A friend travelling in Europe pleaded recently on Facebook for information to help her respond to a fellow tourist, an “alpha male” from the US, who was criticizing the Canadian health care system. He claimed, for example, that he had seen statistics showing that 20% of Canadians go to the US each year for elective surgery.
We should brace for more such criticisms as Senator Bernie Sanders and at least some Democrats promote what they call “Medicare-for-All” as a plank for the 2020 US elections. They view Canada’s system as a possible model. As for my friend, I did some quick research and responded to her, as did a number of her other Facebook contacts.
The alpha male critic is simply and ignorantly wrong to say that 20% of Canadians (seven million people) go to the US annually for elective surgery. The Vancouver-based Fraser Institute is a right-wing organization known for its hostility to Medicare. It claims that 63,000 Canadians sought medical treatment in other countries in 2016. The Institute frequently writes ideological reports whose methodology is suspect, and several academics have said that this report is not accurate either. But even if it were, there is a big difference between 63,000 Canadians going to a variety of countries for health care, and seven million going to the US alone every year.
Interestingly, a publication called the Fiscal Times estimated in 2016 that 1.4 million Americans would leave the country in that year for medical procedures. That is mainly because health care in the US is so expensive. In fact, some employers actually encourage their insured workers to seek cheaper care elsewhere.
Yes, in some cases waiting lists in Canada are too long, particularly on elective surgeries for less serious conditions. But I can say that when I was diagnosed with a blood clot in my lower leg late in 2018, I saw my family doctor on a Wednesday, had an ultra-sound on Friday, and visited a specialist on Saturday. I was impressed. Also, our daughter recently had a baby and the medical and associated care was excellent.
I am not an expert on health costs, but a quick bit of research provides some interesting comparisons. A study by the Kaiser Family Foundation found that in 2017 the US spent 17% of its GDP on health care. Canada spent 10.5%, and the average in comparable countries (Canada, Germany, UK, France, Belgium, Austria, Australia, and Switzerland) was 10.6%. In dollar terms in 2017, the US spent $10,224 per capita on health care. Canada spent $4,826, and the average among comparable economies was $5,280.
Contrary to common belief, there are publicly-funded health care programs in the US as well, for senior citizens, military veterans and others. Yet most people there have either to pay for services out of pocket, or to face hefty insurance premiums. The Kaiser study also found that spending in the US public health care sector is quite similar to that in other countries. It is the private sector that is so costly. There are numerous possible answers as to why, but surely high profits extracted from the system and the cost of advertising to compete for clients would be a big part of the reason.
And while under Medicare everyone in Canada has access to hospital care, doctors’ visits and associated laboratory and diagnostic services, the same cannot be said in the US. The government’s own National Centre for Health Statistics reported that in September 2016, 12.3% of Americans adults aged 18-64 were uninsured.
That was a big improvement over earlier years when more than 20% of those same people lacked insurance. The Affordable Care Act (commonly called Obamacare) is the most obvious reason why more people came to be covered. But the Republicans are doing their best to reverse Obamacare so the number of uninsured may well rise again.
I am not expert in health outcomes either but one statistic caught my attention. In 2015, the world’s highest life expectancy at birth was 83.7 years in Japan. Canada ranked 12th at 82.2 years and followed countries such as Switzerland, Singapore, Australia, Spain, Iceland, Italy, Israel, Sweden, France and South Korea. The US ranked 31st in the world with a life expectancy of 79.3 years, just after Chile and Costa Rica, and just ahead of Cuba, at 79.1 years.
Surely life expectancy is an important health outcome. If so, one has to ask why the US, which spends much more on health care than any comparable country, ranks 31st in the life expectancy of its residents.
From what I seen on Facebook, my friend continues to enjoy her European vacation. I am curious to know how her fellow tourist responded when provided with the facts.
Thanks, Dennis, for this succinct assessment of the health care situation. I have friends who no longer go south in winter because they fear possible medical expenses should they have health problems while on vacation in the USA. Our health care system is not perfect, especially when it comes to chronic care, but cost is seldom a barrier to receiving first-class medical attention. I hope your article gets to some of our friends south of the border.
Thanks for the comment Bob. It is especially noteworthy since you were a medical specialist who practiced for many years.
Thank you for your post – which has also appeared at rabble.ca and for your cogent response to rightwing Americans who attack our healthcare system without actually studying it. There is a lot to improve – dental care, chronic care, mental health care and care in Indigenous communities, but it stands head and shoulders above the private, deeply inequitable model to our south.
Félicitations to you, your wife, your daughter and your new grandchild!
Maria in Montréal