Sunday, December 31, 2017

Five American myths about the Canadian Health Care system

Several years ago, during the heated debate over the Affordable Care Act or "Obamacare" (which, as my wife pointed out to me, is not a "heath care" program, but is a "health insurance" program) I compiled a list of myths I've heard propagated about Canada's universal single-payer health system.

By far the most prevalent myth about the Canadian health care system is that it is government-run. That is a gross misunderstanding, but a common one.  The health care system in Canada is not run by the government; it is funded by the government; and there is a huge difference.  Nearly all health care in Canada is provided by private providers and administered by private or non-profit organizations.  None of the four hospitals whose services we've used are administered or owned by the government; they merely bill the government for services rendered under the provincial Medicare program.  The provincial government (not federal) is their primary client for billing purposes only.  Medical provides just have to abide by the Canada Health Act of 1984, which basically guarantees every Canadian resident equal access to all "medically necessary" health care services, without co-payments of any kind.

Americans badly need a health care system like the one we enjoy in Canada; where doctors and hospitals have one customer for billing:  their provincial government.  The Canadian government, certainly at the federal level, does not concern itself with health care provision.  


Myth:  Medicare is a Canadian-wide federal government program.  Canada's Medicare system is not a federal program, and is not administrated by the federal government; it is provincial, and service varies, coverage varies, taxes vary, between provinces.  In some provinces, people pay insurance premiums for Medicare; in New Brunswick it is free, but here we don't have prescription drug coverage under the age of 65 (I have employer-provided supplemental insurance coverage for medications).  The only thing the federal government has to do with Medicare is to set "guidelines" for the provinces to ensure that every Canadian resident has equal access to all "medically necessary" health care services, without co-payments of any kind, under the auspices of the Canada Health Act.  Incidentally, access to medical care is a right of all human beings under the 1948 UN Universal Declaration of Human Rights, which was written, incidentally, by a New Brunswicker, John Peters Humphrey.

Myth:  Wait times for medically-necessary procedures are long in Canada.  I know there are horror stories, I've heard them too, but I'm not aware of anyone, personally, who has gone without badly-needed medical treatment ... elective surgery can have long waits.  If you have a need to see a  medical specialist, at least in New Brunswick, you go immediately in most cases. That's my personal experience, in this province.  
As for waiting linefor health care ... how many Americans wait the remainder of their natural lives for necessary medical procedures?  Far too many.

Myth:  Government bureaucrats, not doctors, make medical decisions in Canada.  It is important that every one understand that, in Canada, the only people who are allowed to make decisions about who gets care are physicians.  In the United States, by contract, HMOs and other private medical insurers do indeed make decisions about who gets what care (it's probably more appropriate to say "who gets denied the care they need).  In Canada, medical decisions are left entirely up to doctors, and there are no requirements for pre-authorization whatsoever.   If your family doctor says you need an MRI, you get an MRI.  In the U.S., if an insurance administrator or HMO rep says you are not getting an MRI, then you're not getting  one regardless of what your doctor thinks — unless, of course, you pay for it out of your own pocket.  I bet you there are far more Americans paying for necessary medical procedures out of their own pockets than there Canadians who find it necessary to do that.

Myth:  The government "manages" patient care in Canada.  Another misconception among Americans is the government of Canada "manages" patient care.  That's a gross misunderstanding, but a common one.  The health care system in Canada is not run by the government; it is funded by the government; there is a huge difference.  Medical treatment is solely the responsibility of doctors, not the Medicare system and its administrators.   This is complete unlike Health Management Organizations (HMOs)  in the US, where, essentially, a corporation DOES make medical decisions.  In Canada, a doctor's relationship to his patient is a professional medical one only; and doctors bill the government for services rendered under Medicare.  The doctor isn't forced to deal with insurance claims or payment collections.  It's much better that way.

Myth:  Doctors in Canada work for the federal government and draw civil servants' salaries.  Nearly all health care in Canada is provided by private providers and administered by private or non-profit organizations.  None of the four hospitals we've used are directly administered by the government:

  • The Dr. Georges-L. Dumont Regional [francophone] Hospital is run by the Vitalité Health Network, (or Réseau de santé Vitalité, if you prefer), which employs 7500 people about about 500 physicians in this province, none of whom are government employees.
  • The Stella-Maris-de-Kent [francophone] Hospital in Sainte-Anne is also run by the Vitalité Health Network.
  • The Moncton [anglophone] Hospital, is run by the Horizon Health Network which employs 13,000 people, and over 1,000 physicians in this province, none of whom are government employees. 
  • The IWK Health Centre in Halifax is 100% privately-owned and funded by a charitable foundation called the IWK Health Centre Foundation (be generous, please, with your tax-deductible contributions).
Americans badly needed a health care plan like Canada's; a single-payer, universal health care plan that is not run by the government.  Unfortunately, Obamacare is not it.