If Mr. Ruess can link us to a Canadian of any prominence who has stated that it's the "best in the world", then we aren't talking about a strawman argument...but I don't think he can.
We aren't the best, but we aren't bad. Not just outcomes, but costs must be compared. The use of ordinals ("ranked 16th", "30th best") is statistically worthless. What if the 15 better were better by meaningless amounts? Don't use ordinals.
A clearer story is told in "The Spirit Level", about income inequality. Nearly all healthcare outcomes relate more-closely to your GINI number than to any specifics of your health care system. The US has the worst, by far, because they really are exceptional in the area of income inequality. Canada has worse income inequality than most of the health care systems at the top of the charts (France, Italy).
Remarkable health-care outcomes for comically small outlays of money are being realized by Costa Rica, including amazingly good pandemic results, because they made a focus on public health first. The public health visits leading to more critical care, early on, rather than a crisis-response model where health care becomes aware of you when you stagger in. (See The Atlantic for the article, "Why It's Better to be Poor in Costa Rica")
Here's a thing to get upset about, though. I screwed up, the other day, liking a National Post comment so much I copied it - and forgot to save the name of the commenter. He's a physician from rural Nova Scotia:
======
When I came to Canada in 1985 from the UK, to be a rural physician in a post no Canadian had been willing to fill for the two years it had been advertised, I ran, with one other doctor, a 29 bed rural hospital, with 24 hour ER, lab and X-ray. We had one administrator, the board in charge were local worthies (unpaid) and the budget was just over 1mCDN/year.
...Now it has eight beds, the 'urgent care' is open 7 hours a day, but not every day, it has no lab and X-ray availability is sporadic. And it's run by five docs, two NPs and we were up to 14 administrators when I quit in 2015. Goodness knows what the budget is now, but it's whatever is spared us by the large and greedy regional hospital (75 beds and 4 admins in 1985, 50 beds and 70 admins when I quit). They also make all decisions for us and there is no local control.
Seems to me the old ways, before the government decided to reign in health care spending by appointing managers for everything, were cheaper and far more effective.
==============
...that tracks with things that happened in my career, totally different industry, but the takeover of the professional administrators proceeded similarly, with comparable effects on productivity.
During the campaigns for the last two elections the candidates barely even discussed our healthcare, our loss of standing on the world stage, the abysmal flow of capital out of this country, or our debt, to which has only multiplied. These are the things most politicians concentrate on for the welfare of the country. With the Government of the day they are too busy virtue signaling, demeaning and dividing people while destroying the economy and indebting generations of Canadians. They have no time to consider healthcare so they will will throw money at it by adding another layer of bureaucratic waste to do further studies. It will amount to the usual government rhetoric, virtue signaling, promises, but zero change and higher taxes. I have lost any faith in this Government, our institutions, and the country as a whole.
The biggest problem is our spineless politicians. I mean, its obvious, if a system isn't working well, you look to where it is working well. But will anyone in power do it? No. Because they wet their pants at the thought of receiving the wrath of the health care cultists who have drunk the kool-aid and forever more believe in the ultimate perfection of our health care system. They are just like any other cultists; they refuse all facts and believe the 'true belief'. They are pathetically ignorant people and the politicians that kow-tow to them shiver in fear. Wait times contributed to the death of my wife and these people reject any change for the better. I'll sign off now before I go over the top saying what I think of them.
We emigrated to Canada from the UK many years ago. We thought things were better and cheaper than in the UK, but I talk to my sister all the time and it annoys me that healthcare in the Uk sounds so much better than Canada. Everything just about in the UK sounds better than Canada. Sometimes I’m tempted to go back but we have family here now. Public transport is better. Over 60s get free bus rides anywhere. She gets free hearing aids. My other sister lives in BC. She’s been trying to afford hearing aids for years. They have public and private healthcare in the UK. I know you can get quicker surgery if you can afford to pay and there is some arrangement when you do that benefits a public patient too.
Is it not possible to see what other countries do that is more successful than our system and do what they do.
Equality in mediocrity is a feature, not a bug, for a critical mass of Canadians. Tall poppyism in health care.
Canadian health care is mediocre at best and just isn't good enough. But it is better for poor people than what the US offers and that is good enough for most people in Canada, until they actually need to use the health care system.
Canada should literally just copy the systems of our peer nations who do better than us, there are 29 examples to choose from. But we aren't confident enough, and besides Canadians can't resist defining equality as preventing "the rich from skipping the line."
Canada's health care system represents what is best and worst about Canadians. Will it change, nope, too confrontational. We will muddle with workarounds for those who can afford them, all while trying to avoid the "two tier" label that gets the class warriors all worked up.
Like most things in Canada that involve both Federal and Provincial governments, there is little progress. Since health care is primarily a provincial responsibility a national solutions to health care woes is very difficult to orchestrate even for single elements such as long term care.
Are woeful politicians don't have the necessary skills or desire to fix long term problems.
Unfortunately Canada/provinces are not a very serious country anymore.
I suggest the issue about "improving" Canada's health care system for many, if not most, reformers is more privatization and profit oriented operations. That's always, it seems, the subtext of the discussion.
Indeed, I don't recall the more vocal health care reformers bringing up other aspects of health care. But, perhaps I'm wrong. What health care reforms are being debated that are not about privatization?
Thanks for calling Canadians smart and sensible people but I really don’t think we are either. If we were we wouldn’t put up with the chronic under achieving of governments both federal and provincial that have contributed to the slide down the scale of our health care systems. For the money and labour numbers involved in this sector it appears more boondoggle than trophy achievement.
One thing the pandemic has shown is how unkind, unbending Canadians are. They have been very quick to throw anyone under the bus who isn't willing to get on the bus In the latest example Ronald McDonald House in Vancouver just evicted a family whose 4 year old has cancer. Utter cruelty - yet I see loads of people defending the decision, parents are “too stupid to get vaxed they deserve this”. I won't bother linking to it as it will be all over twitter.
Part of this discussion has to be how much Canadians are willing to pay in taxes for improved healthcare - something that oddly doesn't seem to come up much. Sure, there are diminishing returns to shoveling more money into the system, but at the end of the day improved care will require more staff and more infrastructure, which means more money. A lot more. It would be naïve to pretend otherwise or that restructuring alone will get us out of this mess.
Looking at the US, I always thought there was a bit of a "meanness/F-you" attitude among a large enough chunk of the US population that would never allow single payer/universal access to take hold there. Its not that they dont want it for themselves, they just dont want to pay it for THOSE people. Substitute "THOSE people" for whatever hated outgroup you despise. I didnt think that sentiment was here in Canada, but I think the debate Quebec opened up about punishing people who are not vax'd exposed a real vitrol that I didnt think was nearly as wide spread here in Canada. Mind you this is on social media (Twitter/reddit etc) but even among my leftie friends (I consider myself very left politically and socially). There seems to be a very strong attitude to punish / scold and exclude that wasnt there before. Two years ago if you asked should fat people or smokers or those who engage in unhealthy behaviour should pay more for health care, I doubt there would be significant uptake. I kinda of wonder about that now :(
As a layperson living in Alberta, would somebody with knowledge and an opinion clue me into what the Kenney government's plans to offer two tier health actually were, and whether or not they would have recreated the more abysmal parts of the American system up here?
The column by Harrison Ruess disparaging Canada's healthcare system confuses apples and oranges. While we have reason to be concerned about health outcomes in Canada - such as healthy life expectancy or recovery from heart disease, or vaccination rates among young children - these are not the direct responsibility of the healthcare system. The healthcare system is a huge repair shop. But if we want to achieve better health outcomes, and we should, then the real focus of attention should be on the social determinants of health, the factors that determine why some populations are healthier than others. Angus Deaton has given us recent data in his book, The Deaths of Despair, in which middle-aged unemployed white males predominantly are dying from opioid overdoses. In Canada it is estimated that between January 2016 and June 2021 some 24,626 Canadians died from apparent opioid toxicity deaths - this did not result from a failed healthcare system but from the despair in the lives of those who died and the predatory and the shameful behaviour of private companies that pushed opioid usage fatal levels in pursuit of higher profits. There are great disparities in health outcomes and healthy life expectancy in Canada based on socio-economic status. These are not the consequence of a failed healthcare system but of the social and economic conditions under which many Canadians live. The median hourly wage for a typical Canadian worker, adjusted for inflation, between 1976 and 2019, rose by $1 an hour - that's just $1 spread over 45 years, or just over 2 cents a year - but those in the upper quintiles did much better. Who do you think has a better health outcome? Our goal in Canada should be to raise the health outcome gradients for the bottom quintiles in our society, so that the health outcomes of those in the bottom quintile are almost level with those in the top quintile. Throwing more money at hospitals or privatizing the system won't do that. Reuss has got it all wrong - a nicely written polemic to show another area where Canada fails. But it is, of course, much easier to blame on the healthcare system when the goal of a healthier population across all socio-economic quintiles requires much different policies. And since the U.S. data is even more discouraging it is not a model for Canada to follow. If we want a healthier population the focus must be on the social determinants of health rather than putting the responsibility n our healthcare system, David Crane
If Mr. Ruess can link us to a Canadian of any prominence who has stated that it's the "best in the world", then we aren't talking about a strawman argument...but I don't think he can.
We aren't the best, but we aren't bad. Not just outcomes, but costs must be compared. The use of ordinals ("ranked 16th", "30th best") is statistically worthless. What if the 15 better were better by meaningless amounts? Don't use ordinals.
A clearer story is told in "The Spirit Level", about income inequality. Nearly all healthcare outcomes relate more-closely to your GINI number than to any specifics of your health care system. The US has the worst, by far, because they really are exceptional in the area of income inequality. Canada has worse income inequality than most of the health care systems at the top of the charts (France, Italy).
Remarkable health-care outcomes for comically small outlays of money are being realized by Costa Rica, including amazingly good pandemic results, because they made a focus on public health first. The public health visits leading to more critical care, early on, rather than a crisis-response model where health care becomes aware of you when you stagger in. (See The Atlantic for the article, "Why It's Better to be Poor in Costa Rica")
Here's a thing to get upset about, though. I screwed up, the other day, liking a National Post comment so much I copied it - and forgot to save the name of the commenter. He's a physician from rural Nova Scotia:
======
When I came to Canada in 1985 from the UK, to be a rural physician in a post no Canadian had been willing to fill for the two years it had been advertised, I ran, with one other doctor, a 29 bed rural hospital, with 24 hour ER, lab and X-ray. We had one administrator, the board in charge were local worthies (unpaid) and the budget was just over 1mCDN/year.
...Now it has eight beds, the 'urgent care' is open 7 hours a day, but not every day, it has no lab and X-ray availability is sporadic. And it's run by five docs, two NPs and we were up to 14 administrators when I quit in 2015. Goodness knows what the budget is now, but it's whatever is spared us by the large and greedy regional hospital (75 beds and 4 admins in 1985, 50 beds and 70 admins when I quit). They also make all decisions for us and there is no local control.
Seems to me the old ways, before the government decided to reign in health care spending by appointing managers for everything, were cheaper and far more effective.
==============
...that tracks with things that happened in my career, totally different industry, but the takeover of the professional administrators proceeded similarly, with comparable effects on productivity.
During the campaigns for the last two elections the candidates barely even discussed our healthcare, our loss of standing on the world stage, the abysmal flow of capital out of this country, or our debt, to which has only multiplied. These are the things most politicians concentrate on for the welfare of the country. With the Government of the day they are too busy virtue signaling, demeaning and dividing people while destroying the economy and indebting generations of Canadians. They have no time to consider healthcare so they will will throw money at it by adding another layer of bureaucratic waste to do further studies. It will amount to the usual government rhetoric, virtue signaling, promises, but zero change and higher taxes. I have lost any faith in this Government, our institutions, and the country as a whole.
The biggest problem is our spineless politicians. I mean, its obvious, if a system isn't working well, you look to where it is working well. But will anyone in power do it? No. Because they wet their pants at the thought of receiving the wrath of the health care cultists who have drunk the kool-aid and forever more believe in the ultimate perfection of our health care system. They are just like any other cultists; they refuse all facts and believe the 'true belief'. They are pathetically ignorant people and the politicians that kow-tow to them shiver in fear. Wait times contributed to the death of my wife and these people reject any change for the better. I'll sign off now before I go over the top saying what I think of them.
We emigrated to Canada from the UK many years ago. We thought things were better and cheaper than in the UK, but I talk to my sister all the time and it annoys me that healthcare in the Uk sounds so much better than Canada. Everything just about in the UK sounds better than Canada. Sometimes I’m tempted to go back but we have family here now. Public transport is better. Over 60s get free bus rides anywhere. She gets free hearing aids. My other sister lives in BC. She’s been trying to afford hearing aids for years. They have public and private healthcare in the UK. I know you can get quicker surgery if you can afford to pay and there is some arrangement when you do that benefits a public patient too.
Is it not possible to see what other countries do that is more successful than our system and do what they do.
Equality in mediocrity is a feature, not a bug, for a critical mass of Canadians. Tall poppyism in health care.
Canadian health care is mediocre at best and just isn't good enough. But it is better for poor people than what the US offers and that is good enough for most people in Canada, until they actually need to use the health care system.
Canada should literally just copy the systems of our peer nations who do better than us, there are 29 examples to choose from. But we aren't confident enough, and besides Canadians can't resist defining equality as preventing "the rich from skipping the line."
Canada's health care system represents what is best and worst about Canadians. Will it change, nope, too confrontational. We will muddle with workarounds for those who can afford them, all while trying to avoid the "two tier" label that gets the class warriors all worked up.
The only other solutions I've ever heard for proposing better outcomes are in the "more privitization" vein.
Canada has two big challenges to delivering quality affordable healthcare:
i) Canada has an extremely spread out population making it much more difficult to deliver health solutions.
ii) Canada also has a very culturally similar neighbour who pays far more to physicians far more leading to a brain drain.
Like most things in Canada that involve both Federal and Provincial governments, there is little progress. Since health care is primarily a provincial responsibility a national solutions to health care woes is very difficult to orchestrate even for single elements such as long term care.
Are woeful politicians don't have the necessary skills or desire to fix long term problems.
Unfortunately Canada/provinces are not a very serious country anymore.
I suggest the issue about "improving" Canada's health care system for many, if not most, reformers is more privatization and profit oriented operations. That's always, it seems, the subtext of the discussion.
Indeed, I don't recall the more vocal health care reformers bringing up other aspects of health care. But, perhaps I'm wrong. What health care reforms are being debated that are not about privatization?
Thanks for calling Canadians smart and sensible people but I really don’t think we are either. If we were we wouldn’t put up with the chronic under achieving of governments both federal and provincial that have contributed to the slide down the scale of our health care systems. For the money and labour numbers involved in this sector it appears more boondoggle than trophy achievement.
One thing the pandemic has shown is how unkind, unbending Canadians are. They have been very quick to throw anyone under the bus who isn't willing to get on the bus In the latest example Ronald McDonald House in Vancouver just evicted a family whose 4 year old has cancer. Utter cruelty - yet I see loads of people defending the decision, parents are “too stupid to get vaxed they deserve this”. I won't bother linking to it as it will be all over twitter.
Part of this discussion has to be how much Canadians are willing to pay in taxes for improved healthcare - something that oddly doesn't seem to come up much. Sure, there are diminishing returns to shoveling more money into the system, but at the end of the day improved care will require more staff and more infrastructure, which means more money. A lot more. It would be naïve to pretend otherwise or that restructuring alone will get us out of this mess.
Looking at the US, I always thought there was a bit of a "meanness/F-you" attitude among a large enough chunk of the US population that would never allow single payer/universal access to take hold there. Its not that they dont want it for themselves, they just dont want to pay it for THOSE people. Substitute "THOSE people" for whatever hated outgroup you despise. I didnt think that sentiment was here in Canada, but I think the debate Quebec opened up about punishing people who are not vax'd exposed a real vitrol that I didnt think was nearly as wide spread here in Canada. Mind you this is on social media (Twitter/reddit etc) but even among my leftie friends (I consider myself very left politically and socially). There seems to be a very strong attitude to punish / scold and exclude that wasnt there before. Two years ago if you asked should fat people or smokers or those who engage in unhealthy behaviour should pay more for health care, I doubt there would be significant uptake. I kinda of wonder about that now :(
Interesting article and comments.
As a layperson living in Alberta, would somebody with knowledge and an opinion clue me into what the Kenney government's plans to offer two tier health actually were, and whether or not they would have recreated the more abysmal parts of the American system up here?
The column by Harrison Ruess disparaging Canada's healthcare system confuses apples and oranges. While we have reason to be concerned about health outcomes in Canada - such as healthy life expectancy or recovery from heart disease, or vaccination rates among young children - these are not the direct responsibility of the healthcare system. The healthcare system is a huge repair shop. But if we want to achieve better health outcomes, and we should, then the real focus of attention should be on the social determinants of health, the factors that determine why some populations are healthier than others. Angus Deaton has given us recent data in his book, The Deaths of Despair, in which middle-aged unemployed white males predominantly are dying from opioid overdoses. In Canada it is estimated that between January 2016 and June 2021 some 24,626 Canadians died from apparent opioid toxicity deaths - this did not result from a failed healthcare system but from the despair in the lives of those who died and the predatory and the shameful behaviour of private companies that pushed opioid usage fatal levels in pursuit of higher profits. There are great disparities in health outcomes and healthy life expectancy in Canada based on socio-economic status. These are not the consequence of a failed healthcare system but of the social and economic conditions under which many Canadians live. The median hourly wage for a typical Canadian worker, adjusted for inflation, between 1976 and 2019, rose by $1 an hour - that's just $1 spread over 45 years, or just over 2 cents a year - but those in the upper quintiles did much better. Who do you think has a better health outcome? Our goal in Canada should be to raise the health outcome gradients for the bottom quintiles in our society, so that the health outcomes of those in the bottom quintile are almost level with those in the top quintile. Throwing more money at hospitals or privatizing the system won't do that. Reuss has got it all wrong - a nicely written polemic to show another area where Canada fails. But it is, of course, much easier to blame on the healthcare system when the goal of a healthier population across all socio-economic quintiles requires much different policies. And since the U.S. data is even more discouraging it is not a model for Canada to follow. If we want a healthier population the focus must be on the social determinants of health rather than putting the responsibility n our healthcare system, David Crane
Morality rates?
Also, the Canadian population is aging, so our health-care needs will increase over time.
So how do we improve health care in Canada? Charles Wright has a suggestion: cost-benefit analysis. https://reviewcanada.ca/magazine/2009/11/too-much-health-care/