October 15, 2007

According to the Canadian think tank the Fraser Institute, health care wait times in Canada are at an all time high:

"Despite government promises and the billions of dollars funnelled into the Canadian health-care system, the average patient waited more than 18 weeks in 2007 between seeing their family doctor and receiving the surgery or treatment they required," said Nadeem Esmail, director of Health System Performance Studies at the Fraser Institute and co-author of the 17th annual edition of Waiting Your Turn: Hospital Waiting Lists in Canada.

The 2007 survey found the total median waiting time for patients between referral from a general practitioner and treatment, averaged across all 12 specialties and 10 provinces surveyed, increased to 18.3 weeks from 17.8 weeks observed in 2006. This was primarily due to an increase in the first waiting period, between seeing the general practitioner and attending a consultation with a specialist.

You can access the full report here. Will this affect Canadians preference for their single-payer system? Unlikely; universal health care is a point of national pride for Canadians that sets them apart (or in their view, above) their U.S. cousins.

What is ironic, however, is that the Canadian commitment to health care equality is honored more in the breach than in reality with wealthy and/or politicially savvy Canadians visiting private clinics or going abroad for treatment even as some American pundits praise health care equality in the Great White North.

Says, Jonathan Cohn in the New Republic:

One way to think of Canada is that it rations its care in a more egalitarian way than we do. It's a one-size-fits-all, single-payer system, so everybody is subject to the same limitations. Here in the United States, we have enormous disparities, where people with insurance tend to have pretty good access to care while people without have lousy access.

This is a rose colored reading of the Canadian reality, highly dubious given the growing popularity of private clinics there. But how do the U.S. and Canada fare in a head to head comparison? Unbiased reports are hard to come by, but one economist, June O'Neill, recently published a paper at NBER that found that the U.S. actually fares quite well on equity grounds with Canada, while offering superior innovation.

Every health care system has its problems, of course. And, as Cohn correctly notes, American health care is rationed by price, while Canadian care is rationed by political horsetrading (on spending) and non-price contstraints (like wait times). The question is, would Americans tolerate these kinds of constraints? The answer, I think, is no.

Posted by Paul Howard at October 15, 2007 02:05 PM