When mainstream media report on widespread dissatisfaction with the HMO-driven U.S. healthcare system, reporters seldom mention proposals for fundamental health reform; debate is usually limited to modest, incremental plans, like the "patients' bill of rights."
But as Canada has struggled this year with a funding shortage for its much-admired public health system, ABC News and the New York Times have pounced on the story as an opportunity to declare the failure of that country's system of universal healthcare.
On February 3, ABC aired a report by correspondent Deborah Amos in Toronto, depicting a country "struggling with universal healthcare." Most of Amos' report was taken up by grim descriptions of crowded hospitals: "The emergency rooms in Toronto hospitals are so clogged this winter, patients wait hours for critical treatment," Amos reported. "They sleep on stretchers in drafty hallways. And wait days for a hospital bed."
But Amos' attempt to explain why Canada's health service has suffered in recent years did not even make a pretense of journalistic balance. She reported that while health authorities blame shortages on this year's flu epidemic, "many Canadians believe it is the healthcare system itself that is truly sick":
The problem goes back a decade to when the Canadian government, in the middle of a recession, recognized that universal care was inefficient and expensive. So Canada closed hospital wards, eliminated 11,000 hospital beds, reduced nursing staffs, cut the number of places in state medical schools.
Not only does Amos' diagnosis blatantly take sides in an obviously controversial debate, but it contradicts a large body of evidence about the Canadian health system. The notion that universal health care is "expensive" in Canada is hard to reconcile with the fact that per capita health spending in the U.S. is more than twice as high: $4,000 last year, compared with $1,800 in Canada.
And while Amos calls Canada's system "inefficient," administrative costs in the U.S. system are far higher, due to a sprawling private-sector bureaucracy: A landmark 1991 New England Journal of Medicine study (5/2/91) found that 24 percent of U.S. health spending went to administration, compared with 11 percent in Canada.
In fact, as Amos' own comment suggests, the immediate causes of Canada's current healthcare delivery problems are the austerity measures implemented by a series of recent budget-cutting governments. While real per capita health spending in the U.S. has risen by 27 percent since 1990, in Canada it has risen by only 7 percent—leading to predictable shortfalls in services, given the healthcare industry's higher rate of inflation.
Likewise, a January 16 New York Times article, headlined "Full Hospitals Make Canadians Wait and Look South," also made dubious claims about Canada's health program. Illustrated with a photograph of an overcrowded Montreal hospital, correspondent James Brooke's story depicted a country rejecting its model of universal care in favor of more American-style solutions:
When Canada's state-run health system was in its first bloom, in the 1970s, Americans regularly trooped up here on inspection tours, attracted by Canada's promise of universal 'free' health care. Today, however, few Canadians would recommend their model for export.
Yet the closest evidence Brooke could find to support this thesis was a January poll by the Pollara firm that found 74 percent of Canadians "supported the idea of user fees," which have been outlawed in Canada since 1984. But Pollara surveys have also found that Canadians would only be willing to support very small fees, averaging about $18 per health visit—a sum that is unlikely to add more than 1 percent to the annual health budget (Montreal Gazette, 1/13/00).
Moreover, the poll presented user fees as the only alternative to higher taxes or less spending on other government programs. (Respondents rejected both higher taxes and lower social spending, but 64 percent favored cutting military spending to pay for health.)
Yet Canada has a large and growing federal budget surplus that can be used to dramatically increase healthcare spending—an option endorsed by the leaders of Canada's 13 provinces and territories at their February 3 meeting, but not given as an option in the poll (Montreal Gazette, 1/13/00; Globe and Mail, 2/3/00).
The last time the Gallup polling firm asked Canadians whether they preferred the American healthcare system, in 1993, only 2 percent said they did; 96 percent preferred their own system (UPI, 9/13/93). By contrast, a 1998 survey by Zogby, the Republican-oriented polling firm, found that 51 percent of Americans would favor a "government-run healthcare plan that covers everyone in the same way, like the system used in Canada. It would be paid for through taxes and cover all necessary medical costs." Despite the abundance of negative buzzwords like "government-run," only 38 percent were opposed.
<div id="extra-index-link"><a href="http://fair.org/extra-issues/extra-may-june-2000">Extra! May/June 2000</a></div>