Human Exceptionalism

Canadian Single Payer System “Humpty Dumpty”

I first realized the Canadian single payer system had terrible problems whilst in Toronto maybe 10 years ago, and seeing a front page headline that 900,000 Ontarians could not find their own primary care physician.  That stunned me.  Prior to then, I had urged that the USA adopt the Canadian system.

In the years since, I have become increasingly convinced that Canada’s (and all) single payer no longer can work effectively and efficiently, as I have written here many times.  Now more evidence: Canada isn’t experiencing the economic dislocations of the USA and Europe. Even so, its single payer Medicare continues to implode–to use the terminology of the former head of the Canadian Medical Association.  From the Vancouver Sun story:

Cancelled surgeries. Patients who need hospital care but who can’t get it. Families forced to sell their homes to pay for an autistic child’s treatment. In person and online, thousands of Canadians who participated in a nationwide consultation over the past year say the country’s health system is faltering badly and that more needs to be done to deliver care when and where it’s needed. The nation’s “once proud” health system is fundamentally fractured and failing – especially for vulnerable groups such as children, the elderly, aboriginal peoples and those with mental illness – says a report from the Canadian Medical Association…The report says the system is good at providing acute, or short-term care immediately after an illness or injury – what one participant called “Humpty Dumpty medicine.” Where it fails, participants said, is in providing care to the elderly and others with chronic, longterm illnesses.

That’s not surprising. In tough times, those who need it most–and have the least political power–often are the first to have their care cut. But that’s not all:

Canadians spoke about long waiting times, the high cost of prescription drugs, patients languishing on hospital wards who need care in long-term facilities, doctors offering nextday surgery in a private clinic for $2,000 rather than have the patient wait a year or two to do so in hospital, and the need to spend less money on administration and more on front-line workers and services…”We heard of people who waited inordinately long – and their health suffered as a result of that – to get meaningful, thoughtful services,” Turnbull said. “Long waits in emergency departments, cancelled surgeries – we heard that right across the country. We heard of not being able to access a primarycare physician, right across the country.

Canadians still support single payer, but I think the idea has been so inculcated into the body politic as “the Canadian Way,” that the reality of the need for change is difficult to assimilate.

I remember last year meeting a very nice fellow from Canada who introduced himself to me after a speech.  I asked him about the Canadian single payer–he was an avid supporter even though his wife had to fly on their own dime to San Diego to obtain needed surgery (the treatment itself paid for by Canada’s Medicare)!  That hardly convinced me the system was working. 


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