Canada’s health system a point of pride, but has big gaps

It’s the only developed-world country with universal care that doesn’t cover prescription drugs.

  • Amanda Coletta The Washington Post
  • Saturday, February 24, 2018 2:14pm
  • Nation-World

By Amanda Coletta / The Washington Post

TORONTO — When the Canadian Broadcasting Corp. asked Canadians to pick the greatest-ever Canadian in 2004, they did not select hockey star Wayne Gretzky or Nobel laureate Sir Frederick Banting, who co-discovered insulin.

They chose Tommy Douglas, who almost lost a leg to a bone infection as a boy because his parents couldn’t afford his medical treatment. When he became premier of Saskatchewan in 1944, he implemented a single-payer, universal health-care system that became the model for the rest of the country.

Canada’s health care system, known as Medicare, is an unrivaled pillar of Canadian national identity. Nearly 90 percent of Canadians believe that eliminating it would result in a fundamental change to the nature of Canada.

And as Americans have debated health-care revisions, many advocates of universal coverage like Sen. Bernie Sanders, I-Vt., have looked at Canada as a model to emulate.

But Canada’s universal health care system is in danger of becoming outdated, putting its credibility as a global health leader at risk, according to a new series of papers and commentaries published Friday in the Lancet, a British medical journal.

This is the journal’s first series on Canada and its release was timed to coincide with the beginning of the country’s G-7 presidency and the 150th anniversary of Confederation.

“The Canadian system gets batted around as either an example of a socialist disaster or a utopian dream,” said Danielle Martin, one of the authors of the study and a Toronto-based physician and professor. “It is a good time for Canadians to set the record straight about who we are and how our health care system does and doesn’t work.”

Under Canada’s taxpayer-funded Medicare system, Canadians don’t pay out-of-pocket for essential medical services like doctor and hospital visits. Co-payments are a foreign concept, and buying private insurance for health care procedures covered under Medicare is banned.

Nearly two-thirds of Canadians have supplemental private insurance or employer-sponsored plans to cover the costs of prescription drugs, dentistry, vision care, rehabilitative service and home health care.

The delivery of health care is left up to the provinces and territories, which each have their own insurance plans and receive transfer payments from the federal government. The private sector delivers a lot of the care.

Canada spends less per capita on health care than the United States and performs better on a wide range of indicators like life expectancy, obesity rates, infant mortality and “amenable mortality” — deaths that theoretically could have been avoided by timely and effective medical care — according to the series.

But its authors note that these glowing statistics conceal abysmal health outcomes for Canada’s 1.7 million indigenous people, who face disproportionately higher rates of suicide, infant mortality and chronic disease. Canada’s Inuit people have a life expectancy that is as much as 15 years shorter than non-indigenous Canadians, and tuberculosis rates that are 270 times higher than those of the Canadian-born, non-indigenous population.

In an introductory commentary, editors of the Lancet write that these health inequities “suggest a developing world within Canada’s borders.”

The study is also critical of Canada’s long wait times for nonemergency, specialty procedures like knee and hip replacements and non-urgent advanced imaging — higher than those in America — describing them as a “lightning rod issue” that could undermine support for Medicare among Canadians.

Canada’s status as the only country in the developed world with universal health care that does not cover prescription drugs is panned, too. In almost one-quarter of Canadian households, someone is not taking medications because of an inability to pay, according to the Angus Reid Institute, a polling organization.

“When we compare ourselves to the United States, we feel really great,” Martin said. “But when it comes to prescription drugs, we are in the exact same situation as our American colleagues, when we write out prescriptions and our patients don’t know how they are going to pay for them.”

As one of the biggest champions of Canada’s Medicare system, Sanders appears to have taken this criticism into consideration when designing his own single-payer plan. His proposed Medicare for All Act offers coverage for prescription drugs, optometry and dentistry, making it more generous than what Canada currently offers.

Of course, not all Democrats support that approach. House Minority Leader Nancy Pelosi, D-Calif., for instance, has advocated making health coverage more expansive through smaller, more gradual steps as opposed to a radical overhaul.

The Lancet series faults Canada’s incrementalist approach to health-care changes for Medicare’s status as “a system in stasis.”

“Incrementalism only works if you take one step, and then immediately take the next, and then immediately take the next,” Martin said. “The concern always is that you will take one step and then spend all of your time defending the one step.”

Talk to us

> Give us your news tips.

> Send us a letter to the editor.

> More Herald contact information.

More in Nation-World

FILE - Britain's Queen Elizabeth II looks on during a visit to officially open the new building at Thames Hospice, Maidenhead, England July 15, 2022. Buckingham Palace says Queen Elizabeth II is under medical supervision as doctors are “concerned for Her Majesty’s health.” The announcement comes a day after the 96-year-old monarch canceled a meeting of her Privy Council and was told to rest. (Kirsty O'Connor/Pool Photo via AP, File)
Queen Elizabeth II dead at 96 after 70 years on the throne

Britain’s longest-reigning monarch and a rock of stability across much of a turbulent century died Thursday.

A woman reacts as she prepares to leave an area for relatives of the passengers aboard China Eastern's flight MU5735 at the Guangzhou Baiyun International Airport, Tuesday, March 22, 2022, in Guangzhou. No survivors have been found as rescuers on Tuesday searched the scattered wreckage of a China Eastern plane carrying 132 people that crashed a day earlier on a wooded mountainside in China's worst air disaster in more than a decade. (AP Photo/Ng Han Guan)
No survivors found in crash of Boeing 737 in China

What caused the plane to drop out of the sky shortly before it was to being its descent remained a mystery.

In this photo taken by mobile phone released by Xinhua News Agency, a piece of wreckage of the China Eastern's flight MU5735 are seen after it crashed on the mountain in Tengxian County, south China's Guangxi Zhuang Autonomous Region on Monday, March 21, 2022. A China Eastern Boeing 737-800 with 132 people on board crashed in a remote mountainous area of southern China on Monday, officials said, setting off a forest fire visible from space in the country's worst air disaster in nearly a decade. (Xinhua via AP)
Boeing 737 crashes in southern China with 132 aboard

More than 15 hours after communication was lost with the plane, there was still no word of survivors.

In this photo taken from video provided by the Ukrainian Presidential Press Office, Ukrainian President Volodymyr Zelenskyy speaks to the nation in Kyiv, Ukraine, Sunday, Feb. 27, 2022. Street fighting broke out in Ukraine's second-largest city Sunday and Russian troops put increasing pressure on strategic ports in the country's south following a wave of attacks on airfields and fuel facilities elsewhere that appeared to mark a new phase of Russia's invasion. (Ukrainian Presidential Press Office via AP)
Ukraine wants EU membership, but accession often takes years

President Volodymyr Zelenskyy’s request has enthusiastic support from several member states.

FILE - Ukrainian servicemen walk by fragments of a downed aircraft,  in in Kyiv, Ukraine, Friday, Feb. 25, 2022. The International Criminal Court's prosecutor has put combatants and their commanders on notice that he is monitoring Russia's invasion of Ukraine and has jurisdiction to prosecute war crimes and crimes against humanity. But, at the same time, Prosecutor Karim Khan acknowledges that he cannot investigate the crime of aggression. (AP Photo/Oleksandr Ratushniak, File)
ICC prosecutor to open probe into war crimes in Ukraine

U.N. human rights chief Michelle Bachelet confirmed that 102 civilians have been killed.

FILE - Refugees fleeing conflict from neighboring Ukraine arrive to Zahony, Hungary, Sunday, Feb. 27, 2022. As hundreds of thousands of Ukrainians seek refuge in neighboring countries, cradling children in one arm and clutching belongings in the other, leaders in Poland, Hungary, Bulgaria, Moldova and Romania are offering a hearty welcome. (AP Photo/Anna Szilagyi, File)
Europe welcomes Ukrainian refugees — others, less so

It is a stark difference from treatment given to migrants and refugees from the Middle East and Africa.

Afghan evacuees disembark the plane and board a bus after landing at Skopje International Airport, North Macedonia, on Wednesday, Sept. 15, 2021. North Macedonia has hosted another group of 44 Afghan evacuees on Wednesday where they will be sheltered temporarily till their transfer to final destinations. (AP Photo/Boris Grdanoski)
‘They are safe here.’ Snohomish County welcomes hundreds of Afghans

The county’s welcoming center has been a hub of services and assistance for migrants fleeing Afghanistan since October.

FILE - In this April 15, 2019, file photo, a vendor makes change for a marijuana customer at a cannabis marketplace in Los Angeles. An unwelcome trend is emerging in California, as the nation's most populous state enters its fifth year of broad legal marijuana sales. Industry experts say a growing number of license holders are secretly operating in the illegal market — working both sides of the economy to make ends meet. (AP Photo/Richard Vogel, File)
In California pot market, a hazy line between legal and not

Industry insiders say the practice of working simultaneously in the legal and illicit markets is a financial reality.

19 dead, including 9 children, in NYC apartment fire

More than five dozen people were injured and 13 people were still in critical condition in the hospital.

15 dead after Russian skydiver plane crashes

The L-410, a Czech-made twin-engine turboprop, crashed near the town of Menzelinsk.

FILE - In this March 29, 2018, file photo, the logo for Facebook appears on screens at the Nasdaq MarketSite in New York's Times Square. Facebook prematurely turned off safeguards designed to thwart misinformation and rabble rousing after Joe Biden defeated Donald Trump in the 2020 elections in a moneymaking move that a company whistleblower alleges contributed to the deadly Jan. 6, 2021, invasion of the U.S. Capitol. (AP Photo/Richard Drew, File)
Facebook, WhatsApp, Instagram in hourslong worldwide outage

Something made the social media giant’s routes inaccessable to the rest of the internet.

Oil washed up on Huntington Beach, Calif., on Sunday, Oct. 3, 2021. A major oil spill off the coast of Southern California fouled popular beaches and killed wildlife while crews scrambled Sunday to contain the crude before it spread further into protected wetlands. (AP Photo/Ringo H.W. Chiu)
Crews race to limited damage from California oil spill

At least 126,000 gallons (572,807 liters) of oil spilled into the waters off Orange County.

Support local journalism

If you value local news, make a gift now to support the trusted journalism you get in The Daily Herald. Donations processed in this system are not tax deductible.