Canada's the wrong model for universal health care

If you want to sell Americans on universal health coverage, it's not helpful to use a model that makes patients wait five weeks to see a cancer doctor. That's Canada.

There is much to admire in the Canadian system. It covers everyone, while spending only 10 percent of the country's gross domestic product on health care. (The United States spends 16 percent.) It is simple and doesn't burden employers with the job of insuring workers and their kin.

The flaws, however, are unacceptable.

Many of my left-leaning friends nonetheless worship at the altar of "Canadian-style single-payer." (I once belonged to the cult.) That's too bad because there are better universal-access systems to parade through a PowerPoint presentation. A health-care system that tolerates an average 10-week wait to use an MRI machine is not to be copied.

The Fraser Institute in Vancouver recently compared Canada's health-care system to about two dozen others — and found Canada's highly wanting. Yes, the Fraser Institute has an agenda: It promotes privatization and in the Canadian context is economically conservative. But its analyses of Canadian health care are sophisticated and honest. Unlike many conservatives in this country, Fraser starts with the premise that universal coverage would be a basic requirement of a modern health-care system.

The enduring mystique of the Canadian system surprises Michael Walker, Fraser's founder and co-author of "How Good Is Canadian Health Care: An International Comparison of Health Care Systems." Even some people who have studied it, Walker told me, cling to "the mythology rather than the reality."

The report leaves out the United States, because it does not offer government-guaranteed health care. But for Americans trying to create a rational and humane health-care system, a discussion of Canada's shortcomings offers some useful not-to-dos:

First off, don't go the single-payer route, where the government picks up all the bills. Americans often confuse "universal coverage" with "single-payer." The great majority of universal health-care systems are not single-payer. They allow private coverage into the mix.

Why is that better? For one thing, patients who use private medical services reduce the load on the public system. In New Zealand, for example, private hospitals do more of the common, less-invasive procedures, leaving the high-tech care in the publicly run facilities.

Private competition also helps assure quality. Without an alternative, the monopolistic system becomes an "uncontested standard" that may be inferior.

There's also the freedom argument. People don't want to be told that they can't spend their own money on goods that would benefit them — and who can blame them?

Canada and a few others take pride in not asking patients to pay a cent of their health-care costs, but it's a mistake not to charge user fees. If people don't have to dig into their own pockets when they use medical services, Walker says, "you find yourself giving universal access to a physician for sniffles and company."

Canada's medical free ride leads to overuse of services. And that may add to the long waiting times — for which Canada is the worst, except for Britain's dismal National Health Service.

Looking at health-care proposals now floating around the United States, Walker prefers the vision of California Gov. Arnold Schwarzenegger, because it resembles the Swiss system. "In Switzerland, you must have insurance," he says. "If you can't afford insurance, we'll pay for you, but there's a minimum package that you must have."

Many paths can lead to a health-care system that serves all, offers high-quality medicine and doesn't waste taxpayer dollars. Americans who want to get there would do well to drop their fixation with Canada and look across the Pacific and Atlantic for inspiration.

Providence Journal columnist Froma Harrop's column appears regularly on editorial pages of The Times. Her e-mail address is fharrop@projo.com