The Mirror South of the (Canadian) Border by Catherine Varner, MD

The current health care debate in the United States has had the effect of stoking our own debate on the Canadian health care system—and some misunderstandings about proposals for health reform in the United States have had the effect of perpetuating several myths regarding the Canadian health care system.

My perspective is that of an American-trained physician who came to Canada to complete a family medicine residency. I trained in a public hospital in North Carolina that served many of that state’s uninsured. The uninsured of North Carolina are the working poor, as in most of the United States. Indeed, my patients’ stories were tales of woe—inaccessible health care, end-stage presentations of preventable disease, and growing insurmountable debt.

For the first time in more than a decade, health care has become a potluck, church, and dinner table conversation in my home town. However, as I piled on another spoonful of baked beans at a wedding attended last July, the discussions I overheard were not belabouring the details of the contentious Health Care Reform Act; rather, they were corroborating the media’s representation of the “Canadian health care system”—refusal to treat based on advanced age, devastating wait times for emergent surgeries, or inaccessibility to state-of-the-art diagnostic testing. Being American and Canadian trained, I have found myself addressing many of the myths surrounding this contentious debate on both sides of the border at a number of social gatherings, as well as in the clinic.

Myth 1: The Obama administration is proposing a “Canadian system”

In opposition to the Health Care Reform Act, Republican Senator Judd Gregg said that a government insurance program being considered in the United States “is a slippery slope to a single-payer system like Canada or England.”1 Those who oppose this bill are quick to compare its contents to a single-payer system. In reality, however, the bill adds to the hodgepodge, multipayer American system, hoping to insure the uninsured and making health insurance more affordable. In short, it means to expand health care coverage to the approximately 40 million uninsured Americans2 by lowering the cost of health care and making the system more efficient. To that end, this includes a new government-run insurance plan to compete with private companies, a requirement that all Americans have health insurance, a prohibition on denying coverage because of pre-existing conditions and, to pay for it all, a surtax on households with an income above $350 000.3

Myth 2: Too old for care

Physicians in Canada have far less third-party interference than physicians in the United States do. For multiple reasons, including greater physician autonomy and less fear of litigation, physicians in Canada are better able to provide evidence-based medicine, the cornerstone of medical practice.

Myth 3: No access to specialists

According to the American Academy of Family Physicians, in the past 10 years 90% of medical school graduates in the United States have opted to enter into subspecialties. Only 10% have chosen primary care.5 These figures are in comparison with the nearly 40% of medical graduates in Canada who were matched to family medicine in 2009 by the Canadian Resident Matching Service.6 It is no surprise, therefore, that Americans see 40% more doctors, most likely owing to increased specialist referrals and self-referrals.

Health care reform is a contentious and divisive issue in my home town this year. Even at neighbourhood potlucks, it replaces talk of traditionally divisive issues such as war, abortion, and gay marriage. Unfortunately, rather than focusing on the need to change the US system, the debate vilifies the Canadian single-payer structure and offers a distorted view of health care across the border. As Canadian family physicians, we should use the attention garnered from the American debate as an opportunity to increase public awareness of successful elements of our system and to highlight failing areas, rather than allowing a wide net of negativity to be cast over the entire Canadian health care system.

Read more about these myths here.