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Don't believe hype about Canadian health care model


By Steve Chapman

June 20, 2005

CHICAGO - To critics of the American health care system, Shangri-La is not
a fantasy but a shimmering reality, though it goes by another name: Canada.

Recently, the Canadian Supreme Court, ruling on a challenge to the health
care system in the province of Quebec, sent a clear message south: Don't
believe the hype.

The health care program, said the court, has such serious flaws that it is
violating constitutional rights and must be fundamentally changed. And the
flaws are part of the basic structure of Canada's health care policy.

The dirty secret of the system is that universal access is no guarantee of
treatment. Sick Canadians spend months and even years on waiting lists for
surgery and other procedures.

In 1993, the average wait to see a specialist after getting a doctor's
referral was nine weeks. Since then, according to the Fraser Institute of
Vancouver, it has increased to 18 weeks.

The typical patient needing orthopedic surgery has time to get pregnant and
deliver a baby before being called. The Supreme Court cited the testimony
of one orthopedic surgeon that 95 percent of patients in Canada waited over
a year for knee replacements - with many of them in limbo for two years. In
some cases, the delay lasts longer than the person enduring it. Or as the
Supreme Court put it: "Patients die as a result of waiting lists for
public health care."

Not only does the government subject its citizens to painful and even fatal
delays in the public system, it bars them from seeking alternatives in the
private market. You see, it's illegal for private insurers to pay for
services covered by the public system.

That policy is what forced the Supreme Court to order changes. "The
prohibition on obtaining private health insurance," it declared,
"is not constitutional where the public system fails to deliver
reasonable services."

The program has created a gap between supply and demand that is wider than
Hudson Bay. Its failings, however, go beyond that. The single-payer
approach, for example, is often held up as the only way to simultaneously
control costs and deliver quality care. In fact, Canada has somehow managed
to do neither.

After adjusting for the age of the population, the Fraser Institute
compared 27 countries in the Organization for Economic Cooperation and
Development that guarantee universal access to health care. By some
mysterious alchemy, Canada has proportionately fewer physicians than most
of these nations but spends more on health care than any except Iceland.

It would be a dubious feat to control costs only by depriving people of
treatment. But to forcibly deprive people of treatment while letting costs
surge is no achievement at all.

Admirers of our good neighbor to the north say the United States pours
money into all sorts of fancy equipment but doesn't get better results by
such measures as life expectancy. But life expectancy is affected by
multiple factors, including education, crime rates and diet - with health
care playing only a modest role. In those areas where modern medicine can
make a big difference, the United States does very well.

Take breast cancer. In Britain, which is famous for its socialized system,
close to half of all victims die of the disease, according to a recent Cato
Institute study by John Goodman, head of the National Center for Policy
Analysis. In Germany and France, almost one-third do. In Canada, the figure
is 28 percent - and here, it's 25 percent. Our mortality rate for prostate
cancer is 67 percent lower than Britain's and 24 percent lower than
Canada's.

The usual story we hear is that the health care system next-door provides
first-rate care to all, at low cost. The realities - dangerous delays,
bloated expenditures and mediocre results - are not so appealing. American
liberals may not welcome evidence that the single-payer model works far
better in theory than in practice. But for that, they can blame Canada.

Steve Chapman is a columnist for the Chicago Tribune, a Tribune Publishing
newspaper. His column appears Mondays and Wednesdays in The Sun.

Copyright + 2005, The Baltimore Sun

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