Posted on March 9, 2009

A Canadian Comments on Experiences with Single Payer System in Canada


Posted By Chris Dinn
March 5, 2009

As a Canadian who watched and helped his sister go through 5 years of elite treatment medical treatment for a rare brain tumor, I consider myself experienced with the single-payer approach and I have generally great things to say about it.

First things first, and this is a hugely important factor, Canada’s health care system is PROVINCIALLY RUN. That is to say, constitutionally, it’s not the purview of the federal government, it’s the explicit responsibility of the provinces. Over the years, various federal governments have issued transfers to the provinces explicitly for health care, but the responsibility for delivery remains with the provinces.

Additionally, as Ezra noted once upon a time in a review of international health care systems, the providers in a single payer system are private. This is an important distinction. Doctors in Canada are small business-people competing for customers. Canadians choose which doctor to visit and the doctor with the most visits gets better reimbursement from the province.

Get that? That’s provinces competing to do the best job on health care management (keeping costs down) with doctors and hospitals competing to get the most visitors, to keep business booming and government reimbursements coming.

The upside of this is that it promotes competition for efficiency of delivery. In fact, Canada’s entire system evolved that way, beginning as a Saskatewan program pioneered by Tommy Douglas.

Now, before you write off the single payer system (I’m looking at you wisewon), keep in mind that not only did Canadians recently vote Tommy Douglas the greatest Canadian in a recent CBC reality show (, but he’s also Keifer Sutherland’s grandfather (no lie).

We should be honest about the downsides of a single-payer system. Despite the sundry downsides you may here from US commentators, criticisms in Canada come from mainly two areas.

First is equal access. In Canada it doesn’t really matter how rich you are or how much money you have to throw at your medical problems, you get treated in the same line as the poor farmer, the homeless guy and the suburban middle-class family who need the same treatment. To you, maybe, this is a bug. To me, it’s a feature. The idea that in Canada we treat our poor in the same order we treat the rich seems an impressive display of equality when it matters the most.

The second is for wait times. This is not a material concern to this discussion. If you want to know why read

While there are some exceptions to these rules, such as Canada’s rare and controversial private clinics, the system generally works as advertised.

As an example, in 1996, when she was 10 years old my sister was diagnosed (in Newfoundland) with a rare brain tumor. She was treated in Newfoundland, but when a better treatment became available in Toronto the provincial government sent her to Toronto for the care and covered its cost. Had a better program existed in an American children’s hospital, she could’ve been treated there.

My family was middle class for our rural community, but would hardly qualify as rich. My parents had a combined income of under $100,000 yearly, but my sister received three rounds of neurosurgery, three rounds of chemotherapy and a three-weeks-in-isolation bone marrow transplant. All without my parents paying out of pocket for anything.

In the US people go bankrupt in situations like this. In Canada, they live through it. My parents are now happily in retirement and relatively well financed.

Meanwhile an exgirlfriend of mine from Wisconsin needed her wisdom teeth out. Her plan was to go get the treatment and stiff the hospital on the bill. She said future creditors would understand, since medical bills are often skipped out on.

I’m not an American, and I don’t know how typical or a-typical that is, but it definitely happened.

Are you still telling me the Canadian approach is completely the wrong solution? I’m sorry, but I just can’t take Americans with a straight face on that point.