces in 2023, six million Canadians still don’t have a family doctor.
That situation is unlikely to change soon, given that the number of medical school graduates has been stagnant for a decade — a decade in which the population of Canada has grown by five million people.
Wait times for radiation oncology and medical oncology are significantly shorter at less than five weeks.
But how many patients with a reversible illness have seen their condition deteriorate to become chronic and irreversible because of these waits?
How much pain, mental anguish and death could have been avoided if the system were more efficient?
Canadians have seen this degradation of service and are not happy. They may not be rushing into Trump’s arms but a Navigator survey from last fall indicated three-quarters of respondents believe the status quo is no longer acceptable and they want to see major reforms. Two-thirds said they have experienced unreasonable waits, and eight in 10 support more private-sector involvement in a publicly funded system. The consensus is that innovation, rather than more funding, is required.
If the answers are not found in the U.S., there may be lessons to be learned from the Netherlands, consistently ranked as a top-three global health performer.
The Netherlands offers universal access but citizens are required to purchase private insurance in a regulated, competitive marketplace. Competition between providers is also regulated.
Insurers are obliged to accept all applicants and charge their policyholders the same monthly fee for coverage, regardless of pre-existing conditions.
The system is designed to put a strong emphasis on primary care that offers delivery at the lowest appropriate level to free up resources for more complex cases.
The Dutch are clearly doing something right. An OECD study suggested 83 per cent of the population was satisfied with the system in 2022.
That compared with just 56 per cent in Canada, down 13 percentage points from just five years earlier.
The lack of access to care in this country is Canada’s disgrace and the system needs some shock treatment to fix it.
National Post
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