Appeared on Forbes.com
The heated and often emotionally charged debate over the Affordable Care Act (aka Obamacare) hasn’t subsided despite it being the law of the land for more than four years. Indeed, with the VA scandal, continuing problems in the rollout of aspects of Obamacare and the upcoming mid-term elections, the likelihood of increased acrimony is high.
One aspect of the health care debate in the United States that is, unfortunately, riddled with misinformation is the state of Canada’s single-payer health care system. Too often advocates of Canadian-style health care in the U.S. present limited or even misleading information about the true state of Canada’s health care system and worse, often times present the ideal of Canadian health care rather than its reality.
It’s first important to recognize that a single-payer model is not a necessary condition for universal health care. There are ample examples from OECD countries where universal health care is guaranteed without imposing a single-payer model.
Amongst industrialized countries – members of the OECD – with universal health care, Canada has the second most expensive health care system as a share of the economy after adjusting for age. This is not necessarily a problem, however, depending on the value received for such spending. As countries become richer, citizens may choose to allocate a larger portion of their income to health care. However, such expenditures are a problem when they are not matched by value.
The most visible manifestation of Canada’s failing health care system are wait times for health care services. In 2013, Canadians, on average, faced a four and a half month wait for medically necessary treatment after referral by a general practitioner. This wait time is almost twice as long as it was in 1993 when national wait times were first measured.
Wait times are not a general characteristic of universal health care countries. The Commonwealth Fund’s research consistently shows that Canada has longer wait times than a number of other countries with universal health care. For example, in 2010, 41 percent of Canadian patients waited for two or more months for a specialist appointment compared to only five percent in Switzerland. Further, 25 percent of Canadians waited for four months or more for elective surgery compared to just five percent in the Netherlands. There is also evidence from the OECD showing that some nations with universal access health care systems—Belgium, France, Germany, Japan, Luxembourg, Korea, the Netherlands, and Switzerland—report no problems with wait times.
Long wait times in Canada have also been observed for basic diagnostic imaging technologies that Americans take for granted, which are crucial for determining the severity of a patient’s condition. In 2013, the average wait time for an MRI was over two months, while Canadians needing a CT scan waited for almost a month.
These wait times are not simply “minor inconveniences.” Patients experience physical pain and suffering, mental anguish, and lost economic productivity while waiting for treatment. One recent estimate (2013) found that the value of time lost due to medical wait times in Canada amounted to approximately $1,200 per patient.
There is also considerable evidence indicating that excessive wait times lead to poorer health outcomes and in some cases, death. Dr. Brian Day, former head of the Canadian Medical Association recently noted that “[d]elayed care often transforms an acute and potentially reversible illness or injury into a chronic, irreversible condition that involves permanent disability.”
New research also suggests that wait times for medically necessary procedures may be associated with increased mortality. A recent report concluded that between 25,456 and 63,090 Canadian women may have died as a result of increased wait times between 1993 and 2009. Large as this number is, it doesn’t even begin to quantify the possibility of increased disability, poorer quality of life, and mental stress as a result of protracted wait times.
As Americans struggle with determining the next steps for health care reform, whether that means continuing to tweak the ACA or “repealing and replacing it,” they should keep in mind that the success of any reform depends in part on the degree to which facts dominate fiction and ideology. Discussion of the Canadian model is worthy of inclusion in such a debate, but more in terms of “what to avoid” than as a model for reform. The reality of Canadian health care is that it is comparatively expensive and imposes enormous costs on Canadians in the form of waiting for services, and limited access to physicians and medical technology. This isn’t something any country should consider replicating.
Authors:
Jason Clemens
Executive Vice President, Fraser Institute
Bacchus Barua
Director, Health Policy Studies, Fraser Institute
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