Canadian Medicare, our northern neighbor’s universal health care system, generally receives rave reviews from proponents of nationalized or socialized health care, but the Fraser Institute found that more than 63,000 Canadians left their country to have surgery in 2016.
As Americans contemplate overturning our health system in favor of one similar to Canada’s, we must ask why so many leave.
The Canadian system consistently ranks low or lowest across numerous metrics in the Commonwealth Fund’s extensive survey on health care. With regards to specialists and surgeries, the United States ranked best or nearly best.
The Fraser Institute study did not examine where Canadians traveled for surgery, but given proximity and our much better metrics, most probably came here.
Surgeries are scheduled after patients are seen by the surgeon, and most people see surgeons only after a referral by either their primary care physician in America, or their general practitioner in Canada. In the United States, 70% of patients are able to be seen by specialists less than four weeks after a referral. In Canada, less than 40% were seen inside of four weeks.
After being advised that they need a procedure done, only about 35% of Canadians had their surgery within a month, whereas in the United States, 61% did. After four months, about 97% of Americans were able to have their surgery, whereas Canada struggled to achieve 80%.
America is significantly outperforming Canada in surgery wait times even as it’s likely that tens of thousands of Canadians come here to use the American system.
General surgery, procedures such as appendectomies, cholecystectomies, and hernia repairs, make up the largest portion of those who leave Canada for care. Based on the latest available date from the Organization for Economic Cooperation and Development, the total Canadian case load for many of these procedures is about 10% of America’s.
America’s health system is certainly flawed and in need of reform, but there is clearly something working well enough that our system, despite already treating 10 times more cases of appendicitis, can absorb the dissatisfied Canadians.
This has been a consistent trend since at least 2014, when an estimated 52,513 Canadians left for their medical care. In 2015, the number went down slightly to 45,619. 2016 exceeded the 2015 number with an estimated 63,459 patients seeking care elsewhere.
Moreover, both countries have had comparable rates of private health insurance coverage for the past 20 years, roughly 60-70%. But the Canadian private insurance market is entirely supplemental—it covers co-payments for services not covered or not entirely covered by the provincial insurance.
Primary coverage, which is the predominant form of insurance in America, is all but illegal in Canada, and would be under “Medicare for All” as well.
In the United States, government insurance covers gaps left by the private market. Private insurance is the norm and Medicare and Medicaid provide a health insurance safety net for elderly or low-income Americans.
In Canada, government-provided Medicare is the primary form of insurance, and private plans merely fill in gaps in coverage for those with more disposable income or employee benefits. The two systems are mirror opposites of one another.
Health care is a product of the labor of physicians, nurses, technicians, and a whole ecosystem of health care workers. If making the government the primary payer for these services is so smart, why does the universal system next door shed patients by the tens of thousands to ours?
American health care can be improved and should be; American health care performs about middle-of-the-pack for many other items on the Commonwealth Fund survey. There are many inefficiencies, often government-imposed, that increase the cost of health care and restrict the insurance market.
The administration already has loosened some regulations that will give employers more flexibility in providing health benefits and has begun to push for price transparency, which also should bring down costs.
Whatever the case may be, reforming American health care should focus on enabling our strengths. Under no circumstance should we tear it down and build it anew to resemble the system whose citizens escape by the tens of thousands just to be treated in a timely manner.