Health Care: U.S. vs. Canada

Summary

The transcript captures a discussion between Senator Burr, Dr. Martin, and Ms. Pipes about the healthcare systems in Canada and the United States. Dr. Martin refutes claims that Canadian doctors are leaving the public system and advocates for improving wait times without moving to a multi-payer system. Ms. Pipes highlights that many Canadians come to the U.S. for quicker healthcare services due to long wait times. The conversation touches on the differences between both systems, the role of private insurance, and public perceptions of quality healthcare.

Takeaways

• 😀 Canadian doctors are not exiting the public system; instead, there is a net influx from the U.S.
• 🤔 The solution to reducing wait times in Canada isn't moving towards a multi-payer system.
• 📊 Studies in Australia show that private insurance increased wait times in the public system.
• 💡 Some Canadians perceive private healthcare in the U.S. as better due to higher costs, but this isn't supported by evidence.
• 🌍 Canadian pioneers lead in certain medical procedures, offering top-tier outcomes within the public system.
• 📉 42,000 Canadians seek healthcare in the U.S. due to long wait times in Canada.
• 🏥 Canada is working to reorganize its system to reduce wait times equitably for all patients.
• ⏱ The focus is on using existing resources more effectively rather than moving to a two-tier system.
• 🩺 45,000 Americans die annually due to lack of insurance, a significant contrast to Canada’s single-payer system.
• 🔗 Support for the single-payer system in Canada crosses political lines, and there is little interest in adopting the American healthcare model.

Q & A

Why are doctors exiting the public system in Canada according to Dr. Martin?

Dr. Martin clarified that there are no doctors exiting the public system in Canada. Instead, there is a net influx of physicians from the United States into the Canadian system.

What is the impact of a multi-payer system on wait times as experienced by Australia?

A study by Ducat et al. found that when Australia moved to a multi-payer system, wait times in the public system increased in areas where private insurance was utilized.

Why do some Canadians choose to go to the United States for healthcare?

Some Canadians travel to the U.S. for procedures like heart valve replacements, often due to the perception of better quality or innovation, despite the availability of such procedures in Canada.

How many Canadians come to the United States each year for healthcare?

More than 42,000 Canadians come to the United States each year for healthcare, often for MRIs and CT scans.

What does Dr. Martin suggest as a solution to wait times in Canada's healthcare system?

Dr. Martin suggests focusing on reducing wait times in an equitable way for all, emphasizing the importance of organizing resources effectively rather than just increasing them.

What benchmarks has the Wait Time Alliance in Canada established for reasonable wait periods?

The Wait Time Alliance in Canada has established benchmarks across various diagnoses to define what constitutes a reasonable waiting period for care.

How does Dr. Martin respond to the idea that paying more for healthcare leads to better quality?

Dr. Martin counters the notion that paying more guarantees better healthcare quality, stating that evidence on outcomes does not support this belief.

What is the political stance of Canada's Prime Minister regarding the healthcare system?

Canada's Prime Minister is conservative, and despite this, there is broad support across political parties for the single-payer Medicare system in Canada.

Why do Canadians not adopt the American healthcare system?

Canadians are aware of the American healthcare system and have chosen not to adopt it, likely due to a preference for a system that guarantees healthcare to all in a cost-effective manner.

What does Dr. Martin suggest about the relationship between the Canadian and American healthcare systems?

Dr. Martin implies that despite the proximity and similarities between Canada and the U.S., Canadians have a clear preference for their own healthcare system over the American model.

How does Dr. Martin describe the Canadian public's perception of the American healthcare system?

Dr. Martin suggests that Canadians are familiar with the American healthcare system and have made a conscious choice to maintain their own system, indicating a preference for universal healthcare.

Outlines

00:00

🏥 Canadian Healthcare System's Strengths

Dr. Martin clarifies misconceptions about Canadian doctors leaving the public healthcare system for private practice, emphasizing that there is actually a net influx of physicians from the United States. He argues against moving to a multi-payer system, citing Australia's experience where wait times increased with the introduction of private insurance. He also addresses the perception that healthcare outside of Canada is superior, highlighting that world-class care for certain procedures is available within Canada. Dr. Martin suggests that the focus should be on improving wait times within the single-payer system rather than seeking alternatives, and he points out that the Canadian public broadly supports their healthcare system across political ideologies.

05:01

🌎 Cross-Border Healthcare and Perceptions

The discussion continues with the reasons why some Canadians choose to seek healthcare in the United States, despite the Canadian system's overall effectiveness. It is noted that approximately 42,000 Canadians travel to the U.S. annually for medical care, often due to long wait times for non-emergency procedures. The conversation touches on the Canadian public's awareness of the U.S. healthcare system and their preference for their own system, even under conservative political leadership. The dialogue suggests that Canadians are patient and value their universal healthcare system, which provides cost-effective care to all citizens.

Keywords

💡Public Health System

The public health system refers to government-funded healthcare services accessible to all citizens. In the context of the video, Canada's single-payer public health system is discussed, with Dr. Martin arguing that while there are wait time issues, the solution isn't moving towards a multi-payer private system. This system is central to the debate about the pros and cons of healthcare models between Canada and the U.S.

💡Wait Times

Wait times in healthcare refer to the duration a patient has to wait to receive medical care, especially for elective procedures. In the video, Dr. Martin acknowledges that Canada has challenges with wait times, but suggests they can be managed within the current system. Miss Pipes, on the other hand, argues that long wait times push Canadians to seek healthcare in the U.S. The debate centers around how best to reduce these delays without compromising equity.

💡Single-payer System

A single-payer system is a healthcare model where the government pays for healthcare services rather than private insurers. The video discusses how Canada’s single-payer system ensures equitable healthcare for all citizens. Dr. Martin defends this system, suggesting it offers better overall outcomes compared to multi-payer systems like Australia's, which have reportedly increased wait times.

💡Multi-payer System

A multi-payer system allows multiple insurance providers, both public and private, to cover healthcare costs. In the video, Australia’s shift to a multi-payer system in the 1990s is discussed. Dr. Martin cites a study indicating that this move resulted in longer wait times in areas where private insurance became popular. The concept contrasts with Canada’s single-payer approach.

💡Elective Medical Procedures

Elective medical procedures are non-emergency surgeries or treatments that can be scheduled in advance, such as knee replacements or cataract surgeries. In the context of the video, Canada’s wait times for these procedures are criticized. Dr. Martin acknowledges the issue but argues that it can be improved within the existing public system rather than adopting a private option.

💡Private Healthcare

Private healthcare refers to services provided by privately owned and operated hospitals or doctors, often requiring out-of-pocket payments or private insurance. Miss Pipes highlights that over 42,000 Canadians visit the U.S. annually for healthcare, opting for private services because of long wait times in Canada. This is presented as an alternative to the public system, although Dr. Martin challenges its effectiveness.

💡Australia’s Healthcare System

Australia's healthcare system transitioned from a single-payer to a multi-payer system in the 1990s. Dr. Martin refers to a study by Duckett et al. that tracked the impact of this change, showing increased public wait times in areas where private insurance was used. This serves as a cautionary example against moving Canada’s system toward privatization.

💡Cross-border Healthcare

Cross-border healthcare refers to patients seeking medical treatments in other countries. Miss Pipes mentions that many Canadians travel to the U.S. for procedures such as MRIs or surgeries due to long waits in Canada. This cross-border movement highlights one of the central issues in the debate over the efficiency of Canada’s healthcare system.

💡Healthcare Outcomes

Healthcare outcomes measure the effectiveness of medical treatments, including patient survival rates, recovery times, and overall health improvements. Dr. Martin points out that the best outcomes for heart valve replacement surgery are available in Toronto, disputing the idea that higher-cost healthcare in the U.S. guarantees better outcomes. This concept contrasts perceptions of healthcare quality between the U.S. and Canada.

💡Political Influence on Healthcare

The political influence on healthcare refers to how government leaders and policies shape healthcare systems. The video discusses how even Canada’s conservative prime minister supports the public healthcare system, illustrating that universal healthcare enjoys broad political support across party lines in Canada. This contrasts with the U.S., where healthcare reform is more politically divisive.

Highlights

Dr. Martin clarifies that there are no doctors exiting the public system in Canada, and there is a net influx of U.S. physicians into the Canadian system.

Dr. Martin explains that the solution to Canada's wait time challenges does not lie in moving to a multi-payer system, citing Australia's experience where public wait times increased with the introduction of private insurance.

Senator Burr asks Dr. Martin about Canadian officials seeking healthcare in the U.S., and Dr. Martin emphasizes that Toronto's Peter Munk Cardiac Centre offers world-leading outcomes for the same surgery sought in the U.S.

Dr. Martin believes that perceptions of better care in the U.S. are partly influenced by media and that paying more does not necessarily equate to better health outcomes.

Ms. Pipes states that over 42,000 Canadians come to the U.S. annually for healthcare due to long wait times, often seeking services like MRIs and CT scans.

Ms. Pipes provides an example of Brian McCreeth, who came to the U.S. for a brain tumor diagnosis because of long wait times in Canada.

Dr. Martin argues that the focus should be on reducing wait times in a way that is equitable for all, emphasizing that solutions exist within the single-payer system.

Dr. Martin compares Canadian healthcare to a security line, illustrating that it's not always about the amount of resources, but how they are organized for efficiency.

Senator Burr asks how many Canadian patients die annually while on a waiting list, but Dr. Martin counters with a U.S. statistic, stating that 45,000 Americans die each year due to lack of insurance.

Senator Burr points out the close relationship between Canada and the U.S., and questions why Canada doesn't adopt the American healthcare system if it is superior.

Dr. Martin responds that Canadian political support for single-payer healthcare spans all parties, including conservatives, and that there is no major effort to move towards the U.S. system.

Dr. Martin recalls a debate where the leader of Canada's most right-wing party held up a sign saying 'No Two-Tier,' reassuring the public that they would not dismantle the single-payer system.

Senator Burr expresses surprise that Canadians, despite being very familiar with American media and politics, continue to prefer their own healthcare system.

Ms. Pipes reiterates that 42,000 Canadians come to the U.S. for healthcare each year, but Senator Burr refocuses, asking why most Canadians still prefer their own system.

Ms. Pipes speculates that many Canadians are unaware of an alternative to their healthcare system, while Senator Burr points out the cultural difference between Americans' impatience and Canadians' acceptance of waiting.

Transcripts

Senator Burr

Dr Martin in your testimony you note

that Canadian doctors exiting the public

system for the private sector has had

the effect of increasing increasing

waiting lists for patients seeking

Public Health Care why are doctors

exiting the public system in Canada

thank you for your question Senator I I

if if I didn't express myself in a way

that would make myself understood I

apologize there are no doctors exiting

the public system in Canada and in fact

we see a net influx of Physicians from

the United States into the Canadian

system over the last number of years

what I did say was that the solution to

the wait time challenge that we have in

Canada which we do have a difficult time

with weights for elective medical

procedures does not lie in moving away

from our single-payer system towards a

multi-payer system and that's borne out

by uh the experience of Australia so

Australia used to have a single tier

system and in the 1990s moved to a

multiple payer system where private

insurance was permitted and a very

well-known study by ducat at Al was

tracked what took place in terms of wait

times in Australia as the multi-payer

system was put in place and what they

found was in those areas of Australia

where private insurance would was being

taken up and utilized weights in the

public system became longer what do you

say to a an elected official who goes to

Florida and not the Canadian system to

have a heart valve replacement it's

actually interesting because in fact the

the people who are the pioneers of that

particular surgery which Premier

Williams had and had the best health

outcomes in the world for that surgery

are in Toronto at the at the Peter Monk

cardiac center just down the street from

where I work so what I say is that

sometimes sometimes people have a

perception and I believe that actually

this is fueled in part by media

discourse that going to wear something

where you pay more for something that

that necessarily makes it better but

it's not actually borne out by the

evidence on outcomes

people prefer their system because they

know consciously they pay more no I

think it's because they judge quality

and they judge Innovation Miss uh pipes

in your testimony you noted that more

than 42 000 Canadians come to the United

States each year for health care why is

that

because they find that they're on a

waiting list in Canada for too long a

period and they feel that their health

is at stake so a lot of people in Canada

come to the U.S for MRIs CT scans there

are many examples in the media of people

like Brian mccreethe who came to the U.S

because he was told by his primary care

doctor that he might have a brain tumor

but the weight for an MRI was very long

he spent the thousand dollars came to

the U.S paid out of pocket you will see

advertisements in Canadian newspapers

for MRIs it's pretty fertile ground to

uh to Market in right Dr Martin in your

testimony you state that the focus

should be on reducing waiting times in a

way that's Equitable to for all what

length of time do you consider to be

Equitable

um when waiting for care

well in fact the wait time Alliance in

Canada sir has established benchmarks

across a variety of different diagnoses

for what's a reasonable period to wait

and what we've we've found is that

actually working within the single-payer

system we can reorganize things you know

I waited more than 30 minutes at the

security line to get into this building

today and when I arrived in the lobby I

noticed across the hall that there was a

second entry point with no lineup

whatsoever sometimes it's not actually

about the amount of resources that you

have but rather about how you organize

people in order to use your cues most

effectively and that's what we're

working to do because we believe that

when you try to address wait times you

should do it in a way that benefits

everyone not just people who can afford

to pay on average how many Canadian

patients on a waiting list die each year

do you know I don't sir but I know that

there are 45 000 in America who die

waiting because they don't have

insurance at all I live one hour away

from the Canadian border

Canadians watch American television

Canadians are very familiar with our

political system probably know more

about politics in America than most

Americans know

uh is Dr is your prime minister a

socialist

no sir our prime minister is quite

conservative he's conservative so

obviously as a conservative he wants to

implement the American Health Care

system that the Canadians are very aware

of I gather that was probably the first

thing he did when he took power is that

right

thank you

not exactly why not

support for single-payer Medicare in in

Canada is goes across all political

strike Stripes quite famously we had the

leader of the most right-wing party in a

Canadian Federal debate on television uh

hold up a sign in the middle of the

debate on which he'd written in marker

no two-tier as a means of trying to

reassure the Canadian public that if

elected he would not dismantle this in

other words you have a nation bordering

on the United States two Nations that

are probably as close together in so

many respects as any two nations in the

world

a conservative prime minister and yet

there is no effort to move to an

American Health Care system I would say

to my colleagues there's not a better

example

of maybe how people feel about two

systems they know the American system

they have a conservative prime minister

they can move in our Direction but for

whatever reason and I think sensible

reasons they understand that A system

that guarantees Health Care to all of

their people in a cost-effective way is

the way that they want to stay Miss

pipes let me ask you that question why

do the Canadians not come to the

American Health Care System well as I

mentioned in my testimony about 42 000

Canadians every year come to the U.S and

pay out a pocket for assistance that

wasn't my question no I just made that I

don't want to make that point first

second the Canadian government and the

provinces who administer the Canadian

Health Care system this started in 1974.

a lot of people in Canada have no idea

of an alternative system oh my goodness

they live an hour away from me in

Burlington Vermont they watch American

television they read American newspapers

they have no idea of what goes on in the

United States of America that is a

little bit hard for me to believe I

would say that Canadian people are very

very nice people they're not impatient

like Americans my mother said to me I

hope you're not becoming an impatient

American I am an impatient American

Americans do not want to wait Canadians

are very nice well I think it says and

then the second I miss lives I have a

limited time yes I I think the the the

answer is pretty clear the Canadians

have seen uh the American system they

prefer their own