Does Canada's health care system really work?

CRESTON, British Columbia - In most respects, the residents of this small, rural farming community, about 35 miles north of Bonners Ferry, are little different from their Idaho neighbors to the south.

People here worry about their children. They're concerned about the economic future of the region. They regularly question the wisdom of federal and provincial politicians. They even grumble about Canada's public health care system.

One major difference, though, is they rarely seem to worry about how to pay for their health care needs. In the event of a layoff or serious illness, that's one stress the average person here doesn't have to deal with.

"Cost doesn't factor into it," said Muriel Buhr, a member of the Central Kootenay Advisory Planning Commission. "You can come to the hospital for a year and not pay a cent. It doesn't matter if you're out of work, you can still get your children looked after. You don't have to choose between paying for medicine or paying your mortgage. If you can stop a whole nation from having to worry, why wouldn't you have public health care? To me, the stress relief for families far outweighs the cost."

Many supporters of reforming American health care reform would agree with Buhr. Rather than abandoning millions of uninsured to an uncertain future of charity care or postponed medical needs, reform advocates say, the Canadian system guarantees treatment for everyone, while simultaneously curbing costs and maintaining quality.

U.S. opponents of Canada's system cite horror stories about long waiting periods, inadequate care, bureaucratic decision-making and exorbitant taxes. Some worry that a nationalized U.S. health plan would remove all incentives for individuals to take care of themselves. Others see it as an unwarranted expansion of government, something that would result in yet another massive federal bureaucracy.

Interviews with about a dozen Creston residents indicate they share some of these concerns. Overall, though, most seem generally satisfied with Canada's public system.

Ron Toyota, Creston's new mayor, isn't covered by the city, so he pays about $100 a month in insurance premiums for himself and his wife. That includes a medical exam every year.

"To me, it's a pretty good value," he said. "And it's available to everyone."

In Canada, the federal and provincial governments share the cost of health care. Each province handles things slightly differently.

EMPLOYER-PURCHASED INSURANCE IS OPTIONAL

British Columbia charges $54 per month for individual health insurance (about $50 U.S.). Couples pay $96. A family of three or more pays $108. Enrollment in a government plan is mandatory for people who are not covered by their employers. Subsidies of 20 percent to 100 percent are available for those who can't afford it.

Although they don't have to, most larger employers in British Columbia buy group policies through the provincial government. The basic health plan covers hospital stays and medical or diagnostic services required by a physician, plus routine eye exams for children and the elderly. It typically doesn't include dental care, prescription drugs or ambulance transport, although supplemental policies are available to cover those.

Everyone in Canada gets a provincial "Care Card" for use when they go to a doctor or hospital. At the Creston Valley Hospital, people come in, have their cards swiped and wait for whatever service they need. The card brings up their personal and medical information on a screen. The entire check-in takes less than 10 seconds. When a reporter visited recently, no one waited for service more than a few minutes.

Unlike the United States, Canadian and provincial governments dictate which services and surgical procedures are offered at public facilities. In many cases, operations are limited to regional hospitals or specialty centers. That's one of the primary methods the government uses to contain costs, because it limits capital equipment and labor costs and ensures high utilization rates.

MORE CUTS, LONGER TRIPS TO HOSPITALS

"We're finding more and more cuts, especially in rural communities," said Lawrence Ward, who runs a small retail business in downtown Creston. "The hospital here used to be 55 beds and used to offer significant surgeries, like gall bladder operations or knee replacements. Now it's down to 21 beds, and the government has centralized some surgeries (at larger, regional facilities) ... meaning people have to travel."

When Ward's daughter went into premature labor, she was sent to the regional hospital in Cranbrook - about a 70-minute drive - but it wouldn't admit her because she was 32 weeks pregnant and the hospital couldn't take anyone under 34 weeks. She was flown to Kamloops. Because it wasn't a round-trip flight, "she got dinged for the cost," Ward said.

Such bureaucratic meddling is one of the concerns cited by opponents of nationalized health care in America.

But Irene Deprey, a retired nutritionist and volunteer at the Creston Food Bank, said meddling isn't limited to Canada. "In the U.S., your insurance companies run the show. Here, the government runs it," she said with a shrug. "Your Social Security system works, so why wouldn't a public health care system?"

NO DELAYS FOR EMERGENCY CARE

Lorraine Ward, Lawrence's wife, has 35 years of experience as a nurse. She said her impression of health care in America is that it's a business.

"That's what sticks in our craw," she said. "We don't look at it like that here. Anyone can walk through the door and get the same treatment as anyone else. We do have delay times and we have to travel, (but) I wouldn't have it any other way. You know you're going to be covered."

The B.C. Ministry of Health Services says more than half the surgeries performed in the province are done on an emergency basis, with no delays. Median waiting times for non-emergency operations were four to five weeks from 2001 to 2009, although that varied depending on the procedure. Knee and hip replacements had the longest waiting times; they peaked at 22 and 29 weeks, respectively, in 2004, before dropping to 10 and 13 weeks by 2008.

None of this comes for free, of course. During fiscal 2010, 36 percent of British Columbia's total budget will go toward health care, or $14.2 billion. Insurance premiums cover only 10 percent of that amount, meaning the rest comes from taxes.

HIGHER TAXES THAN IN U.S. FOR HEALTH CARE

The province's personal income tax rate ranges from 5.1 percent to 14.7 percent, compared with 1.6 percent to 7.8 percent for Idaho. The federal tax rate tops out at 29 percent north of the border, compared with 35 percent in the United States. Unlike Americans, though, Canadians pay taxes on health care benefits received through their employers.

Corporate income taxes are higher as well - 11 percent in British Columbia, versus 7.6 percent in Idaho. And the federal/provincial sales tax adds up to 12 percent, about double the rate in Idaho and Washington.

Overall, though, British Columbia spends just under $3,200 per person on health care - less than half the per capita expenditures in the United States. The waiting lists and centralized services haven't hurt average life expectancy, either: It is 81 years in the province, compared with 78 for Americans.

"It's a relief to know if you're sick, you'll be looked after," said Lori Kepke, a dairywoman and dance instructor. "I don't get hurt by having to come up with an extra $5,000 (to pay for a sudden illness). I know that's because the cost is hidden in our regular taxes, but I don't see it as all about me."