Why Socialized Health Care in Canada Is Not the Model to Follow

ASge-adjusted Health Spending in OECD Countries
Source: OECD 2003; Fraser Institute

American politicians on the stump are fond of citing Canada’s socialized health care system as a superior alternative to the mixture of public and private health spending in the United States. Such rhetoric may attract votes, but we Canadians, trapped in a broken and deteriorating system, have reasons to disagree.

In 1967, when Canada adopted the British socialist model, our country was near the top of international rankings for the effectiveness of our medical spending. The U.N.’s World Health Organization now places Canada about 30th on that list.

“[Canadian health care] produces inferior age-adjusted access to physicians and technology, produces longer waiting times, is less successful in preventing deaths from preventable causes and costs more than any of the other [health care] systems that have comparable objectives.” — The Fraser Institute of Vancouver, British Columbia

Vancouver’s Fraser Institute recently released a comprehensive study that measured Canadian Medicare’s performance. Called How Good Is Canadian Health Care? An International Comparison of Health Care Systems, the report included only countries that have publicly funded systems with universal access. It excluded the United States and Mexico, which do not.

Of the countries in the Organisation for Economic Co‑operation and Development, only Iceland spends more on an age‑adjusted basis than Canada does on health care. No other countries follow Canada’s model of monopolistic public provision of health insurance. Canada is the only OECD country that outlaws privately funded purchases of basic medical services.

With respect to hard indicators of performance, Canada’s record is alarming for a prosperous country:

  • How many doctors per capita does Canada have? We rank 16th out of 23 OECD countries.

  • What about access to high-tech diagnostic tools? We rank 15th for MRIs, 17th for CT scanners and eighth for radiation machines. We are tied for last for lithotripters (devices that destroy stones in the urinary system)

  • What percentage of our total life expectancy will we live free of disability? We rank 14th.

  • What are the rates for infant and perinatal mortality? We rank 16th and 12th.

  • What about potential years of life lost to disease? We rank ninth.

  • What is our incidence of breast cancer mortality? We rank sixth.

By only one measure is Canada’s performance commensurate with its rate of spending: It has the lowest incidence of mortality from colorectal cancer per dollar spent. Ultimately, the researchers conclude that the Canadian health care model is inferior: “It produces inferior age-adjusted access to physicians and technology, produces longer waiting times, is less successful in preventing deaths from preventable causes and costs more than any of the other systems that have comparable objectives.”

The problem is progressive. For 13 years, Fraser has been tracking waiting lists for common medical procedures. Its latest findings indicate that waiting times for surgical and other therapeutic treatments in Canada increased in 2003: “Total waiting time between referral from a general practitioner and treatment, averaged across all 12 specialties and 10 provinces surveyed, rose from 16.5 weeks in 2001-02 to 17.7 weeks in 2003.”

The structure of Canada’s system is dictated by the federal government, but most health services are delivered by the provinces. Waiting lists and spending levels therefore vary quite widely from province to province. Manitoba spends 12 percent more per capita than the Canadian average. Despite significantly higher spending levels, comparative data on the current state of hospital crowding, waiting lists, delays and denials of medical procedures indicate no significant difference in health care outcomes.

Although the average wait in Manitoba for a primary joint replacement is about nine months, many of the top surgeons have patients who wait for two years, according to the Winnipeg Free Press: “The longer they wait, the more trouble they have, partly because they are in worse condition when they have the surgery.”

This dynamic is the unmeasurable cost of Canada’s socialized health care. Because timely treatment is routinely denied, people cannot work or lead normal lives. The costs in lost production — never mind the losses due to pain and suffering — are difficult to quantify. Economists have calculated the cost of adverse consequences for cardiac patients waiting for surgery. They broadly estimated it at from $1,100 to $5,600 annually per patient.

When you consider last year’s average of 17.7 weeks of waiting for all treatments, the staggering hidden price Canadians pay for socialized medicine becomes clearer. This does not include the people who die while waiting for bypasses, radiation or chemotherapy, or because treatment was started too late.

When the results are considered, it is hard to understand why anyone would advocate the Canadian model. Americans should be more cautious when they extol its virtues. You may get what you ask for.


Dennis Owens is Senior Policy Analyst at the Frontier Centre for Public Policy in Winnipeg, Manitoba (www.fcpp.org), and an adjunct scholar with the Mackinac Center for Public Policy in Midland, Mich. (www.mackinac.org). Permission to reprint in whole or in part is hereby granted, provided that the author and the Mackinac Center are properly cited.


Canadians are discovering that they spend large sums on health care and receive worsening services in return. The costs to the country’s citizens and its economy are staggering, even when they are hard to measure.

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