The summer before starting medical school, I trekked through Europe carrying an oversized nylon backpack draped with a giant red maple leaf. I would run into many other travelers sporting similar colors, naively assuming that their choice of emblem identified them as fellow Canadians. But two weeks into the trip, I became suspicious after bumping into a group of four guys from El Paso. They spoke with lazy Texas drawls, yet claimed to hail from Vancouver, which turned out to be the only Canadian city they could name. To add insult to injury, they failed to correctly answer the most basic of all Canadian questions: Who won the Stanley Cup that year? Over a couple of beers, they intimated that their reception in Europe became far more pleasant after they donned the Canadian colors.
To many Americans, Canada is that vast, friendly swath of land to the north inhabited by folks who speak English with a funny accent (maybe not as funny as a Texan?). Its major exports include cold weather (since most of Canada has two seasons, winter and July), hockey players, and great comedians who end up performing on Saturday Night Live (see Mike Myers, Jim Carrey, John Candy, Leslie Nielsen, Dan Ackroyd, and Lorne Michaels, to name a few).
But there are real differences between the two countries. There are the trivial ones—besides word pronunciations, the spelling sometimes differs: “Is that flag the colour red?” The country is crazy about hockey, not football. In fact, the $5 bill depicts boys and girls playing hockey on a frozen pond. So Canadian! Peace, order, and good government. That’s a phrase lifted from the Canadian Constitution, which expresses much about the Canadian temperament.
Seriously though, perhaps the key public policy distinction between the two countries can be found in the realm of healthcare. Canada has had a single-payer universal healthcare program in place for more than 40 years. I was a medical student at McGill University in Montreal during the early years of its implementation. Many of my public health and epidemiology professors came from the ranks of U.S. medical schools. They were excited to be involved in this grand experiment and wanted to help shape its course. Most realized that they would never get to experience a similar opportunity south of the border. I am neither a health economist nor an expert in public health policy, but I have trained and practiced on both sides of the border and, through the lives of many relatives, I have continued to experience the joys and the hazards of Canadian and American healthcare. Here are some of my thoughts about what is good and not so good about the way each country takes care of its nation’s health needs.
The Canadian Healthcare Experience
Let me start by stating my own personal view, which is that healthcare is a basic right. Everyone should have access to affordable healthcare. Canada accomplishes this goal by providing coverage through a government-sponsored system, with each province administering the system in its own way. There are many advantages to this approach. First, coverage is universal and portable. This means that each citizen or legal immigrant is covered at any age and regardless of his or her occupation—or lack of one. There are no preexisting medical conditions that deny access to affordable healthcare. Having a child diagnosed with a chronic disease such as juvenile arthritis, lupus, or diabetes; losing one’s job; or starting a new small business does not create insurance angst. Turning 26 does not throw you off your family’s health plan as it does in the United States. What a relief! Canadians pay about 11.4% of national gross domestic product (GDP) to insure 100% of citizens in their single-payer system, compared with more than 17.4% of GDP to insure 85% of Americans. According to the latest available data from the Organization for Economic Cooperation and Development, in 2009 healthcare expenditures per capita amounted to $7,960 in the United States compared with $4,363 in Canada.