Healthcare reforms warnings from France and Canada

July 20, 2009

healthcare-combo— Brian Lee Crowley is the founding president of Atlantic Institute for Market Studies (AIMS), a public policy think tank in Canada (pictured left) and Valentin Petkantchin is director of research at the Paris-and Brussels-based Institut économique Molinari. The views expressed are their own. —

President Barack Obama’s package of heathcare reforms – mandatory health insurance, public health option and increased federal government financing – is being sold as preserving independent high quality care and choice for patients while keeping down costs. Taxpayers and patients in both Canada and France know better.

Unfortunately, our experience is that once the government gets its nose in the healthcare tent, not only is spending not contained, but health care professionals lose their freedom to practice. Left with few choices, patients face shortages and waiting lists.

Washington’s proposed new public health insurance option, while not imposing Canadian-style single-payer monopolistic public health insurance immediately, will almost certainly lead to that result in the end.

One of two things will happen. If doctors prove reluctant to accept patients covered by the public option and it is thus unable to compete successfully with private insurers, the politicians will not stand idly by.

Physicians’ freedom to practice outside the public option will become increasingly hedged with restrictions, perhaps ultimately ending up, as in Canada, with doctors in the public system being prohibited from taking private patients.

Or, more plausibly, in the short term at least, private insurers will gradually withdraw from the business, incapable of winning against a government-subsidized “competitor.”

In both cases, competition in the health insurance sector will progressively vanish and the U.S. will wake up with a monopolistic-style health insurance system, à la France or Canada.

Consider yourself warned.

Our respective health care systems have proven incapable of reining in rising costs. Health spending in France, while lower than the U.S., is among the highest in the world, whatever the indicator, despite decades of mandatory, subsidized health insurance. After 1988, the public health care system has regularly been in the red, with deficits numbered in the billions of euros. The forecast deficit for 2009 alone: 9.4 billion euros (over US$13 billion).

French officials are scrambling to take more control of the system to bring these costs down, but Canada, where government controls all “medically necessary care,” shows that this is no solution at all. A growing share of Canadian provincial budgets is also swallowed by the health care system, going in 20 years (1983-2003) from 32% to 41% and on the way to 50% in a few short years. As a portion of GDP, and adjusting for population age, Canadian health care spending even ranked ahead of France’s in 2005.

But the oxymoron of government cost containment is not the only problem. In the name of restraining costs – so fashionable currently in Washington – governments are adding further inefficiencies by piling on more bureaucracy.

Since 1996, there is a cap on national health care spending in France and growing pressure on health care professionals in the public system to cut costs. In 2004, patients’ choice of physician and specialist was also severely limited.

Independent private medicine – once one of the main pillars guaranteeing quality and timely care in the French system – is being slowly strangled. At the end of 2008, nurses lost their freedom to practice where they please, while a new law will do the same for physicians by imposing an annual financial penalty if they refuse to practice where the government tells them to. Specialists’ fees are increasingly regulated. The last pillars of competition among providers, and choice for French patients, are thus undermined.

Canada again is a good example of where the logic of such policies will lead the French and the Americans in the future.

North of the border, decades of total government control over health care have led to chronic doctor shortages and waiting lists. Roughly 1.7 million Canadians were unable to find a family doctor in 2007 and have to queue in impersonal clinics where they exist. Yet only a physician can order tests or get a patient in to see a specialist.

Despite continual infusions of fresh tax dollars, waiting times for hospital treatment went from an average of 7.3 weeks in 1993 to 17.3 weeks in 2008, although there was a minuscule decline last year as a result of massive political pressure. The problem is so severe that the Supreme Court of Canada acknowledged in a historical 2005 ruling that patients die as a result of waiting lists for public health care.

Finally, coverage of new drugs is delayed by a year or more for patients relying on the public system. Even with this delay, by October 2007 less than half of new drugs launched between 2004 and 2006 had been listed for payment.

Based on experience in both our countries, government health insurance and government financing inescapably lead to a crackdown on health care providers and bureaucratization of the entire health care system. Americans should look carefully at our experiences before going any further down the slippery slope of state-controlled health care.


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Sounds to me like the systems in Canada and France do not work. Do the authors have a system that does work. If you know the systems please tell us what will work. We have plenty of people trying to take our money for giving us information on things that don’t work.

Posted by f belz | Report as abusive

The healthcare debate personifies the unforgiving landscape within America. US politicians are anxiously proposing a healthcare system that will alter the way of life before all the details have been inked. And, if the past serves as a guide, very few politicians will read the bill once all the details are inked. Meaning, most politicians will likely not know or understand the short, intermediate or long term outcome of their meddling. . . other than successfully having created one more bureacracy subject to intervention by politicians who commonly abrogate their oversight responsibilities.

If only the US government would focus on ‘governing’ and not portray itself as a diety over the basic laws of economics. And how rational it might be to govern based not only on the merits but to identify a specific problem and address only that specific problem within the context of the US Constitution.

Posted by rbblum | Report as abusive

Sounds to me like people from conservative think tanks emphasize the negatives to push their agenda. The only system they would advocate, the free market, is already a proven failure in assuring public health.

Posted by Chevalier Mal Fet | Report as abusive

be carefull

Posted by Sergie | Report as abusive

This is an editorial, not a “warning.” Are there no examples from the U.K., from Germany, from Norway, Sweden, Denmark? And even given the problems described for France and Canada, are their respective situations any worse than the vicious financial triage system we have here in the U.S.?

What point are the authors trying to make other than that there are problems in the French and Canadians systems?

Posted by Rupescissa | Report as abusive

It is very simple if you want healthcare in this country,join a union.

Posted by Tony | Report as abusive

another scary fairytale from from the proponents of the status quo. our family of four has been in the apparently murderous canadian system since its inception in the early 70`s and tell you what, we would not trade places with an american family of similar financial means for any reason. by the way your system costs double what ours does in terms of percentage of gdp expended on health care.

Posted by paul robert | Report as abusive

There lies the problem that reason Obama is pushing for passing the legislation this year as next congress he may not have the necessary votes after next election cycle.
According to Hillary Clinton and Raum Emanuel they have to seize the occasion. They have nationalized the banks in a way, own car companies and are in the pocket of Unions. As I understand from Canada and France experience this is a power grab by Obama and democrats. Only place this will work is not in this world but may be in different galaxy or universe. It may work even in science fiction but not in real life.

Posted by VJ | Report as abusive

This article is absolutely crap, crap, crap! The measure of any h health care system is NOT how much the physicians can make by offering “choice” but how well the populous lives. By such measures, the US “choice if you’ve got the money” fails miserably when compared with Canada, France, Japan, practically any other developed nation.
One would think that after the revealing article on medicine in McAllen Texas, practically a physician choice utopia, that as stupid an article as this one would be rejected out of hand. The McAllen article showed that “choice” led to more procedures, more medication, more office visits, more costly medicine on every front but with the result of poorer health care for citizens. And the poor citizens couldn’t even sue since Texas severely limits malpractice awards.
Why can’t the print and electronic media tell the real story: that for all the US citizens are forced to pay, the US medical system produces patient outcomes worse than the majority of developed nations, outcomes standing no better than 25th in the world. Oh, I know why: our costly health system makes plenty of billionaires, individuals with financial clout to insure that articles like this one instead of the real facts get published.

Posted by James Reed | Report as abusive

Well put and thank you. America is making some very bad mistakes with the ballooning of the feds. Very frightening to know that federal health control is even being considered. Mr. Belz asks what will work. In my opinion, get rid of the bloated federal government’s reach into healthcare regulation and employer healthcare coverage tax credits. Allow insurance companies freedom to dictate their own terms and for their customers to do the same. We need to get rid of federal mandates that override states’ healthcare budgets and helps drive local budgets into oblivion while losing states sovereignty to more federal control in the name of federal funding. The more we give up our right to free market decision making the worse EVERYTHING will get for all of us. Freedom in the marketplace is the best solution in my opinion.

Posted by jason | Report as abusive

So 1.7 million Canadians wait at a clinic for healthcare? That’s 5% of their population. In the US 13% are waiting in the emergency room. If we achieve Canadian success rates we will have provided healthcare for 25 million Americans who don’t currently have it. Sorry, but I don’t see the downside.

Posted by AT | Report as abusive

One reason we have doctor shortages in Canada is that the doctors we graduate can immediately move to the US state of their choice, at twice the salary, and have all their schooling reimbursed. One year Dalhousie graduated 18 doctors, two stayed in Canada.

Posted by RC in Canada | Report as abusive

Keep in mind that Pfizer and Merck are both supporters of this conservative “free market” think tank. If they have to keep their costs down, then their profits will go down, too, and to prevent that, they’ll say whatever it takes to defeat national health care. Corporate interests should not be allowed to take precedence over public health.

Posted by Karen | Report as abusive

Interesting how France and Canada is plucked off the tree of PLENTY, out of all the developing nations. Regardless of the TYPE of healthcare these countries have, the QUALITY is plentiful, and sure, thats arguable, but being a recipient of healthcare outside our country, its my opinion and i’m sticking to it. The US healthcare system is sickly and does not provide the TYPES nor the QUALITY but the costs are PLENTY. Its like buying that delicious looking bag of potato chips, the bag is large. You shake it, you hear the chips. You open, and the bag is half full, and mostly air. Our healthcare has a deceptive illusion of choice, quality and plenty, but its only full of air. These countries and others overall still have better healthcare that the US.

Posted by Dahc | Report as abusive

Obama’s error about the health plan is that HE DOES NOT WANT TO LIMIT THE LAW SUITS. One of the major reasons for increased cost is that the doctors order EVERY test and scan even when the patient’s condition does not warrant them to protect themselves from law suits. The same applies to end-of-life care because if they do not do EVERYTHING possible to prolong the lives of those who are hopless, they get sued! Statistics also show that the highest percentage of law suits comes from patients on government programs.

Posted by Albert | Report as abusive

So, are the citizens of Canada or France demanding that they abolish their health care systems, and adopt America’s system? Uh, no.

Posted by DLN | Report as abusive

Funny thing is that no system works perfectly. People always push their own agenda. The bottom line should be what benefits the population at large the most. If US spends the most amount per person versus the rest of the world and it only has a sub par system, things can only get better. Smile and be happy people. Don’t be taken in by the words of people who see themselves on the losing side by these changes. Question agendas.

Posted by Sam | Report as abusive

Any solution proposed by extremists of either stripe will never work. So forget “complete freedom in the marketplace” and “complete government control”. It would be nice if we could receive a sensible and economically viable proposal.

Posted by Steve Numero Uno | Report as abusive

Problem with health care costs? Big government unions. Problem with poor schools? Big unions. Big bureaucracy. Problem with auto industry? Big unions. Notice any point of commonality?

As for James Reed comment – if American would only get its fat backside out of the potato chips, colas, candy, grease soaked bacon and buttered pancakes, maybe there wouldn’t be a problem. Lets spend some money on NUTRITIONAL EDUCATION.

Posted by Hur Tinn | Report as abusive

Everyone is up in arms about the QUALITY of health care, and somewhere in that the COST becomes a moot point. I don’t care how much that shiny new bicycle will help you in life, if you can’t afford it, you don’t get it (unless you are in Congress). Again and again, it becomes an ideologue’s debate, and the wonks only consulted at the very end. Also, a rebuttal:

“It is very simple if you want healthcare in this country,join a union.”
posted by Tony
–Yes, Tony, but I would also like to have a JOB as well. But maybe I’m overreacting. Look how great the auto industry is doing (Thanks UAW!?!). “Big 3″ retirees just saw their dental and vision coverage evaporate, and none of them had prepared for it. Imagine a whole nation this naive…

We will sell our children for a CAT-scan. When did it stop being about tomorrow, and start being about “ME, ME, ME!”?

Posted by Patrick | Report as abusive

The authors write: “Roughly 1.7 million Canadians were unable to find a family doctor in 2007 and have to queue in impersonal clinics where they exist.”

Scary, scary!! I live in Canada, and although I have a family doctor, today I decided to drop into a nearby walk-in medical clinic. These clinics are all over the place in urban areas — almost as common as Starbucks. You don’t need an appointment, and many of them don’t even give appointments. I had never been to this clinic before today, so they didn’t have any of my info beforehand. Nevertheless, I was in, saw the doctor, and was out within about an hour. The charge to me: nothing. There was no paperwork; required administration info was processed with a few clicks on the computer by the very friendly receptionist. No one will have to send me a bill or follow up to try to collect. The doctor (friendly, as it turned out, and who, like nearly all doctors in Canada, does NOT work for the government) is guaranteed full payment for service, on time, by the province’s medical services agency.

So be afraid, all you Americans. Be very afraid. If you don’t listen to the insurance companies, the pharmaceutical industry, and right-wing ideologues, you could end up in the same pickle as Canadians.

Posted by Taylor | Report as abusive

Neither Canada nor France are experiencing a health care crisis.

You are.

And you have the gall to criticize them … LOL!

Posted by Wally Beaver | Report as abusive

Why should health care be a right? If it is, where does the line stop? Why isn’t food or water a right? I’m so tired of people wanting everything handed to them. If you want health care go out and get a job where your employer can help you pay for it. All people are “created equal” this means we all can choose what we do with our life and where we can work. I’m so tired of supporting others with my tax dollars. Keep health care in the free market system!!

Posted by Brian | Report as abusive

The current Obama plan will be worse than the Brit/Canada model. Healthcare coverage could have been increased if the senators had voted to allow small businesses to band together accross state lines to form purchasing pools for health insurance. Premiums would be substantially reduced. Considering that small business employee the majority of Americans that would settle the issue quickly. For people who choose or can not work or get insurance, then allow Doctors to get a tax credit for care to the uninsured based on the difference between the medicare fee schedule and maybe a mandatory 10 or 20 dollar copay. Why should our bright students go into healthcare to have mountains of debt, limited income, and malpractice headaches. If the senators want to decrease the cost of healthcare, legislate strict malpractice reforms and caps on fees. Unfortunately many of the legislators are lawyers and would never take on that crowd. Thanks to our politicians for driving away the American medical student and opening the flood gates for Foreign Medical Gradutates. We have brilliant minds in our country, why wouldn’t we want them to take care of us?

Posted by Jim | Report as abusive

Pharmaceutic companies: Our pharma companies innovate in every arena. They all provide indigant programs with free drugs. They do the research that lets us survive. They pay the dividends in our 401K’s. They are a business. They stop innovating, we start dying.
Whats benefits the population at large the most:
Stop giving prisoners better healthcare access than teachers. Stop giving healthcare for free to non-American residents and visitors. Stop allowing liver and kidney transplants to alcholics, drug users, prisoners. What politican will be brave enought to make these choices?
Doctors: 8-12 years of training, hugh med school debt for years, insurance company limits on fees. Doctors can advise, prescribe, and perform procedures. They can not make an idiot patient actually take their medicine, get some exercise, or follow a diet. American healthcare costs are higher, because American’s choose to sit on their but, eat junk food, and take no personal responsibility for their health or anything else. However, Americans want their bypass immediately lest they die or to see the specialist because they read on the internet about a disease they do not have. The Europeans walk and exercise more, eat healthier –so their cost goes down. Or they die waiting for the bypass…

Oh and by the way, poor school performance by students is not due to poor teachers, its due to poor involvment by the parents. When Americans really take responsiblity for their lives and children, healthcare and education will improve. Until then, let me keep my money.

Posted by Jim | Report as abusive

Oh no, here comes another terrible warning from Canada

7/10 say its working well.

Well obviously those 30% would prefer the American system right?

82% prefer the Canadian system to the American system.

The problem must be the heavy hand of government right?

55% think it should be more public, 27% believe the balance is right, 12% believe it should be more private.

Epic fail for Reuters and this “Thunk Tank”, if you want a good opinion on France and Canada’s healthcare system, ask the people, not the pundits.

Posted by Chevalier Mal Fet | Report as abusive

“If only the US government would focus on ‘governing’ and not portray itself as a diety over the basic laws of economics. And how rational it might be to govern based not only on the merits but to identify a specific problem and address only that specific problem within the context of the US Constitution.”

– If the economists and financial wizards didn’t demand the “deity” for billions – and received them – then you could have had a valid point. The american government is like one of those hindu deities you have to bring a book of gold leaves and rub them on their fat bellies.

Health Care – When disease strikes, it doesn’t care about who is rich or poor. A rich man will have the flu just the same as the poor man and I know of many rich people who use the public health care system in their countries, even though they can use the private.

Having universal health care is LIBERATION for populations.

You are free to engage in working for yourself, your family and the common good when basic medical needs are met. Taxes are for those things exactly: water and sewer systems are thought to supply and maintain good health standards, otherwise disease would be rampant (like it was prior to its inception.)
The effort of the many will make the effort of the few more bearable. It doesn’t help me with the expenses of my private health insurance, that there are scores of people sick and deprived out there.
Wonder why most countries with a national health care system seem to be happy? Because they don’t live in desperation.
To be desperate is not to be free and brave, it’s just negative all around. It forces jealousy of those who can’t have it for the ones who do.

Posted by Bottle of Wine and some Cheese | Report as abusive

Please tells us do doctors in France and Canada refuse patients with pre existing conditions???

And also please tell us how much people pay for drugs in those countries versus here???

If you’re blind and you can’t see you that the insurances make big profits out of sick people here in the us then you better look closer..And make no mistake there is NO country with the perfect health care system but there must be a basic health plan free to all just like France, Canada England and all other countries…Health care shouldn’t be a priviledge but a RIGHT!

Keep on fearmongering to the ignorants of this country with your ‘facts’

Posted by xlane | Report as abusive

We have a tendency in America to argue for or against a concept based on our own personal philosophy or view of the world, what advances our personal interests, or the interests of our party, family, organization, or region. Perhaps viewing the issue from a management or systemic perspective might result in innovative approaches to the issue. The American national mindset, citizen philosophy, lack of citizen motivation to be proactively healthy, and governance model make the socialization of health care in America very problematic, particularly at this point in time. A country needs to know its limitations.

Posted by Reggie Greene / The Logistician | Report as abusive

Health care in Canada and France do work! American’s travel to those countries for affordable health care. Where did this comment come from? Someone needs to do the research before they make comments.

Posted by Andrea | Report as abusive

One of the major reasons for moving back to Canada is the health care system here for ourselves and our
family. It has worked and continues to work well for
routine medical needs and specialized needs ( one of
my sons has Crohn’s Disease and has received superb
care utilizing the health system here ). In addition,
it is important to know that everyone in this
country can be eligible for universal health care unlike
the United States where too many are without access.

Posted by Michael Wheeler | Report as abusive

Both of these authors should be cursed with the worst curse to be found in mythology! To come out with such bold faced lies is an insult to our intelligence. Who is funding these guys? Oh, wait, I bet it will be a health care insurance company or some link to one.

Posted by Digital Sheila | Report as abusive

Who says there is a perfect answer to the health care problem? The more restrictions put on doctors the worse the quality of care gets. The more tinkering that the government does with our nation’s healthcare, the less willing the bright young minds of today are going to be willing to step up as the next generation of doctors. We will end up with restricted doctors of average intelligence.

Posted by Luke | Report as abusive

As a Canadian who deals with a chronic disease (Crohn’s Disease) I can tell you that the much maligned system here is a god send to me. I have been able to access all of the x-rays, ultrasounds, colonoscopy, blood tests, and even surgery and a hospital stay at zero cost to me. I would not have been able to afford these if it wasn’t for our health care system here in Canada.

Sure, I had to wait for a couple weeks for a few of the tests or procedures, but that’s nothing compared to being unable to get the procedures at all. I talk to other Crohn’s Disease sufferers in the USA and several of them are suffering without treatment because they can’t afford the thousands of dollars these procedures cost.

You can judge Canada all you want, and yes we pay higher taxes to get these services, but I would not trade it for anything. It is more than worth the occasional wait times (not as bad as the press makes it seem) and higher taxes. I’m sure that the extra taxes I pay for Canada’s health plan is MUCH less than the cost of all the procedures I have needed. It is the reason why I am now living a happy, pain free life with my Crohn’s properly diagnosed and under control.

I also get private heath insurance via my employer which covers the costs of prescriptions, dental, ambulance rides, and semi-private hospital rooms and other extras.

As a Canadian living in one of the cities that is supposed to have the worst wait times (Windsor), I can tell you the system works very well for me.

Also, when my brother and his wife had a baby, when my sister needed stitches, and when my mom went through treatment for breast cancer all of these things went well and were at zero cost to us. How many new American parents are saddled with a hospital bill, and how many Americans avoid proper treatment due to money reasons? You be the judge.

Posted by Sam | Report as abusive

In Canada the health care is free. BUT if you want a dentist you have to pay. If you want medicine, you have to pay, if you take an ambulance, you have to pay, if you want an MRI or Ultrasound without waiting for a couple of months, you need to pay. And by pay I mean you need to have extra insurance over and above OHIP (or whatever provincial plan you belong to). I had cancer this year and I’m very glad I had extended health care benefits from my employer. Even so, I still had to pay $200 per day to get a private room at the hospital. Nothing is perfect and neither is the CDN health care system. But the alternative of being unemplyed with no coverage at all seems to be contrary to human decency if you ask me. We all benfit from having a healthy society after all.

Posted by James | Report as abusive

According to SourceWatch ( tle=Atlantic_Institute_for_Market_Studie s), Brian Lee Crowley, one of the authors of this article, works for a think tank that is patronized by the pharmaceutical companies Pfizer and Merck Frosst. It would be nice if Reuters required its sources to disclosure their own personal financial interests when spreading their propaganda.

Posted by Rhett Mock | Report as abusive

You can tell where the priorities lie in a country when they can send off $800 billion in taxpayer money to save their bankers in crisis.. but start whining if they have to help out their fellow american in a health care crisis.

Posted by Nathan | Report as abusive

I’m a Canadian, and I have been really well served by our health care system. My whole family has.

Years ago, my little brother got hit by lightening while on a canoe trip in Northern Quebec…our public health care system even covered his transport out to a small hospital, and his entire hospital stay. He lived; he’s fine; our family wasn’t bankrupted.

I’ve had X-Rays, chemo, bonesetting, Pap smears, regular checkups, ultrasounds, and anything else I needed, as has everyother member of my family.

I paid nothing at all for the the expenses related to childbirth at home with a midwife. I had two midwives and a student helping me, and this was all covered by OHIP and was actually cheaper than a simple, normal delivery in a hospital; I did meet with an OB GYN, too, in case we’d had to movethe delivery to the hospital; that was free, too. I loved that I cost the system less but got a better service, with more pre-and post natal care.

Every day for three days after my daughter was born, the midwives came to my home to check on us, and I had tonnes of follow up for both physical and mental health; I was fine, but if I’d had post-partum depression, they’d have caught it, and I’d have been treated.

All the blood and lab work relating to the pregnany and birth and the care of my newborn was free, as were her shots and checkups this year.

I love our health care system. It has made a huge difference in my life and in the life of my family. It makes me proud to pay taxes. And my taxes rise at a much more stable rate than health insurance premiums do, and they are based on my income, not on my chronic health problem.

I like that we get cheaper drugs than Americans do, because our system organizes bulk purchases. I love that I do not have to fear medical bills. I don’t even have to pay medical bills. Vision care is pretty easy to pay out of pocket, and dental care can be expensive, but good habits and a good dentist are keeping my costs low.

I chose my own doctor. No bureaucrat has ever refused to authorize a proceedure I needed.

Our system would be better if we started our consideration of population health with our neighbourhood plans and zoning. We need to encourage walkable neighbourhoods and real communities: driving = crashes and smog and many health problems.

I’d also like to see us looking at nutrition and food security, and at restoring the phys. ed. programs that have been cut from schools; taxing junk food would be good, too. I’d like to see first aid and even paramedical training taught in school.

People are working to get better translation services so immigrants can get care in their languages; I’d like to see that recieve more funding.

Care in community settings is better for immigrant and poorer people; more of this would be good. In Toronto, we have heroic street health nurses and great clinics for homeless youth. This is awesome, as are the sexual health clinics that do anonymous AIDS testing: at risk teens get tested!

We need to do better on care for Native Canadians, starting with clean water on reserves, and housing.

I love that some jurisdictions that are very Chinese are looking at funding aspects of Chinese traditional medicine, not just the Western “here’s a pill” way; I love that our system is slowly becoming more open to different healing paradigms.

We do need more family doctors; the specialists are politically influential, so our healthcare dollars are sent to them while many have to hunt hard for primanry care doctors still taking new patients; we have foreign trained doctors we aren’t letting be doctors. That’s a problem.

Also, we need to open up more medical school places in universities; good students who in earlier times would have gotten in now can’t: no room. The nurse practitioner option is great. Nurses and paramedics deserve better treatment in our system.

Our system has some problems, but Americans keep trying to fit our issues into catagories that are really about them. When they hear “some Canadians are disatisfied”, they assume that the debate we have about our systems is about the same range of potential options they understand or are considering. It isn’t.

You guys have more uninsured children than we have total population, and the worst infant mortality in the Western world. We don’t want what you’ve got as an alternative to what we have.

We sometimes have longish waits. But a longish wait for free care is better than no care at all, and you all have waits in your system, too.

In the USA, it took my ex almost a month to get a test to tell him what blood type he belonged to, and he had “great” private insurance.

In Canada, I got our daughter’s pink eye diagnosed and medicine for her within an hour of walking in off the street.I took her to a neighbourhood walk-in clinic; we didn’t even need an appointment; the eye drops cost ten bucks.

We like our system; check out decades of election polling. We also named the guy who invented it the “greatest Canadian” in a big national contest.

We want to tweak our system, to change the emphasis, to redirect it in ways that are true to our nature, towards inclusivity, prevention, and deep health-promoting strategies. We don’t want US health care– Yikes!

Our system started in one province first.

Perhaps letting states decide if they would like to create and run a strong public option would work in the USA; there is a big difference between running a public system with 34 million people and one for 300 million and more.

The USA has many distinct cultures within it, and some will take better to a public plan than others will. That said, please change UA law to allow doctors to cross state lines to donate health care services for free; Remote Area Medical is calling for this change.

For the USA, I like the current mixed notion, which allows people to keep their private insurance if it is good, but I hope a strong public option gets approved.

Sorry this is so long. Good Luck.

Posted by sasha | Report as abusive

I find it deeply disturbing that the US government wants to increase their involvement in the healthcare industry when they already handle close to 40% of it currently. This is why the US system needs to be changed. Obama doesn’t understand that the government is the one that is making my healthcare system worse, not the so-called “evil corporations”. Just look at the budgets for Canada, France, and state’s that have an large reliance on government programs here in the US. They have bankrupted us.
I work in retail and grocery sales, and the people I see coming in with government food stamp cards not only do not need them, but they regularly abuse them. This is not a small minority either, I would say 4 out of 5 people that use EBT cards do not use them to buy large quantities of food. These “people” have better things than my own family, and I work 60 hours a week just to help us get by (which therefore means I can’t get government help, even though I work hard).
The last thing the US needs is to cover even more expenses for these fat slobs that continously abuse the charitable American people. I don’t want to pay for someone elses irresponsibility. I have five kids to worry about!

Posted by Frustrated Middle-Class | Report as abusive

As a Canadian, our “Healthcare system” is not perfect and we pay a high economic price for this ‘right’. Our taxes are among the highest in the world, and yes, we pay and pay and pay. Most of the above stories I have read are true for me…its difficult to find a family doctor but there are clinics…our hospitals are entirely government run. We take care of all including the drug dealers shot on the news every night. i would like to see a different type of set up here but its difficult. What would you rather choose? Profit driven scumbag insurance companies or ineffectual government run? I

Posted by Drew | Report as abusive

Brain and Valentin are charlatans at best, lunatics at worst. Why has Reuters given them a forum to discuss this, and do they hold the influence to deserve this forum? And why is the ‘best comment’ made by someone who only generally refers to the premise of the article? It sounds like most of the comments made by Canadians support their health care system … maybe Reuters should note that?

Posted by Coach Danger | Report as abusive

Also from the Canadian perspective…We had a large tax increase in our province a few years back – The largest in the history of our province – called a “health care premium” (Ontario has 11 million people), however, these monies go into the governments “general coffers” and we as citizens do not know how much of this tax money is actually going to hospitals.

The United States is a beacon freedom and I’m afraid of whats happening in your country because I know this road.
State-run healthcare is a great thing for big government.

My prediction for the U.S….healthcare reform, big government, your nation taking away your arms, much higher taxes…a kindler-gentler nation.

I hope this helps.

Posted by Drew | Report as abusive

I think the article address’ the fact that the systems in both Canada and France do not work. The waiting lists is a recurring theme and can be quantified. In America we already have government run health care in the form of Medicade and Medicare and both programs are
wrought with corruption and abuse. Neither is producing the desired results and both operate in the DEEP red.
They are a burden on the tax payor, and the Medicare reimbursement allowances reduce the number of physicians that are willing to accept those insured under the government run program as patients.
If the government were to take over the remaining private programs and those that have insurance under them, where would the off-set in physician and provider fees come from? Increased taxes and reduced coverages?
They constantly cite 45 million uninsured….many of the uninsured are uninsured by choice, young and healthy and many with the opportunity to get coverage through their employer at minimal cost. But choose not to! Others are illegal aliens who still have access to our emergency rooms and other government programs. Yes we do have uninsured’s that are in need of help, but why not just expand the Medicade and Medicare benefit and better manage the outcomes and spending? To destroy a system that is often cited as 1/6 of our ecomony and put the government in control is beyond the scope of reason and good American common sense.

Posted by David | Report as abusive


Posted by Jonathan | Report as abusive

It should be noted that canadian healthcare is subsidized by America in the form of our constant defense of north america. I wonder if Canada would be able to spend so much on health care if the US did not provide for the common defense of all of north america and they had to up their defense budget. sounds crazy i know but think about it…

Posted by Concerned | Report as abusive

I am originally from England and the National Health system is an absolute disgrace. My sister has lymphomia and the doctor told her that it was too expensive to treat the condition and refuses to send her to a specialist. Her legs swell considerably and she has problems walking. My sister’s friend, who was a professor, suffered from bad headaches, his doctor told him that he was just depressed and sent him away with pain killers. 1 year later he was dead. He died of brain cancer. My father’s friend also had brain cancer and was also told that he was depressed and there was no need for any tests to be done. He also died. Colonoscopies are not done in England and people die of colon cancer. In addition, there are no mammograms undertaken, like here in American for women over 50 years. The end result breast cancer.

By killing people, especially the old, it saves the government money. The little money the National Health has, is spent on younger people.

Be prepared for Obama’s wonderful socialzied medicine.

Posted by Linda Pendergast | Report as abusive

You don’t have to go to Canada or France, try TennCare in Tennessee and see how costs can skyrocket by the government taking over.

Posted by Dan Lidster | Report as abusive

“Physicians’ freedom to practice outside the public option will become increasingly hedged with restrictions, perhaps ultimately ending up, as in Canada, with doctors in the public system being prohibited from taking private patients.”

Sorry, already been happening with Medicare in the US. Physicians who contract with over 65 year olds outside the constraints of MEdicare are prohibited from attending to a patient covered by Medicare for 3 years from the last date of service for that privately contracted “elderly”. This effectively prevents most US physicians from practicing outside Medicare – given that the solo practitioner model has been going extinct from rising costs associated with running a business (staff payroll, billing & referral services, rent, utilities, slip & fall insurance & the oh so needed malpractice insurance), being excluded from billing Medicare for 3 years at a pop makes most physicians who see adults eschew the private patient option as they would effectively be unemployable if not in their own practice.

Posted by stormracer | Report as abusive

I can tell you first hand, waiting lists for health care suck. People that are diagnosed with serious illness sometimes find themselfs gridlocked in Canadian health care. HOWEVER, almost all of said people would never have afforded the medical attention leading up to said diagnoses due to extreme costs of medical attention in the United States. Personally, I will take having to wait (and risk it) over never knowing what is wrong with me and have a 100% chance of death or permananent disabiity due to my low income. I’ll choose living, thanks. Canadian health care: not perfect, but functional. American Health Care: dysfunctional and a slap in the ace.

The Ontario woman that is seen slamming Canadian health care in US anti-health reform ads forgot that little nugget of truth, her money would have run out long before she saw that specialist in the US.

Why have Canadian health care costs balooned? Simply due to the fact that North Americans live unhealthy life styles, live with too many enviromental carcinogens, exercise too little, and only seek medical attention when something is wrong. Private or public health care will not change that fact. What ‘Canadian’ style health care can provide is care to all citizens, regardless of wealth.

Posted by Richard Barr | Report as abusive

Answer from a French. (Christian is my firstname)
Since World War II, French system was designed to give as best as possible heath care to the population. Since Free Market arrived in France, around 1970, the goal as been to ivert ressources to feed private companies, since we send our jobs in China and real jobs disappeared, real income decrease…
Our ‘public’ (in fact managed by syndicates and companies) has a 2% cost compared with private companies who first take money (15-20%) for investors then use the rest to pay their clients.
French government took control of the system some time ago, and since that time reduces the benefits since increasing cost for people. From that time, costs exploded. Because private companies are not effectve in term of money used to care people, since if you don’t meet your doctor when you begin to be sick, you’ll need very expensive hospital cares…
All this since the french government try to implement US style system in France.
We dream to go back to the one payer system…
Since things should have been changed, it seem we always head to the wrong direction: less care, more costs.
Don’t forget that French productivity has been proven the best of the world by English and US studies.
WHY? Good education, good health, good infrastructures. But this mean that government need money.
And we have a 50% taxes in France (in average when you take Income taxes, VAT,social systems…), and I’m happy of this.
Think about it and choose.

Posted by Christian | Report as abusive

Unfortunately we are focusing on the wrong thing. The issue is not that we can’t afford health care. The problem is we can’t afford anything. Our entire economy is falling apart. Health care is just one more nice thing we can’t afford (public or private) in a failing economy. Fix the economy and all the sudden health care becomes affordable. The public option is always the least efficient of course.

GDP has been sliding in relation to total money supply (M3), ie Velocity of money (VOM), for 100 years. Use of credit rather than cash as the primary source of our money supply has been rising for 100 years and now stands at 97% credit and 3% cash. In 1865 we were 50/50. Wonder if that could have something to do with the stagnant GDP? Sure could use another Abraham Lincoln / Henry Charles Carey combo with their clear thinking on Macro-Economics. They faced a seemingly insurmountable problem in their day, paying for the civil war. They managed to pay for the war and stimulate the economy, tripling the VOM/economy. Wonder how they did that? These problems aren’t new and have all been solved in the past, just have to study a bit of history.

Posted by Henry HOLLENBERG | Report as abusive

If America goes with single payer system, then I would be glad to have the same medical benefits as our President and Government Senators and Congressmen.

Am I asking too much? If they are covered by Government Medical Insurance why CAN’T the regular Joe Six-Pack have the same benefits?

I pay $1200 year on Point of Service health care I pay a premium and co-pay with $500 deductible. I am fairly happy with my Insurance. However, once I get on Social Security and medicare, I will have to drop my Company Insurance and wait in long lines with inferior care-not able to CHHOOSE my own Doctor.

I will then have to buy supplemental insurance to cover what Medicare refuses to insure.

God help us all!

Posted by General_Mortars | Report as abusive

Wake up people! You only get what you pay for. It is time to make the hard choices as to what you really need and how you are going to pay for it. Don’t expect a government mandate that everyone gets free health insurance to be a reality. At some point the money runs out and you have to decide who gets what treatment and who doesn’t get treated. I’m talking about cost / benefit ratios. Are you going to spend 1/2 of a person’s total health care costs in the last year of life like we presently do, or allocate that money to patients that have many years of life?

The medical malpractice situation must change because 15 to 20% of your dollars are going to lawyers and the few people who file these lawsuits. 75% of malpractice suits are frivolous and need to be squashed before they ever reach a court. The other 25 % need to be adjudicated by a medical review board, not a court of law. A board composed of elected members representing the people, and the medical profession would hear cases and decide guilt or not. The monetary awards would be appropriate to the injury. No lawyer’s contingency fees, no excessive pain and suffering fees.
It is time to decide what you want, or the forces of special interests and financial necessity will decide for you!

Posted by william scott | Report as abusive

You collectively described the financial pressures that Canada and France are facing. They pale in comparison to what the US government is facing. Health care outcomes are across the board better in both countries than in the US. They are by and large getting what they pay for. Infants don’t die as often, people, on average live longer. Without hard data to support this, much like the authors, I would say from my experience practicing medicine for 10+ years in Washington, DC, a far greater percentage of Americans “die waiting for care” than in either country combined. Very few Canadian or French politicians or news outlets are calling for a fully-privatized system of insurance that ensures that care is unequally available. This despite the fact that both countries provide care for all citizen and non-citizen alike.

One last point: please stop implying that waiting a year for a physical exam by a family physician is somehow bad. If you’re between the ages of 16 and about 40 and have no significant family history to speak of (i.e. most people in most countries, although that’s shifting) you don’t need an annual physical. Its in no one’s interest to delay finding a serious illness, more advanced disease is much more expensive to care for than early stage disease. No well-designed, implemented and managed system created in this era would deliberately push people into greater degrees of illness, the system and the payors (that’s us) couldn’t afford to. Stop peddling fear, start thinking of ways to get the best of private and government plans. The US military does it exceedingly well, driving innovation and keeping private industry fat. Surely the health of our fellow citizen is worth the effort, yes?

Posted by Michael Williams, MD | Report as abusive

Again the Canadian perspective, we have a government scandal here involving tax payer money and abuse of health care funds. E-health is a disgrace in this province (google: E-health scandal Ontario).

Scumbag insurance companies are one thing…but giving your hard earned money to the government is not a lesser evil. Your taxes, your political freedom might be at risk, in my opinion. Canada has the highest taxes in the world, also one of the lowest birthrates. Taxes kill jobs. Canada has a generation of its best and brightest living in their parents basement…

Your Cash for Clunkers is a great example. The government now owns the U.S. automakers. And if the government sees competition it eliminates it. Look what they are doing to the competition: old cars. Destroying old cars forever is a ass-backwards way for your government to be touting the environment while pulling this crap.

But this is the thing…State-run healthcare will have consequences, good or bad depending on if you like the nanny state…Good luck. You’ll need it.

Your Canadian Neighbour,
Bracebridge, Ontario

Posted by Drew | Report as abusive

OK! I get it, all of the US’s problems are the fault of worthless-workless people like me? OMG thank you for that insight. When a bag of potato chips and a soda cost less than a bag of crisp veggies and a bottle of water, then you can criticize me for my choices. I am more than sick to death of your types. I am ‘diseased’ of them. I put in my time as a drone..did an honest job in construction fed my children healthier and all of that, now I have been unable to even get an interview for a new job, so we rely on California’s medi-cal to keep my daughter from being an ADD nightmare and to keep my wife from dropping into a coma from hypothyroidism. Get off these forums if you can’t acknowledge what simultaniously advances and bankrupts the US is GREED. And a healthy dose of hate for those who have fallen on hardships. And I will proudly use my EBT card to feed my family and hope this subsidized healthcare for all comes into play, so when I am forced to take a minimum wage job after my unimployment ensurance runs out…I can affordthe same medicines that some in my family need to survive, sure it will cost more taxes. But I’ll be lgad to pay em whenever someone decides that I am worthy to be their employee. Hate sucks and so do you.

And I wasn’t even going to comment until I kept reading that somehow the problems were all my income groups fault, instead of blame sitting on elitist well-to-do who think they can stand on our backs to remain ridiculously weathly.

Posted by Fat Lazy Low-income Slob | Report as abusive

Did you know that the US is the only industrialised country in the world that still lacks a wholly public health care system?

What does private health care cost? Studies show that Americans pay more money for less health care than other countries. American corporations cannot compete with other corporations from around the world because they are burdened with the financial and bureaucratic difficulties associated with insuring their employees’ health. And while bankruptcies can result from any number of financial difficulties, half of the bankruptcies filed in the US are a direct result of medical costs. This is not solely the problem of the uninsured: the vast majority of those health care-related bankruptcies come from those who are insured.

But the cost is much more than dollars and cents. It is about human lives. Our infant mortality rate is higher than that of Taiwan and Cuba, in addition to most European countries including Croatia. Entire cities’ worth of American babies die each year in the US compared to Canada because our infant mortality rate is that much higher than theirs. 18,000 people die in the US every year because they could not access health care. This number includes the insured and uninsured. 47 million people in the United States do not have health insurance.

How much longer will we force ourselves and our fellow Americans to suffer from our pride and our unwillingness to stand up to the message streaming from the lobbyists of our corporate HMOs? How much longer will we watch our corporations struggle and fall while those in other countries struggle and survive? When will we regain our sense of pride and take back this system which has been controlled by impersonal, uncaring corporations for far too long?

Posted by Pink Muslimah | Report as abusive

Without going into specifics, I will say only one thing. The Canadian health care system is imperfect but improving. Would I trade the Canadian system for the American system, or what is being proposed? No bloody way.

Posted by Jon | Report as abusive

[…] in every province and territory within a few years. Needless to say, this is unsustainable. Healthcare reforms warnings from France and Canada | Analysis & Opinion | What are wait times in France and Britain for example, atrocious across the border. But the […]

Posted by A Few Misconceptions | Report as abusive