By Carlin Becker – Re-Blogged From IJR
Health care is always on Americans’ minds, and the politics around keeping people insured and healthy, cutting costs and providing high-quality care remains a critical issue.
While some have argued for deregulating the health care industry, insisting less red tape and more competition would yield better results, others on the political spectrum have pushed for a government-run system reminiscent of our neighbors to the north — but is Canada’s health care system really better than ours?
The Canadian health care system is better than that in the United States.
“Here in Canada,” Bernie Sanders (I-Vt.) said on a trip to the country last year, “they provide quality health care to all people — and I don’t think there’s any debate that the quality of care is here is as good or better than in the United States, and they do it for half the cost.”
But are his assertions correct?
When comparing the two models, it’s important to take a look at how each system works, spending and costs for both, access to and quality of care, and health and wellness figures for each country.
How the Systems Work
In the United States, health care plans are typically provided by private insurers, with most of the privately insured population getting coverage from their employers, according to the Kaiser Family Foundation. Government-run insurance options like Medicaid and Medicare function as safety nets for those who qualify — usually low-income individuals and senior citizens, respectively.
Intended to help cover those still left without insurance, the Affordable Care Act (ACA) expanded Medicare and also offers individual plans for purchase on the Obamacare market.
Canada, however, provides access to medical coverage to all citizens through its publicly funded universal health care system. Each province is then responsible for administering health care services in compliance with federal standards.
While it does cover what Americans consider “essential health benefits,” Canadian Medicare does not cover other services like prescription costs or dental care, leading a large number of Canadians to supplement the coverage with a private health insurance plan. With price controls for medication, prescriptions in Canada tend to cost less than in the U.S., but many patients without private insurance still forgo filling prescriptions or receiving dental care, according to the Canadian Institute for Health and Information.
Spending and Costs
When it comes to spending less, covering more people and keeping health care less expensive, it looks like Canada has us beat. According to the Organization for Economic Co-operation and Development (OECD), the United States spent 17.2 percent of its gross domestic product (GDP) on health care in 2016 alone. Canada, on the other hand, spent less on health care, clocking in at just 10.3 percent of its GDP in 2016.
Additionally, the average annual cost per person for health care is higher in the United States than in Canada. In 2016, for instance, the average American spent around $10,345 on health care, including insurance premiums, deductibles, co-pays, and other out-of-pocket costs. Meanwhile, the average Canadian spent nearly half that, paying about $6,299 that same year.
Access to and Quality of Care
Both the Canadian and American health care systems come with their own sets of issues when it comes to accessing and receiving quality care. A large number of Americans remain uninsured, oftentimes making it incredibly expensive to receive care — to the point where one in five patients chose not to receive medical care due to high costs in 2016, according to the Kaiser Family Foundation.
While the number of uninsured Americans was on a steady decline following the passage of the ACA, the Commonwealth Fund found that 15.5 percent of adults between the ages of 19 and 64 were uninsured as of this past March, an increase from 12.7 percent in 2016. During that time period, an estimated 4 million people lost individual coverage — a change some have linked to the Trump administration’s continued unraveling of the ACA.
Canadian patients, however, face lower costs and enjoy universal coverage — but often in exchange for extremely long wait times compared to the rest of the world. Although wait times tend to vary from province to province, a 2017 Fraser Institute study found a median wait time of 21.2 weeks between receiving a referral from a general practitioner and receiving treatment from a specialist. In the U.S., wait times for specialists average around just 24.1 days in major markets, according to a 2017 Merritt Hawkins study.
Even getting diagnosed can take a while in Canada, as patients also experience significant wait times for diagnostic technologies. The Fraser Institute estimated that patients could wait around 4.1 weeks for a CT scan, 10.8 weeks for an MRI scan, and 3.9 weeks for an ultrasound in 2018. The issue has led numerous Canadians to travel to other countries to receive care instead, with a whopping 63,000 doing so in 2016.
In the United States, “the wait time for scans is minimal,” University of Pennsylvania Wharton School professor of health care management Mark Pauly told IJR.
“If you are in the ER and need a scan, you will get it right away,” he said of American patients. “There may be some delay in scheduling at a particular facility if you want an elective scan. Though in any large city, I am sure you could find someone who would take you within a few days.”
Additionally, Pauly said Canadian patients suffering from acute diseases experience fewer options for specialists and worse outcomes, as the country’s health care system places greater emphasis on primary care than on specialist care or hospitalization.
“If you are a basically healthy person and your needs can be satisfied with primary care, you’re probably going to be better off under the Canadian system,” he said. “On the other hand, if you are sick, and especially if you have a chronic condition, you’re going to wait longer in Canada and have to hobble around in pain for a longer period of time than you would in the U.S.”
Health and Wellness Figures
According to 2017 life expectancy rates, Canadians are expected to live longer than Americans. Canada had the 13th-highest life expectancy last year, with people living until around age 82. The United States, on the other hand, finished in 45th place, with Americans expected to live until around age 79.
Canadians are generally healthier overall, as major disease rates tend to be lower in the country than in the U.S. For example, the National Cancer Institute estimated that 1,735,350 new cancer cases will be diagnosed in the United States this year, with 609,640 people dying from the disease. Meanwhile, the Canadian Cancer Society estimated that Canada saw 206,200 new cancer diagnoses last year and 80,800 deaths.
When it comes to outcomes for major diseases, though, Pauly pointed out that “ordinary people in Canada are healthier than in the U.S., but outcomes for cancer and very serious illnesses are less good there. It’s a great place to live as long as you don’t get too sick, as one critic put it.”
However, he also noted that the larger fraction of doctors who are primary care physicians in Canada may contribute to better health outcomes overall.
“The supply of primary care physicians relative to specialists is a lot more generous in Canada than in the U.S., where a much larger fraction of our doctors are specialists,” Pauly said. “Other outcomes comparing both countries as a whole tend to be somewhat better in Canada mostly because of the contributions primary care has made to things like prenatal care and preventative care.”
Fact or Fiction
It may be impossible to say whether the Canadian or American health care system is better since both have their strengths and weaknesses.
Canadians are all insured and deal with lower health care costs but face difficulty accessing quality care due to lengthy wait times and a lack of specialists in the country. In the United States, many people remain uninsured and health care costs are higher, but those covered — or able to pay the price — deal with less hassle from wait times, better access to specialized care and better outcomes for serious diseases.