Skim through the rhetoric on Canadian health care and you’ll quickly encounter a multitude of myths. To detail even a few necessitates some Canada-U.S. comparisons, though as I noted last week, there are superior alternatives around the world on insurance, funding and delivery. But diverse models are rarely considered because our medical myths prevent due consideration.
Here’s a shortlist of a few of our national favourites.
Myth No. 1, “Canada’s system is public and the U.S. system is private.”
Wrong. According to the Organization for Economic Co-operation and Development (OECD), just over 70 per cent of our Canadian health-care spending is routed through government; that leaves 30 per cent spent privately. The U.S. breakdown is 45 per cent government and 55 per cent private. The effect of such a myth means private alternatives are verboten here even if, on occasion, sensible.
Myth No. 2: “Our system is more efficient than the American one; after all, 15.3 per cent of the American economy is spent on health care; Canada spends just 9.8 per cent.”
This is a significant myth so I’ll bust it in detail. Our system might produce less paperwork produced relative to the American one, where health maintenance organizations and insurance companies track every pill, but that’s about it. Beyond that, our system doesn’t track much of anything.
Dr. Brian Day, now head of the Canadian Medical Association and owner of the private Cambie clinic in Vancouver, once told me he helped public hospitals in Vancouver calculate their costs for knee surgery. They’d never figured out what staffing, equipment, overhead and other costs were for such an operation. A health system can’t be efficient where even the system’s administrators don’t know their input costs in detail, and thus whether the money available is properly prioritized.
In general, the idea that the U.S. is less efficient because it spends more on health care is akin to an argument that South Korea would be less efficient if it spent more of its economy on food relative to North Korea.
Maybe this country should spend more on health care. But even if so, we should be skeptical about funnelling more cash through a system where monopoly delivery of health care is the method of choice for most provincially covered services.
Which leads to Myth No. 3: “Public health care is more efficient because there is no profit margin.”
Wrong again. There’s a profit margin for everyone in the health-care sector. Doctors, accountants, nurses, and janitors earn a “profit.” It shows up as billings or a salary.
The useful question is whether the money spent on profit-seeking providers of health services is allocated in the most effective manner. The likely answer insofar as the government-run system is concerned is “no.”
In Canada, governments often underpay highly skilled people such as physicians and overpay others. That’s due to politics. In the late 1990s in B.C., janitors made almost as much per hour as did nurses: the then NDP government favoured the union with the most clout. Public health-care spending was awarded according to political influence and sympathy, not with regard to needed skills or patient care.
Myth No. 4: “Universal Canadian health care means every Canadian gets treatment.”
False. If everyone had access of the kind that matters — timely — there wouldn’t be between two million and five million Canadians without doctors (estimates vary). Nor would wait lists extend beyond times considered medically safe.
Myth No. 5: “We’ve got the best health care in the world.”
Really? With a 24th place finish out of 28 countries for doctors per 1,000 people, 13th of out of 24 in access to CT scanners, seventh out of 17 in access to mammograms, to name but a few statistics courtesy of the Fraser Institute annual health care report? (Deal with the hard data if you don’t care for the institute.)
The desirable aspect of the Canadian system is universality. But our governments ration health care to control costs. It’s where we fall short. But that “efficiency” means people stay ill longer. Some die as a result of such waits.
The desirable aspect of the American system is that insured patients receive speedier treatment and with better results. But the negative aspect is how care can be costly for the uninsured and underinsured.
Both countries have critical improvements to make and all of us should open our respective minds to worldwide examples and to bright ideas for reform.
There are no perfect health-care systems on the planet, but our collective medical myths prevent us from considering the superior ones.