Hidden costs of Canadian health care system

In a pivotal scene in Sicko, filmmaker Michael Moore marvels at Canada's single-payer health system, suggesting that it is a medical utopia. It's really a fabulous system, explains one healthy Canadian, for making sure that the least of us and the best of us are taken care of.

But healthy people don't use much health care. If Moore had interviewed ill Canadians, he would have gotten a whole different story.

In reality, Canada's health care system is not the paradise Moore presents.

I should know: I live there.

Consider Canada's notorious waiting lists. In 1993, Canadians referred by their doctors to specialists waited an average of 9.3 weeks for treatment. By 2006, it was 17.8 weeks -- almost twice what's considered clinically reasonable.

In the words of Canada's Supreme Court, Access to a waiting list is not the same thing as access to health care. The court used that phrase when it struck down the single-payer system in one Canadian province in 2005. Yet somehow Moore missed this, the biggest story in Canadian health policy in the last 40 years.

Canada's long waits are partially caused by a shortage of doctors. Whereas the United States had 2.4 practicing physicians per 1,000 residents in 2004, Canada had only 2.1. That's a difference of 300 fewer doctors in a city of 1 million residents. New York's population is more than 8 million. Imagine what health care would be like in the Big Apple with 2,400 fewer physicians and you have some idea what it's like in Canada.

Over the last 10 years, about 10 percent of doctors trained in Canada decided to practice medicine in the United States. This is the result of low physician salaries, which are paid by the state. The average Canadian physician earns only 42 percent of what the average U.S. doctor takes home each year. Simply put, single-payer systems exploit medical labor. Any U.S. state that adopts a single-payer approach is going to lose doctors to other states.

Canada's single-payer system is also letting its hospitals rot. While the average U.S. hospital is only nine years old, the average hospital in Ontario, Canada's largest province, has been around for 40 years.

And Canada's system limits the adoption of new technology. Among the 24 Western nations that guarantee access to health care, Canada ranks 13th in access to MRIs and 17th in access to CT scanners. The lack of access to medical technology contributes to longer waiting times for diagnostic tests.

The rationing of medical procedures and drugs is another harmful result of Canada's system. In 2003, twice as many in-patient surgical procedures were performed in the United States per 1,000 residents compared to Canada.

And Canada's universal healthcare system doesn't offer universal drug coverage. Only about one-third of the population is eligible for government drug programs in Canada -- the rest pay cash or have private insurance.

Canada's cost advantage is also an illusion. True, Canada spends less per GDP on medical care than America -- but so does Ethiopia. Such comparisons are meaningless without considering value for money. And compared to Americans, Canadians get relatively little in return for the money they spend. Canada's single-payer system does not cover many of the advanced medical treatments and technologies that are commonplace in America, and Canadians have access to fewer doctors, fewer treatments and fewer new drugs.

Yet in Canada, public spending on health care is still growing faster than the ability of the government to pay for it. As of 2006, public health spending in six out of 10 Canadian provinces was on pace to consume more than half of total revenue from all sources by the year 2020 -- without even taking into account the added pressures from an aging population. As of 2003, the growing unfunded liabilities for health care reached 46 percent of Canada's total economic output.

These are the hidden costs of Canada's health system, and they're far worse than the monetary price of U.S. medical care. But Michael Moore is not interested in such facts. He makes fictional films.