Health Insurance and Health Care are not the same thing

Most recent data from Canada, where there is universal health insurance: Waiting Your Turn – Wait Times for Health Care in Canada, 2017 Report

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.

This edition of Waiting Your Turn indicates that, overall, 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. This year’s wait time—the longest ever recorded in this survey’s history — is 128% longer than in 1993, when it was just 9.3 weeks.

Unsurprisingly, when supply of a good is bureaucratically rationed, shortages result. When the good is “free,” it’s worse.

Somebody should tell Nancy and Bernie.

Canada Health care retrospective

The Other Club has written extensively about health care in Canada (see below). So much in fact, that the story earlier this month about Newfoundland Premier (Governor) Danny Williams coming to the United States for heart surgery seemed like same old, same old.

The comparable story, from a US perspective, might be that the Governor of Mississippi went to India for heart surgery.

Premier Williams came here for a heart operation he could not get in Newfoundland. We don’t know if he could have had the operation somewhere else in Canada. Probably he could, but we do know he chose not to.

In any case, he’s been attacked in Canada for this choice. You can see where it might be embarrassing to a culture heavily dependent upon their health care system for a sense of moral superiority.

Williams’ defense? “I did not sign away my right to get the best possible health care for myself when I entered politics.” It’s “my heart, my choice and my health.” Hear, hear.

This seems to be a story worth noting as President Obama unveils his new plan to destroy Premier Williams’ future health care choices. Without the US, where would he have gone?

IAC, thanks to Jason Gillman for pointing this press release out at Americans for Limited Government.

Following are most of the posts from TOC on the topic of Canadian health care, which has been held up to us as a goal. I put them together because TOC has always contended we can learn something from Canada, and most of these posts depend upon Canadian sources.

Monday, April 04, 2005
Canadian Health Care. You’ll Get Old Just Waiting.

Thursday, June 16, 2005
45 Million Myths

Thursday, June 30, 2005
Medicine Cabinet Minister

Monday, July 11, 2005
Brave New World meets Animal Farm

Thursday, July 14, 2005
You don’t always get what you pay for

Thursday, August 11, 2005
Canada: 3 Examples, 1 Point

Monday, August 15, 2005
Pollyanna Preposterous?

Thursday, August 18, 2005
Ob-Gyns with 10 Month Waiting Lists

Saturday, April 22, 2006
Universal Health Care Update

Wednesday, April 26, 2006
The cost of free health care

Friday, May 05, 2006
Free health care

Wednesday, May 17, 2006
Socialist health care

Wednesday, November 22, 2006
Previewing Hillarycare

Friday, December 15, 2006
Socialized health care choices

Saturday, December 23, 2006
Lessons from Canada

Tuesday, January 23, 2007
…every other advanced country

Thursday, March 15, 2007
Waiting for Trudot

Thursday, August 09, 2007
SCHIP of Fools

Sunday, August 19, 2007
Human gestation period surprises Canadian health administrators

Tuesday, November 27, 2007
Support the system. Game the system. It’s all OK, eh?

Monday, January 21, 2008
Andragogy Canada

Wednesday, May 07, 2008
Obama; Needs time in Canadian Instructional League?

Sunday, June 29, 2008
Canada is telling us something

Sunday, August 10, 2008
Health care lotteries, a Canadian growth industry

Monday, August 25, 2008
Universal health care

Tuesday, January 20, 2009
Safety valve endangered

Thursday, June 04, 2009
Lessons from Canada???

Monday, June 22, 2009
Canada: health care rationing review

Tuesday, June 23, 2009
Canada: health care wait times

Sunday, June 28, 2009
Health care notes

Sunday, July 12, 2009
Canadians criticize Canadian health care wait times

Tuesday, July 28, 2009
Canadian analysis

Monday, August 03, 2009
Canadian counterpoint

“…intractable Canadian health-care problems”

Thursday, August 20, 2009
Message from the President of the Canadian Medical Association

Friday, August 21, 2009
Surgery panels

Friday, September 04, 2009
Reimbursement panels panel

Saturday, September 26, 2009
The View from Dromore

Tuesday, October 13, 2009
Anecdotes

Friday, October 30, 2009
Canada Health Care – Recent News. And some from here, too.

Canada Health Care – Recent News. And some from here, too.

Except for 1 nod to The Wall Street Journal, please note that all sources are Canadian.

Canadians face 16-week wait for surgery: Report
Calgary Herald
October 29, 2009

Canadians looking to undergo surgery can expect to wait an average of 113 days in 2009, a slight improvement over last year, a national health-care survey has found.

The Fraser Institute’s annual report on hospital wait times found that the median wait-time for Canadians seeking surgical or other therapeutic treatment is 16.1 weeks in 2009, down from 2008’s 17.3 weeks.

…”In spite of large increases in health spending, Canadians are waiting 73 per cent longer for surgery than they did in 1993,” said Nadeem Esmail, author of the report and a director with the right-wing think-tank.

Province Wants to Sell Surgeries to Saskatchewan
TheTyee.ca
October 29, 2009

People from Saskatchewan may soon be coming to British Columbia for surgery, if negotiations between the two provincial governments are successful.

B.C.’s health minister, Kevin Falcon, said selling surgeries will bring money into B.C.’s system and help British Columbians get care sooner. But New Democratic Party health critic, Adrian Dix, said the plan makes no sense when health authorities are already cancelling surgeries for British Columbians.

…The move comes while health authorities are cutting the number of surgeries they provide, said NDP critic Dix.

The Fraser Health Authority has said it will cut as many as 9,900 surgeries because of budget constraints and the Interior Health Authority has cut 428 orthopaedic surgeries before the end of the fiscal year, he said.

Across the province, there are 15,000 people waiting for orthopaedic surgery, Dix said. The figure is confirmed on the province’s waitlist website.

“They cancel 10,000 surgeries for us and they offer up those surgeries to people in Saskatchewan,” said Dix. “When you offer up spaces to people from other provinces, then those are spaces that could and should be taken by the people who paid for those hospitals, paid for those operating rooms, paid for that capacity, and that’s the people of British Columbia.”

Tommy Douglas: Not Dead Enough
smalldeadanimals.com
October 29, 2009

There are 1,100 vaccination clinics open in Alberta today.

Manitoba opened to the general public yesterday. Pharmacists can give the vaccine.

And in Saskatchewan?

Nope. Allowing anyone even a sniff of vaccine outside of the Official Health Care System would be “two-tier” health care. So if you want a vaccination for H1N1, you have another two week wait before the vaccine is “released” to the general public. And in Saskatoon, they’re going to have everyone – which will include many who are incubating and infectious – congregate at a single site Prairieland Park) to receive it.

Declining Standards of Canadian Health Care
Canada Updates
October 25, 2009

Mountain-bike enthusiast Suzanne Aucoin had to fight more than her Stage IV colon cancer. Her doctor suggested Erbitux—a proven cancer drug that targets cancer cells exclusively, unlike conventional chemotherapies that more crudely kill all fast-growing cells in the body—and Aucoin went to a clinic to begin treatment.

But if Erbitux offered hope, Aucoin’s insurance didn’t: she received one inscrutable form letter after another, rejecting her claim for reimbursement. Yet another example of the callous hand of managed care, depriving someone of needed medical help, right? Guess again. Erbitux is standard treatment, covered by insurance companies—in the United States. Aucoin lives in Ontario, Canada.

Can there be the slightest doubt that government subsidy brings government control? If you are wavering on that question, you should read what the US government does with car companies, where, unlike health care, it said it does not want to be in the car business.

Politicians Butt In at Bailed-Out GM
The Wall Street Journal
October 30, 2009

Montana Rep. Denny Rehberg was no fan of the $58 billion federal rescue of General Motors Co., saying he worried taxpayer money would be wasted and the restructuring process would be vulnerable to “political pressure.” Now the lawmaker says it’s his “patriotic duty” to wade into GM’s affairs.

…Probably no company has been more on the receiving end of congressional attention than GM, whose widely scattered factories, suppliers and dealership network put it in touch with nearly every U.S. congressional district.

Ask yourself 2 questions.

  1. Given how the US government has maneuvered Medicare into bankruptcy, and given how the US government is currently handling the automobile manufacturing business: If you could, would you switch your health care services to Medicare just before $500 million dollars are cut from it?
  2. Will Congress accept exactly the same health care entitlements they want to force on us?

If you answered either of those questions “Yes,” you need medical attention immediately.

One indication of the level of nanny state control we’ve been paying our national legislators to develop for most of the year: The 1,990 page bill (H.R. 3962) will require nutritional labels on food dispensed from vending machines. Since you probably cannot see what’s printed, in 4 point type, on the package inside that vending machine:

In the case of an article of food sold from a vending machine that—

(I) does not permit a prospective purchaser to examine the Nutrition Facts Panel before purchasing the article or does not otherwise provide visible nutrition information at the point of purchase; and

(II) is operated by a person who is engaged in the business of owning or operating 20 or more vending machines, the vending machine operator shall provide a sign in close proximity to each article of food or the selection button that includes a clear and conspicuous statement disclosing the number of calories …

This is what Congress thinks of as health care reform. The number of calories for vending machine snacks have to be displayed, so before you select “Deep-fried Twinkies” or “Unsalted Chocolate-covered Bacon/Cheese Sausage/Reject Bits,” you’ll be able to compare caloric content.

Let me suggest that the only people interested in this information are people who would prefer to starve to death rather than eat from a vending machine. Well, they are also interested in what you eat from a vending machine, but isn’t that the whole point? All in all, though, this is small stuff. A half… no, a quarter-measure.

Consider that minor adaptations to vending machines would allow detecting your weight and height. Certain combinations of weight and height could be refused service for certain snacks. If you persist despite a recorded warning, you don’t get a snack and you don’t get a refund, that’s a “trying to game the system” fine.

A blood pressure cuff and blood sugar testing device could be installed in the snack delivery opening, and if you fail to meet a government determined ratio of these numbers you can’t pull your arm out until you drop the snack. You don’t get a refund, and the snack is donated to People for the Ethical Treatment of People for third world disposal. That’s a healthy living tax.

Finally, while we’re talking about whether your body is your property, can we at least recognize the threat posed to the pregnancy termination advocacy industry?

It was something that got into your body that caused that medical condition, wasn’t it? How it got in there can effect very different outcomes. To ensure choice at the earliest stages, and to avoid the necessity of FCC monitored wireless personal-implant electronic devices, the caloric content of a unit dose of semen alongside a warning of the risks of pregnancy must be tattooed on all male, um… biologic delivery systems.

We can probably persuade condom manufacturers to subsidize the tattooing. It’s a natural advertising opportunity for male enhancement.

Anecdotes

The Mackinac Center for Public Policy has spoken with some Canadians about wait times for health care. This is anecdotal, of course, and you could certainly find stories in the United States that would tear at your heart. For example, Michelle and Barack Obama both tell an intensely personal health scare story involving meningitis and their daughter, Sasha. In fact, they tell two substantially different stories. Both are anecdotal. One can’t be true.

Often, as any normal politicians would, the Obamas arrange for people to show up at their pressers in order to illustrate particularly poignant failures of the health care system in the United States. Several of these have turned out to be on the order of Al Gore’s claim that his mother and his dog took the same arthritis medicine, and his mother was being ripped off. This was not the truth, but Gore said it was for a good cause.

Anecdotes from ordinary people do have their place, though, especially when not promoted and financed by government. Among many other Canadian health care related posts, I have conveyed my own anecdotes, having had 22 years experience with Canada’s system. TOC has also had Canadian guest posts on the topic. This blog is interested.

So when Michigan Taxes Too Much posts Mackinac Center videos of Canadians speaking about their health care, I recommend a look-see. Click the link, but also click the link to the Mackinac Center for Public Policy, in the blogroll or at the top of this post. They deserve your attention and support.

The View from Dromore

Recently, I was visited by an old friend from Dromore, Ontario, Canada. During his visit I had occasion to see my doctor because of an infection on my left ankle that was not responding to home treatment. Because it resulted from a quite minor scrape, I expected it to heal in a few days. A month later it was getting worse, so I called my Doc around 11AM Wednesday and was given an appointment at 10AM Thursday. I had a followup a week later, and he was quite pleased with the progress of the treatment (antibiotics and hydrogen peroxide soaks).

Following is the impression this made on my visitor:

Duane,

During my recent visit to Michigan, I was totally shocked by your ability to get a doctor’s appointment on short notice. If the American health care system is “broken”, I didn’t see it. It may be expensive, but it would appear to work the way most people would want it to work. It doesn’t matter what your problem was (not immediately life-threatening – apparently easily resolvable with antibiotics), what struck me was the speed with which you got a doctor’s appointment. I think you said you called on Wednesday and had an appointment on Thursday – unheard of in Canada in my experience. You also lost very little time from work. The appointment was at 10:00 and you were probably back at your desk by 10:30. It would appear that when you make an appointment for 10:00, the doctor actually sees you at 10:00. Interesting concept.

It made me reflect upon what would have happened to me in a similar situation under the Canadian government-run single-payer system.

First off, I have a “family” doctor and have had for over 30 years. That immediately puts me in a rather unique position. Neither he, nor any of the other doctors in my area are accepting new patients unless a current patient dies or moves away – the wait-list is years long. My doctor, who used to have his own office, is now part of a government-mandated Local Healthcare Integrated Network (LHIN) – i.e. a clinic, composed of local docs and supported by a number of nurses and nurse practitioners (a relatively new breed – registered nurses who have taken additional training and are allowed to do certain things normally done only by doctors) as well as a common administrative staff.

So, let us assume that I had a relatively minor problem similar to yours. What would my options be under the Canadian system?

There are four: 1) Ignore the problem, cross your fingers and hope it goes away on its own – an option I have taken in many cases; 2) Ask for an appointment with “my” doctor – and be prepared to wait a couple of months (not that dissimilar to option 1); 3) Ask for an appointment with any doctor at the clinic and be prepared to wait for a couple of weeks; and 4) Go to the emergency at the local hospital and bring a copy of Tolstoy’s War and Peace with you as you are likely to be able to get most of the way through it while you sit in the crowded waiting room for several hours.

At the emergency, there is a one-in-six (we have six local docs) chance that I will actually see my own doctor because they are mandated to supply emergency room service on a rotating basis (I am in a rural area – this may not be true in an urban area).

In defense of the system, the common administrative staff and records at the clinic means that any doctor has complete access to my medical history. How much time they may have to review that information before seeing me is open to question. Nonetheless, it seems mildly efficient.

Also in defense of the system, if I was exhibiting symptoms of a truly serious nature (arriving at the emergency carrying a severed limb, bleeding from the ears, chest pains, etc.), I would move to the express line and would probably be seen fairly quickly.

The vagaries of our Canadian system means that I normally take option 1 (ignore the problem) or option 4 (go to the emergency). Options 2 and 3 are not really viable options.

Having said all that, no matter what my situation may be, I only need to present a health card, not a credit card. It’s “free” in the sense that I’ve already paid for it through my taxes. I will never be bankrupted or even majorly affected in financial terms by my health situation.

Again, I was impressed by your ability to get quick medical attention from your own doctor. If Americans want to experience my situation, go ahead, but I’m not sure you’ll be all that happy with the resulting process.

Rationing of services and extended wait-times are the real prices you will pay for a government-run system. Cheaper? – probably (although I question the government’s (either yours or mine) ability to run anything either efficiently or effectively). Better? – you decide.

As to the expense, it was paid for by insurance and, having given my insurance particulars many years ago, I did not need to present any card. This does not mean that I like the idea of employer-based health care, or that I had not been paying (tax exempt) premiums. Still, the visit was simple and easy, including scheduling the followup appointment.

Finally, it turns out that options 1 through 3, above, would have been pretty bad choices. The Doc explained that if the infection spread to my Achilles tendon I would have been in for significant difficulty and the insurance company in for significantly greater expense.

Surgery panels

Thousands of surgeries may be cut in Metro Vancouver due to government underfunding, leaked paper

VANCOUVER — Vancouver patients needing neurosurgery, treatment for vascular diseases and other medically necessary procedures can expect to wait longer for care, NDP health critic Adrian Dix said Monday.

Dix said a Vancouver Coastal Health Authority document shows it is considering chopping more than 6,000 surgeries in an effort to make up for a dramatic budgetary shortfall that could reach $200 million.

RTWT

H/T National Center Blog

Message from the President of the Canadian Medical Association

How Canadians run their health care system is a concern to Americans only to the extent that some American supporters of nationalized medical care have pointed to Canada’s “single payer/universal coverage” system as a model. Those of us who think health care reform requires more individual control and less government intervention therefore naturally look for lessons from Canada’s experiment. President Obama, though he favors a SP/UC system, does not want to acknowledge we can learn something by looking north. He has said Canada’s model is not appropriate for the US. He does not say what details of Canada’s system are inappropriate for us. Because there are necessarily broad similarities to his own preferences, he does not want to talk about it. It’s to remain “mystery meat” until served.

Like Obama, Canadians can be very defensive about discussing health care, and resent foreigners who do not recognize the superiority of Canada’s health care system. Many Canadians routinely deny there are any problems with their system. Several have left comments on this blog claiming I don’t understand the Canadian system despite; a) I lived there for 22 years and, b) 95% of the criticisms documented here are from Canadian sources. Some examples:

Lessons from Canada???

Canada: health care rationing review

Canada: health care wait times

Canadians criticize Canadian health care wait times

Canadian analysis

The point is recently reinforced by the new President of the Canadian Medical Association:

The incoming president of the Canadian Medical Association says this country’s health-care system is sick and doctors need to develop a plan to cure it.

…”We all agree that the system is imploding, we all agree that things are more precarious than perhaps Canadians realize,” [Dr. Anne Doig, see also this interview] said in an interview with The Canadian Press.

…The pitch for change at the conference is to start with a presentation from Dr. Robert Ouellet,

…His thoughts on the issue are already clear. Ouellet has been saying since his return that “a health-care revolution has passed us by,” that it’s possible to make wait lists disappear while maintaining universal coverage and “that competition should be welcomed, not feared.”

In other words, Ouellet believes there could be a role for private health-care delivery within the public system.

…”(Canadians) have to understand that the system that we have right now – if it keeps on going without change – is not sustainable,” said Doig.

Politically, Ouellet can’t come right out and say there must be a larger role for private health-care – he dare not risk comparison to the US system. South of the border, however, there are lessons from which Canada could benefit. The most important is our thriving private care option, a safety valve for Canadians when their system fails them: Canadians visit U.S. to get care

Agreements between Detroit hospitals and the Ontario Ministry of Health and Long-Term Care for heart, imaging tests, bariatric and other services provide access to some services not immediately available in the province, said ministry spokesman David Jensen.

…Canada’s U.S. backup care “speaks volumes to why we don’t need government to take over health care,” Scott Hagerstrom, the state director in Michigan for Americans for Prosperity, said of the Canadian arrangements with Michigan hospitals. “Their system doesn’t work if they have to send us their patients.”

But Dr. Uwe Reinhardt, a Princeton University health economist who has studied the U.S. and Canadian health systems, said arrangements with cities like Detroit “are a terrific way to manage capacity” given Canada’s smaller health care budget.

“This is efficient,” he said. “At least in Canada, you don’t worry about going broke to pay for health care. You do here.”

Dr. Reinhardt apparently thinks that even if the US starts rationing health care it will still provide Canadians with a safety valve. His praise of Canada’s efficiency depends on the status quo. That some services simply are not available to Canadians in a timely fashion would look less like prudent fiscal management if people were actually dying due to unavailability of care. Providing such care is a political decision forced by proximity to a market where the care is quickly available. If Canada refused to pay for such treatment and Canadians were dying every day from its lack, what politician would be safe? Refusal to pay would be possible only if the US health care system did not exist.

In Canada, you don’t have to worry about going broke, but without access to US care, you do need to worry about suffering and even dying while waiting for treatment. This is not an argument that US health care does not need reform – it does – but moving in Canada’s direction is the wrong way to go about it for BOTH countries.

Health care is rationed in Canada; no reasonable observer can dispute it, and despite President Obama’s assurances to the contrary, choice will be ever more restricted in the US if “the public option,” shows up in any health care bill here: Fighting false health care claims, Obama repeats one of his own

Related:

American view
Wall Street Journal:
We Don’t Spend Enough on Health Care

Mr. Obama has said that “the cost of health care has weighed down our economy.” No one thinks the 20% of our GDP that’s attributable to manufacturing is weighing down the economy, because it’s intuitively clear that one person’s expenditure on widgets is another person’s income. But the same is true of the health-care industry. The $2.4 trillion Americans spend each year for health care doesn’t go up in smoke. It’s paid to other Americans.

…The U.S. health-care economy should be viewed not as a burden but as an engine of growth. Medical and orthopedic equipment exports increased by 65.1% from 2004 through 2008. Pharmaceutical exports were up 74.6%. The unprecedented advances expected to come out of American stem cell, nanotechnology and human genome research—which other countries’ constricted health sectors cannot support—will send these already impressive figures skyward.

A study by Deloitte LLP has found that more than 400,000 non-U.S. residents obtained medical care in the U.S. in 2008, and it forecasts an annual increase of 3%. Some 3.5% of inpatient procedures at U.S. hospitals were performed on international patients, many of them escaping from Canada’s supposedly superior health system.

“Inbound medical tourism,” Deloitte stated, “is primarily driven by the search for high-quality care without extensive waiting periods. Foreign patients are willing to pay more for care within the United States if these two factors play a large role.” The deficiencies of the foreign health-care systems the Obama administration wishes to emulate can be counted on to generate ever-increasing revenues for U.S. providers and employment for Americans.

Canadian view
London Free Press
:
Problems in health care won’t be fixed just by cash

Many jurisdictions are still woefully short of family doctors and the country need another 16,000 nurses. Canadians still rely on their own personal finances, or company benefit programs, to pay for their pharmaceuticals. Emergency rooms remain clogged. Patients are still waiting agonizing weeks for diagnostic scans to learn if they have cancer. Rural and northern communities are concerned about their access to services. We still lack an efficient electronic health records system.

Yet we continually spend more. According to Statistics Canada, the federal government, provinces and territories will spend a combined $121 billion on health care this year, an increase of 28% since 2005.

If anything, it shows the old solution of throwing money at a problem is incredibly ineffective in our health-care system. All of the benefits of state-run, publicly-financed health care are offset by an onerous, bureaucratic, bloated and expensive system.

What is needed is true systemic change that will ensure every dollar invested in health care benefits patients.

It’s inexcusable that patients have to wait to find out if they have a potentially fatal disease. It’s mind-boggling that people can wait more than a year to have life-altering surgeries like hip replacements.

Indeed. And that’s with a US safety valve in place. If the US moves toward a government run health care system it will be terrible news for us and a death sentence for some seriously ill Canadians.

Canadian counterpoint

A Canadian’s thoughts on US/Canada cultural norms related to health-care. RTWT.

Kathy Shaidle: Obamacare critics: win the debate by changing one word

“Rationing” is supposed to evoke the horror of utilitarianism, but frankly, millions of ordinary Americans are already de facto utilitarians and don’t see that as a bad thing. As long as they aren’t the ones experiencing the utilitarianism.


…OK then Kathy, “Waiting in line.”
;)

"…intractable Canadian health-care problems"

The Ottawa Citizen recognizes what many Canadians deny:

Consider the never-changing list of intractable Canadian health-care problems: We have long wait times for a wide variety of medical services. Our emergency room rooms are clogged. Our hospital beds are often filled with people who should be getting long-term care instead.

Most Canadians are not willing to admit this; not so much because their health-care system delivers on its promises, but because they see their health-care model (regardless of execution) as one of the fundamental proofs that they are better than Americans.

Most Canadians think that ~50 million Americans without health insurance is a systemic failure, even if most of these are people who do not want it, haven’t signed up for a government program for which they are eligible or are illegal aliens getting free treatment in emergency rooms. Most Canadians (and Americans) are unaware that 50% of US health-care is already paid for by government, so they think there is actually a free market here. This distorts Canada’s debate and makes change nearly impossible. Such thinking damages them as much as it does us.

The idea of an alternative to the current monopoly on most major forms of health care is critical to the idea of a patient-first system, [Canadian Medical Association president Dr. Robert] Ouellet argues. Without it, there is no real pressure for government health care to deliver timely results and no alternative for patients when it doesn’t. Ouellet himself is a radiologist who runs a private clinic in Quebec providing service to those whose health benefits will cover it.

Ouellet’s point makes sense, but as soon as the words “private health care” are mentioned in this country, we launch into comparisons with the American system, surely the most costly and least efficient in the world. Our universal health-care system is held up as a Canadian value, as if we were the only ones who had it.

The mythos of Canadian single-payer health-care system superiority is more than a Canadian value: It is demonstrably not an American value. Canadians reflexively reject the possibility that their health-care folkways are not morally superior to those of the United States.

In any case, Dr. Ouellett is not advocating adopting an American approach, and I agree that would be a bad idea (see below), but he recognizes that without patient freedom the system fails patients.

As Ouellet envisions it, a somewhat expanded private sector would not be a parallel system drawing away doctors from public health care, but rather an opportunity for doctors to do supplementary work without restrictions on their operating time or long waits for diagnostic tests. The bulk of any physician’s billing would still be in the public system.

Canadians can’t see, any more than can Democrats, that government interference is the problem on both sides of the 49th parallel. In the United States, massive government meddling in health-care is the single most important factor in driving up costs. In Canada, government control of health-care is the single factor causing the “intractable” problems. What is needed in both countries is a plan to gradually and continually increase privatization. This is the only effective treatment for different symptoms of the same basic disease: Statism.