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Hate to (Br)eak it to You Walt, But it's Pretty (Ba)d in Canada, Too

Friday, October 11, 2013

The popular Internet meme that 'Breaking Bad' would never have happened in Canada displays a lack of understanding of that country's health care system.

The season finale of the popular U.S. drama “Breaking Bad” brought with it renewed interest in a viral internet meme that implicitly suggested the entire story might not have taken place had the main character, Walter White, lived in Canada. The meme suggests that within a short time of being diagnosed with cancer, Walt’s “free” treatments would begin.

“Breaking Bad” tells the tale of an Albuquerque high school chemistry teacher (Walt) who decides, after a diagnosis of untreatable lung cancer, to turn to a life of criminality, producing and selling meth in order to make sure he leaves behind enough money for his young family.

The question of exactly how the “Breaking Bad” story arc may have changed depending on which country it took place in, while surely fun, is ultimately moot. It is, after all, a piece of creative fiction. For all we know, Walt might have simply decided to retire in British Columbia and start a marijuana grow-op instead.

Addressing the meme’s naïve and misleading allusion to the idea of timely access to “free,” high quality health care in Canada, however, is important — especially for those relying on it for support of the status quo in Canada or in support of arguments to adopt a Canadian-style health care system elsewhere.

Canada actually has fewer medical resources (physicians, beds, and diagnostic imaging scanners, for example), and performs fewer medical interventions than its American and European counterparts.

To begin, health care in Canada is anything but free. The average Canadian family of two parents with two children (similar to Walt’s family in the drama) pays approximately $11,320 in taxes for hospital and physician care through the country’s tax system, in addition to — for those who buy it — the cost of private insurance for things such as dental care and outpatient prescription drugs. While overall health care spending is lower in Canada than the United States in comparison to their overall economies, it is certainly higher than in almost any other developed country that offers universal health care.

Canadian Care?

Next comes the question of the scope and timeliness of medical services provided in exchange for this substantial expenditure. Surely such expenditure is justified if Canadians receive a stellar health care system in return for their tax dollars. Unfortunately, that simply isn’t the case. Canada actually has fewer medical resources (physicians, beds, and diagnostic imaging scanners, for example), and performs fewer medical interventions than its American and European counterparts.

In fact, Canada has one of the lowest physician-to-population ratios in the developed world. Add fixed hospital budgets and the monopolization of health insurance by the government, and you get a universal access health care system that also fails to provide access to services in a timely manner. The most recent annual survey of wait times in Canada revealed that patients have to wait approximately four and a half months on average to receive treatment for medically necessary elective procedures after referral from a general practitioner (whom many Canadians also have a hard time finding). While the wait is shorter for cancer patients (about a month), we also have to remember the long wait patients face for access to diagnostic imaging technologies like MRIs (over two months on average) and CT scanners (almost a month on average) which are vital for assisting in making the diagnosis in the first place. Such delays can have large impacts on cancer patients given the possibility that the size of a cancerous tumor doubles every four months.

Lengthy delays are one possible driver behind the decision some forty thousand Canadians make annually to leave the country and seek treatment elsewhere.

Even worse, Canada’s waiting lists are among the longest in the developed world. A recent survey by the Commonwealth Fund revealed that Canadians were most likely to wait four months or more for elective surgery, two months or more for a specialist appointment, six days or more for access to a doctor or nurse when sick or needing care, and four hours or more in the emergency room in comparison with patients in 11 other developed nations. Put differently, it is the predominance of government that causes long wait times for access to less-than-world-class care in Canada, not the noble goal of universality. These lengthy delays are one possible driver behind the decision some forty thousand Canadians make annually to leave the country and seek treatment elsewhere.

But let’s get back to fictional characters and the implications of popular internet memes for a moment. Public health insurance plans in Canada also fail to cover the cost of many new medical options that could prove vital in surviving a bout of serious illness like Walter White’s. One of these costs is borne as a result of a lack of coverage for new prescription drugs. Public drug plans only covered about a quarter of the new drugs approved for sale in Canada between 2004 and 2010. Private drug plans, meanwhile, covered more than three-quarters of the same set of new drugs. Even worse, Canadians also have access to fewer new and innovative drugs than their European and American counterparts — and those they do have access to are approved for use much later than they are in other jurisdictions. In fact, important new cancer drugs like Avastin and Jevtana were only available to patients in Canada more than a year after receiving marketing approval in either the United States or Europe.

These realities serve to dismiss the mythical notion that a Canadian-style health care system would have guaranteed a better outcome for someone facing Walt’s particular circumstances, either in terms of the cost of advanced health care or in terms of the ultimate result. Whether north of the border or south, Walt could just as easily have broken bad.

Bacchus Barua is a senior economist with the Fraser Institute.

FURTHER READING: Christopher J. Conover compares American health care to Canada and other countries by asking “Is U.S. Health Spending on Another Planet?” Jonah Goldberg writes about the AMC drama in “Breaking Bad Breaks Through” while Roger Bate explains “Phakes and the Cancer Fight.” James Pethokoukis explains “Cancer Vs. Innovation” and David Shaywitz contributes “Key Question for Innovators Isn't Where Health Care Is Going, But When It Will Get There.” Joseph Antos starts his four-part series on the Affordable Care Act with “Obamacare: Destined to Flop? Part I” while Bryan Dowd asks “Why Is the Obamacare Tax/Penalty Needed at All?” Mark J. Perry writes “More on America's Longest War: The Cruel, Costly, Senseless and Failed War on Drugs” and “America's Drug War: Either We Are a Uniquely Evil People or We Have Some Uniquely Awful Laws and Social Policies.” 

Image by Dianna Ingram / Bergman Group

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