Senator Bernie Sanders (I - Vermont) scheduled a visit to the University of Toronto in late October. On his agenda are visits to healthcare facilities and a convocation “to see what we can learn from the Canadian system,” Sanders says.
Canada’s publicly funded and administered healthcare system has received much acclaim in the United States, with some associating the country with model health policy. If healthcare is a right, like Sanders suggests, then Canada’s free universal system seems ideal. Neglected in this enthusiasm are the hidden yet very concrete costs of wait times in Canadian healthcare.
Sometimes we deceive ourselves into thinking something is free when we have actually paid for it. At many universities, for example, full-time students may enroll in a meal plan. When students pay for a meal plan, the school allots them a certain number of meals or credits that may be spent at certain campus locations, like the cafeteria, coffee shop, or spirit wear store.
As with any one-size-fits-many program, meal plans do not precisely meet all students’ needs. The end of every academic year sees students milling around the bookstore looking for a t-shirt. These students would not typically be clothes shopping in their campus bookstore, but they feel like they might as well because getting the shirt presents no additional cost to them. In this case, students pay for the ability to not pay for something later. Although they may feel like the shirt is free because they did not exchange cash when they obtained it, they have, in fact, paid for it.
Universal, free public healthcare systems, like Canada’s, contain both these illusions of freedom. Healthcare is not priceless; professionals receive compensation. In Canada’s public care system, the payment for most medical expenses is entirely taxpayer-funded. Taxes are prepaid costs, so receiving care presents no additional costs to a Canadian. Depending on the citizen’s tax status, the care is also paid by someone else. Even though Canadian healthcare is costly, public funding lets citizens perceive it as free.
When the perceived cost of a service is zero, basic economics––and common sense––dictates that the desire for that service will increase. In other words, people prefer more of something when it is free to them. In the world of healthcare, this may take the form of more frequent visits and treatments. At first glance, this may sound like a good deal. But if a treatment is equally available to everyone, the system does not account for the degree to which patients desire the treatment or are committed to its recovery regimen. If this is the case, then opportunities for treatment will sometimes be taken by those who want or need the procedure less than others. For example, because an ACL injury mainly affects lateral movement, an athlete may desire a surgery to repair a torn ACL more than a sedentary person.
In economic terms, this situation is what we expect of a market shortage. In a market shortage, the resource in question is allocated through queues. For an extreme example of this phenomenon, consider the bread lines of the Soviet Union during its economic collapse. People had to wait in lines for hours for necessities, and there was no guarantee that the state wouldn’t run out of whatever supplies they desired.
While not as grim-looking as Soviet queues, a world of “free” healthcare does force people to wait in line. In fact, Canada suffers from some of the longest healthcare wait times in the developed world. These wait times exist across the board: a third of Canadians wait a minimum of four hours for attention in an emergency department, four weeks for an ultrasound, 10 weeks to transfer specialists, and 11 weeks for an MRI scan. At any given time, nearly three percent of Canadians are waiting for treatment, and that is assuming each of them is awaiting only one procedure. It comes as no surprise that Canadians increasingly seek timely treatment in the United States.
Waiting is more than an inconvenience. Researchers reporting to the Organisation for Economic Co-operation and Development (OECD) classify Canada among the nations for whom healthcare wait times are a “serious health policy issue.” Systemic delays of treatment are not mere inconveniences. Postponing treatment forces patients and their families to undergo more suffering. Some procedures lose effectiveness as the gap between injury and treatment widens. Cost of care rises over time. Extended wait times even correlate with higher mortality rates. Additionally, because disabled workers are unable to be productive, one estimate suggests medical wait times cost the Canadian economy nearly two billion dollars in 2016 alone.
Many commentators have speculated about the culprit of Canada’s long wait times. Some argue Canada needs to meet demand by growing its medical labor force. But the number of medical professionals per capita is higher than it ever has been; still, wait times continue to skyrocket. The supply side is not the issue.
The problem here is not necessarily universal healthcare, either. Several countries have universal healthcare and don’t suffer crippling wait times. Unlike Canada, these countries permit private, for-profit institutions of healthcare. In the Netherlands, for example, private healthcare companies compete to offer the mandatory level of healthcare for Dutch citizens. German companies offer alternatives to public healthcare coverage, while Australian and Swedish firms offer supplementary services. These countries rank among the fastest healthcare wait times in the developed world. Canada’s are nearly three times the average of developed nations.
In the United States’ ongoing healthcare reform debate, Americans should be wary of admiring the Canadian system. While “free” public healthcare sounds benevolent, Americans deserve better than to pay the high costs of waiting.
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