In 1999, I wrote my first book, Code Blue: Reviving Canada's Health Care System. In it, I noted Canada's obsession with all things American when it comes to debating health-care issues -- as if the only alternative to Canadian medicare was the American system. My point? Many countries offer sophisticated medical care and universal coverage and yet have very different health-care models. And, more importantly, several of these countries achieve better health outcomes.
In recent years, this problem has reappeared, but in reverse. Americans often talk about comparisons to Canadian health care as if our single-payer model is their only alternative.
Slate's Matthew Yglesias is the latest to offer up the Canadian system as a worthwhile comparison to the American model. To be fair, he actually writes that: "Now, there are, no doubt, downsides to [the Canadian] approach," an honest caveat that many American fans of Canada's system can't bring themselves to acknowledge. The hook for his piece was accurate, too. He wants readers to realize that if you compare public health care spending in the U.S. to public health spending in Canada, our Southern neighbours actually spend more per capita than we do. (That's over and above the billions that the United States spends on private care and private insurance.)
Speaking to his American audience, Yglesias's punchline is that when it comes to health reform, it's "insane to completely ignore the culturally similar neighboring country that spends less while covering more people." And if you put it that way, fine. Completely ignoring the Canadian comparison is foolish. But Yglesias' remarks repeat an implied mistake that others have made. When he talks about how Canada "covers more people" for less money, "covers more people" is a meaningless baseline without factoring for the scope, the speed and the quality of the care that coverage buys.
To get past the Canadian v. U.S. fixation, consider the following international health-care rankings.
- In 2010, the Commonwealth Fund ranked Canada 6th out of 7 countries in overall health care quality. The United States is 7th.
- In 2012, the Conference Board of Canada ranks Canada 10th out of 17 "peer states" on overall health care performance, using metrics that weigh heavily toward mortality rates. The U.S. is ranked 17th.
- In the one area where the U.S. scores consistently best -- publicly-funded access to drugs -- Canada scores very poorly in annual comparisons to other OECD countries, and one 2009 comparison ranks Canada between 22nd place and 29th place relative to OECD nations on various public drug access, public drug plan and reimbursement indicators.
- Another Commonwealth Fund review in late 2012 ranks both Canada and the U.S. poorly on a range of primary care measures. Canada is far back on the use of electronic medical records (just behind the U.S.); we finish 10th out of 10 on urgent access to primary care physicians, and 9th out of 10 (behind the U.S.) on after-hours access to a primary care physician.
And so on. There are other studies, of course, and they draw a similar conclusion.
I work in the Canadian system, and I'm often proud of what we can achieve for our patients. I've also worked with American health policy experts, and envy America's world-class research and the unchallenged leadership of institutions like the Cleveland Clinic, the Mayo Clinic and Johns Hopkins. Yet I've been a critic of both systems because I believe both countries can do so much better.
The first step to better health care? Breaking free from a pair of intellectual traps.
Trap 1: In both countries, the public debate remains fixated on "how many are covered at what cost." We should also be talking about what people are covered for, how and how well they're covered and overall wellness. We skip over these points because both of our (very different) health-care systems were designed around a 1940s and 1950s hospital-centric approach (a point I discuss in more detail in my second book, The Cure).
Trap 2: Too often we speak about "the best in the world" in a tone that suggests that Canadian health care (or American health care) is perfect, even though there are major problems both north and south of the 49th parallel.
To be fair, international health care rankings never offer a consensus on which country truly has "the best" system. But there is one area where these rankings are consistent: they usually place Canada and the U.S. mid to low pack.
We can learn more from a global health care perspective, and the tradeoffs each system makes. We pride ourselves on universality -- but so do the Dutch and the Swiss, and they don't have the sort of problems endemic to medicare (that is, long surgical wait times, diagnostic waits and limited coverage of drugs for rare disease patients).
There is no perfect health care system, of course. But there is world beyond North America. It's a point that writers like Yglesias should acknowledge and -- in an age of budgetary restraint -- governments across the continent should consider.
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Ketchup Chips
There are some snacks that define a nation, but not many that taste good to only those who live there. What do we love? The fact they leave our fingers dyed red after we've had a whole bag. Ketchup has never tasted so salty, non-tomatoey and outright good. Our U.S. friends may go nutty over Doritos, but we love our ketchup chips.
Les Stroud aka 'Survivorman'
Many Canadians will point to the fact that Superman has a strong connection to the Great White North, but we'd like to reintroduce you to the real thing. <a href="http://www.lesstroud.ca" target="_hplink">'Survivorman</a>', while it was on in the late 2000s, showcased Les Stroud, a gritty Canadian who shot his own show in snow, sleet, heat and rain with nothing but random household objects and a trusty knife. We like to think that in a country that's increasingly urban, the outback is still our domain. Les, he's the best of us.
The Greatest Scream On Film
It was the scream heard around the world, and has been imitated - although never duplicated - several times since. <a href="http://www.williamshatner.com/" target="_hplink">William Shatner</a>, who in his own right is a great Canadian, uttered the famous scream '<a href="http://khaaan.com/" target="_hplink">Khaaaaannnnnnnnnnnn!</a>' in a scene during 1982's 'Star Trek II: The Wrath of Khan'. Was it the close up on Shatner's face or the fact he shook while he screamed that made it so powerful? Thirty years later, filmmakers and actors are still trying to outdo Shatner. But some things just can't be beat.
The Caesar
In warm weather, it will cool you down. If you're hungover, it's the magic antidote. <a href="http://en.wikipedia.org/wiki/Caesar_(cocktail)" target="_hplink">The Caesar</a>, Canada's favourite breakfast, lunch and evening cocktail adds a spicy twist to the Bloody Mary. Canadians are so particular about how it tastes -- with Clamato, not tomato juice -- that many don't even bother ordering it in the U.S. out of fear of disappointment. Served with celery, a lime and, if you're lucky, a fat dill pickle, it's the perfect cocktail. Who knew clam juice could add that kind of magic to a drink? (Photo Shutterstock)
Cheaper Drugs
Overall, Americans can save 24 per cent if they buy their drugs from online Canadian pharmacies versus filling their prescriptions at home, according to a <a href="http://www.annals.org/content/143/6/397.abstract" target="_hplink">study published in the Annals of Internal Medicine.</a> The study sought to find out why so many U.S. citizens have been taking advantage of the deep discounts north of the border, and the results showed dramatic savings across the board. "Forty-one of the 44 brand-name medications examined were less expensive in Canada." Canucks are proud of their health-care system and easier access -- in this case financially -- to pharmaceuticals. (Photo Alamy)
Our Ties To The Monarchy
The debate on whether we should cut ties to the monarchy was <a href="http://www.theglobeandmail.com/commentary/why-the-monarchy-sigh-still-survives-in-canada/article4181939/" target="_hplink">all but quashed last year</a> after the outpouring of pomp and pageantry -- in Canada -- around the royal wedding. Canadians embraced the nuptials as if Prince William was their own and turned out in droves to see the newlyweds during <a href="http://www.huffingtonpost.ca/news/royal-visit-canada-2011" target="_hplink">their cross-country tour last July.</a> From trying to get Pippa's butt to putting in their two cents on whether Prince Charles deserves the throne, Canadians love their Queen and all of the gossip that goes with her. (Photo Rex Features)
Coffee Crisp
When it comes to food, Canadians concede there's far more selection in the U.S. but we're fiercely proud of the candy bars that can only be found here. <a href="http://en.wikipedia.org/wiki/Coffee_Crisp" target="_hplink">Coffee Crisp</a> is a great example. Consisting of a crunchy wafer, milk chocolate coating and slightest hint of coffee flavouring, the chocolate bar is true to its marketing slogan of making 'a nice light snack' and is adored by all moms and seniors. Rumour has it they've been spotted in a few U.S. border town convenience stores. We want proof!
Better View At Niagara Falls
Undoubtedly one of North America's natural wonders, the power and beauty of Niagara Falls never ceases to amaze, whether it's your first trip or 100th. Luckily for Canucks, the <a href="http://www.world-of-waterfalls.com/eastern-us-niagara-falls-which-side-is-better.html" target="_hplink">best place to view the falls is on the 'Canadian side'. </a>That's right, busloads of tourists from around the world flood the observation areas near the falls in Ontario every day to snap the perfect picture for their Facebook profile. Do Americans bother to cross the border for the better view? You betcha. Just look out for the person using 'eh' at awkward times. (Photo Shutterstock)
We Love Seeing Our World
About 56 per cent of Canadians have a passport while just 37 per cent of Americans do. While the majority of Canadians haven't been to countries like Azerbaijan, they do take pride in seeing the world and it's difficult to not run into a Canadian while travelling abroad. A story by TechCrunch claims <a href="http://techcrunch.com/2011/07/22/more-americans-are-on-facebook-than-have-a-passport/" target="_hplink">more Americans have a Facebook page than a passport.</a> Perhaps they prefer to view the travel photos of their friends online than to actually see sights for themselves... (Photo CP)
Limits To Election Spending
Canada limits corporate influence on our electoral process via spending limits on political donations and third-party advertising. The 2010 decision by the U.S. Supreme Court to strike down <a href="http://www.huffingtonpost.com/2010/01/21/supreme-court-rolls-back_n_431227.html" target="_hplink">similar campaign finance laws in that country</a> -- on grounds they violate the free-speech right of corporations -- poses a serious threat to democracy and the integrity of future elections in America. (AFP/Getty Images)
Hockey In Middle Earth
The soul of hockey isn't at the Hockey Hall Of Fame. Or the Air Canada Centre (sorry Leafs fans). It's in places like Windy Arm, Yukon where you can skate on ice clearer than your bedroom mirror in a setting that's straight out of Tolkien's Middle Earth.
President's Choice
There are few brands in Canada as reliable as President's Choice. Mr. Christie thinks he makes good cookies but nothing tops<a href="http://reviews.presidentschoice.ca/6584/F14934/reviews.htm" target="_hplink"> the Decadent</a>, the brand's answer to Chips Ahoy. Kraft Dinner, in its familiar blue box, pales in comparison to <a href="http://www.presidentschoice.ca/LCLOnline/products.jsp?type=details&sortOrder=byRate&productId=4745" target="_hplink">PC's White Cheddar Mac & Cheese</a>. It also doesn't hurt that nerdily-handsome Galen Weston (hearthrob of Canadian suburban housewives everywhere) is the pitchman for this iconic line of Canadian products. Why yes, Mr. Weston, I'd like some more <a href="http://reviews.presidentschoice.ca/6584/Fprod1410011/reviews.htm" target="_hplink">Memories of Morocco Sweet And Spicy Sauce</a>...
Better Cities
Ours might be smaller and fewer in number but Canadian cities consistently rank above American cities on livability.<a href="http://www.huffingtonpost.ca/2011/11/30/mercer-quality-of-living-cities-canada_n_1120615.html" target="_hplink"> In the most recent Mercer survey of livable cities</a>, Canadian cities took 4th, 14th, and 15th place, while the highest-ranked American city was 33rd. (Photo Getty Images)
Best Place To Do Business?
According to Forbes, <a href="http://www.huffingtonpost.ca/2011/10/04/forbes-canada-best-country-business_n_994554.html" target="_hplink">Canada is the best country in the world to do business</a> and it's not because of the climate. Chalk it up to a lower corporate tax rate, excellent infrastructure and a well-educated populace. The U.S. and Europe's recent economic woes don't help them either. (Photo CP)
Social Mobility
<a href="http://www.huffingtonpost.ca/2012/05/27/canada-income-inequality-by-numbers_n_1545900.html" target="_hplink">Canada has greater social mobility.</a> If you are born into the poorest 10 per cent, your odds of making it to the richest 10 per cent are considerably better in Canada than in the U.S. In other words, it's easier to realize the American Dream in Canada than it is in the U.S. (Shutterstock)
Hey Girl...
(Photo Getty Images)
Canadian Anthem
When it comes to national anthems, we've always had a bit of an inferiority complex (the maple leaf is not a banner spangled in stars). But according to new research, our simple and quaint pro-Canuck ballad "O, Canada" is <a href="http://www.huffingtonpost.ca/2012/02/16/best-national-anthem_n_1282311.html" target="_hplink">among the world's finest.</a> We even trump the Americans and Brits. So what if you can't remember all the words? This is an anthem worth singing. (Photo Getty Images)
Maternity Leave
Having a baby is hard work. And many women around the world aren't given the amount of time off they deserve post-delivery. But here in Canada, the true north strong and free, a lady can take up to <a href="http://www.huffingtonpost.ca/2012/05/22/maternity-leaves-around-the-world_n_1536120.html" target="_hplink">a full year of paid maternity leave </a>(17 weeks at 55 per cent of their salary and an additional 35 weeks after that). This contrasts vastly with The United States, Papua New Guinea, Swaziland, Liberia and Lesotho who provide no type of financial support for new mothers. (Alamy)
Our Milk!
It completes your morning bowl of cereal, can quench thirst and is the perfect companion to chocolate chip cookies. Milk, dear readers, is an all around amazing drink. And grabbing a glass of the white stuff in Canada is unlike anything you'll be able to experience in many other countries. That's because there's <a href="http://www.dairygoodness.ca/good-health/dairy-facts-fallacies/hormones-for-cows-not-in-canada" target="_hplink">a complete lack of unnatural hormones in our dairy products</a> (so concerns about negative side effects simply doesn't exist), and we <a href="http://www.thestar.com/news/ontario/article/760654--so-we-drink-milk-from-bags-does-that-make-us-weird" target="_hplink">serve the beverage in a plastic bag</a>, which, frankly, is far more convenient and environmentally friendly than cardboard containers (the baggies can be reused as makeshift lunch bags!). (Photos Shutterstock)
Our Air!
Take a deep breath in... and slowly exhale it out. Do you smell that? You may not, but that's the <a href="http://www.cbc.ca/news/interactives/air-quality/" target="_hplink">scent of clean air flowing through your lungs</a>. According to new research, Canada rates tops in air quality (meaning you can say "ta ta" to stinky smog and gross pollution. [Ed. Note unless you live in smog-heavy Toronto]). In fact, while the U.S. averages 18 micrograms of particulate matter per cubic metre of air, Canada averages only 13 micrograms. That also decreases our risk of developing bad air-induced health conditions like allergies. Now once again and all together now: inhale... (Photo Alamy)
Gay Marriage Rights
This "fake" Heritage Minute says it all: on July 20, 2005, Canada's government passed the Civil Marriage Act giving same-sex couples the same rights and privileges as heterosexual pairings. The LGBT community can not only marry, they can also adopt children. We also host one of the largest Gay Pride festivals in the world in Toronto every June/July.
Poutine
French fries. Cheese curds. Gravy. All mixed together in one bowl. There's really nothing more to say than <a href="http://www.huffingtonpost.ca/jacqueline-vong/poutine-guilty-pleasure-food_b_1366823.html" target="_hplink">this dish is gluttonously awesome</a>. And we're proud to say it's 100 per cent Canadian. (Photo CP)
We Can Go To Cuba
A decades-long U.S. trade embargo on evil 'Communist' Cuba means that that island's beaches and resorts have long been free of American tourists. Canadians, needing an escape from long winters have been <a href="http://www.gocuba.ca/client/home/index.php" target="_hplink">flocking to the island for decades now</a>. Since the collapse of the Soviet Union, Canada has also been a crucial trading partner of the island country. (Photo Getty Images)
Joe Fresh
Many people think Canada is a country of citizens who don plaid, beaver tails and fur all year round. (We also, obviously, live in igloos.) So thank goodness for Joseph Mimran, the fashion powerhouse who is behind one of Canada's biggest and most popular clothing exports: <a href="http://www.joefresh.com/" target="_hplink">Joe Fresh</a>. His bright, colourful and decidedly on-trend collections are showing the world what Canada has to offer sartorially (which is not limited to some hipsterish version of a lumberjack). (Getty Images)
Canadian Music
Once a 44.5 kg weakling, The Great White North punches way above its weight class in the music world. A few decades ago, only a rare few Canadian musicians managed to establish international careers. But the rise of government funding for music and CanCon radio regulations supporting domestic tunes developed our homegrown scene until it was strong enough to lead a post-millennial Canadian Invasion. Nowadays we claim the world's biggest artists in almost any imaginable genre - Arcade Fire, Justin Bieber, Feist, Drake, Michael Buble, Deadmau5, Metric, Shania Twain, Celine Dion, Nickelback, Diana Krall, etc. Don't tell the Republicans, but we can thank "socialism" for all that money, money, money these musicians are making. (Photos By Getty Images)
Your Turn!
Tell us why you think Canada is great. Is it a photo of your favourite camping spot, a Canadian you really admire, our weird obsession with hockey and cold weather? We're looking for your responses on Twitter with the <a href="http://twitter.com/#!/search/%23LoveCanada" target="_hplink">#LoveCanada</a> tag, Facebook, in the comments and <a href="mailto:canada@huffingtonpost.com?subject=Love Canada" target="_hplink">via e-mail</a>. We'll be collecting the best responses and featuring them on our site in the coming weeks. (Photo Getty Images)
http://www.theglobeandmail.com/commentary/the-best-health-care-system-the-numbers-say-otherwise/article5577290/
The op ed has a few more numbers than Gratzer's, though makes similar points.
http://www.youtube.com/watch?v=DII7v8yeRjs
And linking to a video featuring Dennis Kucinich is hardly boosting your credibility.
The Congressman couldn't even hold his own seat.
http://www.cbsnews.com/8301-503544_162-57392078-503544/dennis-kucinich-concedes-defeat-to-marcy-kaptur-in-ohio-democratic-primary/
Maybe he's been spending too much time interpreting drones as UFOs.
http://www.motherjones.com/mojo/2008/01/kucinichs-ufo-sighting-what-he-really-saw”
In 2007, Gordon H. Guyatt et al. conducted a meta-analysis, or systematic review, of all studies that compared health outcomes for similar conditions in Canada and the U.S., in Open Medicine, an open-access peer-reviewed Canadian medical journal. They concluded, "Available studies suggest that health outcomes may be superior in patients cared for in Canada versus the United States, but differences are not consistent." Guyatt identified 38 studies addressing conditions including cancer, coronary artery disease, chronic medical illnesses and surgical procedures. Of 10 studies with the strongest statistical validity, 5 favoured Canada, 2 favoured the United States, and 3 were equivalent or mixed. Of 28 weaker studies, 9 favoured Canada, 3 favoured the United States, and 16 were equivalent or mixed. Overall, results for mortality favoured Canada with a 5% advantage, but the results were weak and varied. The only consistent pattern was that Canadian patients fared better in kidney failure.
http://www.diffen.com/difference/Healthcare_In_Canada_vs_Healthcare_In_The_United_States
Service may not at times be as fast as it should be here at times but you can walk into any doctors office without worrying that you are at risk of rejection or losing everything you have worked for your entire life in a flash.
Let's just think about where we'd all rather be struck by a sudden heart attack or stroke right now.
Canada or the US?
Hmmmm.
If a person can afford it, US hospitals are generally far better equipped to treat such an unfortunate emergency.
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Is that why 5 out of 7 studies on survival and recovery rates from heart disease favoured Canada over the Backward States of America? That's right, Canada has a better survival rate from heart disease and heart attack than the Backward States by a wide margin.
Canadian taxpayers already pay into the universities that educate doctors, they don't need to subsidize their excessive incomes after graduation.
We need our provincial medical associations to remove their blinders, admit that they don't know everything and start working with LICENSED naturopathic doctors whose forte is preventative and wholistic medicine. Their results are amazing.
It's a shame that as Canadians, that we can't rationally, discuss some pragmatic reforms to healthcare without being labeled "American" or "Teabagger", even though, some European and Scandinavian countries have been introduced some kind of public funded and regulated private care to their models, successfully.
The trap is to lump all opposition into the same category as the label-mongers and thus devalue any contrary views. You are effectively placing the blame on 'them' and saying there is no infraction by 'us'. This is precisely what you just did in your comment.
As well, you dismissed an entire viewpoint by labeling as paranoid those who are concerned with emulating any perceived negative aspects of American culture.
In short, I suggest you be mindful of the glass house in which you are living.
That's a reality that we as Canadians have to face at some point.
America is not the only country w. privatized aspects of public healthcare. You'd be surprise of what these countries can accomplish with both aspects working together. Cheaper too.
All of us 5 girls have been very pleased with Mom's care, the Dr.s have been very upfront with everything, and her expenses have been limited to the pain medication that OHIP does not cover. That is where our Mom's savings are going, which she will not outlive.
Mother had a sister in Arizona, who just died of lung cancer. She died penny-less after a working all her adult life, she always had health care coverage, but her "maximum amount allowed" was used up, her savings were quickly spent, and a mortgage on her home did not see her through to her final days. The market crash on real estate had her house under water, so she died penny-less.
Our family is very glad our Mother did not follow her sister to "the land of gold n honey". Our Aunt died worrying about money. Mom is dying peacefully and grateful she stayed in Canada.
So no, we aren't denied coverage, but my aunt was living and dying in Arizona, so she couldn't get any assistance for her home country. Had she come home to die, she would have had the coverage, but she chose to stay with the Dr.'s she knew.
1.reduce doctor salaries. This might reduce some of the part-time doctors who get subsidized education and then make enough money to work only part-time, and will also allow us to hire more doctors. Most of the countries with better quality health care at similar or lower prices to us have more doctors per capita and pay them less.
2.allow private provision but tax it so heavily that doctors only have a small incentive to do it (it should be treated like overtime - you want to jump the queue? fine, pay up and let the doctor do it to earn extra money after meeting some quota for the public system) and plow that money back into the public system. One of the problems in Canada is that we are so obsessed with equality we forget about quality - it is not impossible to construct a system where the very rich get better care but are forced to increase (rather than take away) resources for the public system, but right now that rich money is going to relative untaxed private providers (like Medcan) and to the US health system.