Where would you rather get sick – in the U.S. or in Canada?

by Carolyn Thomas

I have an ever-so-slightly jaded view of American health care since spending time at Mayo Clinic. While there, I met an alarming number of heart attack survivors from across the U.S. – yes, even those who thought they had good health insurance coverage  – who had lost their homes, their businesses, and faced collection agencies at the door or even imminent bankruptcy because they’d had a cardiac event that had left them with crushing medical debt.

Last month in Toronto, the 5th semi-annual Munk Debate featured the Great Health Care Debate resolution: “I would rather get sick in the United States than in Canada.”  Here are some of the pros and cons raised by each side during this debate:

I would rather get sick in the U.S. because:

• The U.S. spends 87% more per person than Canada on health care ($7,290/patient vs. $3,895).
• 54% of American men had PSA tests for prostate cancer. Only 16% of Canadian men did.
• There are 34 CT scanners per million citizens in the U.S. In Canada, only 12.
• There are 27 MRI machines per million citizens in the U.S. compared to just six in Canada.
• Canadians wait twice as long as Americans for elective surgery like hip replacements.
• The U.S. is responsible for the vast majority of health care innovations, both medically and technologically. They are the world’s undisputed leaders in biomedical research and diagnostic treatment.

But on the other hand, here’s why it’s better to get sick in Canada: 

• You’re three times more likely to go bankrupt in the U.S. thanks to unforseen medical expenses. And 62% of all bankruptcies in the U.S. are related to an inability to pay medical bills.
• 46 million Americans have no health insurance at all.
• 31% of American health care expenditures go towards paperwork, salaries, and profits of private insurance companies. In Canada, the figure is 1%.
• The U.S. spends 17% of its GDP on health care, covering 90% of the population. Canada spends only 10% of its GDP on health care, and yet covers 100% of the population.
• Canadians, on average, live three years longer than Americans.
• America would save $161 billion a year in bureaucracy if it were to go to a single-payer system like Canada has.

The debating teams read like a Who’s Who of medical heavyweights and senior politicians from both Canada and the U.S.  Speaking in favour of the U.S. health care system were:

• Dr. William Frist, former U.S. Senate Majority Leader, nationally recognized heart and lung transplant surgeon, and Professor of Business and Medicine at Vanderbilt University
• Dr. David Gratzer, a licensed physician in both the U.S. and Canada, senior fellow at the Manhattan Institute, and author of The Cure: How Capitalism Can Save American Health Care, as well as Code Blue: Reviving Canada’s Health Care System, which was awarded the 2000 Donner Prize for best book on Canadian public policy

And arguing for the benefits of the Canadian health care system were:

• Governor Howard Dean, former U.S. Democratic National Committee Chairman, presidential candidate, six-term Governor of Vermont, a leading advocate for universal health care coverage in the U.S. – and a physician himself.
• Dr. Robert Bell, President and CEO of University Health Network (Toronto General Hospital, Toronto Western Hospital and Princess Margaret Hospital) Canada’s largest hospital system, and an internationally recognized orthopaedic surgeon.

Debate points were hammered home in predictably colourful fashion. Dr. William Frist, for example, reminded the audience:

“America has the best doctors, the best nurses, the best hospitals, the best medical technology, the best medical breakthrough medicines in the world.”

But Dr. Howard Dean argued in favour of the universal health care that Canadians have:

“Every single industrialized country on the face of the earth has health insurance for all of its people. Why can’t we in the U.S. have what all those countries have?” 

On the other hand, speaking for the affirmative team, Dr. David Gratzer said:

“Yes, everyone in Canada is covered by a ‘single payer’ – the government. But Canadians have to wait for practically any health care procedure or diagnostic test or specialist.”

On that issue about excessive U.S. health care expenditures on paperwork, salaries and private insurance company profits, Dr. Bob Bell pointed out this example of U.S. bureaucracy:

“At the MD Anderson Cancer Centre in Houston, Texas, there are 500 people working in the billing office alone.

“Here at the University Health Network in Toronto, there is one person (who deals with patients who want TV service or private rooms).”

Dr. Bell turned out to be a tireless champion of the Canadian system all evening, comparing his tenure at Harvard with his work in Toronto like this:

“Private health insurance in the U.S. was the root of all evil. They may call Canada the land of socialized medicine. But they’re soulless vampires making money off human pain.

“You’ll die sooner in the U.S. and if you’re sick enough, you’ll go bankrupt.”

Here’s my own experience of surviving a heart attack here in Canada.

My care in a world-class heart institute here cost me not one penny.  I paid nothing for my E.R. visits, all cardiac tests and procedures, medical and nursing care, all drugs while in hospital, my stay in the Coronary Care Unit, my hospital bed, and unlimited follow-up visits with my cardiologist and other specialists.  And I will never get a bill for any of this truly outstanding cardiac care.

Even though I had a heart attack, I will never lose my home, my business, have an insurance company deny my claims, worry that my heart attack now means a pre-existing condition that makes me ineligible for any future care, declare bankruptcy due to catastrophic medical debt, or have a collection agency at the door because I haven’t paid the hospital bills from my last cardiac event.

But all of these things have happened to heart patients I know in the U.S.

Our Canadian health care system is certainly not perfect, very far from it – but I can’t imagine trading it for the health care nightmares listed above that my American heart sisters have told me about. And I’m not alone. Despite common American scare-mongering about Canada’s “commie, pinko, socialized medicine”, over 85% of Canadians report satisfaction with our current public health care system.

So who won that Munk debate in Toronto? At the beginning of the evening:

• 68% of the audience supported the Canadian health care system
• 24% preferred the U.S. system
• 8% were undecided

After the 90-minute debate, the 8% formerly undecided broke a little more towards Canada:

• 73% preferred the Canadian system (an increase of 5 percentage points)
• 27% preferred the American system (an increase of 3 percentage points)

See also:

Why You Should Have Your Heart Attack in Canada and Bob Hepburn‘s piece from the Toronto Star called Why I’d Rather Be Sick Here Than in the U.S.

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Q:  Where would you rather get sick?