Oh, Canada

Why do Canadians love their health-care system?

Most policy analysts are only comfortable with the usual and tangible metrics of health-care access, cost and quality.

The real answer might come as a surprise to those analysts.

Although it is accessible, cost-effective, and provides good quality care, Canadians love their health-care system for what they think it represents about them and their basic values.

Those values are remarkably consistent across the country -- when the issue is health care, Canada has no "red" or "blue" states.

A full 90 percent of Canadians believe that no one should be denied health care simply because they don't have money.

Fairness and equity are values that most Canadians like to think their country stands for. Because they see and hear so much about the real and imagined horrors perpetrated by the U.S. health-care nonsystem, Canadians like their system even more by comparison.

I do think Canadians would be less fervent about their system if health-care delivery in the United States didn't look so awful by comparison.

But, put bluntly, democratic countries tend to get the health-care systems they deserve, based on history, culture and national values.

Most of the debates about health-care reform in the United States that I have seen and heard over the last 30 years have focused on details of how care is paid for, rather than on the fundamental question of what values should drive the provision of care.

So, is money the only value driving the American health-care system? If so, it is more than a bit misguided.

If we truly want to make the system better, as Americans we should find an answer to the hard questions.

What does the present way of apportioning health care in our country say about us and our values? What would we want it to say?

Understanding the Canadian System

Canadian health care is not socialized, as it is in Great Britain. It is not even one system.

Each province and territory has its own provincially administered insurance plan.

These plans are conditionally and partially supported by federal funds. The conditions require the provinces to provide insurance that is universal, covering all citizens and legal residents for all necessary medical and hospital services, on the same terms and conditions -- no co-pays, no deductibles, and no lifetime or yearly limits.

Each province must accept the other provinces' plans.

Some Problems are American Only

The worst features of U.S. health insurance do not exist in Canada.

Canada has no medical underwriting, no pre-existing condition exclusion, and no insurance premiums to pay except in Alberta and British Columbia, where nominal premiums are required from those financially able.

The only qualification for coverage is permanent, legal residency.

The quality of care in Canada is at least as good -- and sometimes at least as bad -- as it is in the United States. Medical schools are accredited by the same organization -- the Liaison Committee on Medical Education -- applying the same standards on both sides of the border.

Hospitals are also accredited against the same standards in Canada and the United States. The same pharmaceutical firms manufacture and sell the same drugs used in both countries.

The same health care costs so much more in the United States than it does in Canada for two principal reasons -- administrative costs and provider prices.

Administrative costs in the U.S. system are 300 percent greater than in Canada (so much for the myth of cost-saving efficiency in a largely privatized system) and provider prices are much higher too -- often 100 percent to 1,000 percent higher for the same service.

A personal story may help readers understand how this can play out in a system like the one in Canada.

Ten years ago my younger sister, while working in British Columbia, realized that her longstanding breast cancer had recurred and was told it would likely kill her within a few months.

Our mother lived in Alberta and was confined to a nursing home. My sister wished to spend as much time as she had left sharing love and life with mother.

She quit her job in British Columbia and moved to Alberta, but she did not lose her insurance coverage, even though she had left her employer.

Because her health insurance was not tied to her job, and pre-existing conditions are not an issue, she never missed a treatment, which was remarkably effective, giving her two more very good years of life.

Eventually she died, at peace, leaving her family with very fond memories, but no medical bills to pay.

Somehow, Canadians believe this is the way it should be.

Dr. M. David Lowe is an adviser to the president on public health at the Markin Institute in Alberta, Canada, and is the former president of the University of Texas - Houston Health Science Center.