Health Care in the United States and Canada: Neither is Perfect; Both Need Help

Canada’s health system is often held as a shining example of what a health care system can be.

Some have the notion that everyone north of the border gets everything for free. If that sounds like it’s too good to be true – well, it is.There are a lot of good things about Canadian health care delivery, for sure. Every citizen, by virtue of being born, automatically is covered by whatever system the province has in place. (Each province – Canada’s version of a state – has its own plan.)

An American friend of mine who moved to Canada during the 1960s and married a Canadian woman decided not to return to the states because benefits for his autistic son were so much better in Canada. This same friend happened to be the guy picked by the Ontario government to redesign the province’s system for long-term care.

Just like in the United States, Canadians are living longer and costing the health care system more each year. In Toronto, the problem was particularly acute. The city is one with high diversity, and each ethnic group has nursing homes “just for their people.” This had advantages; caregivers in these institutions are familiar with the ethnic traditions, customs, foods etc., and can provide comfortable, nurturing environments. The disadvantages: This makes for duplication of services and inefficiency, and with an ever-increasing aging population, Ontario’s health system is running out of money.

My friend's mission was to streamline services without raising the ire of any group – a nearly impossible task – but he's a smart man. He told the groups to come together and develop solutions they all could live with.

So I learned that Canada’s “perfect health care system” is not so perfect, and some Canadian journalists agree. Here is what five of them had to say in interviews in HealthBeat, published by the Association of Health Care Journalists , based in Columbia, MO.:

“Despite health care coverage for everyone, many people in Canada don’t have a family doctor. Health care coverage here includes psychiatric care, but it doesn’t include psychotherapy because therapists cannot bill the provincial health insurance plans. It also doesn’t include medication, and many people in Canada cannot afford their meds.“(The United States has) a terrific system in many ways if you can access it. It’s cutting edge, it’s competitive and consumer oriented – but as a physician, the patients I cared for weren’t able to access it.” – Miriam Shuchman, a physician-reporter for 20 years and medical school instructor who writes for the Canadian Medical Association Journal and formerly for the New England Journal of Medicine.

“Despite our universal Medicare system, there are some two-tiered aspects to the system, especially as each province controls their own health care system. Different drugs are covered in the provincial formularies for different folks, seniors, those on social assistance, but mostly prescription drugs are not covered. You need insurance for that.

“The head of the Canadian Medical Association runs a private hip and knee replacement clinic in Vancouver which gets you in and out faster than the hospital, although that often depends on the region you live in. (We also have) a scarcity of family practitioners, especially in smaller cities and rural areas.

“(The U.S. health system is) good in some ways – new treatments, interdisciplinary health teams – but abysmal in others. Hard to fathom 40 million people with no health insurance.” – Kathryn O’Hara, a faculty member at Carleton University’s School of Journalism and Communication in Ottawa and vice president of the Canadian Science Writers Association.

“Canadians are very attached to their universal health care system and usually agree that it is superior to that in the U.S., but most admit there are many challenges. Health care is eating up a larger share of provincial budgets and it’s difficult to keep spending in check when everyone expects cutting-edge treatment and care. Canada does not have a national drug plan and many people are not covered for drugs by their employer.

“Most provinces cover drugs for seniors and the poor. Some private type of services are beginning to crop up in some provinces, for example, MRI and orthopedic clinics. Only the very wealthy would be able to take advantage of these services and many say this is a slippery slope to two-tier health care.

“(The U.S. has) no system at all. Huge numbers of citizens are uninsured and go without treatment for a variety of chronic diseases. The wealthy are over-treated, over-tested, over-medicated and there’s no evidence they live healthier or longer than Canadians, who all have access to health care regardless of income.” – Maureen Taylor, Canadian Broadcasting Corporation.“(In the U.S., there are) great doctors, great facilities and a shocking disregard for patient care by major insurers.” – Terry Reith, Canadian Broadcasting Corporation.

“…Canada’s health system is not utopian or…not a socialist evil incarnate. What Canada has is a decent publically funded health insurance system, one with many benefits and many flaws. “I don’t think the U.S. has a health system. Rather, it has many disparate elements of care that range from among the best in the world to the shamefully mediocre for a country of such wealth. …U.S. health care is expensive, bureaucratic and often inequitable.” – Andre Picard, public health reporter for The Globe and Mail.

Having read these comments, what can you say about American health care versus the Canadian health care system?

Tell us what you think.