Thanks to Premier Danny Williams’ comments, we are in another short bout of collective denial and misunderstanding of Canada’s healthcare system and the public perception thereof.
For those not in the know, Premier Williams recently jaunted down to Miami for heart surgery. In his interview with NTV reporter Fred Hutton, he stated, “This is my heart. It’s my health and it’s my choice.” True. It is a choice. If you can afford it.
It’s also a wonderful reflection of the fact that despite all the mythology awe, in Canada, actually have a three-tiered healthcare system. Williams enjoys the benefit of tier three – travel to the US. It’s a choice that many, many wealthy Canadians make. Indeed, it’s a choice other wealthy politicians have made, including former Quebec premier Robert Bourassa and former MP Belinda Stronach. I’m willing to bet that the Mayo Clinic has made a lot of money off wealthy Canadians.
Of course, this effect is largely ignored since most Canadians can’t afford to go to the US. So we pretend it doesn’t happen. Indeed, the 1998 Katz paper, a frequently cited paper that claims Canadians don’t travel to the US for healthcare, strikes me as deeply misleading. As the study states:
An important limitation of this study is that only public out-of-country expenditures are included in the analysis; private sources of funding, including “travel” health insurance plans and out-of-pocket payments, are omitted.
This of course doesn’t prevent them from drawing some very strong conclusions, namely that Canadians don’t go to the US for healthcare. In some ways they are right, average Canadians don’t, but what did you expect if the study only looks at people who used Ontario public insurance – in short, those who couldn’t afford to travel to the US and pay privately…
Then of course, there is the more familiar second tier. This is private healthcare available here in Canada. Don’t be fooled, there is plenty of private healthcare in Canada. Indeed, at least 30% of healthcare spending in Canada is from private funds. This includes simple things like your glasses and dental costs, as well as the more complex, such as clinics that conduct surgery in Quebec (which the Feds don’t dare close) to those in British Columbia (which most people pretend don’t exist). These service upper middle class Canadians and, ironically, provincial Workers Compensation Boards which are not bound by the Canada Health Act and so can pay to have their patients serviced by private clinics in Canada. Irony!
Finally, there is familiar tier one — the public system that most of us avail ourselves of. (Which still has a huge private component – all those doctor offices are private businesses…) The system generally works, but often has too few doctors (try finding a GP – 4.5 Million of us haven’t!), long wait lines in Emergency Rooms (often hours long) and waiting lists for some procedures (don’t break your hip).
This is the reality of healthcare in Canada. Yes, we have universal healthcare. But it is within a three-tiered system and the wealthy – like Danny Williams – opted out a long, long time ago.
2. (Mis)perceptions of Canadian (Mis)perceptions
Of course, many Canadians know that the wealthy go elsewhere. They even know that their healthcare system is either groaning or breaking (try being on a waiting list) or financially unsustainable (try living in a province where healthcare eats up 45% of the budget and rising). Moreover, they know more money isn’t going to magically solve it (or at least not the amount of money we can afford). Did anyone really believe that $41 billion over 10 years would “save healthcare for a generation?”
(As an aside, I suspect this is why Canadians reject the Liberals’ National Daycare Program – many people agree daycare is good and important but they remain suspicious of a system that is likely to become as top-down, hard to contain and even more difficult to reform/evolve as Healthcare. In short, they don’t wanted it modeled after I system they already think is borked.)
But the story isn’t that Canadians want either the status quo or the American option. Although Canadians recognize our system has huge challenges, most of us agree the American system is far, far worse, particularly for the vast majority of us who can’t afford to fly down there to begin with. Far better to stick with the devil we know, than the bogey man to the south. The fact is… better the system you know and hate, then the one you don’t know and hate even more.
Ultimately, both the Canadian and the American models are likely done. Neither country can afford to manage double digit (or even high single digit) increases in healthcare costs. Somewhere, something has to give. But we’ll have to experience a lot more pain (and denial about how great our system is) before we get there. What I suspect is true is that the wealthy and privileged stopped caring a long time ago. They aren’t invested in the system because – residing in the third tier – they are outside of it.