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Posted at 3:42 PM ET, 02/15/2011

Health care in Canada

By Ezra Klein

I'm on record as having some problems with how the Canadians run their health-care system. In particular, I think it's good to have a floor for health care -- and that floor could be single-payer, as it is in Canada -- but it's a problem to have a ceiling. It should be easier to pay more for better care. But I think a lot of Americans look at the outcomes of the Canadian system and assume that the Canadians would prefer to be more like us. Not so much:

it’s been driving me nuts when I hear: “we were supposed to get our MRI next April, but thankfully we knew someone on the board of directors, so we got it in two weeks,” as though there is ANY DIFFERENCE between “knowing someone on the board” and “having enough money to go get it done in the States.”

If there’s a system where you get what you need faster than anyone else for ANY reason other than “has the most urgent need,” it’s two-tier, guys.

You hear this a lot when you read Canadians talking about the problems in their system. The issue is rarely that they're not enough like America. In general, it's that they're too much like America. My read is that this has actually led to bad policy, as the fear of Americanization and two-tiered health care has led Canadians to reject certain reforms that would take some of the pressure off their system at the cost of introducing a little more inequality into it. It's rather the reverse of the way the dreaded specter of socialism has impeded Americans from taking smart steps towards a more cohesive and efficient health-care system that could cover more people at a lower cost.

By Ezra Klein  | February 15, 2011; 3:42 PM ET
Categories:  Health of Nations  
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Comments

My Mom is Canadian. She underwent surgical and chemotherepy treatments for breast cancer a few years ago. This was followed by an unrelated problem that required a series of surgeries. There were plenty of hostipalizations. A nurse visited her home for a period when she needed daily shots. She did not recieve a single bill. She had no extra financial stress to deal with and neither did I, her recent college grad. kid. I am so thankful for that system. When you experience a system that works that well, you defend it.

Posted by: ideallydc | February 15, 2011 4:10 PM | Report abuse

I want to add that as a foreign student the Canadian health care system is extraordinarily frustrating. For your fundamental care - emergency care and basic care essentially- it works okay so long as you don't have any emergency. But the supplemental care which covers anything not on UHIP (most things other than Emergency and Basic care, including medicine) is provided by a private insurer, which for students sucks royally. Reimbursment takes forever, not everything is covered outside of basic care, and when things are covered the payment is usually pitifully small ($35 for me). Canada isn't a true single payer system. Emergencies and basic care are covered, but for everything else it's like the States where you need private insurers (usually employer based)

Posted by: doctorrobert | February 15, 2011 4:23 PM | Report abuse

As I heard Marcia Angell (former editor of NH Journal of Medicine and single-payer advocate) say at a lecture some years ago: "In America if you're insured you may get an MRI you don't need, but if you're uninsured, you can't get an MRI you do need."

If there are waiting lines in Canada for some services, Canadians know that at least the rich are waiting in line as long as ordinary folks. And the statistics I've heard are that Canadians prefer their system 97% to going American style.

Posted by: jshafham | February 15, 2011 5:07 PM | Report abuse

" It should be easier to pay more for better care."

No, no, no, Ezra. See, progressives have led us to this world where health care is a right, not a product. Providing health care is a fundamental responsibility of government, not a nice-to-have if government can afford it.

Therefore, if you as a progressive say EVERYONE is entitled to government-guaranteed health care, how can you turn around and say that some people (the rich) should be worthy of better health care than others simply because they can afford it? That's not fair, is it liberals? Everyone should get the exact same access to care, regardless of income...right?

Funny how the best of progressive ideals ultimately...without fail...lead to unintended negative consequences.

Just for fun some time, research waiting times for various common procedures in Canada vs America. When American's realize what comes with single-payer, government-guaranteed health care, they will recoil at the new reality awaiting us if Ezra and other progressives ever get their way with single payer....as you get to sit on your hands for months while a government bureaucrat determines the worthiness of the procedure you need.

Posted by: dbw1 | February 15, 2011 5:08 PM | Report abuse

its really not honest Ezra to paint it all rosy and cheery like that. Do they prefer it to our system, absolutely. Are there issues, sure.

We've heard all the conservative stories of wait times etc so instead of being called a "scare mongerer" I'll simply post a link and let people decide for themselves.

https://secure.cihi.ca/estore/productSeries.htm?pc=PCC395


As said before we ration on availability to get and pay for insurance, they ration on overall care to all and as you say private enterprise is coming in (because of cost of care and cutbacks in government care which you conveniently don't mention).

Another survey that includes the good and the not so good of Canadian healthcare:

http://www.nationalpost.com/story.html?id=2737354


and a good take directly from the Canadian Medical Assocation President (albeit from 2009) about the concerns, pluses and minuses of the Canadian system.

http://www.canadianmedicinenews.com/2009/08/new-cma-president-anne-doig-urges.html

Posted by: visionbrkr | February 15, 2011 5:15 PM | Report abuse

It's great that you are still talking about health care when Obama's bill passed a year ago, but what about jobs? Nobody can afford health care without a job. Nobody can afford health care when they have student loans that are being paid back on wages from Costco. Unemployment and Underemployment is at historical levels, what is Washington going to do to fix the health of our economy?

Posted by: comma1 | February 15, 2011 5:30 PM | Report abuse

I think the point Ezra was making is that single payer provides a basic amount of health care to all citizens. That's the floor Ezra is talking about. I don't know to many people that think the rich shouldn't be allowed to spend as much money as they want on additional procedures or doctors not covered under the government plan. In fact this would great, as the competition and innovation created could eventually trickle down to everyone.

dbw1 completely misses the point of single payer. It's not meant to ensure everyone gets the same coverage, but that everyone gets at least some coverage.

Posted by: jsrice | February 15, 2011 6:00 PM | Report abuse

"Funny how the best of progressive ideals ultimately...without fail...lead to unintended negative consequences. "

It seems to me that conservative ideals, to paint with a broad brush, lead to Gilded Era conditions of greater wage disparity and greater poverty for the masses. I don't know about you, but I don't think I want the economic standing of our population as a whole to be like India's.

Posted by: arm3 | February 15, 2011 6:08 PM | Report abuse

"as you get to sit on your hands for months while a government bureaucrat determines the worthiness of the procedure you need."

dbw1 has apparently never spent time on the phone with an insurance company bureaucrat ascertaining whether a procedure will be reimbursed, or received bills from a hospital bureaucrat stipulating that $10 for a Tylenol is the going rate, or from an insurance company bureaucrat declaring that while the hospital is in-network, one of the doctors who walked past your bed was out-of-network?

Perhaps dbw1 was dipped in the Styx as a child, like Achilles, and has yet to sustain a crippling heel injury?

Posted by: pseudonymousinnc | February 15, 2011 6:47 PM | Report abuse

At least some Canadians have free market options:

"A Buffalo-based company is the latest to get in on the medical brokering scheme that’s gaining ground in Canada as lengthy wait times force more and more people south of the border for treatment.

"Cross Border Access has been helping Canadians book appointments and negotiate fees for a variety of procedures in upstate New York since May, putting a new twist on an industry that’s raising ethical questions and helping fuel the private-public health-care debate."

http://www.timescolonist.com/health/York+medical+brokerage+gains+ground+Canada/4273077/story.html


Posted by: msoja | February 15, 2011 7:24 PM | Report abuse

--*If there’s a system where you get what you need faster than anyone else for ANY reason other than “has the most urgent need,” it’s two-tier, guys.*--

I offer that a system based on first come/first served, with everyone responsible for his or her own bills is the most fair and efficient.

One of the problems with the Canadian system, and the UK's NHS, is that there is insufficient capacity to honor "has the most need". Hence, the waits, and situations ripe for corruption.

The U.S. has abundant capacity because people who can pay want prompt service, and there are other people willing to provide such service.

Posted by: msoja | February 15, 2011 7:37 PM | Report abuse

and our good progressive friend pseudo still thinks (or lies) by saying that insurance company bureaucrats make coverage decisions.


At the end of the day whenever we eventually move to a single payer model of any form those who have coverage now will sacrifice the speed with which they get their access for increased access for all. if you're going to tell them how its going to be, you need to tell them the WHOLE story.

Posted by: visionbrkr | February 15, 2011 7:42 PM | Report abuse

--*dbw1 has apparently never spent time on the phone with an insurance company bureaucrat*--

You might want to double check me on this, mousi, but isn't Medicare the largest denier of claims in the country? Dollarwise. Percentagewise. I could be wrong.

Posted by: msoja | February 15, 2011 7:47 PM | Report abuse

"still thinks (or lies) by saying that insurance company bureaucrats make coverage decisions."

Oh, look, it's the Chris Christie conservative, the noble skimmer. Insurance company phone-drones won't tell you if you're covered or not, so it's up to the poor suckers who accept their parody of a healthcare system to spin the wheel of fortune and see what comes in on the bill.

As for soggy, I'm done with batshît k00ks. Go and show off your manliness by giving yourself that annual Freedom Colonoscopy with a hosepipe and a webcam.

Posted by: pseudonymousinnc | February 16, 2011 1:09 AM | Report abuse

As a US citizen assigned to Canada, I was in a position to take phone calls from frustrated Canadians wishing to escape their high taxes and horrible health care system -- their words, not mine. My own recent experience with the Canadian system was an attempt to reach the Poison Control Center. A recorded message indicated it was closed, and I was transferred to another number -- no response. I called the US Poison Control Center - they answered immediately - the first responder handled my situation - they followed up two and three days later to ensure that everything was ok.

Posted by: JJGlass | February 16, 2011 7:02 AM | Report abuse

@pseudo,

Yes i'm a Chris Christie conservative, you caught me. But my question is when he's so FOR children and students why aren't you pseudo? Why are you against the status quo that's not working in healthcare but NOT against it that's working just as poorly on education?

http://www.nj.com/news/index.ssf/2011/02/nj_education_chief_chris_cerf.html

i'm sure knowing you you're just as stagnant on the public sector benefits and pension issues.

http://www.nj.com/news/index.ssf/2011/02/sen_stephen_sweeney_calls_on_p.html

Thank GOD for Chris Christie.

Posted by: visionbrkr | February 16, 2011 7:56 AM | Report abuse

--*Go and show off your manliness by giving yourself that annual Freedom Colonoscopy with a hosepipe and a webcam.*--

Well, we know where mousi's head is at!

But, yeah, Medicare is the biggest denier of claims in the country, while this morning's health care news (not part of Klein's propaganda book) reveals that at least ten percent of the claims Medicare does pay are fraudulent.

What do they say about government work?

Posted by: msoja | February 16, 2011 9:27 AM | Report abuse

@JJGlass
Yes, I find that high tax payers the world over complain a lot too. There they are, at the top of the pile, with the big incomes (oh, and they work so hard for it, not like all the rest of lazy goodfornothings) paying the top tax rates and you just can't get good service anymore - no matter how many times you snap your fingers. (That would be "good" entitlement, wouldn't it?.) So, that "here, now" thing is just not working for you at the moment, huh? I know, why don't you go where money talks - and make room for us. And you can get what you want when you want it and everyone has the good manners to drop down on the sidewalk to let you get past. Now that's what I call a good system!

But as for that serious after hours poisoning emergency - I hope it was resolved. And that you didn't need to go to a hospital - that would have been in Canada I assume? That would have been all right would it?

Oh, by the way, Ms Brockovich could explain why the US needs a 24 hour national poison advice service.

Posted by: WilliamTell | February 16, 2011 9:30 AM | Report abuse

I'll bet the rich in Canada would hate it if the U.S. went to a government run Canadian style system. Where would they go to get the high end service they now get by coming to this country.

Posted by: RobT1 | February 16, 2011 11:32 AM | Report abuse

As always, we play this silly game where we pretend we should be emulating Canada.

We should be emulating France, Germany, Netherlands, Belgium, Switzerland and all the other countries that HAVE NO SIGNIFICANT WAITING TIMES, spend about half what we do on health care, COVER EVERYONE, and have BETTER OUTCOMES!

Playing this game with conservatives where they trash the Canadian system and we try to defend it has got to stop.

Ezra, next time this comes up, point out that Canada does ALMOST as poorly as we do in most measures of health outcomes, but look, look(!) at France and Germany! They eat our lunch every single day on this, and conservatives have no response except to talk about Canada.

As Don Berwick has said, you can't say that you can't deliver high quality health care with efficiency and low cost, because it is being done every day.

Posted by: cmhmd | February 16, 2011 11:34 AM | Report abuse

msoja goes from asking "isn't Medicare the largest denier of claims in the country?" to stating it as a fact later on the same page without offering any proof.

Isn't Medicare the biggest single insurer in the USA? Don't medical management firms rate Medicare as the easiest insurer to deal with? Yes. And I'm offering just as much proof as msoja but have the advantage of knowing what I'm writing about.

Posted by: steveh46 | February 16, 2011 12:08 PM | Report abuse

here's the proof steveh46,

http://www.ama-assn.org/ama1/pub/upload/mm/368/reportcard-short.pdf


Admittedly this is from 2008. Looking for more current stats now.

yes that shows Medicare's denials at 6.85% and every insurer either slightly below that or more than slightly.

That to me is odd because one of medicare's positive things is that everyone (doctors that is) knows what it covers and what it doesn't. Private insurance isn't the same. Is the actual medicare number possibly higher becuase doctors don't bother to submit things they know will get denied? If someone has other insurance though they will submit it to get the denial because private insurers require that denial to pay as primary.

Posted by: visionbrkr | February 16, 2011 1:11 PM | Report abuse

I lived in Canada as a 'landed immigrant'. I have had rheumatic heart disease since I was 11 and now far past 65. I can tell you that the Canadian medical system was efficient, and even as a landed immigrant, I had medical insurance through their BCHIS program and I had my second heart surgery there. Although I had medical insurance from my Alaska employment in force, the hospital chose to collect their money through BCHISs because they said it was efficient, they did not have to spend a lot of time arguing with the payer, and if they billed my Alaska Insurance, it would take ages to collect the money. I alweays get a chuckle when Americans bad mouth Canadian Medical care. As an RN, I felt the care there was first class like I got with the Hawaii and Arizona surgeries I had. Canadian health care costs are a fraction of the US average costs because everyone is insured and can get health care when treatment is the cheapest to deliver.

Posted by: mJJ2 | February 16, 2011 4:12 PM | Report abuse

I lived in Canada as a 'landed immigrant'. I have had rheumatic heart disease since I was 11 and now far past 65. I can tell you that the Canadian medical system was efficient, and even as a landed immigrant, I had medical insurance through their BCHIS program and I had my second heart surgery there. Although I had medical insurance from my Alaska employment in force, the hospital chose to collect their money through BCHISs because they said it was efficient, they did not have to spend a lot of time arguing with the payer, and if they billed my Alaska Insurance, it would take ages to collect the money. I always get a chuckle when Americans bad mouth Canadian Medical care. As an RN, I felt the care there was first class like I got with the Hawaii and Arizona surgeries I had. Canadian health care costs are a fraction of the US average costs because everyone is insured and can get health care when treatment is the cheapest to deliver.

Posted by: mJJ2 | February 16, 2011 4:13 PM | Report abuse

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