No Country for Sick Men

"Us Canadians, we're kind of understated by nature," Marcus Davies told me in his soft-spoken way. "We don't go around chanting 'We're No. 1!' But you know, there are two areas where we feel superior to the U.S.: hockey and health care."

Davies is an official of the Saskatchewan Medical Society, so it's not surprising that he would want to extol Canadian medicine. But that feeling of patriotic pride in the nation's health-care system is something that just about all Canadians share. They love to point out that Canada provides coverage for everybody, usually with no copay and no deductible—while the U.S. leaves tens of millions of its citizens uninsured. They love to remind us that, while the U.S. lets some 700,000 people go bankrupt due to medical bills each year, the number of medical bankruptcies in Canada is precisely zero.

Yet I wasn't inclined to let Davies go unchallenged. I agreed that Canada does an admirable job of providing free and prompt care to anybody with an acute medical condition. But for nonemergency cases, the system often provides nothing but a long wait. Last summer I tried to get an appointment with an orthopedist in Canada to treat my aching right shoulder; the waiting time, just for an initial consultation, was 10 months. How could you be proud of that?

"You're right," Davies said frankly. "We keep people waiting, to limit costs. But you have to understand something basic about Canadians. Canadians don't mind waiting for elective care all that much, so long as the rich Canadian and the poor Canadian have to wait about the same amount of time."

In that last sentence, Davies set forth the national ethic of health care in his country: medicine is not a commodity to be sold to the highest bidder, but a right that must be distributed equitably to one and all. In short, the Canadians have built a health-care system that neatly fits the Canadian character: ferociously egalitarian, but thrifty at the same time.

I found that same pattern—a health-care system that reflects a nation's basic cultural values—everywhere I went when I traveled the world for a PBS documentary and a book about how other wealthy countries provide health care. "The fundamental truth about health care in every country," notes Princeton professor Uwe Reinhardt, one of the world's preeminent health-care economists, "is that national values, national character, determine how each system works."