Canada’s Single-Payer Health Care System Slow and Inefficient

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Their single-payer system is characterized by long waits, equipment shortages, and expensive drugs

Medicare for All may not be a part of Democratic presidential nominee Joe Biden’s agenda. But the rest of the party is smitten with the idea of a federal takeover of our health-insurance system.

Senator Kamala Harris (D., Calif.), Biden’s running mate, co-sponsored Senator Bernie Sanders’s (D., Vt.) Medicare for All bills in 2017 and again in 2019. Last week’s Democratic National Convention, meanwhile, featured speeches from many of single-payer’s most visible proponents, from Sanders and Representative Alexandria Ocasio-Cortez (N.Y.) to Senator Elizabeth Warren (Mass.) and progressive activist Ady Barkan, who runs the Be A Hero PAC and suffers from ALS.

In fact, the moderates and progressives within the Democratic Party largely agree that they want to work toward Medicare for All. They just disagree on how to get there, and how fast.

A detour to Canada should disabuse them of their fondness for single-payer. Our northern neighbors wait months for routine care and lack access to the latest life-saving medications and technology. Importing this system would lead to widespread misery.

I know firsthand. I was born in Canada and watched the government-run health-care system there turn a blind eye to my mother’s suffering. After experiencing stomach pain, she requested a colonoscopy but was denied one because of her age; there were too many younger people ahead of her on the waiting list. By the time she got one, her cancer had become untreatable. She died shortly thereafter.

I’ve been educating Americans about the pitfalls of single-payer for years. Earlier this month, I was called out by Wendell Potter, a former insurance executive who took to the pages of the Washington Post to apologize for using my work to “obscure important truths about the differences between the U.S. and Canadian health-care systems.”

“Of the many regrets I have about what I once did for a living, one of the biggest is slandering Canada’s health-care system,” Potter wrote.

But Canada’s health-care system does not merit praise.

Long waits for care are a fact of life in Canada. Last year, the median wait between referral from a general practitioner and receipt of treatment from a specialist was nearly 21 weeks. In 2019, more than 175,000 people in Canada’s four easternmost provinces were waiting for a family doctor.

Fans of Canadian health care, including Potter, claim that Canadians wait only for elective procedures, such as knee replacements. But “elective” is in the eye of the beholder. Is a six-month wait for a knee replacement — the median in Canada last year — reasonable, when it keeps someone in pain and unable to work? One study puts the total cost of waiting for joint-replacement surgery after taking into account lost wages and additional tests and scans at almost $20,000. It’s no wonder that more than 323,000 Canadians left the country to seek care abroad in 2017.

Canadians also wait for access to novel drugs and medical technologies, if they get access to them at all. Of the 290 new medicines brought to market between 2011 and 2018, fewer than half were available in Canada. U.S. patients had access to 89 percent of those new drugs.

In many cases, Canada’s Patented Medicines Prices Review Board determines that, even at a discounted price, cutting-edge drugs are still too expensive to be available to Canadian patients.

Last year, the median wait for an MRI was more than nine weeks in Canada. It was nearly five weeks for a CT scan. Perhaps those waits shouldn’t be surprising. As of 2017, Canada had fewer than 16 CT machines for every million people. The United States had 2.6 times as many per capita. MRI machines are just as hard to come by up north. There are fewer than 10 units per million Canadians — one-fourth as many as in the United States.

Canada doesn’t appear interested in addressing these discrepancies. A recent report from the Conference Board of Canada found that 27 percent of Canada’s stock of medical-imaging equipment is more than ten years old. The rate at which new machines are being added is at a 20-year low.

But “Who cares about those numbers?” cry the fans of Canadian health care. Canadians, they say, live longer than Americans while spending far less.

It’s true that life expectancy in Canada is a little under two years higher than in the United States. But that doesn’t tell us much about the relative quality of the countries’ health-care systems, because so many factors that have nothing to do with health care affect life expectancy.

For example, the U.S. murder rate is three times Canada’s. Almost twice as many Americans, per capita, die in car crashes. And, tragically, on a per-capita basis, many more Americans die via suicide and drug overdose than do Canadians.

Those are all serious public-policy issues. But it’s unlikely that Medicare for All would have much of an impact on them.

Canada may have universal coverage, but as recently retired Canadian supreme-court chief justice Beverley McLachlin wrote in a 2005 ruling on a case that unsuccessfully challenged Canada’s ban on private insurance, “access to a waiting list is not access to health care.” Those pushing for Medicare for All are intent on ignoring that lesson — to the detriment of American patients.

Sally C. Pipes is the president, CEO, and Thomas W. Smith Fellow in Health Care Policy at the Pacific Research Institute. Her latest book is The False Promise of Single-Payer Health Care (Encounter). Follow her on Twitter @sallypipes.