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Debunking myths about Canadian health care

Are Canadians flooding into the United States to get better health care? No. Are Canadian doctors immigrating to the United States to work for our health-care system? No.

By Ezra Klein  | October 12, 2010; 10:53 AM ET
Categories:  Health of Nations  
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Comments

Yeah, but what about all those long lines and Canadian death panels?

Posted by: leoklein | October 12, 2010 10:59 AM | Report abuse

I am skeptical of the methodology, but lets assume the Canadian numbers are true. By the same token, how many Americans are going north to partake of Canadian health care? My guess is it is many fewer than are coming south.

Posted by: WanderingHawkeye | October 12, 2010 11:22 AM | Report abuse

How many U.S. citizens pay their property (and other) taxes to support the government school system, and still have enough money left over to send their kids to private school?

Posted by: msoja | October 12, 2010 11:41 AM | Report abuse

@WanderingHawkeye : My guess is that numbers will be hard to come by since most Americans who use the Canadian system would have lied, like Palin did, about being American in order to get treatment.

Posted by: lol-lol | October 12, 2010 11:43 AM | Report abuse

Ezra,

if you got sick and I mean really sick (ie stage 4 cancer) where would you go if you had the choice?

Just got done talking to a friend (51) who was recently diagnosed with a highly treatable form of prostate cancer. They found pre-cancerous cells 6 months ago and he's followed up with his urology that confirmed the early diagnosis. He has the option now of surgery or what he's taking, radiation. He also has a family member in Europe who has a similar diagnosis. His options are more limited in what they will do. now I readily admit that every case is different but I guess I'd rather have all options at my disposal.

Posted by: visionbrkr | October 12, 2010 11:55 AM | Report abuse

I've spent a lot of time up there, and have lots of friends there as well. The system works very well, but it's not without its problems.

A friend who needed knee surgery had to wait 6 months to get in. But another friend who has Colitis can see his doctor and any specialists as often as he needs. The knee surgery guy has lots of money, so he found a way to get in quicker. In short, you can still buy your way out of a wait.

People up there decided to trade off a little choice and convenience for ensuring that everyone has the care they need. They pay a bit more in taxes, but employers don't have to worry about huge premiums and the uncertainty of yearly increases. Doctors don't have to deal with a lot of paperwork or hassle and can still practice reasonably state-of-the-art medicine.

If something's not working, they can change what's covered, reimbursement rates, etc. It's not static, and people aren't helpless to change it.

A few people come down here for care in extreme cases, but how many people go to Canada for their prescriptions? How many extreme cases here go untreated altogether? If you're poor, the answer is way, way too many. I see it everyday in my career. It's a moral issue that is hard to stomach once you've had some exposure to the realities.

In health care, there's no perfect system, but as a country, I'd rather have their problems to fix than ours. We've got a long way to go.

Posted by: itstrue | October 12, 2010 11:57 AM | Report abuse

Are Canadians flooding into the U.S. for treatment? No, I agree here.

"These findings from U.S. data are supported by responses to a large population-based health survey, the NPHS, in Canada undertaken during our study period (1996). As noted above, 0.5 percent of respondents indicated that they had received health care in the United States in the prior year, but only 0.11 percent (20 of 18,000 respondents) said that they had gone there for the purpose of obtaining any type of health care, whether or not covered by the public plans."

But 0.11% of the population means about 36,000 Canadians come here for care each year.

Consider that you need a triple coincidence of three factors for a Canadian to travel to the U.S. for medical care:

1) Life threatening or very painful condition which prompts looking outside the system
2) Excessive waitlist time (after all, the life threatening or very painful conditions should be the ones which are put in the front of the queue, no?)
3) Ability to pay out of pocket for treatment in America after already paying taxes to fund the Canadian system, likely to be expensive given 1)

1) and 3) in particular are likely to represent a very small slice of the Canadian population to begin with. The fact that 36,000 Canadians still come to the U.S. for care suggest that either 2) is a problem or perceived quality of care is a problem.

The important question is how many Canadians who have both severe conditions and the ability to pay come to America for treatment? After all, if you don't have a particularly severe health problem you probably aren't going to travel to another country and be willing to pay anything out of pocket to have it fixed.

Posted by: justin84 | October 12, 2010 11:57 AM | Report abuse

Yeah, but we have royalty from all over the world come and get treatment from the Mayo clinic. I guess that makes us the Jamaica of Health Care. Wealthy people from all over the world come here to experience something us plebes cannot.

Posted by: klautsack | October 12, 2010 12:01 PM | Report abuse

What bothers me is people assuming there's no rationing in the US. It's a myth that healthcare decisions in the US are between a doctor and their patient, let's not forget the insurance company. They're the entity telling us what doctors we can see, what treatments they'll approve and/or pay for and deciding when they've paid enough for a person's care (yearly and lifetime maximums). And don't forget the other favorites, pre-existing conditions and dropped coverage.

If we're going to have a true discussion, let's make sure we set the facts ahead of time.

Posted by: phbella61 | October 12, 2010 12:13 PM | Report abuse

phbella61 -

You know who else was interested in facts? Hitler, that's who.

(see how easy it is?)

Posted by: klautsack | October 12, 2010 12:20 PM | Report abuse

justin84:

750,000 Americans go outside the US for medical care ever year.

Posted by: lol-lol | October 12, 2010 1:01 PM | Report abuse

It's true Americans travel abroad for healthcare all the time. To get it less expensively. But Canadians who have the money come here routinely, and it's a lie to say otherwise. Even Belinda Strachan, (if reports are to be believed, Clinton's girlfriend) came here from Canada for breast cancer treatment, which, for an insured American, would cost much less than it cost her.

Posted by: truck1 | October 12, 2010 1:14 PM | Report abuse

Is this really "a pervasive myth"? Who are the serious-minded right-leaning people spreading this "myth"? Seems like a case of burning a straw man, or at least attacking an argument made by people who are woefully uninformed, either way not very helpful for advancing the debate.

Posted by: ab_13 | October 12, 2010 1:15 PM | Report abuse

ab_13 (October 12, 2010 1:15 PM) must have missed last year, especially the summer.

Posted by: AMviennaVA | October 12, 2010 1:19 PM | Report abuse

justin84:

750,000 Americans go outside the US for medical care ever year.

Posted by: lol-lol | October 12, 2010 1:01 PM | Report abuse


because of cost--not because of quality of care. Let's make sure we differentiate between the two. Many people go overseas because the cost of care is less there not because the care is better. Some do go overseas because newer, less tested methods of treatments are approved there and not here as well.

Posted by: visionbrkr | October 12, 2010 1:42 PM | Report abuse

"justin84:

750,000 Americans go outside the US for medical care ever year."

Sure, but it's primarily to save money. Cost insulation, subsidies and barriers to entry - when combined with a very wealthy populace - have pushed the price of medical services in the U.S. into the stratosphere.

Americans are traveling abroad because despite the high travel costs, they can save a ton of money. There are cases where a $200,000 procedure in the U.S. can be had for $10,000 in India. India would be cheaper anyways given the lower cost of living there, but much of the difference is related to cost insulation here.

http://www.webcitation.org/5Ig0CGpSv

It's not the U.S. government saying "your hip replacement surgery will be in 10 months and we're sorry if it hurts" that is driving people to other countries for care.

Likewise, people come to the U.S. for care due to high quality and immediate access - clearly not to save money (Canadians who cared primarily about money would presumably just stay home or travel to a cheaper destination).

In short, it's the market in action.

Posted by: justin84 | October 12, 2010 1:48 PM | Report abuse

justin,

its interesting that you bring up the India case. I have a client of mine that has almost 2000 employees. They're currently looking for ways to legally financally incentivize employees that are of Indian descent to travel back to India for medical care ranging from maternity care (that costs $25k on avg here and $5k on average there) and dental care (where a root canal that costs $1000 here costs $100 there). If there weren't legal issues it'd be happening a lot more than it already is.

Posted by: visionbrkr | October 12, 2010 2:19 PM | Report abuse

"ab_13 (October 12, 2010 1:15 PM) must have missed last year, especially the summer."

I didn't miss anything. If you'd like to point me to serious people saying that Canadians are "flooding into the US" to get medical care I'm all ears.

This is a case of attacking the weakest arguments from uninformed people (and wrongly calling them "pervasive myths") in order to score points, not a serious attempt at advancing the discussion. There are an equal number of specious arguments from people on the other side. I'd prefer to ignore both and focus on discussing how to fix what is broken.

Posted by: ab_13 | October 12, 2010 2:30 PM | Report abuse

Here's one article that I found in 30 seconds on Google.

http://wonkroom.thinkprogress.org/2010/02/03/danny-williams/

As for medical tourism - health care that people can't afford may as well not exist for them. High costs aren't a feature - they're a massive problem.

The free market has utterly failed at providing health care and plenty of countries have proven that the government can do a better job for more people for less money.

But yes, let's continue throwing billions after billions at the most inefficient health care system in the world- it's the Republican way!

Posted by: lol-lol | October 12, 2010 3:26 PM | Report abuse

Where in that article is there a credible person claiming that Canadians are flooding the US for health care? I see a quote from some hack lobbying group.

As for the rest of your comment, if that was addressed to me you're barking up the wrong tree.

Posted by: ab13 | October 12, 2010 8:09 PM | Report abuse

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