Canadian Medicare Deserves its Criticism

Canada’s Medicare system has been mentioned many times in the U.S. debate over health care reform, and not all of the mentions have been positive. Liberal MP Bob Rae has gone as far as to suggest Canada’s Medicare has become a ‘whipping boy’ for at least one side of the US debate, and has joined a cadre of politicians and commentators in rising to Medicare’s defence. The truth, however, is that the criticism of our health care system is well deserved.

A careful look at the realities of Medicare shows that it is in fact a very poor health care system that regularly fails Canadians.

First, Canadians are funding the developed world’s second most expensive universal access health care system. On an age-adjusted basis (older people require more care) in the most recent year for which comparable data are available, only Iceland spent more on their universal access health care system than Canada as a share of GDP, while Switzerland spent as much as Canada. Remarkably, Canada’s health care expenditures were 22 per cent higher than they were in the average universal-access developed country.

With that level of expenditure, you might expect that Canadians receive world-class access to health care. The evidence finds this is not so.

Consider the case of waiting lists. In 2008, the median wait time from general practitioner referral to treatment by a specialist was 17.3 weeks in Canada. Despite substantial increases in both health spending and federal cash transfers to the provinces for health care over the last decade or so, that wait time was 45 percent longer than the overall median wait time of 11.9 weeks back in 1997. It was 86 percent longer than the overall median wait time of 9.3 weeks back in 1993.

Canada’s waiting lists are also, according to the available evidence, among the longest in the developed world. For example, a 2007 survey of individuals published in the journal Health Affairs found that Canadians, as compared to patients in Australia, New Zealand, Germany, the Netherlands, the UK, and the US, were most likely to wait more than one month for elective surgery, six days or longer to see a doctor when ill, and two hours or more for access to the ER.

That is hardly the sort of access you might expect from the developed world’s second most expensive universal access health care system. It is further worth noting that seven developed nations, Austria, Belgium, France, Germany, Japan, Luxembourg, and Switzerland, maintain universal access health insurance programs that deliver access to health care without queues for treatment.

Access to medical technologies is also relatively poor here. Canadians struggle with a relatively small inventory of medical technologies when compared to what other nations manage to deliver through their universal access programs. At the same time, much of that limited inventory of technologies is old, outdated, and in need of replacement.

Canada’s health care system is also a study in decline. Once the home of one of the developed world’s highest physician-to-population ratios, Canada now ranks a miserable 26th among 28 developed nations who maintain universal approaches to health insurance. And the decline is firmly set to continue. Largely due to government restrictions on physician training, Canada’s physician-to-population ratio will fall in coming years without a significant intake of foreign-trained physicians.

And recent data suggests Medicare’s ability to squander financial resources has not abated: The Canadian Institute for Health Information found (not including Quebec) that in 2007-08: “Age-standardized rates of surgery outside the priority areas [hip & knee replacements, cataract surgery, cardiac revascularization, and cancer surgery] are about the same as they were in 2004–2005.” Within the priority areas, rates of surgery climbed by seven per cent between 2004/05 and 2005/06, and then essentially stopped growing to 2007/08. Let’s not forget that these non-increases occurred at the same time as provincial health spending (outside of Quebec) grew by $16.5 billion or about 25 per cent.

Those who criticize Canada’s health care system often raise the ire of politicians and pundits, both here and in the United States, who are quick to defend Canada’s unique approach to health care policy. An examination of the facts shows that it is the pundits who are wrong. Medicare is failing Canadians.