Health
Canada remains poor performer among countries with universal health care
From the Fraser Institute
By Mackenzie Moir and Bacchus Barua
Canada reported far fewer physicians (ranking 28th of 30) and hospital beds (23rd of 29) per 1,000 people in 2021. And ranked low for the availability of MRI machines (25th of 29) and CT scanners (26thof 30) per million people in 2019
Earlier this year, the Trudeau government announced it will increase health-care spending to provinces and territories by $196.1 billion over the next decade. But patients hoping for improved access will likely be disappointed. In reality, Canada’s health-care system already ranks as one of the most expensive systems in the world, but only has mediocre results to show for it. In other words, the problem isn’t the amount of money we spend, it’s the poor value we get for our health-care dollars.
A new study compared the spending and performance of Canada’s system with 29 other universal health-care systems worldwide. According to the study (after adjusting for population age in each country), Canada was the highest spender on health care as a share of the economy (at 12.6 per cent) and ninth-highest on a per person basis in 2021, the latest year of available data.
And yet, compared to other universal countries, Canada reported far fewer physicians (ranking 28th of 30) and hospital beds (23rd of 29) per 1,000 people in 2021. And ranked low for the availability of MRI machines (25th of 29) and CT scanners (26thof 30) per million people in 2019 (the latest year of available data).
Unsurprisingly, scarce health-care resources are accompanied by long wait times. Using data collected in 2020 by the Commonwealth Fund, the study found that only 38 per cent of Canadians reported waiting less than four weeks for a specialist appointment—a much smaller percentage than countries such as Switzerland (68 per cent) and Germany (67 per cent). On this indicator, Canada ranked 10th out of 10 countries. Canada also ranked dead last (10th) on timely access to elective surgery—with 62 per cent of Canadians reporting waiting less than four months—compared to 99 per cent of Germans and 94 per cent of Swiss.
While these results were disappointing, Canada reported mixed results in other areas of performance. For example, although Canada performed poorly on safety indicators such as obstetric trauma during birth (23rd of 23 countries), it performed above the OECD average on other indicators including heart attack survival rates (9th of 25 countries). But while the Canadian system has in some areas performed in line with its high spending levels, overall it’s struggled to meet many of its basic obligations—especially timely access to care.
With its latest increase in health-care spending, the Trudeau government again ignores the fact that Canada already has one of the most expensive universal health-care systems in the world. And although some of this new spending is predicated on provinces tracking progress and demonstrating improvement on certain indicators, international data reveal a simple truth—Canadians do not receive commensurate value for their health-care dollars. Without fundamental reform, it’s unlikely the new spending promised by the Trudeau government will produce improved performance for Canadian patients and their families.
Authors:
This article supplied by Troy Media.
By Pat Murphy
Generous social programs come with trade-offs. Pretending otherwise is political fiction
Nordic societies fund their own benefits through taxes and cost-sharing. Canadians expect someone to foot the bill
Like Donald Trump, one of my favourite words starts with the letter “T.” But where Trump likes the word “tariff,” my choice is “trade-off.” Virtually everything in life is a trade-off, and we’d all be much better off if we instinctively understood that.
Think about it.
If you yield to the immediate pleasure of spending all your money on whatever catches your fancy, you’ll wind up broke. If you regularly enjoy drinking to excess, be prepared to pay the unpleasant price of hangovers and maybe worse. If you don’t bother to acquire some marketable skill or credential, don’t be surprised if your employment prospects are limited. If you succumb to the allure of fooling around, you may well lose your marriage. And so on.
Failing to understand trade-offs also extends into political life. Take, for instance, the current fashion for anti-capitalist democratic socialism. Pushed to explain their vision, proponents will often make reference to the Nordic countries. But they exhibit little or no understanding of how these societies actually work.
As American economist Deirdre Nansen McCloskey notes, “Sweden is pretty much as ‘capitalistic’ as is the United States. If ‘socialism’ means government ownership of the means of production, which is the classic definition, Sweden never qualified.” The central planning/government ownership model isn’t the Swedish way.
What the Nordics do have, however, is a robust social safety net. And it’s useful to look at how they pay for it.
J.P. Morgan’s Michael Cembalest is a man who knows his way around data. He puts it this way: “Copy the Nordic model if you like, but understand that it entails a lot of capitalism and pro-business policies, a lot of taxation on middle-class spending and wages, minimal reliance on corporate taxation and plenty of co-pays and deductibles in its health care system.”
For instance, take the kind of taxes that are often derided as undesirably regressive—sales taxes, social security taxes and payroll taxes. In Sweden, they account for a whopping 27 per cent of gross domestic product. And some 15 per cent of health expenditures are out of pocket.
Charles Lane—formerly with the Washington Post, now with The Free Press—is another who pulls no punches: “Nordic countries are generous, but they are not stupid. They understand there is no such thing as ‘free’ health care, and that requiring patients to have at least some skin in the game, in the form of cost-sharing, helps contain costs.”
In effect, Nordic societies have made an internal bargain. Ordinary people are prepared to fork over large chunks of their own money in return for a comprehensive social safety net. They’re not expecting the good stuff to come to them without a personal cost.
Scandinavians obviously understand the concept of trade-offs, a dimension that seems to be absent from much of the North American discussion. Instead of Nordic-style pragmatism, spending ideas on this side of the Atlantic are floated on the premise of having someone else pay. And the electorally prized middle class is to be protected at all costs.
In the aftermath of Zohran Mamdami’s New York City win, journalist Kevin Williamson had a sobering reality check: “Class warfare isn’t how they roll in Scandinavia. Oslo is a terrific place to be a billionaire—Copenhagen and Stockholm, too … what’s radically different about the Scandinavians is not how they tax the very high-income but how they tax the middle.”
Taxation propensities aside, Nordic societies are different from the United States and Canada.
Denmark, for instance, is very much a “high-trust” society, defined as a place “where interpersonal trust is relatively high and ethical values are strongly shared.” It’s often been said that it works the way it does because it’s full of Danes, which is broadly true—albeit less so than it was 40 years ago.
Denmark, though, has no interest in multiculturalism as we’ve come to know it. Although governed from the centre-left, there’s no state-sponsored focus on systemic discrimination or diversity representation. Instead, the emphasis is on social cohesion and conformity. If you want to create a society like Denmark, it helps to understand the dynamics that make it work.
Reality intrudes on all sorts of other issues. For example, there’s the way in which public discourse is disfigured on the question of climate change and the need to pursue aggressive net-zero policies.
Asked in the abstract, people are generally favourable, which is then touted as evidence of strong public support. But when subsequently asked how much they’re personally prepared to pay to accomplish these ambitious goals, the answer is often little or nothing.
If there’s one maxim we should be taught from childhood, it’s this: there are no panaceas, only trade-offs.
Troy Media columnist Pat Murphy casts a history buff’s eye at the goings-on in our world. Never cynical – well, perhaps a little bit.
Troy Media empowers Canadian community news outlets by providing independent, insightful analysis and commentary. Our mission is to support local media in helping Canadians stay informed and engaged by delivering reliable content that strengthens community connections and deepens understanding across the country.
Ottawa and Alberta have reached a memorandum of understanding that paves the way for, among other things,. a new oil pipeline in return for higher carbon taxes.. How’s it doing? B.C. and Quebec both reject the idea. The Liberals former Climate minister resigned his cabinet post.
The most amazing feature of the Mark Carney/Danielle Smith MOU is that both politicians feverishly hope that the deal fails. Carney can tell Quebec that he tried to reason with Smith, and Smith can say she tried to meet the federalists halfway. Failure suits their larger purposes. Carney to fold Canada into Euro climate insanity and Smith into a strong motive for separation.
We’ll have more in. our next column. In the meantime, another Alberta initiative on healthcare has stirred up the hornets of single payer.
To paraphrase Winston Churchill, “Canada’s health system is the worst in the world. Except for all the other systems.” If there is anything left that Canadians agree upon it’s that their provincial healthcare plan is a disaster that needs a boatload of new money and the same old class rhetoric about two-tier healthcare.
Both prescriptions have been tried multiple times since Tommy Douglas made single-payer healthcare a reality. As a result today’s delivery systems are constantly strained to breaking and the money poured in to support it evaporates in red tape and vested interests.
But suggest that Canada adopt the method of somewhere else and you get back stares. Who does it better? How can we copy that? Crickets. Then ask governments to cut back and create efficiencies. No one wants to tell the unions they are the first to move. As a result, operating rooms sit empty for lack of trained nurses and rationed doctors. The system is all dressed with nowhere to go.
There are many earnest people trying their best to fit the square peg in the round hole. But so far it has produced a Frankenstein quilt of private clinics in other provinces handling overflows and American hospitals taking tens of thousands of overflows or critical cases. Ontarians travelling to Quebec for knee surgery. Albertans heading to eastern B.C. for hips and shoulders. Nova Scotians going to Boston for back surgery.
To say nothing of the legions of Canadians on waiting lists for terminal cancer or heart problems who, in despair of dying before seeing a specialist in 18-24 months, voyage to Lithuania, India or Mexico to save their lives. Everyone knows a story of a family member or friend surgery shopping. Every Canadian health authority sympathizes. But little solves the problem.
Which has led to predictable grumbling. @Tablesalt13 if the Liberals hadn’t surged immigration over the last 4-5 years and if all of the money spent on refugees and foreign aid was redirected to health care how much shorter would Canada’s medical waitlists be?
And if any small progress is made the radical armies opposed to two-tiered healthcare raise a stink in the media, stopping that progress in its tracks. Suggesting public/ private healthcare systems is a quick trip to a Toronto Star editorial and losing your next election.
Into the impasse Alberta has introduced Bill 11 to create a parallel private–public surgery system that allows surgeons to perform non-urgent procedures privately under set conditions, moving ahead with the premier’s announcement last week. The government says the approach will shorten wait times and help recruit doctors, while critics argue it risks two-tier care.
The legislation marks a major shift in healthcare reform in Alberta and faces (shock) strong opposition from the NDP which is pairing these reforms with the province’s use of the notwithstanding clause in banning radical trans surgery and medication for minors in the province.
There are examples of two-tiered healthcare elsewhere in the West. France, Ireland, Denmark, Switzerland and Germany, among others, use a dual-tracked system mixing public and private coverages. Reports FHI, “In the most successful European healthcare systems, e.g., Germany and Switzerland, the federal government handles the PEC risk, via national pools and government subsidies, sparing the burden on individual insurers.” While not perfect it hasn’t produced class warfare.
The Americans, meanwhile learned to their chagrin with ObamaCare (the Affordable Care Act, that government healthcare is not the answer. The U.S. heath system replaces government accounting with health insurance rationers as the immoveable force. Many Americans were outside this traditional system, paying out-of-pocket. Under the Obama plan everyone would be forced into a plan, like it or not.
The AFI continues, “ACA has a flawed design. Its architects meant to appeal to the public, promising what the old system could not fully deliver – guaranteed access to affordable health cover and coverage for pre-existing conditions (PECs). But they were wrong about being able to keep your doctor or your old policy if you wanted.
Previously individual policies had to exclude PEC coverage to be financially viable. Yet employer group policies often covered it after a waiting period, but the extra costs were spread over their fellow workers – a real burden on medium and small-sized companies. Under Obamacare, the very high PEC costs are still spread too narrowly – on each of the very few insurers who have agreed to stay as exchange insurers.”
In other words getting a universal system that helps the needy while not degrading treatment is illusory. Alberta is willing to admit that fact. Like agreement on pipelines it will face nothing but headwinds from the diehards (pun intended) who still believe Michael Moore’s fairy tales about a free system in Canada. And will do nothing to bind Canada’s warring factions.
Bruce Dowbiggin @dowbboy is the editor of Not The Public Broadcaster A two-time winner of the Gemini Award as Canada’s top television sports broadcaster, his new book Deal With It: The Trades That Stunned The NHL And Changed hockey is now available on Amazon. Inexact Science: The Six Most Compelling Draft Years In NHL History, his previous book with his son Evan, was voted the seventh-best professional hockey book of all time by bookauthority.org . His 2004 book Money Players was voted sixth best on the same list, and is available via brucedowbigginbooks.ca.
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