It's a decision worthy of Sophie's Choice, where saving one life means condemning others to certain death, a decision that no rational human would feel comfortable making.
But the reality is that these decisions are made every day by government bureaucrats here in Canada or nameless insurance actuaries in the United States and belies the truth that we cannot provide maximum healthcare to all of our citizens, regardless of whether we are American or Canadian because we do not have the financial wherewithal to pay for it.
And so painful decisions have to be made, decisions that in effect ration healthcare on the basis of cost.
It is a healthcare pie that is to be divided, wherein Canada, each of us gets an equally small sliver or in the United States when the slices are decidedly uneven.
And there is the rub.
And so debate rages here and in the United States over which system can deliver the most for the least, despite the fact that no system can or will deliver all that is ideal and that, to all members of society.
The Canadian system is called single-payer, where the government provides all services related to healthcare and funds the system through special health levys and general taxes.
Both Obamacare and Trumpcare are hybrid systems where the government pay for about half the healthcare service, while the other half is funded by employers and administered by private insurance or health care providers using private doctors and healthcare facilities.
On the face of it, the Canadian system makes a lot more sense. It is plain and simple, eliminates the profit aspect and should in theory spread out health resources (hospitals and doctors) evenly, based on need instead of profit.
But like communist or social systems, it sounds a lot better on paper than in real life and the benefits as opposed to the free market system don't necessarily pan out.
Bureaucracy and low productivity are the Achilles heel of the single-payer system, whereby layers and layers of administrators rob the system of valuable resources and where inefficiency due to poor management and oversight, coupled with low productivity are the bane of the system.
This can be best illustrated by the administration of health services in Quebec versus the rest of Canada, whereby Quebec's infamous bureaucracy and abysmally low productivity rate demonstrate how two single-payer systems operating under the exact same rules can register different results.
Let us remember that 25% of Quebecers cannot find a family doctor despite the province paying for more doctors per capita than Ontario. It is illustrative of how bureaucracy, bad management and laziness makes Quebec's healthcare system so bad as compared to other Canadian provinces, despite having equal financial resources.
At any rate, healthcare in Canada is rationed through long waiting lists for surgery and treatments, and where appointments with doctors, especially specialists, takes much too long. Certain 'exotic' treatments and expensive drugs are just not available due to the perceived poor cost/benefit ratio and so many Canadians afflicted are deprived of essential treatments, condemned to suffer the consequences of non-treatment or forced to travel to the USA to get what they need or want, at their own expense. How many of us give up waiting in the emergency room because of the interminable hours upon hours of waiting? The societal cost of these delays is incalculable, but impactful just the same.
There is no doubt that long delays for appointments with doctors or waiting lists for surgery or treatment is not a problem in the United States, where health services are plentiful, superb and available almost on demand.
The problem here is getting in the door, where millions upon millions of Americans cannot avail themselves of these excellent services because they don't have the means to pay or the insurance to cover it.
This is the American version of rationing.
When people vaunt the benefits of the American system over the Canadian system they always point to the availability and quality of services as compared to Canada, but always fail to include the crucial aspect of access, whereby too many Americans are locked out of the medical system.
In the end no system is perfect, but let us consider that Canada spends half of what the USA does on healthcare and I can only imagine how much better our system would be versus Trumpcare or Obamacare if we had access to double our healthcare budget.
In the chart above you can see that the USA spends US$8,233 per person, per year on healthcare, while Canada spends almost half that at US$4,445, perhaps the key element in the USA/Canada debate on healthcare.
While most Americans have been frightened away from the concept of Canadian style single-payer system by the entrenched healthcare and insurance industry who constantly 'trump' up the negative aspects of our system, the reality is that only a fraction of Canadians would opt for Trumpcare or Obamacare care, despite the shortcomings of our system.
But before we get too full of ourselves, we shouldn't be too proud of our medicare system and ask ourselves the important question, how it is that countries like France, Great Britain, Germany and others, all have better healthcare systems than ours, while spending considerably less.
