Canadian vs. American Healthcare: 10 Myths Busted

By Sara Robinson

This is the election year that we may finally get to have the Great American Healthcare Debate. If we're going to have this conversation, it would be great if we could start out (for once) with actual facts, instead of ideological posturing, wishful thinking, hearsay, and random guessing about how things get done up here. I'm both a health-care-card-carrying Canadian resident and an uninsured American citizen who regularly sees doctors on both sides of the border. As such, I'm in a unique position to address the pros and cons of both systems firsthand. Here are my 10 healthcare myths, busted:

False. In socialized medical systems, the doctors work directly for the state. In Canada (and many other countries with universal care), doctors run their own private practices, just like in the U.S. The only difference is that every doctor deals with one insurer, instead of 150. And that insurer is the provincial government, which is accountable to the legislature and the voters if the quality of coverage is allowed to slide.
The proper term for this is "single-payer insurance." In talking to Americans about it, the better phrase is "Medicare for all."

True and False. Doctors in Canada do make less than their U.S. counterparts. But they also have lower overhead, and usually much better working conditions. A few reasons for this:

First, they don't have to charge higher fees to cover the salary of a full-time staffer to deal with over a hundred different insurers, all of whom are bent on denying care whenever possible. Second, they don't have to spend several hours every day on the phone cajoling insurance company bean-counters into doing the right thing by their patients. My doctor in California worked a 70-hour week: 35 hours seeing patients, and another 35 hours on the phone arguing with insurance companies. My Canadian doctor, on the other hand, works a 35-hour week, period. Third, the average American medical student graduates $140,000 in hock. The average Canadian doctor's debt is roughly half that. Finally, Canadian doctors pay lower malpractice insurance fees.

Canadians are far less likely to sue, since they're not having to absorb devastating financial losses in addition to any physical losses when something goes awry. And, no matter what happens, the victim will remain insured for life.

One unsurprising side effect of all this is that the doctors I see here are, to a person, more focused, more relaxed, more generous with their time, more up-to-date in their specialties, and overall much less distracted from the real work of doctoring.

True and False again — it depends on which province you live in, and what's wrong with you. As a general rule, the farther north you live, the harder it is to get to care, simply because the doctors and hospitals are concentrated in the south. But that's just as true in any rural county in the U.S.

The percentage of Canadians who'd consider giving up their beloved system consistently languishes in the single digits. A few years ago, a TV show asked Canadians to name the Greatest Canadian in history; and in a broad national consensus, they gave the honor to Tommy Douglas, the Saskatchewan premier who is considered the father of the country's health care system. In spite of that, though, grousing about health care is still unofficially Canada's third national sport after curling and hockey.

And for the country's newspapers, it's a prime watchdogging opportunity. Any little thing goes sideways at the local hospital, and it's on the front pages the next day. Those kinds of stories sell papers, because everyone is invested in that system and has a personal stake in how well it functions. The American system might benefit from this kind of constant scrutiny.

Critics should be reminded that the American system is not exactly instant-on, either. When I lived in California, I had excellent insurance, and got my care through one of the best university-based systems in the nation. Yet I routinely had to wait anywhere from six to twelve weeks to get in to see a specialist. Non-emergency surgical waits could be anywhere from four weeks to four months. After two years in the BC system, I'm finding the experience to be pretty much comparable, and often better.

4. You wait forever to get a family doctor.

Mostly False. Again, it all depends on where you live. I live in suburban Vancouver, and there are any number of first-rate GPs in my neighborhood who are taking new patients. If you don't have a working relationship with one, but need to see a doctor now, there are 24-hour urgent care clinics in most neighborhoods that will usually get you in and out in under an hour.

Scurrilously False. For the record: Canadians pick their own doctors, just like Americans do. And not only that: since it all pays the same, poor Canadians have exactly the same access to the country's top specialists that rich ones do.

True — but not as big an issue as you might think. The province does charge a small monthly premium (ours is $108/month for a family of four) for the basic coverage. However, most people never even have to write that check: almost all employers pick up the tab for their employees' premiums as part of the standard benefits package; and the province covers it for people on public assistance or disability.

"The basics" covered by this plan include 100% of all doctor's fees, ambulance fares, tests, and everything that happens in a hospital — in other words, the really big-ticket items that routinely drive American families into bankruptcy. In BC, it doesn't include "extras" like medical equipment, prescriptions, physical therapy or chiropractic care, dental, vision, and so on; and if you want a private or semiprivate room with TV and phone, that costs extra (about what you'd pay for a room in a middling hotel). That other stuff does add up, but it's far easier to afford if you're not having to cover the big expenses, too.

More preposterous bogosity. They are exactly the same drugs, made by the same pharmaceutical companies, often in the same factories. The Canadian drug distribution system, however, has much tighter oversight; and pharmacies and pharmacists are more closely regulated. If there is a difference in Canadian drugs at all, they're actually likely to be safer.

False. And bogglingly so. One of the things that constantly amazes me here is how well-cared-for the elderly and disabled you see on the streets here are. No, these people are not being thrown out on the curb. In fact, they live longer, healthier, and more productive lives because they're getting a constant level of care that ensures small things get treated before they become big problems.

False. The philosophical basis of America's privatized health care system might best be characterized as medical Calvinism: Health, like salvation, is entirely in our own hands. If you just have the character and self-discipline to stick to an abstemious regime of careful diet and clean living, you'll never get sick. Of course, this is bad theology whether you're applying it to the state of one's soul or one's arteries. The Canadian system reflects a very different philosophy. It's built on the belief that maintaining health is not an individual responsibility, but a collective one. Since none of us controls fate, the least we can do is be there for each other.

This difference is expressed in a few different ways. First: Canadians tend to think of tending to one's health as one of your duties as a citizen. You do what's right because you don't want to take up space in the system, or put that burden on your fellow taxpayers. Second, "taking care of yourself" has a slightly expanded definition here, which includes a greater emphasis on public health. Canadians are serious about not coming to work if you're contagious, and seeing a doctor ASAP if you need to. Staying healthy includes not only diet and exercise; but also avoiding stress and getting things treated while they're still small and cheap to fix.

The bottom line: When it comes to getting people to make healthy choices, appealing to their sense of the common good seems to work at least as well as Calvinist moralizing.

False with a grain of truth. On one hand, our annual Canadian tax bite runs about 10% higher than our U.S. taxes did. On the other, we're not paying out the equivalent of two new car payments every month to keep the family insured here. When you balance out the difference, we're actually money ahead. When you factor in the greatly increased social stability that follows when everybody's getting their necessary health care, the impact on our quality of life becomes even more significant.

But, as many of us know all too well, there's also constant tension between what patients want and what private insurers are willing to pay. At least when it's in government hands, we can demand some accountability. And this accountability is what makes all the difference between the two systems.

The end result is that the vast majority of Canadians get the vast majority of what they need the vast majority of the time. It'll be a good day when Americans can hold their heads high and proudly make that same declaration.

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