Claim: E-mail offers information about the Canadian health care system.



Status: Multiple — see below.



Example: [Collected via e-mail, September 2007]







This was sent from Canada to a friend in the States. This was sent from Canada to a friend in the States. I saw on the news up here in Canada where Hillary Clinton introduced her new health care plan. Something similar to what we have in Canada. I also heard that Michael Moore was raving about the health care up here in Canada in his latest movie. As your friend and someone who lives with the Canada health care plan I thought I would give you some facts about this great medical plan that we have in Canada. First of all: 1) The health care plan in Canada is not free. We pay a premium every month of $96 for Shirley and I to be covered. Sounds great eh. What they don’t tell you is how much we pay in taxes to keep the health care system afloat. I am personally in the 55% tax bracket. Yes 55% of my earnings go to taxes. A large portion of that and I am not sure of the exact amount goes directly to health care our #1 expense. 2) I would not classify what we have as health care plan, it is more like a health diagnosis system. You can get into to see a doctor quick enough so he can tell you “yes indeed you are sick or you need an operation” but now the challenge becomes getting treated or operated on. We have waiting lists out the ying yang some as much as 2 years down the road. 3) Rather than fix what is wrong with you the usual tactic in Canada is to prescribe drugs. Have a pain here is a drug to take — not what is causing the pain and why. No time for checking you out because it is more important to move as many patients thru as possible each hour for Government re-imbursement 4) Many Canadians do not have a family Doctor. 5) Don’t require emergency treatment as you may wait for hours in the emergency room waiting for treatment. 6) Shirley’s dad cut his hand on a power saw a few weeks back and it required that his hand be put in a splint – to our surprise we had to pay $125 for a splint because it is not covered under health care plus we have to pay $60 for each visit for him to check it out each week. 7) Shirley’s cousin was diagnosed with a heart blockage. Put on a waiting list. Died before he could get treatment. 8) Government allots so many operations per year. When that is done no more operations, unless you go to your local newspaper and plead your case and embarrass the government then money suddenly appears. 9) The Government takes great pride in telling us how much more they are increasing the funding for health care but waiting lists never get shorter. Government just keeps throwing money at the problem but it never goes away. But they are good at finding new ways to tax us, but they don’t call it a tax anymore it is now a user fee. 10) A friend needs an operation for a blockage in her leg but because she is a smoker they will not do it. Despite paying into the health care system all these years. My friend is 65 years old. Now there is talk that maybe we should not treat fat and obese people either because they are a drain on the health care system. Let me see now, what we want in Canada is a health care system for healthy people only. That should reduce our health care costs. 11) Forget getting a second opinion, what you see is what you get. 12) I can spend what money I have left after taxes on booze, cigarettes, junk food and anything else that could kill me but I am not allowed by law to spend my money on getting an operation I need because that would be jumping the queue. I must wait my turn except if I am a hockey player or athlete then I can get looked at right away. Go figger. Where else in the world can you spend money to kill yourself but not allowed to spend money to get healthy. 13) Oh did I mention that immigrants are covered automatically at tax payer expense having never contributed a dollar to the system and pay no premiums. 14) Oh yeh we now give free needles to drug users to try and keep them healthy. Wouldn’t want a sickly druggie breaking into your house and stealing your things. But people with diabetes who pay into the health care system have to pay for their needles because it is not covered but the health care system. I send this out not looking for sympathy but as the election looms in the states you will be hearing more and more about universal health care down there and the advocates will be pointing to Canada. I just want to make sure that you hear the truth about health care up here and have some food for thought and informed questions to ask when broached with this subject. Step wisely and don’t make the same mistakes we have.







Origins: The first thing to note is that any broad statements about “the Canada health care plan” have to be qualified, because Canada does not have a single national health care plan (and therefore what is true about health care in one part of Canada is not necessarily true in another). What Canada has is a national health insurance program which is implemented via (thirteen different) provincial and territorial health insurance plans, according to the guidelines of the Canada Health Act:





Canada’s health care system is best described as a collection of plans administered by the 10 provinces and 3 territories, each differing from the others in some respects but similarly structured to meet the federal conditions for funding. The simplicity of the five federal conditions is arguably one of the beauties of the Canadian system. They are the provision of all medically necessary services (defined as most physician and hospital services), the public administration of the system, the portability of coverage throughout Canada, the universal coverage of all citizens and residents, and the absence of user charges at the point of care for core medical and hospital services.





As for the issues raised in the e-mail quoted above:

The health care plan in Canada is not free. We pay a premium every month of $96.

Each province (and territory) has a number of options for financing its share of the cost for its health insurance plan. Some provinces have opted to finance their health insurance costs through the payment of premiums; other provinces and territories have chosen to finance their shares through various taxes and/or other revenue streams:





Each province and territory has considerable leeway in determining how its share of the cost of its health insurance plan will be financed. Financing can be through the payment of premiums (as is the case in Alberta and British Columbia), payroll taxes, sales taxes, other provincial or territorial revenues, or by a combination of methods. Health insurance premiums are permitted as long as residents are not denied coverage for medically necessary hospital and physician services because of an inability to pay such premiums. Each province and territory has considerable leeway in determining how its share of the cost of its health insurance plan will be financed. Financing can be through the payment of premiums (as is the case in Alberta and British Columbia), payroll taxes, sales taxes, other provincial or territorial revenues, or by a combination of methods. Health insurance premiums are permitted as long as residents are not denied coverage for medically necessary hospital and physician services because of an inability to pay such premiums. Provinces that levy premiums have also instituted premium assistance schemes that are based on income, and those who cannot afford to pay premiums may apply for assistance through the provincial health insurance plans.





The referenced $96 figure is what a family of two living in the province of British Columbia would pay in monthly Medical Service Plan (MSP) premiums.

What they don’t tell you is how much we pay in taxes to keep the health care system afloat. I am personally in the 55% tax bracket. Yes 55% of my earnings go to taxes.

The highest federal income tax rate in Canada is 29% (for persons with annual taxable income over $120,887), and the highest provincial income tax rate in British Columbia is 14.7% (for those with annual taxable incomes over over $95,909). The typical upper-income level Canadian taxpayer is not in a 55% tax bracket.

By way of comparison, a typical upper-income level American taxpayer residing in California pays a roughly equivalent share of his income in federal and state taxes, even though the U.S. has no national health insurance program.

We have waiting lists out the ying yang some as much as 2 years down the road.

As noted above, any broad statement about Canada’s health insurance program is difficult to assess because Canada has a number of different provincial/territorial programs, not one national program. Wait times for medical procedures in particular can vary quite widely across provinces, cities, and individual hospitals, and of course wait times can also vary widely depending upon the type of procedures involved.

Using Ontario (Canada’s most populous province) as an example, we find that provincial wait times measured in mid-2007 ranged from 13 days for angioplasty to 297 days for knee replacements.

Similar, median wait times in British Columbia (measured for the three months ending in July 2007) ranged from 1 week for cancer services to 17.5 weeks for knee replacements.

Rather than fix what is wrong with you the usual tactic in Canada is to prescribe drugs. Have a pain here is a drug to take — not what is causing the pain and why. No time for checking you out because it is more important to move as many patients thru as possible each hour for Government re-imbursement.

We have not found any study demonstrating that doctors in Canada are more likely to issue prescriptions in lieu of performing more thorough diagnoses than doctors in any other western countries are. An important factor to consider in this area (one which is not unique to Canada) was reported in a 1997 British Medical Journal article which noted that studies have found patients often report dissatisfaction with their doctors if they don’t receive prescriptions as a result of office visits, even if prescriptions are not the best course of treatment for their health issues.

Many Canadians do not have a family Doctor.

A 2005 survey conducted by the College of Family Physicians of Canada, the Canadian Medical Association, and the Royal College of Physicians and Surgeons of Canada reported that “more than 4 million Canadians do not have access to a family doctor.” This figure represented about 12% of the 2005 population of Canada.

Note that the term “family doctor” as used here refers to a family (or general) practitioner. Thus the statement “some Canadians do not have family doctors” does not simply mean those persons see a number of different physicians instead regularly visiting the same physician; it means they do not have access to physicians who specifically practice family medicine.

Don’t require emergency treatment as you may wait for hours in the emergency room waiting for treatment.

As with other kinds of medical care, emergency room treatment wait times can vary quite widely from province to province, region to region, and hospital to hospital.

A 2005-2006 study of Ontario emergency departments conducted by the Canadian Institute for Health Information (CIHI) found the following:





Ninety per cent of patients who went to major teaching hospitals were seen within nine hours while the vast majority of patients who sought care at busy community hospitals (those with more than 30,000 emergency visits per year) concluded their visits within 7-1/2 hours. Ninety per cent of patients who went to major teaching hospitals were seen within nine hours while the vast majority of patients who sought care at busy community hospitals (those with more than 30,000 emergency visits per year) concluded their visits withinhours. Waits were shorter in less busy community hospitals, where 90 per cent of patients spent three hours or less seeking and receiving emergency care. But only 30 per cent of people in need of help went to these smaller institutions. Seventy per cent sought assistance at either the busier community hospitals or teaching institutions, where waits were two or three times longer. The good news for the extremely ill is that 50 per cent of patients who require the most urgent care were seen by a doctor within six minutes and 86 per cent were seen within 30 minutes of arrival in emergency departments. Geography clearly mattered in terms of wait times, according to the study data. People in the Toronto area, where 90 per cent of patients were in and out in just under 12 hours, faced the longest delays. The shortest waits were in the Sudbury-Sault Ste. Marie area, where 90 per cent of patients finished their visit to hospital emergency departments in about 4-1/2 hours





Shirley’s dad cut his hand on a power saw a few weeks back and it required that his hand be put in a splint — to our surprise we had to pay $125 for a splint because it is not covered under health care plus we have to pay $60 for each visit for him to check it out each week.

Again, details vary from province to province, but some patients in some provinces may (depending upon the circumstances) have to pay (some portion of the cost) for medical appliances such as splints, trusses, braces, casts, or crutches, and/or the replacement, repair, fitting, or adjustment thereof.

Shirley’s cousin was diagnosed with a heart blockage. Put on a waiting list. Died before he could get treatment.

The medical history of someone’s unidentified cousin cannot be verified. However, the way this statement is worded, the anonymous person referred to could have coincidentally died of something unrelated to a heart blockage.

Government allots so many operations per year. When that is done no more operations

The Canadian government does not “allot” or set quotas on the number of operations for a given year. Obviously how many surgeries can be performed is limited by available resources (e.g., doctors, hospitals, equipment), so patients have to be prioritized and scheduled, with the most urgent cases receiving priority.

The Government takes great pride in telling us how much more they are increasing the funding for health care but waiting lists never get shorter. Government just keeps throwing money at the problem but it never goes away.

Canada has indeed committed to investing billions of dollars in a 10 Year Plan to reduce waiting times for access to health care:





The 10 Year Plan outlines strategic investments directed toward reducing waiting times for access to care, especially for cancer, heart, diagnostic imaging, joint replacement and sight restoration services. To support the reduction of wait times, the Federal Government committed to investing $4.5 billion over six years, beginning in 2004-05, in the Wait Times Reduction Fund. The 10 Year Plan outlines strategic investments directed toward reducing waiting times for access to care, especially for cancer, heart, diagnostic imaging, joint replacement and sight restoration services. To support the reduction of wait times, the Federal Government committed to investingover six years, beginning inin the Wait Times Reduction Fund. The Wait Times Reduction Fund will augment existing provincial and territorial investments and assist jurisdictions in their diverse initiatives to reduce wait times. This Fund will primarily be used for jurisdictional priorities such as training and hiring more health professionals, clearing backlogs, building capacity for regional centres of excellence, expanding appropriate ambulatory and community care programs and/or tools to manage wait times.





The broad (and absolute) statement that “waiting lists never get shorter” is not supportable. As noted in the example of Ontario cited above, wait times for some medical services have decreased significantly in the last two years. Similar statistics for other provinces and territories are linked here.

A friend needs an operation for a blockage in her leg but because she is a smoker they will not do it. Despite paying into the health care system all these years.

The medical history of an anonymous friend is not verifiable, but it is possible that (under any medical system) doctors might delay a non-urgent surgery until complicating factors (such as obesity or smoking) which could greatly increase the risk of the operation and/or significantly interfere with the patient’s ability to recover from it have been ameliorated.

Forget getting a second opinion, what you see is what you get.

In general, provincial health plans do not limit patients to visiting only one doctor each for any given medical issue. Patients may consult multiple specialists if they so choose (with the caveat that each additional consultation will likely require another wait for access).

I can spend what money I have left after taxes on booze, cigarettes, junk food and anything else that could kill me but I am not allowed by law to spend my money on getting an operation I need because that would be jumping the queue.

As the Newfoundland and Labrador Medical Association (NLMA) noted in a 2005 newsletter:





Canada is distinct from other industrialized countries to the extent that it does not have a parallel private system for the services covered by the public system. For example, care provided in hospitals and by family doctors is almost exclusively publicly funded. Canada is distinct from other industrialized countries to the extent that it does not have a parallel private system for the services covered by the public system. For example, care provided in hospitals and by family doctors is almost exclusively publicly funded. Private medical care is not illegal in Canada. But the provinces do employ a number of disincentives to discourage a parallel private system. The disincentives used vary from province to province. One of the main disincentives used is to deny physicians the opportunity to work under the public insurance plan and to also have eligible patients paying privately. In other words, physicians are forced to choose between whether they will have only patients who pay for services themselves or patients who are covered under public provincial plans. Some provinces deny any public subsidy to patients of physicians who opt out of their Medicare program. Some provinces do not allow physicians who opt out of the public system to bill patients more than what they would under the public system. Others ban the sale of private insurance for services covered by the public plan. It is this last legal disincentive which is the subject of a recent Supreme Court case [in which the court ruled that a Quebec law banning the sale of private medical insurance for medical services already covered by the public health care system violates Quebec’s Charter of Human Rights and Freedom].





Immigrants are covered automatically at tax payer expense having never contributed a dollar to the system and pay no premiums.

Again, all statements about medical coverage in Canada have to be qualified with the fact that regulations and procedures vary from province to province. Some provinces impose mandatory waiting periods on health insurance coverage for immigrants, and as the Canadian Medical Association Journal (CMAJ) noted in 2006, many immigrants end up waiting much longer than those mandatory periods for coverage:





Physicians in this country may be surprised to know that, despite Canada’s universal health care system, many who reside here legally are never granted public health insurance. Other immigrants and refugees are granted coverage, but only after long delays: 4 provinces impose a mandatory 3-month waiting period — but in our experience, our patients’ wait has averaged 2.1 years.





Oh yeh we now give free needles to drug users to try and keep them healthy. But people with diabetes who pay into the health care system have to pay for their needles because it is not covered but the health care system.

Needle exchange programs created to provide clean needles and syringes for injection drug users have been operating in various parts of Canada since 1989. Canadian studies of such programs have generally found them to be effectively inexpensive means of preventing greater health care costs. The level of insurance coverage provided for diabetic supplies (such as syringes) varies from province to province.

Last updated: 18 October 2007





