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August 19, 2006

Health Care Woes in Canada

(Posted by John.)

I have, on occasion, seen American authors talk about Canada's health-care system and remark that, unlike in the US, Canadian doctors have embraced single-payer and find it superior.  This is true in an academic sense (Canadian medical journals who have studied it unequivocally say our system is better) but it misses some important counter-examples.

One of the best examples of how Canadian doctors' have a love-hate relationship with our system comes from way back in 1985, when the government of Ontario had to endure a doctor's strike over the issue of extra-billing practices by the province's doctors.  More recently the Canadian Medical Association has, while being opposed by its younger members, endorsed expanding private, for-profit medical care in Canada.  And now, the election of the President of the CMA has become another battleground for the fight against what many Canadians see as the Americanization of their health care system.  (link via Pogge.)

The point of all this is that while Canadian doctors have accepted single-payer health care, they've done so somewhat unwillingly, and they have - since it's inception in the 1960s - continued to fight it on a regular basis.  There's a lesson here for the American advocates of various health-care reforms - don't expect this fight to be over, even if you do win it once.

The one caveat is that I actually think the socialization of American health care would have an immensely salutary effect on the debate in Canada.  On any number of issues, including health care, media policies, and energy issues, the presence of a wealthy, rather predatory* industry to Canada's south has seriously perverted the debate.

*at the very least, the word "predatory" defines the American insurance, energy, and media industries, if not understates their behaviour.

August 19, 2006 | Permalink


Of course Canadian doctors fight single-payer -- they make a lot less money. Never discount self-interest.

The reason folks in the US bring up Canada's system is not its structure's innate superiority, or even that its particulars are so stellar. Admittedly inexpert, I get the idea it is a middle-of-the-pack exemplar in the developed world. (Ezra, this right?)

The reason we bring it up is that it is right across the border and that even it as a middle-of-the-pack system creams the US in outcome-per-dollar, not to mention in how it treats the 98% who are not making $200 grand a year.

I was not myself so vehement until recently, when my wife has had a couple minor procedures. We're healthy and insured, and the billing alone nevertheless is an ongoing ordeal which the adjective 'kafkaesque' does not do justice.

Posted by: wcw | Aug 19, 2006 2:45:27 PM

Or at least the perception of more money south of the border. Last year the average US internist made $166K US and the average Canadian primary care doctor made $185K CDN. By today's exchange rate the Canadian doc made $164.9 US. The Canadian doc probably worked slightly fewer hours, too. I suspect the difference is actually noticeable for specialists, but like everybody else, I like to use my statistics for support rather than illumination.

It should be pointed out that most US docs are forced to use a billing service to interact with multitudinous insurance companies. These services usually charge 20% of collections, so the US MD charged substantially more, but netted about what the Canadian netted.

Posted by: J Bean | Aug 19, 2006 3:43:30 PM

Not to mention that the Canadian single payor system is ILLEGAL, even in Canada.

Socialists beware//The Supreme Court of Canada ruled Thursday that the Quebec government cannot prevent people from paying for private insurance for health-care procedures covered under medicare.

In a 4-3 decision, the panel of seven justices said banning private insurance for a list of services ranging from MRI tests to cataract surgery was unconstitutional under the Quebec Charter of Rights, given that the public system has failed to guarantee patients access to those services in a timely way.

As a result of delays in receiving tests and surgeries, patients have suffered and even died in some cases, justices Beverley McLachlin, Jack Major, Michel Bastarache and Marie Deschamps found for the majority.

The Quebec government reacted by saying it would apply immediately for a stay of between six months and two years before the decision takes effect, given the chaos it could cause in the delivery of medical services in Quebec.//


Single payer will never work in the United States because it would be unconstitutional here too.

So all you Deaniacs, back to the drawing board.

Posted by: Ron Greiner | Aug 19, 2006 4:37:57 PM

"Last year the average US internist made $166K US and the average Canadian primary care doctor made $185K"

Those Canadian stats are wrong. According to the US Labor Dept, the average general internist pulled in 156k per year


the stats you are using for Canadian doctors are TOTAL BILLINGS, not salary data. Total billings are net revenues, out of which doctors have to pay staff, utilities, etc. The true salary numbers are a lot lower.

According to the income statistics division, Canadian docs salary across all specialties AVERAGES 110k CDN. When converted to USD, that drops to about 90k USD.

Posted by: joe blow | Aug 19, 2006 6:14:53 PM

Bottom line --

If you're uninsured because you can't afford it, the Canadian system is SUPERIOR.

Posted by: Jay Jerome | Aug 19, 2006 6:31:05 PM

I think it is worth noting in this context that when we discuss the virtues of markets, we usually point to the benefits they provide to consumers by disciplining producers. You would not expect the producers to be happy about a situation in which they are (as a result of competition, say) prevented from charging just as much as they might please. This is why producers are always looking for ways to create barriers to entry into their industries and otherwise to secure monopoly rents.

But ironically, in the case of health care, markets and monopolies each produce the opposite results from what we are otherwise inclined to expect: Canadian doctors are much less happy with their system than American doctors (and as joe blow points out, the Canadians make much less), while Canadian consumers are much happier with their health care system than Americans are. So the fact that Canadian doctors are in various ways unhappy with their lot, far from being a bad sign for advocates of a national health care system, is evidence that such a system does the market's job better than the market.

Posted by: Rich C | Aug 19, 2006 11:31:22 PM

Single payer will never work in the United States because it would be unconstitutional here too.

So all you Deaniacs, back to the drawing board.

Single-payer will never come to America, and it has nothing to do with the Constitution.

It will never come to America, because it means that colored people will prosper thereby.

Our polity counts among its members fifty million voters who would each volunteer to live with their family in a cardboard box under a bridge and eat sparrows toasted on an old curtain rod, provided only that the boss guarantees that the black-gay-Mescin in the next box over doesn't even have a curtain rod, and will burn his fingers.

Unless this changes, you'll never see national health care.

Remember that when Social Security first came in, domestics (black women) and agricultural hired help (black men) were excluded, until the mid-1950's.

If you could craft a national health service that could legally, constitutionally, exclude black and brown people, Congress would have the bill passed by Tuesday afternoon.

Posted by: Davis X. Machina | Aug 20, 2006 11:50:04 AM

sadly Davis does capture a part of this equation. Not so much color a lone, but the aspect of believing the 'other' whoever the 'other' is will receive a benefit. So long as it is considered 'same' (ie, same class, same race, same sexual orientation, etc) then peo in this country have traditionally not as had as many problems with it. At work, there is this white Republican woman who is a temp so she uses the govt funded low income insurance that she regularly bitches that others should not get. She does so because my company does not cover temp and her agency doesn't provide her health insurance. she doesn't catch her own irony in using this insurance but then saying she doesnt want to give others a 'hand out.' who are these others she is talking about? my guess is those who dont look or seem like her.

Posted by: akaison | Aug 20, 2006 3:52:35 PM

The OECD and the IMF both have done studies, the upshot of which is that public support for social provision, and especially actual transfer payments, increases as the diversity of a country decreases, in countries generally.

Posted by: Davis X. Machina | Aug 20, 2006 4:36:40 PM

WTF are you talking about? Are you honestly claiming that Americans vote down entitlement programs because they dont want "those other people" getting funds?

Thats a load of bull. Take a recent look at american voting records and you will find that hte general public LOVES to get free money from the fed govt. All this talk about voters denying themsevles fed money so they can screw over blacks and mexicans is pure myth.

Posted by: joe blow | Aug 20, 2006 7:46:28 PM

akaison and David X Machina: You are wrong. The fact that outlawing private insurance is UNCONSTITUTIONAL, even in Canada, is exactly the reason that its not going to happen in the US.

This so-called white temp in New York is allowing federal taxpayer dollars to flow into NY at the pathetic cost of $10,000 per year. Its a giant river of money, Federal funds, flowing into NY. If a single person in NY costs taxpayers $10,000 per year for Medicaid, how much does a family of 4 cost, $40,000 a year!!!!!

Government always pays way too much, to politically connected employer-based insurance companies who have Medicaid contracts too, wake up.

Besides, if a broke person on Medicaid does get a job they get a "termination notice" from the state of NY's Medicaid program. So if you're diagnosed with a sickness while on Medicaid don't try and make a buck because your insurance will terminate. How stupid is that?

President Bush wants the Federal Government to purchase portable individual health insurance for poor people then have the federal government also make an HSA deposit too, tax free, so the family can use those funds for 1st dollar coverage for medical, vision and dental expenses. The choice is the poor person's to either save or spend the HSA funds.

As Governor, Lynn Swann supports tax credits for employer HSA deposits. This means Pennsylvania employers have a choice too. Employers can spend their Pennsylvania Corporate State Income Tax to the State or choose to give their tax dollars to their own employees. Governor Swann would target wealth to the poor. The current Democrat Governor, Rendell, has no ideas about healthcare, its sad. Rendell has no vision. Rendell has no ideas.

Come on guys, support Lynn Swann because he has wonderful ideas. What would happen if a high school football player had spinal damage as a minor? With the state of NY' Children Health Insurance Plan (CHIP or SCHIP) all children are terminated at a majority age. This is so sad for sick or hurt children.

President Bush and Lynn Swann support portable health insurance that everyone can keep if the get older, change jobs, get fired or retire.

Who you choose matters. Smart parents prefer to choose the health insurance company on their children and not some uninformed union, employer or the government. Its just common sense guys. Don't forget, the average cost for employer-based health insurance is over $1,000 a month per family. Medicaid spends more. In contrast, a few companies have portable individual HSA insurance for less than $300 a month in Pittsburgh (30 year old couple + 2 children).

Of course in NY the cost is much more for portable HSA insurance, if you can even find it, because of government regulation to keep competition out of the state to creat giant monopolies. Same with New Jersey.

Vote for Democrats and line the pockets of Blue Cross CEOs. Lynn Swann wants reform. Like Lynn Swann said, "If you want change, I'm you're guy."

Lynn Swann's new commercial that hits today can be seen at his website. Be fair, watch it then decide.

Posted by: Ron Greiner | Aug 21, 2006 10:20:10 AM

WTF are you talking about? Are you honestly claiming that Americans vote down entitlement programs because they dont want "those other people" getting funds?

I'm maintaining precisely that, and that it's not an American phenomenon, either, and I've got studies that show it.

What you got?

Posted by: Davis X. Machina | Aug 21, 2006 11:24:25 AM

In a 4-3 decision, the panel of seven justices said banning private insurance for a list of services ranging from MRI tests to cataract surgery was unconstitutional under the Quebec Charter of Rights, [...] Single payer will never work in the United States because it would be unconstitutional here too.

And further more, there is no legal way to ban women from wearing trousers, and therefore dresses are unconstitutional!

Posted by: Phoenician in a time of Romans | Aug 21, 2006 9:26:53 PM

Phoenician: The Canadian Government has a problem with single payer under their constitution. Look at the Canadian court ruling. Good luck trying to get single payor in the US. We have a Constitution too.

Your dresses comment was really smart. You must be some kind of policy researcher.

Posted by: Ron Greiner | Aug 21, 2006 9:59:46 PM

Ron, you have a problem with logic. That a court says you cannot ban A does not mean B is unconsitutional.

Your comment was really stupid. Did you have to use a dictionary to spell "policy researcher"?

Posted by: Phoenician in a time of Romans | Aug 21, 2006 11:06:53 PM

I think every place has their own woes when it comes to their health care. I think it is the usual thing and hopefully, it will end nice and good.

Posted by: Geriatric Medicine doctor Detroit | Sep 10, 2010 4:07:15 AM

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