Too many Canadians and Americans are negatively fixated on each other’s health systems — and the distortions that accompany so many conversations about health reform make it harder to improve care on both sides of the border.
Canadians staunchly support our universal health care system, according to polls over many years. We live longer, healthier lives than Americans, and our survival rates for cancer and other diseases are comparable. The father of universal health coverage in Canada, Tommy Douglas, is considered a national hero.
Like much of Europe, Canada considers access to health care a right on par with the right to food and shelter. In a country where medical bankruptcy is almost unheard of, we are reminded of our privilege every time we read about the shortcomings of the American health care system.
And yet Canadians are forced to defend our health system every day in the American media. American politicians grossly distort reality, proclaiming as fact the myth that Canadians die waiting for treatment. Perhaps that’s why many Canadians and some Americans cheered when I took on such claims at a United States Senate subcommittee a few years ago.
What Americans may not realize is that most Canadians are just as terrified of your system as you may be of ours (which, in fact, are several province-level systems). But sometimes that mix of pride, defensiveness and terror of American-style health care makes it hard for us to admit where Canada falls short.
In a paper recently published in The Lancet, my co-authors and I analyze the Canadian systems’ strengths and weaknesses, and we explore the obstacles to change. The weaknesses exist not because our systems are universal and centrally coordinated; rather it’s because they are often not universal or coordinated enough.
For example: Most provinces don’t cover prescription drugs for most people. Many people live in remote, sparsely populated areas where specialized care is hard to get. Indigenous peoples and many new immigrants and refugees face complex barriers to health care access.
And long waits for non-urgent services like hip replacements or M.R.I. scans for back pain are a genuine problem in many parts of our country. More than a third of Canadians wait more than two months to see a specialist, and 18 percent of Canadians wait at least four months for elective surgery.
But it’s important to recognize that long waits are not an inherent feature of all universal health care systems — many countries in Europe and elsewhere with strong universal systems don’t experience these problems. What’s different is that in Canada, doctors and hospitals have a high degree of autonomy, and don’t always participate in efforts to reduce waits. At times they have opposed attempts to have other professionals care for patients or to shift resources into needy communities.
And we have been slow to adopt virtual care, group-based care, and other models that would reduce waits. The solutions to delays in Canada lie in changing how we deliver health care services, not how we pay for them.
More robust dialogue is needed to really tackle these important problems — but the long American shadow chills our discussions. Fear of an American-style market-based system inhibits a national conversation about how to expand the breadth of coverage and increase the timeliness of services. Instead of talking about how to make our system better, we’re talking about how much worse things are in the United States.
And such behavior is evident on both sides of the border: Instead of closing their insurance coverage gaps, many Americans are busy pointing fingers at our difficulties. It’s an absurd habit that needs to end so that both countries can engage in more meaningful debate about how to fix our systems.
In truth, neither country performs as well as it should aspire to do. For our part, Canadians must tackle a culture of incrementalism that stops us from expanding services and improving how they’re delivered.
I know many doctors in the United States who would say the same about your system. The opportunities and challenges of rapid technological advances and an aging population don’t respect international borders. It would help us all if both countries stopped making each other a boogeyman to excuse their own paralysis.
Danielle Martin is an associate professor of family and community medicine at the University of Toronto and the vice president for medical affairs and health systems solutions at Women’s College Hospital in Toronto.