In his Nova Scexit op-ed, Michael Kennedy argued: “Nova Scotia is experiencing a healthcare crisis which would be alleviated by joining the United States. The shortage of doctors is one of the main contributors to poor healthcare quality in Nova Scotia. Many of our doctors have little choice but to move to the United States in order to pay off massive medical school debts, since the United States pays them much, much better than we do.”

What are the facts and data to support this concept? All western countries are facing the same healthcare problems, whether they have a universal, one-payer system like Canada’s, a two-tier system like the United Kingdom or a for-profit sector like the United States. And looking at healthcare on an individual basis, the for-profit system pays more for poorer outcomes.

The idea that the American healthcare system is better than Canada’s overlooks the fact that Canadians live longer than Americans, are generally healthier than Americans and have more live births.

The idea that the American healthcare system is better than Canada’s overlooks the fact that Canadians live longer than Americans, are generally healthier than Americans and have more live births. (Editors’ note: Michael Kennedy does not claim the American healthcare system is better than the Canadian system. He specifically calls it “costly and problematic”.)

Universal healthcare also provides a business advantage. In the 1980s, I managed several newspapers in Southern Ontario. Our communities were full of auto parts manufacturers. A Chrysler vice-president told me Canada’s lower healthcare costs equated to a $700 cost advantage on every unit. Later a GM rep said healthcare costs saved them $1,500 per unit. These savings spread across all sectors.

Former TD Bank economist Don Drummond, who studied Ontario’s public service came up with a 100-item list for improving the province’s health care. Drummond wrote, “none who manage parts of the system argued more money alone is the solution to the problems of the healthcare system. Indeed, some argued the system is now well funded and that too much money would simply impede needed reforms. Certainly, the evidence of the recent past is that more money — political rhetoric notwithstanding — did not buy change, only more of the same, at higher cost.”

A number of American colleagues complain not only about their care, but about the costs. In October, a Texas-based editor wrote: “For health insurance, my wife and I pay about $360 per month (for both of us), BUT that includes a ridiculous deductible. So, we have to pay $7,500 each before insurance really kicks in. And after that, insurance covers 80% of the costs. There is an out-of-pocket max (it’s under $20,000), after which insurance covers all costs. So, essentially, the $4,200 we pay out each year to have insurance coverage just covers catastrophic costs.

“Of course, given the financial situations of most Americans, one hospitalization is enough to crush them financially for years.

“Of course, given the financial situations of most Americans, one hospitalization is enough to crush them financially for years. I think I saw a statistic that 60% of all bankruptcies in the U.S. are due to medical bills…even though, I think most medical debts cannot be written off by declaring bankruptcy, so the bankruptcy just eliminates the OTHER debts, allowing the patient to focus on paying back their medical debts. #YayAmerica

“You won’t catch me arguing in favor of America’s medical system.”

Of course, before you pay for insurance, you have to qualify for coverage. In Canada we don’t deny healthcare based on a pre-existing condition.

Three years ago, a high school friend was at her Georgia home when she had an incident which sent her to hospital for a night. The bill was $53,000. Fortunately, her college roommate worked in healthcare and advised negotiating the bill. My friend took her chequebook and settled the account for $11,000! That $11,000 had a profit margin in it, so the $42,000 she saved was pure profit. No wonder healthcare is so profitable for some.

The healthcare executive recently murdered in New York city was CEO of a company that insured 48 million Americans. Their 2023 profits were in excess of $230 billion!

While U.S. doctors can gross more than their Canadian counterparts, their costs are also much higher.

I was surprised to learn that the U.S. Congress provides over $35 billion a year to keep hospitals open. Hospital closures are a major issue. Especially for rural America. In the last decade, 10 hospitals a year closed in America. That said, Baker’s Hospital Review summarized 25 closures for 2024. Baker’s also tracks doctor and nurses strikes in the U.S. This January, 5,000 doctors, nurses and other hospital workers in Oregon; 1,000 hospital doctors at four NYC hospitals; 2,000 health workers in Michigan; and 2,000 front line health workers in Rhode Island are set to strike.

While U.S. doctors can gross more than their Canadian counterparts, their costs are also much higher. Their office is a business. Utah-based Weave Communications which specialize in services to the medical sector, says the average cost of operating a medical practice in the United States is 60-70 per cent of gross. Medical billing and collection can account for three-to-ten per cent of revenues. Staff medical insurance is another six per cent of gross. Medical malpractice insurance can be as much as $70,000. A marketing manager is another $70,000. The Canadian Medical Association Journal puts Canadian practice costs at 37 per cent for family physicians, less for specialists.

In every province, we have been led down a garden path to believe money is the issue. While healthcare budgets have soared, we are still talking about wait times, ER closures, drug costs, doctor and nurse shortages.

How much money is enough? No one in health care has ever said. That’s because the real issue is not money, it’s management. If an organization hasn’t solved a problem in over three decades, how can it be anything but a management failure?

Our healthcare is so bad because we keep hiring the same skill set. The other management problem is that while we have lots of people in charge, no one is accountable when things go wrong. Better healthcare starts with a radical change in the executive suite, not joining America.

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Allan Lynch is a writer, author, speaker and former community newspaper publisher. He is currently at work on his fifth book. He also publishes helphealthcare.wordpress.com

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