Democrats and Bernie Sanders are pushing for single-payer health care. Many Americans think that’s a good idea: What’s wrong with everybody having free health care? Of course, it’s not really free: we’d be paying for it with our tax dollars.
But the proponents are not telling the public what their health care would look like if we did take that path. Single-payer allegedly will cover all needed health care for anyone who wants it. But, because “free” health care is available to all, the costs of doing that inevitably rise each year. The only mechanism the government has to control those costs is by rationing health care—making it harder to access.
In Canada, health-care costs are paid for by the taxpayers. Those with larger families or higher incomes pay more. But because taxes for health care are rolled into the entire tax burden, it’s hard to tell how much individual families are really paying for their care. Click here for info on that.
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But in Canada, people wait a long time for things like seeing a specialist and getting diagnostic scans. The Fraser Institute keeps track of these times, in a report titled, “Waiting Your Turn: Wait Times for Health Care in Canada.”
Americans will find the 2017 Edition shocking. The introduction says:
“Waiting for treatment has become a defining characteristic of Canadian health care. In order to document the lengthy queues for visits to specialists and for diagnostic and surgical procedures in the country, the Fraser Institute has—for over two decades—surveyed specialist physicians across 12 specialties and 10 provinces.”
The report continues:
“Waiting times for medically necessary treatment have increased since last year. Specialist physicians surveyed report a median waiting time of 21.2 weeks between referral from a general practitioner and receipt of treatment—longer than the wait of 20.0 weeks reported in 2016.”
“Among the various specialties, the shortest total waits exist for medical oncology (3.2 weeks), radiation oncology (3.9 weeks), and elective cardiovascular surgery (11.7 weeks). Conversely, patients wait longest between a referral by a GP and orthopedic surgery (41.7 weeks), neurosurgery (32.9 weeks), and ophthalmology (31.4 weeks)”
“This year, Canadians could expect to wait 4.1 weeks for a computed tomography (CT) scan, 10.8 weeks for a magnetic resonance imaging (MRI) scan, and 3.9 weeks for an ultrasound.”
Long waits for diagnostic scans—which of course must be prescribed by a doctor, who has a separate waiting period—can be critical in diagnosing things like cancer.
Here’s a realistic example. Let’s say you’re a Canadian who’s a former smoker. You see your doctor who gives you a routine chest X-ray. It shows a 5-mm nodule that appears to be in your right lung. But 20% of ‘nodules’ found on a chest X-ray are actually not in the lung.
Only a CT scan can determine if it is in the lung, and what its internal characteristics are. If contrast is used, that can determine if there are enlarged lymph nodes in the area near the lungs or if the nodule shows enhancement—is much more visible, due to more blood supply—a sign of malignancy.
Your doctor recommends a visit to a medical oncologist. That’s a 3.2 week wait. The medical oncologist recommends a CT scan. That’s a 4.1 week wait. The total wait time is at least 7.3 weeks. And that doesn’t count the time it takes the oncologist to receive the scan report and for you to get a second appointment to see him.
Lung cancer is curable if the nodule is small enough, it can simply be removed with non-invasive techniques. “Over 90% of pulmonary nodules that are smaller than two centimeters (around 3/ 4 inch) in diameter are benign,” says the Cleveland Clinic.
How comfortable would you be waiting nearly two months to find out if you even have a nodule in your lung—and if it is in your lung and looks malignant, it got a pass for nearly two months to grow? Maybe by then it’s not so curable.
The reason for the scan delays is simple: not enough facilities: in 2015 the number of CT scanners in the United States, per 1 million people was 40.94 vs 15.01 in Canada.
That year, the number of MRI units per 1 million people was 38.96 in the United States vs 9.48 in Canada. —source: Statistica.com
An NHI study in 2012 concluded the following:
Several lessons can be learned from the Canadian experience. When government provides a product “free” to consumers, inevitably demand escalates and spending increases. Products provided at zero price are treated as if they have zero resource cost. Resource allocation decisions become more inefficient over time and government is forced either to raise more revenue or curb services.
“A number of the provincial health plans are moving to reduce spending by dropping services from the approved list of the “medically necessary”. A second lesson from the Canadian experience is that everything has a cost. When care requires major diagnostic or surgical procedures, the “free” system must find some other mechanism to allocate scarce resources. The Canadian system delegates this authority to the government. Resource allocation is practiced, not through the price mechanism, but by setting limits on the investment in medical technology.”
In Canada, the most visible means of cost-cutting is long wait times for care.
“Proponents will argue that using waiting lists as a rationing measure is reasonable and fair. Opponents find the lists unacceptable and an unwelcome encroachment on individual decision-making in the medical sector. Proponents of the single payer alternative must deal with the fact that Canadians face waiting lists for some medical services especially for high – tech specialty care. To avoid delays in treatment, many Canadians travel south to the United States for more advanced treatment.” At their own cost, of course.
A number of Quebeckers sued their government for violating their “right to life and security” under the Quebec Charter of Rights and Freedoms. Canada’s Supreme Court has acknowledged the pervasive rationing that occurs. In the 2005 case Chaoulli v. Quebec (Attorney General) , the majority opinion stated: “The evidence in this case shows that delays in the public health care system are widespread, and that, in some serious cases, patients die as a result of waiting lists for public health care.”
Those who advocate for such a system in the United States know full well that it is not working in Canada. But they hope to con America into accepting single-payer anyway.
