Canada’s Government-Run Madicare: Low Expections Cloaked in Lofty Rhetoric


On the campaign trail, presidential candidate Barack Obama promised health insurance for all Americans. Now, newly minted President Obama, along with Congressional Democrats, appears eager to deliver on that pledge by giving government a greater role in health-care insurance. Were Mr. Obama to consider Canadians’ struggles with government-run universal health insurance, however, he might have second thoughts.

Those who favor adopting a Canadian-style government-run universal health insurance program need to have a careful look at reality. Canada’s health care system is more an example of how not to organize health care policy. Some Canadians have even resorted to the courts in hope of better access to health care.

Let’s start with the facts about Canada’s Medicare program.

First, it is not cheap. While less expensive than the US health care system, Canada maintains, on an age-adjusted basis, the second most expensive universal access health insurance system in the developed world (of 28 such systems).

Yet Canadians endure service that ranges from mediocre to terrible. Medical technologies like MRI machines, CT scanners, and lithotriptors are in short supply. Canada is also slow to invest in medical technology, while much medical and diagnostic equipment is outdated.

Queues for health care in Canada also rank among the longest in the developed world. A recent study published in 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 2 hours or more for access to the ER. Consider also that in 2008 the median wait time for orthopaedic surgery, from mandatory GP referral to treatment, was nearly 37 weeks. It was nearly 32 weeks for neurosurgery. While wait times for cancer treatment were shorter at 4.6 to 5.8 weeks, they were hardly what you might consider prompt treatment.

Once the home of one of the developed world’s highest physician-to-population ratios, Canada now ranks (on an age-adjusted basis) 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.

Worse still, Canadian governments have proven impotent in the face of the problem: Recent government attempts to save the public system have shown little initiative and therefore little result.

For example, governments across Canada have attacked the waiting time problem by announcing long wait time benchmarks and selective wait time guarantees along with large increases in funding. Neither the benchmarks nor the guarantees are what you might call ambitious: 4 to 8 weeks for radiation therapy, to as long as 26 weeks for hip and knee replacement, cataract surgery, and lower urgency cardiac bypass surgery.

Government inaction and poor service have brought some Canadians to the realization that the courts may provide the only hope of recourse. In a landmark ruling on Quebec health insurance in 2005, the Supreme Court of Canada found that Canadians suffer physically and psychologically while waiting for treatment in the public health care system, and that the government monopoly on essential health services imposed a risk of death and irreparable harm to health. Ultimately, the Supreme Court determined that the government of Quebec’s prohibition on private health insurance violated citizens’ right to life, personal security, inviolability, and freedom as guaranteed by Quebec’s Charter of Human Rights and Freedoms.

Constitutional challenges before the courts elsewhere in Canada are seeking to expand that finding to other provinces.

In Ontario, the case involves two patients who went abroad for more detailed diagnoses of their brain tumors because of untenable delays in the public health care system. Even armed with clear evidence of dangerous tumors, they could not convince the government health care system to provide treatment quickly and so went to the US to buy treatment. They are challenging Ontario’s government-run monopoly health-insurance system, claiming it violates the right to life and security of the person guaranteed by the Canadian Charter of Rights and Freedoms

In Alberta, a man who was denied a Birmingham hip replacement at age 57 because he was “too old” to enjoy the benefits of returning to an active lifestyle, and then who was denied the opportunity to even pay for it himself in Alberta, is taking the government to court claiming a violation of Charter rights as well.

These legal challenges, along with a Constitutional challenge launched in British Columbia in January, share a common goal: give Canadians the freedom to spend their own money to protect themselves from the all-too-likely (and perhaps inevitable) failure of the government insurance system to provide care in a timely fashion.

The realities of what Canadians endure on a daily basis are far from the paradise many believe to exist. To the contrary, Canada’s health care system is one of low expectations cloaked in lofty rhetoric. It fails Canadians on a regular basis.

It is obviously up to Americans to decide what kind of health care system they want. But this much we know: Canada’s government-run system comes at the cost of pain and suffering for patients who find themselves stuck on waiting lists with nowhere to go. Americans would be well advised to look elsewhere (away from government control and intervention) for their solutions. They should hope that President Obama heeds the lessons that can be learned from Canadians’ hardships and does the same.

Nadeem Esmail is the Director of Health System Performance Studies at the Fraser Institute based in Canada.

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