My dear American neighbours

Neil Macdonald explains Canadian medicare to his Washington neighbours.

Dear neighbours,

It looks as though you will be hearing quite a bit more about Canada in the next couple of years, so I thought we should have a word.

No, no, now, come on. I'm not going to bore you about our cultural festivals or our clean streets.

It's our health-care system you'll be hearing about. And some of what you'll hear won't be pleasant.

Now that President Barack Obama seems determined to plow ahead with that campaign promise to create affordable, universal health care, the uproar is already starting and my country's system, understandably enough, seems to be the point of reference.

As you might know, we Canadians actually have universal health care. It's a big deal for us. In fact, it's probably the thing we cite most often when we try to explain what makes us different from you (other than our apparent willingness to pay more for just about everything we buy).

Burton Cummings of the Guess Who: American woman, "sparkle someone else's eyes." (CBC)

Look, I'm going to be honest here: our system makes us feel superior. I don't know a Canadian who doesn't work it into any conversation with an American that lasts more than two minutes.

Guess who

We call our system a "safety net." We think it helps prevent the sort of crushing social inequality that most of us think is everywhere on your side of the border.

We actually love hearing about your crushing social inequality. It's a favorite Canadian topic. Remember that famous Canadian rock song, American Woman, by the Guess Who back in the '70s? Listen to the words sometime.

Anyway, while the progressives among you seem to envy our system, your conservatives hate it. And they seem to think our system is where your president is headed.

They're the ones you'll be hearing most from.

Actually, you're already hearing from them if you watch cable news. A group called Conservatives for Patients' Rights has already started running attack ads talking about the "victims of government-run health care." Most of these "victims," it turns out, are Canadian.


The ads seem a bit over the top. But — and this is not going to help my popularity back home — there's a fair amount of truth in them, too.

One features Dr. Brian Day, a private clinic owner and former head of the Canadian Medical Association, saying that what we Canadians really have is access to "a government/state-mandated wait list."

According to Day, "the wait lists are long, the patients are languishing and suffering on wait lists."

Another features a British Columbia businessman named Don Neufeldt, who grew tired of waiting for treatment for his heart arrhythmia and headed to Oklahoma to have it fixed.

After the doctors there sewed him up, they told him it had been a life-threatening condition. In other words, he could have died on the Canadian wait list.

These ads are already provoking indignation in Canada, but really, they shouldn't. The fact is, the provincial governments that run the health-care system up there practise rationing.

Effectively, they pay doctors to decide who deserves quick treatment and who doesn't. This is not radical; Britain does it too, among others.


It is an approach that is incomprehensible to most Americans, I grant you. But Dr. Day is right: depending on your age and condition, you can suffer for quite a while in Canada before the doctor gets to you, and it's all pretty much up to the governments, which control the spending taps.

(Of course, if you're somebody important, or you know somebody important, the queue can be quite flexible. Canadian VIPs, as a general rule, don't spend much time waiting for health care).

Now, Canadian politicians are constantly promising to fix the situation and, during election campaigns, they stand in front of big backdrops promising shorter wait lines.

The queues, however, never seem to get much shorter. As one medical-industry monitoring group put it in a report last year: "Commitments (made five years ago) have been only partially met at best."

It's your money

There is something else you're going to be hearing about our system, too: we Canadians can't just reach into our pockets and pay for quick care.

Rick Baker is a Vancouver-based broker who arranges American treatment for impatient Canadians. He appears in the new ads, saying "there is only one other country in the world, that's North Korea, that follows our pattern."

In Canada, he points out, "It is against the law for a medical provider to accept payment for rendering medical services."

Again, pretty much accurate, except for the foolish North Korea comparison. There is a principle behind the ban on patients paying: it's based on the notion that you shouldn't be able to buy your way to the front of the line.

That's a difficult one to explain to Americans. Most of you are accustomed to spending your money as you see fit once the government is finished taxing you.  Canadians just don't have that privilege.

Customer service

While I'm at this, dear friends, I might as well tell you a few other things about our system.

You know how doctors here sometimes give you their home or cellphone numbers and ask you to call them directly if you have a problem?

Or how they'll call you in the evening to check up on you after a treatment? Or how many others on the hospital staff here are always trying to answer your questions, instead of telling you only the doctor is permitted to speak?

It's not like that where I come from. Most of you wouldn't be happy at all with our customer service.

In the interest of balance, though, I must tell you about a few other things you won't have to deal with if President Obama gets Congress to adopt something like the Canadian system.

You won't have your health insurance cancelled on an insurer's whim, which happens here all the time, or have it denied if you or some relative was once sick. "Pre-existing conditions" don't matter at all in Canada.

You won't have some bean-counting weasel in your health group or your insurance plan conspiring to deprive you of the treatment to which you are entitled.

You won't lose your health care if you lose your job. You won't have ever-rising "co-pays" and deductibles and fees; and you won't wind up hounded by a collection agent who calls at all hours to inform you that your credit could be wrecked for life if you continue to dispute a charge on your medical bill.

Also, if you spend some time in hospital, you won't end up with months of incomprehensible invoices from everyone who provided any service, from the guy who operated the EKG machine to the guy who read the test results to the woman who administered the anaesthetic to the lab that did the blood work.

The difference between our systems is pretty simple really.

If you have money or gold-plated coverage, you're probably better off here the way things are now.

If you can't afford insurance or you're a working stiff struggling to pay your premiums, you're probably better off in Canada.

It's hard to tell exactly what system exactly President Obama has in mind. It's probably going to involve a big fight. But if you don't mind me offering some advice: don't believe everything you hear.


Neil Macdonald is a former foreign correspondent and columnist for CBC News who has also worked in newspapers. He speaks English and French fluently, as well as some Arabic.