This week’s Canada Letter includes observations from the Yukon and a ticket offer for Times subscribers. But first we have an exclusive item for readers of this newsletter from our colleagues at The Upshot, the group at The Times that examines the world through data.
Aaron E. Carroll, a professor of pediatrics at Indiana University School of Medicine, and Austin Frakt, a health economist with several governmental and academic affiliations, frequently analyze health care policy for The Upshot. (They also have an excellent blog about health care economics.)
Recently, they gathered two other economists and a physician and held a tournament to pick the world’s best health care system. Canada was knocked out early by Britain. Long wait times delivered the fatal blow. But in this essay for the Canada Letter, Professor Carroll and Dr. Frakt offer a positive take on that result:
One of the most common complaints about the Canadian health care system is the duration of wait times. That was the reason that some judges favored other nations in The Upshot’s tournament-style comparison of various countries’ health systems. Indeed, fear of long wait times is one of the most commonly cited reasons people in the United States reject a single-payer health system.
But there are trade-offs for seemingly everything in health care systems, and Canada benefits in other ways.
Let’s acknowledge that, compared with patients elsewhere, those in Canada often have to wait longer for care. In the recent international comparison published by the Commonwealth Fund, only 43 percent of Canadians were able to see a doctor or nurse on the same or next day when they needed care, tying for last. Half of them had to wait two or more hours for care in the emergency room (again, last place). Thirty percent of them had to wait two or more months to see a specialist (last place), and 18 percent had to wait four or more months for elective surgery (last place).
But these access issues are not necessarily because Canada has a single-payer, or government-run, system. After all, Britain has a much more socialized system, and performs much better than many other countries with respect to wait times.
Further, many of the wait time comparisons made between the United States and Canada focus on elective procedures like hip replacements and cataract removals, which predominantly affect older people. Older Americans are covered by Medicare, which is a single-payer system.
The reason for longer wait times in Canada is not because of the system’s design. It’s because of the system’s spending. Canada spends, on average, about half of what the United States does for health care. Spending so much less has to have consequences, either decreased access or decreased quality.
We can quibble about various metrics, but the same Commonwealth Fund study that faulted Canada for access issues didn’t find huge differences in outcomes. Canada beats the United States on population metrics, while the United States wins with respect to hospital-based ones. The United States also does well in cancer survival rates, but we’ve discussed why survival rates are flawed before. Canada may have longer wait times, but it’s hard to see how they are negatively affecting Canadians in comparison with Americans.
The bottom line is that while Canada does have longer wait times compared with other countries, it seems to have made the decision to accept this as a trade-off for significantly reduced spending. We can choose to value different things, but those wait times are most likely an economic decision, not one inherent to single-payer.
Read: The Best Health Care System in the World: Which One Would You Pick?
Beauty and Blight
A dispatch from my colleague Dan Levin who was just on assignment in the Yukon:
I was on a reporting trip that took me into the heart of an important debate in Canada: how to balance the lucrative extraction of natural resources with growing demands to respect Indigenous rights and to protect the nation’s wilderness from environmental destruction.
The Yukon — larger than California but with a population of just 38,000 — distills this tension into perhaps its most vivid form.
I saw black bears crossing the Yukon highway, which roughly follows the route taken by prospectors during the Gold Rush that started in 1896. The Northern Lights glowed green over Dawson City, a clapboard relic of the era built by mineral wealth. The territory’s mining heritage shows itself in the summertime vaudeville performances at Diamond Tooth Gerties Gambling Hall and the piles of dirt tailings from industrial gold dredging. The rugged traditional territory of the indigenous Tr’ondëk Hwëch’in First Nation, whose people have dwelled along the Yukon and Klondike rivers for thousands of years, stretches beyond.
But the legacy of mining has left deep environmental wounds on the Yukon that may prove impossible to completely heal. Even as the territory is prized for its soaring snow-capped mountains and wildlife, the Yukon is also home to one of Canada’s worst environmental blights: the former Faro mine, the world’s largest open-pit lead and zinc mine until it was abandoned in 1998 by its bankrupt operators. They left behind 320 million tons of waste rock and 70 million tons of tailings, enough to cover more than 26,000 Canadian football fields according to the Canadian government, which is planning to spend at least half a billion Canadian dollars to clean up the toxic site.
On my journey, I witnessed another legacy of Canada’s influential mining industry. A dirt road known as the Silver Trail led to a gate blocking the way up to Elsa, once a privately owned mining town that was Canada’s second largest producer of silver in the 1950s, before it too was abandoned, in 1989. Today, Elsa is a ghost town of collapsing buildings too dangerous to enter, while a landfill of junked trucks and industrial equipment rust on its outskirts. Remote and largely forgotten, this apocalyptic scene serves as a sobering lesson about a major part of Canada’s economy and the cost to peoples and wildlife.
As I wrote in his obituary, Allan J. MacEachen, who died earlier this month at the age of 96, was the political mastermind behind two Liberal prime minsters, Lester B. Pearson and Pierre Elliot Trudeau. His political acumen brought, among other things, public health care to all Canadians.
Justin Trudeau, the current Liberal prime minister, has links to Mr. MacEachen that go beyond his father. The son of a coal miner from Nova Scotia’s Cape Breto Island, Mr. MacEachen hired another Cape Breton coal miner’s son to organize his papers after he was appointed to the Senate. Long after sorting out Mr. MacEachen’s papers, that archivist, Gerald Butts, is now Mr. Trudeau’s closest political adviser, effectively fulfilling the role Mr. MacEachen played for the elder Mr. Trudeau.
Read: Allan J. MacEachen, a Force in Bringing Public Health Care to Canada, Dies at 96
Three members of The Time’s Team Canada, including me, will be interviewing writers at next month’s International Festival of Authors in Toronto. And we have a special deal for Times subscribers. Click on the “purchase tickets” tab and the code IFOA2017 will get you half-price tickets to the events where we do the questioning. Here they are in order:
—On Oct. 21, Dan Wakin, the editor of this newsletter, interviews crime writers Sara Blaedel and Peter Robinson.
—It’s my turn during the morning of Oct. 28 when I’ll have a conversation with the novelists Linda Spalding and Wayne Johnston about their careers.
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