There’s a line of thought developing in Canada that says that all the economic pain and physical distancing COVID-19 has put us through, all the lockdowns and restrictions of the past two years, could have been avoided if we’d only had America’s health care system.
The purported evidence for this lies in the belief that public-health measures, implemented with the arrival of the Omicron variant in December, are there for one reason alone: to prevent our hospitals from being overloaded.
Looking south across the border, there are no restrictions, or few. So some have concluded that the difference must be that America’s private health model is so well resourced, and so efficiently managed, that it handled Alpha and Delta and Omicron without breaking a sweat, allowing most Americans to continue living like it’s 2019.
There are two fallacies in this logic. The first is the belief that Canada imposed restrictions for the sole reason of protecting the health care system. The school closings, business capacity limits and the vaccine and mask mandates were done partly for that reason, but they are also about saving lives and lowering cases of severe illness. It was a choice.
The United States made a different choice. Its generally minimalist public-health measures, its lower vaccination rate and the widespread resistance to masks have delivered a death rate that is triple Canada’s.
Two societies, two choices, two different outcomes.
And then there’s the other fallacy: that America’s health system has handled the pandemic with relative ease.
That is far from true. The U.S. has almost exactly the same number of doctors per capita as Canada, and only slightly more hospital beds. But as of last Thursday, the U.S. had more than 156,000 people in hospital with COVID-19, more than double the Canadian rate. And after two years of hospitalization levels generally far higher than Canada’s, America’s hospitals and their staff are at the breaking point.
Huge numbers of U.S. hospitals have cancelled elective surgeries. Last week, President Joe Biden said he would send 1,000 military personnel to help hospitals – a move that some worried wouldn’t be enough.
Canada and the U.S. made different trade-offs during the pandemic. This country chose more restrictions to prevent more deaths and more people sick enough to end up in the ICU; the U.S. did the opposite. But in both places, hospitals have at times been overwhelmed – and more often in the U.S., owing to a consistently higher level of illness.
There is simply no health care system on the planet that could have allowed an unlimited number of people to fall ill from COVID-19 without consequences.
That said, there’s no question Canada’s hospitals were already overburdened, and operating at or above capacity, even before the pandemic. Emergency-room waits were often interminable; too many people who needed to see a specialist or undergo elective surgery faced excruciating delays.
Canadians have anecdotes; years of studies have evidence. Our health system is pretty good, but in many ways it’s also not good enough. There’s a reason the Commonwealth Fund’s ranking of leading health care systems puts Canada in 10th place out of 11 highly developed countries. But who finishes a very distant 11th, year after year? The United States.
Now, thanks to the pandemic, it’s more clear than ever that Canada’s health care system needs improvement.
That probably involves spending more money on things such as additional hospital beds – Canada has fewer per capita than most developed countries. We probably need more doctors. We certainly need more nurses.
We also need to rethink how the system is run, to encourage innovation and efficiencies. That doesn’t mean privatization, or extra billing, or moving services outside of medicare. But it may mean figuring out how to get market incentives into our public, universal insurance system.
What it doesn’t mean, though, is that the limitations of our health care system during the pandemic have been peculiar to it. Around the world, hospitals in 71 countries have cancelled a total of 28 million elective surgeries, according to the World Economic Forum.
What is peculiar to Canada is its death rate per capita, which is among the lowest in the countries hit hardest by the pandemic, according to Johns Hopkins University. We are also among the most vaccinated countries in the world. We got some things right, after all.
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