The idea of a single-payer health system has been gaining ground among the general U.S. population and among doctors.
However, a new study focused on the long wait times that Canadians face between the time they see a primary care doctor and can get an appointment with a specialist for follow-up. Canada has had a single-payer system since 1984.
Opponents to a single-payer system say that’s a big reason why the U.S. should not move toward such a system, which has now largely been dubbed “Medicare-for-all.”
The median wait time of 19.8 weeks was shorter than the wait of 21.2 weeks reported in 2017, but the wait time was still 113% longer than it was in 1993.
There’s great variation depending on the specialist needed. Patients wait longest between a general practitioner’s referral and orthopedic surgery (39 weeks), while those waiting for oncology begin treatment in 3.8 weeks, the Fraser Institute study found.
While proponents of a single-payer system like to praise Canada’s healthcare system as a model for the U.S. to follow, Sally Pipes, who began her career at the Fraser Institute and writes regularly about Canadian healthcare, said that is misguided.
“I think people do not understand how it works and the cost,” Pipes, the president and CEO of the Pacific Research Institute, who now lives in California, said in an interview with FierceHealthcare.
The idea of a single-payer system became popular when Bernie Sanders was running for president in 2016 and talked about healthcare for everyone when he hit the stump, Pipes said.
A Reuters survey in August found that the vast majority of Americans, 70%, now support Medicare-for-all. And doctors, many who once vehemently opposed the idea, are increasingly on board. A survey last fall found that physicians favor a single-payer system by a slight margin even though many say their income will suffer under such a system and possibly lower the quality of care. The survey found that physicians favor a single-payer healthcare system (48%) over a multiple-payer system (45%).
But Pipes, director of the conservative think tank and an outspoken critic of government-run healthcare, said instead of looking to the neighbor to the north as a model, Americans should look at the Canadian health system as a warning. When the government is the sole provider of healthcare, you get long wait times, rationed care and higher taxes, she said.
But another healthcare expert said those long waits in Canada don’t have to translate to the U.S. Those wait times are not a result of the single-payer system itself but of system management, argues Colleen M. Flood, director of the Centre for Health Law, Policy and Ethics at the University of Ottawa.
Wait times vary across many “single” payer systems, which would include social health insurance systems seen across Europe, Flood said in an email to FierceHealthcare. Many “single” payer systems have few or no problems with wait times, she said.
“If there is a desire to get rid of wait times, that is certainly possible with appropriate management,” she said. For example, several years ago Ontario had a problem with wait times for cardiac care, a problem it solved with a central system for the province. It meant patients were assessed based on their need and then prioritized to the first available cardiologist/cardiac surgeon, she said.
“Moreover, in terms of wait times, it is unlikely the U.S. would adopt the Canadian style of Medicare that prevents people buying faster care if they want it than available in the public plan,” she said. U.S. patients could “jump the queue” using private health insurance or out-of-pocket payment.
But Pipes cautions Americans who support a single-payer system to educate themselves. Treatment delays can be deadly, she said. “All of my family and many friends are still in Canada. I can tell all kinds of horror stories,” she said.
Her mother died of colon cancer in 2005, Pipes said. She was diagnosed by her general practitioner, who told her that at her age she would have to wait over a year for a colonoscopy. About six months later after she experienced bleeding and went to the emergency room, she got that colonoscopy that showed her cancer had metastasized and she died two weeks later, according to Pipes.
The Fraser Institute estimates that across 10 Canadian provinces, more than 1 million people are waiting in 2018 for procedures.