Back in 2017, as the Donald Trump administration was trying — unsuccessfully — to repeal the Obama administration’s Affordable Care Act, Vice-President Mike Pence said the following during an with an Alaskan radio station: “You know, somewhere in between where I’m sitting in Washington, D.C., and Alaska is a place called Canada. I probably don’t need to tell the people in Alaska about the failings of national socialized health care, because it’s right in our neighbour, and you see the results every day.”
Does Pence have a point, given Canada’s problems with hallway health care, doctor shortages, and wait times for surgeries? Or are American politicians on the other side of the aisle, such as Senator Bernie Sanders, right that Canada should serve as a model for the U.S.?
Another possibility, of course, is that they’re both wrong — and that neither the Canadian nor the American systems are worthy of emulation.
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“We're smug about our health system, because it's one of the things we think we've done better than the Americans,” says former Ontario deputy health minister Michael Decter. “But, if you compare us to Europe or Australia and New Zealand, we don't look so good.”
So how does Canada’s system stack up against those of other countries?
According to a 2017 study by the U.S.-based Commonwealth Fund, Canada ranked ninth out of 11 advanced countries for the quality of its health-care system — ahead only of France and the U.S., which came dead last. The United Kingdom came first, followed by Australia and the Netherlands.
In all five areas assessed — care process, access, administrative efficiency, equity, and health-care outcomes — the Canadian system was found to be either middling or below average.
Decter says one of the reasons we’ve fallen behind is that our system is not as well integrated. “We are still overusing hospitals and overusing long-term-care institutions,” he says. Ontario has committed to building 30,000 new LTC beds, he notes, while other countries are investing in care that keeps vulnerable seniors in their homes as long as possible.
“And I can tell you,” he says, “when the dust settles on this [COVID-19] catastrophe, it'll turn out that the people that were looked after at home, by home care, had a much lower fatality rate than those in nursing homes.”
Irfan Dhalla, vice-president of physician quality at Toronto’s Unity Health Network and a physician at St. Michael’s Hospital, agrees that Canada’s system has real weaknesses — most people, he notes, need to rely on private insurance to cover important aspects of modern medical care, such as drugs.
In his view, being so close to the U.S. actually makes it harder for Canada to maintain a top-ranked health-care system, as we’re forced to try to keep up with the relatively high salaries south of the border. Our proximity to the U.S., he says, also pushes up our drug prices. “What that means is that there's even less money left over for home care, long-term care, mental-health care. And so those aspects of our health-care system are woefully impaired.”
And our system struggles for another reason — one not covered by the Commonwealth Foundation study, Decter adds. “We've got a very large Indigenous population, probably a million-plus Indigenous people in Canada whose health status is terrible compared to the rest of the population — like eight years less life expectancy,” he says. “It's very hard if you start to compare the health of Canadians to the health of say, the French, and the French don't have a million people that are living in third-world conditions.”
While Dhalla cited the Commonwealth study in a 2018 paper he co-authored on the state of Canada’s health-care system, he cautions that its findings should be taken with a grain of salt. “If you set up a scorecard, in a way, designed to make American system look bad, it will also make the Canadian system look pretty bad,” he says. “And that's because some of the big problems with the United States — affordability of health care, and the accessibility and quality of primary care — are problems that we share.”
Dhalla does add, though, that Canada’s system does a good job in many areas, such as trauma, cancer care, care after a heart attack, and cystic fibrosis care.
Decter agrees that you need to be cautious when attempting to draw international comparisons — and that Canada does quite well in many areas of hospital and specialized care. However, he thinks the Commonwealth study is a solid reference point and that our country falls short when it comes to many aspects of basic care. “The bulk of people don't need to be separated Siamese twins or to have some rare procedure done — what they need is good basic care for chronic diseases,” he says. “There are people in Toronto that don't get basic insulin or basic care for their diabetes, because they fall through the cracks.”
Dhalla cautions against using the U.S. as a model. “We definitely need to look elsewhere when we are thinking about how to improve our health-care system,” he says. “And we also need to hope that the health-care system in the United States gets a lot better — because that will stimulate us to improve our own health care.”