scanners.320 Indeed, there are more CT scan-
many problems and feeling uncertainty
about the future.
ners in the city of Seattle than in the entire
province of British Columbia.321
Canadians may jealously guard their sys-
Physicians are also in short supply.
tem and resist "Americanizing" it, but even
Canada has roughly 2.1 practicing physicians
advocates of universal health care are coming
per 1,000 people, far less than the OECD
to recognize that it does not provide a valid
average. Worse, the number of physicians per
model for U.S. health care reform.
1,000 people has not grown at all since 1990.
And while the number of nurses per 1,000
people remains near the OECD average, that
Conclusion
number has been declining since 1990.322
In addition, although national health care
systems are frequently touted as doing a better
The U.S. health care system clearly has
job of providing preventive care, U.S. patients
problems. Costs are rising and are distributed
are actually more likely than Canadians to
in a way that makes it difficult for some people
receive preventive care for chronic or serious
to afford the care they want or need. Moreover,
health conditions. In particular, Americans are
although the number of uninsured Americans
more likely to get screened for common can-
is often exaggerated, far too many Americans
cers, including cancers of the breast, cervix,
go without health insurance. And while the
prostate, and colon.323
U.S. provides the world's highest quality health
care, that quality is uneven, and too often
Canada has been relatively effective at con-
Americans don't receive the standard of care
trolling spending. The country spends about 9
that they should. But the experiences of other
percent of GDP on health care, a percentage
countries with national health care systems
that has risen only slightly over the last decade.
show that the answer to these problems lies
Relative to average OECD expenditures,
with more pro-market reform, not more gov-
Canadian health expenditures have declined
by 4 percent since 1997.324 That cost control,
ernment control.
Of course, there is no single model for
however, has clearly come at the expense of
national health care systems in other coun-
access to care.
tries. Indeed, the differences from country to
Canadians' dissatisfaction with the prob-
country are so great that the terms "national
lems in their system has been growing for
health care" or "universal coverage" can be
some time. One survey showed that some 59
misleading--as if one collective model shows
percent of Canadians believe that their sys-
how other countries deal with health care
tem requires "fundamental changes," and
and health insurance. Each country's system
another 18 percent believe the system needs
to be scrapped and totally rebuilt.325 Still,
is the product of its unique conditions, his-
tory, politics, and national character. Those
Canadians are reluctant to embrace market
systems range from the managed competi-
reforms that are associated with the U.S.
tion approach of the Netherlands and
health care system--a system that Canadians
Switzerland to the more rigid single-payer
disdainfully reject. As one observer put it:
systems of Great Britain, Canada and
Norway, with many variations in between.
Anxiety about Americanization and the
Some countries have a true single-payer sys-
constantly reinforced strain of national
Universal
tem, prohibiting private insurance and even
pride in Canadian health care coexist[s]
health insurance
restricting the ability of patients to spend their
with considerable uneasiness about the
own money on health care. Others are multi-
actual state of that care. It is as if, when
does not mean
payer systems, with private competing insurers
Canadians look south across the border
universal access
and varying degrees of government subsidy
they swell with pride, but when they
and regulation. Some countries base their sys-
look within they shrink back, seeing
to health care.
33