It's Not Perfect, But It Sure Works

On Jan. 7, Peter Paterson, a retired Canadian accountant, had his first appointment with one of Toronto's leading heart surgeons. The diagnosis: He needed surgery--fast. The next week, Paterson was admitted to a hospital, where he received a quintuple bypass. A rapidly recovering Paterson--who paid nothing for his care--was so impressed that he wrote his surgeon a letter of thanks. "The medical system we have here in Canada is wonderful," he says.

Paterson's experience may be dismissed as an anomaly by the critics, from President Bush on down, who argue that Canada's nationalized health insurance doesn't work. They say it's costly, bureaucratic, and burdened with waiting lines so long that many opt for care in the U.S. Yet Paterson's story is actually typical of the Canadian program's ability to deliver quality care in emergencies. Canada does require patients to wait for critical procedures such as hip replacements. Still, it does a far more equitable job providing reasonably priced health care to all.

LESS DREAD. The merits of the system, a kind of countrywide medicare administered by the 10 provinces, are many. Canadians don't worry about losing their health insurance because of unemployment or "preexisting medical conditions." Nor do they have to dread being financially wiped out by catastophic illness. The system pays the entire cost of medical treatment, though dental care and prescriptions aren't included.

Canada's plan is funded mainly through personal income tax revenues--one reason why Canadians have steep income tax bills. The top combined federal and provincial marginal rate is about 48% on income over $50,000. Even so, Canadian health care expenditures per capita run 40% less than in the U.S., and the burden on large employers is dramatically lower, too. In 1990, Ford Motor Co. of Canada spent $41 million on coverage for its 22,000 workers, or about $65 per vehicle produced. In contrast, Ford Motor Co. USA spent $300 per vehicle.

Does the system work? Life expectancy in Canada is 77 years, vs. 75 in the U.S. And the infant-mortality rate is 7 per 1,000 live births, compared with the U.S. rate of 11 per 1,000. Yet in 1990, Canada devoted only 9.5% of its gross national product to health care expenses while the U.S. spent 12.2% of its GNP.

Canada has controlled costs by relying on a single insurer: the government. As a result, patients don't have to bother with endless insurance forms, and doctors and hospitals need not go to dozens of insurance companies to collect payment. The U.S. General Accounting Office reported last year that the U.S. could save $67 billion in administrative costs by shifting to such a single-payer system--"more than enough to finance insurance coverage for the millions of Americans who are currently uninsured."

`CLEAR THREAT.' These days, though, constraints are worrying Canada. With a recession cutting deeply into tax revenues, the country's 20-year-old system is facing a growing financial crunch. Quebec is proposing a fee of $5 (Canadian) per doctor visit. And treatment delays are mounting. In Toronto, patients must now wait an average of two to three months for a coronary bypass (though those in imminent danger get priority). The restrictions "are a very clear threat to our system," warns Dr. Alan Hudson, CEO of Toronto Hospital.

Nevertheless, Canada's approach provides another compelling advantage: the ability to choose one's own physician--an increasingly limited privilege in the U.S., as employers switch to managed care organizations with their lists of participating physicians. It's ironic that a feature so cherished by free-enterprise-oriented America should thrive in a government-funded Canadian plan.

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