Most every uninformed debate on health care in the United States has its Canadian moment. The guy against universal coverage pounds the table and says: “People in Canada wait three months for an MRI! We don’t want that here.”
Not a bad conclusion. We don’t want the Canadian way of delivering medical services. But that doesn’t mean we don’t want universal coverage. Nearly every industrialized country guarantees health coverage for all without the shortcomings of the Canadian system.
Under Canada’s single-payer setup, the government writes all the checks for health care. Of the 28 developed countries that offer universal coverage, only Canada bans private medicine.
Herein lies the problem that a recent Canadian Supreme Court decision may start to fix. The court has just lifted the prohibition on private health insurance in the province of Quebec.
The ruling has cheered table-pounders from America’s conservative wing. Many are using it to hit the dream of universal coverage over the head. And left-leaning Canadians working their own neuroses are helping them. Both groups are misguided.
“We’ve become stuck in the weird dichotomy that private sector involvement in health care means abandoning the universal access nature of our program,” says Nadeem Esmail, senior health policy analyst at the Fraser Institute, a Vancouver-based think tank.
Not so.
The Supreme Court case centered on George Zeliotis and his bum hip. Zeliotis’ arthritic hip was torturing him, but the Montreal retiree had to wait a year for hip replacement surgery. Private insurance, which he could not buy, might have helped him avoid the long waiting list. (Loopholes in certain provinces let Canadians patronize private clinics, as long as they pay with cash.)
The court said that Zeliotis had the right to buy private health insurance, when the public system didn’t provide timely care. The heavens opened on Canadian politics. “The ban in other provinces still stands,” policy analyst Esmail says, “but it’s on shaky ground now.”
Some Canadians fear that the court ruling threatens their beloved tradition of equal-quality care for all citizens: It would add a second tier of private coverage for rich people, a process they denounce as “Americanization.”
Like it or not, Canadians already have a two-tier health system. The second tier happens to be in the United States. Zeliotis could have gone to Detroit and had his hip replaced for something in the neighborhood of $35,000. He couldn’t afford it. But affluent Canadians can and do avail themselves of American medicine.
Rather than obsess about rich people getting fancier medical services, health-system planners should ensure that the bottom tier gets good care. They should think “floors,” not “ceilings.”
Canada spends more on health care than any other industrialized country with universal coverage, but it doesn’t get great results, according to a Fraser Institute study. The World Health Organization ranks Canada’s health-care system 30th in the world. The No. 1 system is France’s, which allows private medical services to augment its public program. (Canadians could just as easily call allowing private insurance the Frenchification of their system as the Americanization of it.)
Some health-care systems permit a great deal of free-market competition while ensuring universal coverage. Norway’s program, which ranks 11th in the world, has an extensive network of supplementary care. Private clinics there do open-heart, hip and other surgeries that may require a long wait in the public system.
The American debate often skips past the reality that, like the French, we already offer a mix of public and private health care. U.S. taxpayers provide health insurance for select groups – Medicare serving the elderly and Medicaid for the poor. What makes us different from France is that we don’t cover everybody, we spend a ton more per-capita on health services and we sit 37th in world rankings.
Canadians and Americans, meanwhile, seem to nurture mirror-image delusions about their health-care systems. Canadians believe that private health care can’t coexist with a universal system serving rich and poor. Americans think that 45 million uninsured people is the price they must pay for the freedom to buy the medicine they want.
Both peoples are presented a false choice, between a restrictive single-payer system and total chaos, American-style. Other models, on other continents, are definitely worth a look.
Froma Harrop is a Providence Journal columnist. Contact her by writing to fharrop@projo.com.
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