The wrong health-care model. Is Canada's health-care system really cheaper?

National Review, Feb 17, 1992 by Jacques Krasny

Still, the Canadians seem content with their health-care system. A recent Harris poll showed the overwhelming majority of Canadians as preferring their system to that of the United States or Britain, while more than 60 per cent of U.S. citizens indicated a preference for the Canadian system over their own. Why?

Primarily, it is because Canadians live secure in the belief that a catastrophic illness will never be compounded by financial catastrophe. Canadians routinely read about U.S. citizens left destitute by severe illness. It is that freedom from risk of personal financial ruin which underlies the perceived quality of the Canadian national health-insurance system.

But there is a more profound reason for the Canadians' acceptance of a system with so many restrictions. Healthcare systems reflect a society's deepest values; they cannot be examined in isolation from the culture that spawned them. Canada and the United States appear to be culturally similar in terms of language, media, educational systems, and technologies. But that is misleading. Social attitudes toward individual rights and the direct authority of government over daily life differ substantially. In its gradual evolution from a colonial to a democratic society, Canada has maintained many of the centralized characteristics of the colonial administration from which it grew and a corresponding deference to authority among the citizenry. These traditions persuade Canadians o accept limitations on individual rights unknown in the U.S. Among them: no access to punitive damages if wronged by a medical practitioner, no contingent legal fees; no class-action suits (with minor exceptions); no right to sue government officials or ministries of health for medical negligence; no effective chioce between the various provincial medical systems; no private alternatives. None of these limitations would be acceptable to Americans.

In sum, the Canadian health-care system does not operate than the or more effectively than the U.S. system. Its mechanism for funding health-care does constrain expenditure effectively, but comes with a price tag of decreased accessibility to medical technologies and the utilization of procedures that are substantially inferior. The domestic and international popularity of the Canadian system derives primarily from the financial safety net it provides, buttressed by a political culture that accepts government and community-based control of decisions that affect the deepest questions of human life. If Americans were to insist upon retaining the rights they now take for granted, they would make a Canadian-style system of health care both prohibitively expensive and inherently unworkable.

Mr. Krasny, a Canadian citizen, is president of Bogart, Delafield, Ferrier, Inc., a health-care consulting and strategy firm.