Sue Lani Madsen: Canada health care system is messy as well
Heard anyone threaten to move to Canada recently if a particular politician wins an election? We see Canada as a peaceful refuge mostly because we pay zero attention to Canadian politics. We know hockey and health care soundbites. Canadian health care sounds simpler than the tangled mess we still have after passage of the Affordable Care Act.
Only it turns out Canada has a tangled mess, too.
In an interview last week, insurance expert Brian McCulloch said Canada has a system Americans would not accept. McCulloch ran unsuccessfully for Washington insurance commissioner in 1992, and he has over 35 years experience as an insurance broker and adviser. He is married to a Canadian citizen, and they have access to both health care systems.
McCulloch pointed out Canada does not have a true single-payer system. Canada’s basic health insurance is similar to Medicaid, with federal minimum standards, a capped federal subsidy to each province, and provincial taxpayers making up the difference. Each province is independent. In British Columbia, it’s called the Medical Service Plan, with five regional branches.
British Columbia also operates WorkSafe, covering workplace injuries, and pays auto accident-related claims through the Insurance Corporation of British Columbia. Then there’s the Special Benefits Insurance Services offering supplemental health insurance for those services not covered by the Medical Service Plan, like dental, vision, hearing aids, ambulance transportation, physical therapy, expanded pharmacy, hospital upgrades, medical devices, travel coverage, gap coverage for waiting periods after travel … the list goes on.
There’s no shopping around for price or service. It’s a provincial monopoly. Don’t like the coverage or premium pricing in your province? Move. There is no Office of the Insurance Commissioner to hold your insurance company accountable. The Ministry of Health is the insurance company.
B.C. residents pay insurance premiums as well as higher taxes, and just like in the U.S., premiums are going up. The province offers income-based premium assistance or waivers, similar to provisions under the ACA. Some Canadians believe all premiums to the Medical Service Plan should be waived as a right.
The B.C. finance minister responded to this pressure in his 2006 budget speech to the Legislative Assembly: “Burying MSP (premiums) into instruments of general taxation doesn’t make them go away. It merely hides them and may create for some the illusion that health care is free, which it certainly isn’t.”
The key to cost control in the Canadian system is waiting in line. A National Bureau of Economic Research working paper published in 2007 confirmed long waits are a key characteristic of Canadian health care, creating a higher patient dissatisfaction level than in the U.S.
While delays are a primary driver of medical tourism for Canadians, a secondary driver is quality. McCulloch described the co-pays required to access current best practices. For his wife’s hip replacement, that meant $2,500 out of pocket for the current model of hip joint. She also had two roommates during her hospital stay, and had to clean the toilet seat before she could use it. Never mind putting the seat down, she would have been happy if the men had just put it up first.
If you visited a friend in a mixed-sex hospital ward, would “great health care system” be the first phrase that came to mind? U.S. standards limit new hospitals to single-patient rooms as best practice for speedier recovery and reduced infection rates.
The National Bureau of Economic Research results contradict the World Health Organization rankings because it focused on health care delivery rather than literacy and other proxy measurements for health. In pre-ACA 2007, the Bureau of Economic Research found the U.S. had higher patient satisfaction, a slightly greater access to care for chronic conditions, and more cancer screenings for men and women. And in social equity, “Canada has no more abolished the tendency for health status to improve with income than have other countries. Indeed, the health-income gradient is slightly steeper in Canada than it is in the U.S.”
McCulloch summed up both systems when he said, “It used to be so good because medicine was relatively unpowerful and the techno-medical establishment hadn’t taken hold yet.”
We do indeed have a tangled mess in North America.
Columnist Sue Lani Madsen can be reached at rulingpen@gmail.com or on Twitter, @SueLaniMadsen.