TORONTO — When the Canadian Broadcasting Corporation asked Canadians to pick the greatest-ever Canadian in 2004, they did not select hockey star Wayne Gretzky or Nobel laureate Sir Frederick Banting, who co-discovered insulin.
They chose Tommy Douglas, who almost lost a leg to a bone infection as a boy because his parents couldn’t afford his medical treatment. When he became premier of Saskatchewan in 1944, he implemented a single-payer, universal health-care system that became the model for the rest of the country.
Canada’s health-care system, known as Medicare, is an unrivaled pillar of Canadian national identity. Nearly 90 percent of Canadians believe that eliminating it would result in a fundamental change to the nature of Canada.
And as Americans have debated health-care revisions, many advocates of universal coverage like Sen. Bernie Sanders (I-Vt.) have looked at Canada as a model to emulate.
But Canada’s universal health-care system is in danger of becoming outdated, putting its credibility as a global health leader at risk, according to a new series of papers and commentaries published Friday in the Lancet, a British medical journal.
This is the journal’s first series on Canada and its release was timed to coincide with the beginning of the country's G-7 presidency and the 150th anniversary of Confederation.
“The Canadian system gets batted around as either an example of a socialist disaster or a utopian dream,” said Danielle Martin, one of the authors of the study and a Toronto-based physician and professor. “It is a good time for Canadians to set the record straight about who we are and how our health care-system does and doesn’t work.”
Under Canada’s taxpayer-funded Medicare system, Canadians don’t pay out-of-pocket for essential medical services like doctor and hospital visits. Co-payments are a foreign concept, and buying private insurance for health-care procedures covered under Medicare is banned.
Nearly two-thirds of Canadians have supplemental private insurance or employer-sponsored plans to cover the costs of prescription drugs, dentistry, vision care, rehabilitative service and home health care.
The delivery of health care is left up to the provinces and territories, which each have their own insurance plans and receive transfer payments from the federal government. The private sector delivers a lot of the care.
Canada spends less per capita on health-care than the United States and performs better on a wide range of indicators like life expectancy, obesity rates, infant mortality and “amenable mortality”— deaths that theoretically could have been avoided by timely and effective medical care — according to the series.
But its authors note that these glowing statistics conceal abysmal health outcomes for Canada’s 1.7 million indigenous people, who face disproportionately higher rates of suicide, infant mortality and chronic disease. Canada’s Inuit people have a life expectancy that is as much as 15 years shorter than non-indigenous Canadians, and tuberculosis rates that are 270 times higher than those of the Canadian-born, non-indigenous population.
In an introductory commentary, editors of the Lancet write that these health inequities “suggest a developing world within Canada’s borders.”
The study is also critical of Canada’s long wait times for nonemergency, specialty procedures like knee and hip replacements and non-urgent advanced imaging — higher than those in America — describing them as a “lightning rod issue” that could undermine support for Medicare among Canadians.
Canada’s status as the only country in the developed world with universal health-care that does not cover prescription drugs is panned, too. In almost one-quarter of Canadian households, someone is not taking medications because of an inability to pay, according to the Angus Reid Institute, a polling organization.
“When we compare ourselves to the United States, we feel really great,” Martin said. “But when it comes to prescription drugs, we are in the exact same situation as our American colleagues, when we write out prescriptions and our patients don’t know how they are going to pay for them.”
As one of the biggest champions of Canada’s Medicare system, Sanders appears to have taken this criticism into consideration when designing his own single-payer plan. His proposed Medicare for All Act offers coverage for prescription drugs, optometry and dentistry, making it more generous than what Canada currently offers.
Of course, not all Democrats support that approach. House Minority Leader Nancy Pelosi (D-Calif.), for instance, has advocated making health coverage more expansive through smaller, more gradual steps as opposed to a radical overhaul.
The Lancet series faults Canada’s incrementalist approach to health-care changes for Medicare’s status as “a system in stasis.”
“Incrementalism only works if you take one step, and then immediately take the next, and then immediately take the next,” Martin said. “The concern always is that you will take one step and then spend all of your time defending the one step.”