The Death of the Canadian Model

by Russ Roberts on February 26, 2006

in Health

Proponents of single-payer health care reform in the United States have long pointed toward Canada as a model for the US to emulate.

The New York Times reports that the Canadian system is imploding.  A recent Candian Supreme Court decision allowed private health care (oh, the shame, the horror) and as a result, Canadians tired of waiting for radiation therapy, eye surgery and hip replacements have turned toward private alternatives springing up under the new legal environment.

The Times reports:

Canada remains the only industrialized country that outlaws
privately financed purchases of core medical services. Prime Minister
Stephen Harper and other politicians remain reluctant to openly propose
sweeping changes even though costs for the national and provincial
governments are exploding and some cancer patients are waiting months for diagnostic tests and treatment.

But a Supreme Court ruling last June — it found that a Quebec
provincial ban on private health insurance was unconstitutional when
patients were suffering and even dying on waiting lists — appears to
have become a turning point for the entire country.

prohibition on obtaining private health insurance is not constitutional
where the public system fails to deliver reasonable services," the
court ruled.

The key paragraph:

The country’s publicly financed health insurance system — frequently
described as the third rail of its political system and a core value of
its national identity — is gradually breaking down. Private clinics are
opening around the country by an estimated one a week, and private
insurance companies are about to find a gold mine.

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happyjuggler0 February 26, 2006 at 3:59 pm

This is bad news for US health care providers in the short to medium term, but great news in the long term. Presumably Canadians will now stop crossing into the uS for healthcare that their government wouldn't provide for them.

But it is unequivically good for Canadians. It is also great news for Americans who have yet to experience the horrors of months long waiting lines for procedures they can get with less than a day's notice in the US.

catquas February 26, 2006 at 6:00 pm

From "Ruling Has Canada Planting Seeds of Private Health Care" (listed under "related articles"): "Premier Gordon Campbell of British Columbia… presented his vision for a new provincial health care system that would resemble those of most of Western Europe, where the government pays for essential treatment delivered in both public and private clinics and hospitals."

Sounds like a better idea to me. I don't see the point of banning private practice or insurance, as long as those who chose not to use the public system still pay into it (those that can afford to, that is). Furthermore, the decision to copy Europe is enlightened, as continental European countries have the the most excelent health systems in the world, and they still spend much less per capital than the US.

Andy February 26, 2006 at 7:08 pm

This paragraph in the story is slightly wrong:

"Dr. Day's hospital here opened in 1996 with 30 doctors and three operating rooms, treating mostly police officers, members of the military and worker's compensation clients, who are still allowed to seek treatment outside the public insurance system"

That paragraph should read like this:
Dr. Day's hospital here opened in 1996 with 30 doctors and three operating rooms, treating union members, the military and worker's compensation clients, who are still allowed to seek treatment outside the public insurance system.

Even the public employees unions in Canada knew that the public healthcare system was crap and got permission to get healthcare elsewhere.

Bart Hall (Kansas, USA) February 27, 2006 at 7:43 am

I lived in Canada as an immigrant for more than 20 years, eventually deciding that oppressive taxes, stifling regulation and generally bloated statism we not going to get any better.

The real bogeyman of Canadian health care is fear of a "two-tier" system in which the "rich" have access to better (ie private) care while the "poor" do not. Canadians are beginning to figure out that they already have a "two tier" health care system.

The first tier is in the States, and they know it.

The real shocker is that Canada's famously left-leaning Supreme Court voted unanimously against restrictions on private care and insurance, stating clearly that such systems are an illegal violation of Canadians' constitutional right to "security of the person" because under the arrangement people get sicker and even die while waiting for care.

DocBrown February 27, 2006 at 8:23 am

The decision was not by the Canadian Supreme court, but by the Supreme Court in the province of Quebec. It is not binding on other provinces nor on the country as a whole, but it may be influential.

amyc February 27, 2006 at 9:04 am

Andy said:
That paragraph should read like this:
Dr. Day's hospital here opened in 1996 with 30 doctors and three operating rooms, treating union members, the military and worker's compensation clients, who are still allowed to seek treatment outside the public insurance system.

OK, as a US military spouse that pisses me off. Because we military families live with a true Canadian style health system here in the US, and yes, people get sicker and die waiting for diagnostic and surgical procedures in the US military health system while US medicaid (for the poor and welfare recipients) don't. So we military folks get worse health care than the rest of the country. And here I see that liberal, whacked-out Canada actually surpasses the US in "supporting the troops" in a way that actually impacts military lives. Hmmmm. I'm done making fun of Canadian health care.

BigFire February 27, 2006 at 9:15 am

Two Tier Healthcare system has always existed for Canadian who opted not to die. United State is the safety valve for those Canadian who valued their lives over the principal of Socialist Healthcare.

Anonymous February 27, 2006 at 9:16 am

According to this link at the CBC, the
decision was rendered by the Supreme Court
of Canada.

Aaron Krowne February 27, 2006 at 9:20 am

I have written about how the US should *truly* privatize and not go for a state-based system, a-la Canadia [sic]:

"US Health Care: Addicted To The Thing That's Killing Us",

Hope you guys enjoy it.

Matt February 27, 2006 at 9:36 am

I can't believe The New York Times ran that story.

MnZ February 27, 2006 at 10:20 am

I can only hope that this will finally stop the idea of a single-payer health plan in the US. I have talked to several people who thought that a single-payer system was the only way to go. All of them were unaware that (i) very few western countries have a single-payer system and (ii) Canada found their single-payer system unconstitutional.

Moreover, I really cannot understand how a single-payer system would not violate the "right to privacy" that exists in the US. If the government cannot interfere with first term abortions, how can it stop someone from paying for a health treatment that they need?

Paul Pennyfeather February 27, 2006 at 11:04 am

catquas wrote:

"…the decision to copy Europe is enlightened, as continental European countries have the the most excelent health systems in the world…".

I remember being in France two occasions: once when my wife was sick and once when I was floored by a chest infection. In the former case my wife was able to walk into a pharmacy and get antibiotics, which both we and the Pharmacist knew she needed, without jumping through the hoops of a doctor's appointment, etc. The second time, in Paris, I was able to call a French doctor, who came to my hotel at 3am, gave me an examination, a shot, some antibiotics, and a prescription for more medicine if the pills he gave me didn't do the trick. It cost me the equivalent of 70 American dollars. He saved my vacation! [but I always wondered if the French taxpayer wasn't being forced to subsidize my good medical fortune].

I was amazed, as these seemingly free market alternatives would be unheard of (and illegal) here in liberty-loving USA.

From Britain, however, one often hears horror stories similar to Canada, such as the story I read in one of the London papers about a patient sleeping for two weeks in a wheelchair because union rules don't allow the nurses to move a patient. Evidently the person who IS allowed to move patients from wheelchair to bed (orderly? doctor?) could not be found. Ah, socialism.

Don Mynack February 27, 2006 at 11:17 am

Awesome! I had no idea you guys had comments on!

Anyway, in response to Paul's comment above, yes, I agree that the dispensing of perfectly safe legal drugs like most antibotics could be just as easily taken care of through a pharmacist rather than a doctor. I think the argument from an insurer's perspective is that they would have to pay for more expensive drugs, since a pharmacist has a financial incentive to sell you expensive stuff, and a doctor does not.

As far as how you were able to get a doctor to come to your hotel in France, that's rather easily explaned – the doc did it for the money, since they make much less in the gov't compensation scheme. It's a nice little side business for docs over there. You can get doctors here to the same thing if you pay cash and they don't have to deal with your insurance. I saw a news story the other day where a doctor started marketing herself exclusively as a "house call" doctor, using an internet-based virtual office. You sign up, schedule an available time, and she shows up at your house. She also does not take insurance, which saves her a ton of overhead.

Sandy P. February 27, 2006 at 11:44 am

We don't need to rely on the NYT to tell us how lousy the rest of the Anglosphere's socialized med system is. We can read it for ourselves in their papers.

Canada's pouring about 41 billion loonies over 10 years to shore theirs up. Britain, Scotland, Ozland and the Kiwis all have major problems. And Britain's the only one which spends %age-wise about the same as we do on their militaries, although Ozland and Harper have indicated they will start spending more.

HSAs and Wal-Mart will start breaking open our system and put responsibility where it belongs, back on us. We're adults, most of us will be able to handle it, and we'll take care of those who can't.

Tim in PA February 27, 2006 at 12:46 pm

They very idea that a government would tell their citizens that they are not allowed to go and seek their own medical attention is disgusting.

Hardly a week goes by where I don't hear some fool classmate blather on about the wonders of socialized medicine and how they wished we had it. They seriously make me want to scream.

Chester White February 27, 2006 at 8:59 pm

I lost much of the central vision in my right eye at the age of 41 because of British "health care." I was on vacation and went for an emergency visit, and was told nothing was wrong.

By the time I got to a US eye doctor, I'd had a ruptured blood vessel behind my retina and a macular scar for life.

It would have taken nothing more than a fluorescene dye angiogram to see the looming problem, but, of course, that would have cost money. Thank you, Britain.

I think I'll pay for actual care from now on.

Peter Sterne, Sr February 27, 2006 at 10:53 pm

Paul Pennyfeather:

I assume that having said, "I agree that the dispensing of perfectly safe legal drugs like most antibotics could be just as easily taken care of through a pharmacist rather than a doctor", you have probably never lost a close friend to an antibiotic resistant bacteria.

Perfectly safe indeed!

Even our doctors are extremely lax in ensuring that the antibiotics they prescribe actually kill the bacteria they are targeting … dispensing this responsibility to pharmacists seems quite risky!

John Dewey February 28, 2006 at 2:09 pm


Sorry to hear about your disability. I'm sure you had the strength to overcome it, as I had to overcome my hearing loss. It must be frustrating, though, to realize how easily it could have been prevented.

As an airline employee, I can fly to England for next to nothing. But your story, and others I've heard, have convinced me to remain in the U.S. during vacations. England's poor health care system caused them to lose my tourist dollars.

anon March 1, 2006 at 11:41 am

From the title I thought this was going to be a post about Wayne Gretsky's wife or something…

Shirley Rempel March 24, 2007 at 12:46 pm

Where might there be a data bank of health services in the US for Canadians to access? It would be valuable to know. The wait time and complexity in trying to access our publically funded health care system here in Canada for a family member has become too exhaustive. We will need to raise the money to go to the US to find the care.

I appreciate any information on this topic.

James J December 29, 2007 at 10:36 pm

Canada spends about 9.4% of gross domestic product (GDP) to provide universal health care for all citizens. However, the U.S. spends 14% and provides no coverage at all for 43 million of its citizens, and inadequate coverage for 100 million Americans.

long January 8, 2008 at 5:45 pm

I had aterrible feeling grandma takes large dicks that i don t know about the light flicked.

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