Canada’s public universal healthcare model frequently comes up as a possible alternative to the U.S.’ more costly private/public approach to paying for people’s healthcare.
The U.S. is the only developed nation that does not have universal health coverage.
Under Canada’s system, known as Medicare, citizens pay for healthcare through their taxes. The average family of four in Canada pays about $17,713 for healthcare annually through their taxes. Hospital stays and physician visits are covered under the system. Medications and some other services are not, such as dental and eye care. For those, Canadians purchase insurance much like Americans do. By contrast, in 2023, the average cost of health insurance for a family of four in the U.S. was $23,968. That’s before any copays or other out-of-pocket expenses.
The tradeoff is that the Canadian system is not as flexible to meet market demand, leading to physician shortages and longer wait times, according to Christopher Labos, MD, a cardiologist and epidemiologist based in Montreal.
“You can’t just build a new hospital,” he said. “Supply doesn’t grow to meet demand quickly.”
Some physicians choose to work outside of the government system, giving Canadians a bit more control over the timing of their care if they want to pay for it out of pocket. Overall, however, Canada has physician shortages, which can mean long wait times.
“Government cutbacks have allowed the growth of privatized medicine in this country,” he said.
The average wait time to see a specialist for elective or non-life-threatening care in Canada was 27.4 weeks, according to a study. In the U.S., accurate figures are hard to come by, but based on one study, specialist wait times are around 14 weeks. Both Canada and the U.S. have physician shortages, the numbers of which vary year by year but are comparable, with the most recent available figures showing 2.8 physicians per 1,000 people for Canada and 2.6 physicians per 1,000 people for the U.S.
The pandemic exacerbated existing challenges in the Canadian system, which is frustrating for patients, Labos said.
“There are a lot of complaints because people have seen a very noticeable difference between today and what the system was like even five years ago. A lot of that is a question of access—they don’t have a family doctor,” he said. “There are a lot of things about the system that people are frustrated with, but I think they are mostly temporal issues that have grown up because of two very specific problems: cutbacks in government funding because of deficits, and Covid, which has made everything worse.”
What Canadians do like, however, is the fact that their taxes pay for the majority of their healthcare, meaning they are free to seek care when they need it without fear of cost.
“As a general rule, I would say the vast majority of Canadians like the fact that we have a public health care system,” Labos said. “They’re not going to spend $100,000 if they need heart surgery, and [they] like the fact that they don’t have to worry about being financially destroyed by a healthcare bill in a way that we hear some people are in the U.S.”