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Oh, no. Not another international report putting down Canada's health-care system compared to other public systems.

There have been so many of these reports showing that Canada's system doesn't score very well internationally. Against the U.S. system, it does; against most other countries' public health systems, it doesn't.

The latest report from the Commonwealth Fund in the United States underscores the message. Each year, the fund (which wants more American public health coverage, not less) puts the U.S. system up against others in the Western world. Its reports always show that the U.S. system sucks up much more money than other systems without producing discernibly better outcomes.

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If we strip out the United States and look only at public systems, Canada always scores poorly. When the Commonwealth Fund used to compare only seven countries, Canada ranked sixth. Now, the Fund is looking at 15 countries in some categories, and 11 in others. In most categories, Canada comes between the middle and the bottom – except in spending, where Canada is in the upper third, per capita. (A Conference Board scorecard this week ranked Canada in the middle of 16 countries. The public-private Swiss health system came first.)

Almost everybody in the health-care world knows about these rankings. Politicians do, too. Most of them, therefore have shut down the old rhetoric about Canada having the best system in the world, although echoes of that claptrap can still be heard.

Many international studies of the Canadian system highlight its access problems. This one is no different. Among 11 countries, Canada ranks last or second-last in getting same- or next-day doctor appointments, finding after-hours care, waiting for more than two months for a specialist appointment or four months for elective surgery.

Hospitals? Canadian patients spend more time in them, per stay, than anywhere else except Japan. The discharge rate is therefore the lowest. Put the two together – more time in hospital equals slower discharge rates – and we find, not surprisingly, that Canada has the highest spending per discharged patient among countries with largely public health-care systems.

The hospital bottleneck/cost problem has been known for years. Many factors contribute to this chronic problem. An obvious one, studied to death, is the lack of space in other facilities for those who don't actually need acute-care treatment in hospitals – the so-called "bed-blockers."

Governments, to their credit, are working on providing more community care to keep people away from hospitals or get them out more quickly. They are also trying to focus more money and attention on the relatively small number of patients with multiple chronic problems that are costly to treat.

Some good news: Canada has one of the lowest smoking rates, at about 16 per cent. Bad news: We have the third-highest obesity rate.

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What does the public think of its national icon? In 2013, the year from which the Commonwealth Fund culled its results, Canada had one of the lowest rates of those who said health care "works well, only minor changes needed" (42 per cent) and the highest rate who said "fundamental changes needed" (50 per cent). Eight per cent said the system should be "completely rebuilt."

These kinds of responses offer no insight into what kind of "fundamental changes" are needed or what is meant by "completely rebuilt." These are easy phrases to repeat, but what would they mean in practice?

Would people like "fundamental changes," for example, if they meant that people could buy basic health care instead of relying on the state? Likely not. All the results of this survey, and others like it, suggest is perhaps a greater receptivity to other kinds of change than many politicians think.

Among the complexities and contradictions of Canadian health care is that the public sees medicare as a national symbol even though it's mostly the provinces that deliver the goods.

Ottawa transfers $32-billion a year to the provinces for health care, but citizens can't trace that money to any output, machine or service. Ottawa spends another $7.2-billion for specialized health care, including $2.5-billion for aboriginals, $1.1-billion for veterans, $571-million for the military and $614-million for the Public Health Agency. Ottawa also spends money to sponsor medical research. This money, too, is largely invisible to the general public.

We have a series of provincial health-care systems that offer so-so results by international standards for what the public sees, strangely, as a national symbol.

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