Waiting Lists in Canada
Canadian Medicare, administered by each province and funded through taxes, provides healthcare to all residents, with minimal out-of-pocket payments. Private healthcare is not allowed in Canada, so Canadians on long waiting lists have to go to the United States and other counties to get expeditious care.
Waiting lists are a familiar feature of single-payer systems, especially for higher-cost or cutting-edge healthcare. According to a report by the Fraser Institute, an independent think-tank in British Columbia, Canada, the median waiting time to get treatment from a specialist has doubled in the past 20 years, to 18.2 weeks. Canadian patients wait the longest for orthopedic surgery (42.2 weeks), neurosurgery (31.2 weeks), and plastic surgery (27.1 weeks).
Dr Chelliah—whose North Dakota practice is 80 miles from the Canadian border—says that many Canadian patients on waiting lists come to him and other providers in the area for care. He thinks the waiting lists are intentional. "The way I see it, the Canadian system saves money by delaying care by rationing," he says. "The net result is that people die before they finally can get their care. I know that sounds provocative, but I think it's true."
A few years ago, he noticed that a Canadian friend of his was huffing and puffing and told him he needed to get a stress test. His Canadian family physician was initially reluctant to order one but finally agreed, and then it took 3 months to get the stress test done. Even though the results were strongly positive, the man wasn't scheduled for an angiogram until the following year. The angiogram found a 99% blockage, called a "widow-maker," and he finally got a stent. "This patient could easily have died," Dr Chelliah says.
Dr Accad pointed to a recent news report from Canada, in which a leukemia patient had a bone marrow donor, but she couldn't get the transplant because there wasn't a hospital bed available for her. Though the problem sounds crazy, "patients in these systems tend to accept waiting lists," he said.
Quality Problems in the British System
In Great Britain, the National Health Service (NHS), operating separately in England, Scotland, and Wales, not only finances healthcare but also owns hospitals, physician practices, and the practices of other providers of care. However, about 10% of Britons have access to private facilities paid through private insurance.
Those who want to have expedited care buy private insurance. Dr Geddes recalls that his nephew had an anterior myocardial infarction while working in London. He was first transported to a nearby NHS hospital, but they didn't have a catheter lab to treat him, so he was sent to a catheter lab at a private hospital covered by his private insurance. "He probably would have died at an NHS hospital," Dr Geddes says.
Dr Geddes believes strict government controls and impossibly long waiting lists have created a fatalistic attitude among many British doctors, and this makes the waiting lists even longer. Many years ago, he traveled to the United Kingdom to watch a British surgeon operate. The surgery team showed up at 8:00 AM and had two cases for the day. "The first case took a little too long, and afterward we had a leisurely lunch," he says. "The second patient was an open-heart case and had already been prepped, but they decided they wouldn't have enough time." The operation was postponed. "In the United States, we would have gone ahead with the second case and just stayed late," Dr Geddes said.
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Cite this: Leigh Page. Single-Payer System: Why It Would Ruin US Healthcare - Medscape - Sep 29, 2015.