Health Care - A Tale of Two Systems

“It works.”

That was Donald Trump’s straight answer. The question was, “What do you think of the Canadian health care system?” The timing was while Trump was seeking his party’s nomination for the highest office in the land. The answer was short, simple, clear. No hint of an if, an and or a but.

Then, in the second debate with Hillary Clinton, he relabeled the Canadian approach “catastrophic.” As for the U.S. (“Obamacare”) system, he said, Clinton’s proposed changes would make it more like Canada’s – “a disaster.”

With so much at stake, including health care for millions of Americans – maybe even you – don’t you wish you could figure out why the candidate did an about-face? Since he has never offered an explanation, let’s sneak in on an imaginary press conference. Donald Trump is at the mike.

Good morning!

In the interest of transparency – which I’m very much for, of course – I want to tell you why I shifted my position on health care and how we should be doing it to make America great again. I’ll come clean with you on Canada’s awful health system.


At first you gave the Canadian operation a pretty high rating, saying “It works.” But during the campaign you called it a disaster. Which is it?

That first comment was a general impression. It was not based on analysis. Though it was my honest opinion, it was off-the-cuff, impromptu. I wasn’t ready to back it up.

Frankly, I still haven’t studied it. But Republicans up and down the line are against doing anything like it, and Hillary is for it – though with a lot of change, she says – so what else can I do? Of course I oppose it!

Can you be specific? What do you not like about it?

It’s a lousy system. There’s something going on there that the press is not reporting.  Every day Canadians are traveling to the U.S. to get the care they need. They can grow old or even die just waiting to have a hip replacement or a hair transplant or get into the ER after an accident. Why would we go with a system that even the people in it reject? I know more about health care than all the doctors and hospital administrators and insurance actuaries combined, and I’ll come up with a plan that you won’t believe, it’ll be so good!

… (The press conference goes on, too long to include in full here.)

Thank you, Mr. Trump.

One thing is clear: between Trump’s supportive remark and his current opposition, Canada’s system did not change. So we are left trying to understand why he shifted 180 degrees. The fictitious press conference reported above is one attempt.

What we can say about health care in Canada is, by contrast, straightforward: It is

  • Universal. You live in Canada, you’re covered. (A waiting period, typically three months, applies to persons moving into the country, citizens or not.)
  • A single-payer plan. That is, any covered treatment is paid from a central fund. The patient pays zero; no for-profit broker gets involved. As a result, paperwork is reduced; bureaucratic layers eliminated.
  • Administered regionally. This means borders make a difference – between British Columbia and neighboring Alberta, for example. Still, core coverage is constant across the country.
  • Offers continuous care from birth to death: no medical exam necessary; no pre-existing condition walls a person out. The only way coverage is cancelled is to move out of the country or die.

Here’s an example of how the system works.

A friend in Ontario developed a heart problem; his summary of what happened is revealing:

Day 1: First Symptoms, Admitted to E.R:

  • Vital signs taken; hooked up to the heart/vital signs monitor
  • Medications given 4 times
  • nitro spray given as needed, approximately 6 times
  • Blood drawn twice
  • ECG done
  • IV inserted
  • Delivered lunch
  • Nurse checked on me a minimum of every half hour
  • Transferred to Intensive Care.
  • Vitals recorded at shift change, approx. 7am & 7pm
  • Medications distributed five times daily
  • Nitro spray given as needed approximately 8 times over 3 days
  • Blood sugar checked twice daily
  • Daily visits from the cardiac specialist, checking vitals and pain levels
  • Process continued daily over 5 days

Day 5:

  • Transported by Patient Transfer vehicle to a metropolitan General Hospital
  • Admitted to 4 bed ward, vitals recorded twice, blood sugar checked, medications given twice, hooked up to heart/vital signs monitor
  • Nurses in to discuss evening pre-op shower
  • Nurses in regularly to monitor chest pain – approximately every half hour
  • Cardiac surgeon and Assistant attended patient, outlined process, answered questions

 Day 6:

  • Vitals recorded, blood sugar checked, medications distributed
  • Nurse in to remind to take another shower
  • Pre-op shave done
  • Resident Doctor visited with patient
  • Nurse came in to assist in transfer to surgical gurney
  • Anaesthesiologist visit, discussed process, questions answered
  • Patient delivered to surgery, Anaesthesiologist visited with patient and family; discussed process and timeline
  • Surgery began late afternoon, lasted about 4 hours, 5 doctors and 5 nurses in operating room during surgery
  • Post-op/recovery/ICU continual one on one monitoring by RN for 15 hours

Day 6: recovery process

  • Returned to room, vitals checked, medication delivered
  • Surgeon visited, explained process of surgery, triple bypass for 5 blockages performed
  • Assistant and Resident visited, continued for next few days
  • Nursing staff checked vitals at shift changes, distributed medications 5 times, checked blood sugar twice daily
  • Laboratory staff took 3 vials of blood
  • Nursing staff checked comfort level, advised process of monitoring fluid input and output
  • Physiologist attended patient; taught bed routine and safety, practiced process, took for first walk

Day 7:

  • Similar to Day 6
  • Walked with physiologist

Day 8:

  • Similar to Day 7
  • Surgeon visited, checked incisions, discussed release from hospital
  • Assisting Doctor and Resident visited patient, checked incisions, stitches etc.

Day 9:

  • Preparations to be sent home; Nursing staff attended patient to prepare for departure
  • Final check of stitches, some bandages removed, heart monitor resuscitation wires removed
  • Laboratory staff took 5 vials of blood for testing 
  • Physiologist took patient for walk test
  • Patient released approximately 3 pm

All that, of course, is objective, external. At the subjective level, the patient described his experience as “A+. couldn’t have been better.” Gerry, my friend, has no idea what it cost: he never saw a bill. He paid zero. Like other medical procedures, it is simply covered in full.  

How much would he same care cost in the U.S.A.? Answers vary from “very little” to “a staggering sum,” maybe even “enough to bankrupt a person without insurance.”

Does Canada’s system work flawlessly? No way! Some patients – impatiently –  do travel to the U.S. where wait times – to get knee surgery, for example – are typically shorter. (They actually represent a small minority). Still, if that is used to fault the Canadian system, should we not also consider those Americans who opt for “medical tourism” – choosing medical attention in foreign countries where costs are so much lower they can cover their travel expenses and still come out ahead?

Diagnostic Help

One tool for analyzing how different care systems work is the principle of Tough Love, “Love” in this setting means to act for the good of the other; in a national context that means seeking what will help all one’s fellow citizens. So, if enjoying quality health care is good for myself, real love demands that I seek it for everyone. The term for that is universal health care. Canada has it, the United States does not.

That’s where the term tough comes in. If for practical reasons we say we can’t love everybody to that extent, or we don’t have the resources, or we’d soon be bankrupt – or whatever, we need to ask, in all seriousness, what “tough” may mean. Does it mean being tough on those who cannot pay while the well-off accept their privileged access? In that case, does “tough” not cancel out “love”? Does “tough” drive us into the hard decisions in the conviction that good – not perfect, but good – answers can be worked out?

Remarkably, Canada, along with some other countries, has found a way to make it work. Far from Donald Trump’s claim that Canadians are dissatisfied, polls show that they point to their health system as one of the things they like best about their country. Polls indicate that from 82 to 90 percent of Canadians prefer their system to the American model. And in a CBC-TV -sponsored effort to get people thinking deeply about the values they hold, they invited people all across the country to name the most important Canadians, living or historical. Prominent on the list were statesmen (Lester B. Pearson, Prime Minister and winner of the Nobel Peace Prize), founders of the country (John A. McDonald, whose early vision brought the country into being), scientists (Frederick Banting, co-discoverer of insulin for treating diabetes), hockey players, (Wayne Gretzky, “the greatest”) – but – get this – the Number One most admired, most respected Canadian was the person who launched Canada’s universal health care. His name? Tommy Douglas, a Baptist minister, Scottish by birth, who as Premier of Saskatchewan had a vision of providing health care for all and never gave up until the dream came to reality.

Tommy Douglas, father of Canada’s Medicare/universal health care

Tommy Douglas, father of Canada’s Medicare/universal health care

It puzzles me why Americans, with such enviable smarts and such impressive wealth at their disposal, are so slow to catch on.

The fault does not originate with Mr. Trump. Its source is the failure of the American people; when they want health coverage for all, politicians will support it. Such conviction gave Tommy Douglas confidence: "I'm sure that the standard of public morality we've helped build will force government in Canada to approve complete health insurance."

The key is to learn tough love. For some. redemption will come as they apply the Golden Rule. Others may find inspiration in Arno Peters’ principle of equal treatment – in maps, in history, in human relations. Or a renewed respect for the American principle of “liberty and justice for all.” Some may conclude that in our interconnected world it simply makes good sense to enlarge our community of caring.

Sometimes the line between Canada and the United States hardly counts ... but in health care it can make a big difference. North of the border, average life expectancy is 81.3 years; south of the border it is 78.1. What does that say about health care delivery?

Sometimes the line between Canada and the United States hardly counts ... but in health care it can make a big difference. North of the border, average life expectancy is 81.3 years; south of the border it is 78.1. What does that say about health care delivery?

The recent blog Refugees - What's Your Perspective? provoked a range of responses – always appreciated!  Here is one; as you compare it to your own stance we invite you to consider also how it resonates with the current blog on health care. Feel free to add your own perspective, broadening the discussion. (To refresh your take on the refugee question, follow this link.)

well i do have some thoughts........
while i feel for them, i look back to the years when pierre, our govt & the many, many churches & other organizations were helping all the poor countries who could not seem to help themselves at all !!! & still can't & yet there are modern cities in many of them.
i heard the old story of how the money etc did not reach the people who needed it.........
if they keep emigrating today, those countries will soon be empty.........
why not stay & make itbetter by helping their own countries.......
there would likely be a revolt & death but there is death anyway while they try to escape now by water or borders etc......
but freedom does not come easily.......
we in canada, europe & the usa, know that because of the destruction & loss in WW1 & 2.
it just seems to me that the aid given & the missionaries who try to help accomplish nothing the long run...
when the 1st immigrants came to canada & the usa they worked hard for everything they got........
walked miles, starved when crops failed, ate wild animals, etc etc & most of all [most] prayed for help
the modern immigrant is given everything without doing anything.......
our homeless peoples should have it so good
if we have all this extra money etc......
when the mental institutions, orphanages etc closed in ontario, we started seeing the homeless on our streets......
before that i remember growing up ......
& when the curfew rang at 9pm everyone under 13 or 16 [not sure] was taken by police to their homes
& if you were a vagrant etc at midnite the police again picked you up & put you in a cell overnite so the streets were empty of children & strays............
no one slept under the OS bridges or in the parks etc......
i grew up in the best of times truly !!!!!
our 1st immigrants chose to fit in.....
they gave up their homeland to find another where they hoped to avoid war........
when jewish & greek & dutch & german & italian & czeck etc etc etc arrived here .....
they learned the language asap & dressed alike......
they worked together
i don't see that happening now.........
i am told that a lot of easterners come from TO by the busload to our beaches pitching tents & digging holes inside them to use as bathrooms rather than walk to the washrooms on the beach.
sauble was closed 2 summers for ecoli......
unheard of there & no one could figure why until this was discovered......
if they treat canada like india etc we will end up with ganges river waterways....
the bottom line is they do not think like canadians...
their culture & way of life is too different..........
& if we go there we must do as they say not the other way around !!!!
ok this is some of what i feel...
what is your perspective......

MdD Canada