Do Americans go to Canada for health care?

A WSJ reader suggests not:

It is easy to refute the claim in “Sicko” that the Canadian health care system is superior to the U.S. one. It is simple for citizens of either country to cross the border for health care, but no Americans are eager to get care in the socialized Canadian system. The traffic seeking health care is all in the other direction.

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  • MLO

    Metro Detroiters go to Canada to get eye surgery done. It is cheaper and their practices have been around a lot longer. I’ve even heard of folks going to Canada for other things – like Dentistry.

    It is more common to have Canadians using Canada’s Health Care system within American hospitals like Henry Ford or U of Michigan to treat certain illnesses. Those tend to be cases where you are looking for a specialist within a specialty.

    It really depends on what it is someone is talking about. Medical tourism is very common in the border states because for a number of elective procedures it is cheaper to have it done in Canada than the USA.

    Pax,

    MLO

  • Evan

    Americans go to both Canada and Mexico frequently for medical care. It’s just that they buy prescriptions rather than seeing a doctor.

    But medical tourism is medical tourism. The numbers of Americans going to our neighbors for medical reasons is indeed very high.

    Of course I’ve made this point before on this blog but it is universally forgotten.

  • Matthew

    Evan,

    Taking advantage of abusive government price controls across the border by mail is different than traveling for medical procedures that simply aren’t available in a timely fashion in your country of origin.

    Stay on topic, please. Your point wasn’t forgotten; it’s just that everyone else in the room recognized that it’s irrelevant. Try to keep up.

  • Evan

    Matthew,

    I am unaware of any mail order pharmacies in Mexico.

    Second, what you consider to be abusive government price controls in Canada, Canadians consider standard business sense.

    Again, please show me how medical tourism for prescriptions is fundamentally different than any other medical tourism, and then show me that more Canadians and Mexicans come to the US for medical reasons than Americans go to Canada and Mexico for medical reasons.

    I am also completely ignoring surgical and dental tourism to Mexico but I’m sure you think that’s due to some government conspiracy as well, Matthew.

  • Anonymous

    The eye surgery has nothing to do with any health care “system”.

    The eye surgery in question is completely fee-for-service. You get that in the USA as well.

    $XXX – dollar LASIK, just heard about the “Summer Special” on the radio today.

    Well, in a way, there’s a health care “system” involved, in that somehow these practices can offer a cash service cheaper than a USA center doing the same.

    Like the medical tourists going to India and Singapore, etc., maybe there should be more free-standing clinics in Canada and Mexico.

    I wonder about USA Indian reservations. They have ways of exempting themselves from certain laws. Casinos for example.

    I wonder if they can use that in their favor, to ignore laws and regulations that add cost but no value.

  • Matthew

    Evan,

    Since dictionary.com is apparently not accessible from your computer, I’ll help you out. Every definition of the word involves travel, not mailing pieces of paper. There’s your fundamental difference (or at least one of them). End of debate.

    If you’re relying on the Canadian government for a definition of standard business sense, then you’re already far too far gone to be helped. That’s a statement so far beyond parody that no one could top it.

    Thanks for trying, though.

  • Matthew

    You did give me a great money saving idea, though; I think I’ll order some rocks from Arizona. Then I’ll have toured it! It’s pretty much the same thing as going there, right?

    yeah…

  • Evan

    Matthew,

    I know this is difficult for you to grasp, but people cross the border to go buy pills. They do it in their cars, or they take a bus and they buy the pills in stores in the other countries and come back to the US with the pills. They don’t just use mail order pharmacies.

    I know it’s hard being as wrong as you were about something, but you really ought to just accept that you were wrong. You also said nothing about MLO’s comments which also shows you know that the data don’t support your position.

    In case you need some actual data, as you seem not to have researched the matter much, here is a website you can review as I’m sure Google is disabled on your computer. Dictionary.com seems to work fine on mine and it says travel involves things like getting on buses and trains, like the people in the article referenced are doing:

    http://www.cmaj.ca/cgi/reprint/162/13/1869.pdf

  • Anonymous

    Personally, I have confidence in a brick-and-mortar pharmacy where I can see the place is clean, etc.

    I would understand people having confidence in a clean, spacious pharmacy in a Mexican bordertown, clearly catering to Americans (English-speaking staff and all that).

    One might, maybe, have less confidence in a Mexican mail-order pharmacy, where you don’t know where the medicine came from.

    Graymarket medicine is more common than one might think, outside the USA that is.

    Same with the Canadian pharmacies. When the mail-order was a side business of a real pharmacy, and then a side business of Canadian pharmaceutical wholesalers.

    Now the “Canadian pharmacy” is a broker working on a worldwide basis. Demand is larger than the country can handle. The brokers get the drug from outside the country. Commonwealth nations to start. Now, just about anywhere.

    My patients say their drugs from Canadian mail-order pharmacies have return addresses from all over the world.

    I had a patient show me his mail-ordered drug from a “Canadian” pharmacy. The company was Canadian (or at least a Canadian mail drop, who knows). The pill bottle was written in Turkish. Saw it myself.

    There is a Canadian equivalent of the FDA, assuring quality of medicine “sold to Canadians”.

    I would question if their authority applies to a broker who takes money from a US citizen, forwards the prescription to a third country, from where the drug is shipped to the USA. The pills in question were never physically in Canada.

  • MLO

    I think a lot of non-border residents don’t understand just how intertwined the economies are – Congress shows that. In Metro Detroit, Windsor is, for all practical purposes, a suburb of Detroit. I know, it is in Ontario, Canada, but economically it is more tightly tied to Southeastern MI than it is to other parts of Canada due to the manufacturing base and trade.

    A large portion of people cross the border as a normal part of their workday or casual nights out – even post-9/11. Clinics for certain procedures not yet available in the US (LASIK was once like that) are advertised on CKLW all the time. If you are in Canada and need to pick up a drug, you do because the pharmacy is there.

    With the current exchange rate it isn’t as attractive as it used to be, though.

    Pax,

    MLO

  • Matthew

    Evan,

    I certainly can admit when I’m wrong, and I’m happy to do so in this case, although my error isn’t quite the one you’re going to want it to be.

    I thought we were talking about medical tourism, since that’s the term you used earlier. If you look, that term is almost never used to describe driving across a border to simply buy a product and return. It’s certainly not used in the article you attempted to cite as evidence. It’s used to describe traveling to obtain surgery, procedures and care. I know you won’t take my word for it, that’s understandable, but google the term “medical tourism”, or pull it up on Wikipedia. You won’t find much, if anything, on traveling simply to purchase any good, drugs or otherwise.

    So my mistake was to assume you were using the same definitions as most of the rest of the world, as opposed to making your own up as you went along. So, for that error, I apologize. In the future, if you’re going to redefine commonly used terms to suit your arguments, please let me know in advance so I can avoid that sort of misunderstanding in the future.

    To take your argument a step further, I guess we’re going to have to include people who are running to British Columbia to pick up high grade marijuana; after all, it’s a medicine, so I guess that’s part of EvanPedia’s definition upgrade. And since that’s the case, you’re absolutely right, medical tourism is far bigger going out than in, for the USA. We won’t even start on what people drive to Mexico to bring back across the border.

    I think the main thrust of the original post was that people seeking health care, not just drug purchases, do tend to come here for procedures that are necessary but either completely unavialable or hidden behind a mile long waiting list. That point still stands.

  • Evan

    Matthew,

    Assuming the main thrust is people are crossing borders seeking health care, you have been given many examples of just that happening from the US to Canada and Mexico in this comment thread. People go to both places for surgery, dental care and others. I know of no study that quantifies this data accurately.

    Therefore, the article is merely an assertion, and assertions made without evidence can also be dismissed without such.

    On the other hand, if you can discover some health care system that doesn’t use prescriptions as a mainstay of its medical care, please alert me to that fact. Until you do, the travel across borders remains tourism with a medical cause, regardless of how you flog your various definitions. The article cited certainly considers it a form of tourism since it uses that word in the title. Perhaps you would make a fine distinction between “surgical tourism” which would include your definition, and “medical tourism” which would include mine but it seems a distinction without a difference when it comes to comparing one system to another.

    Drugs are drugs, and if you think there’s a pharmacological difference between licit and illicit ones I’m curious how you parse that, especially as many states in the US consider cannabis a pharmaceutical under their state laws.

    If the point of your final paragraph is that surgical tourism goes one way, that’s fine and may be true, but it’s false to argue, as the article does, that patients only go one way for medical care. They go both ways and if we knew some actual numbers comparing the two it might be a little less clear.

  • Anonymous

    Several years ago the Canadian province of Ontario which is a neighbor of Michigan had to re-issue O.H.I.P. cards (medical insurance cards) because there were so many phoney cards being used by Michigan residents. You can’t use the Canadian health system without a card.
    There are several world reknowned Hospitals in Canada starting with Sick Childrens in Toronto.
    The fact that the Canadian system is not driven by the greed of corporations, insurance companies and executives is enough to declare it superior. Canadians are proud of their health care system and would not trade for a corporate system, the short comings of a profit driven system far out weight the benefits.
    Every country that finishes ahead of the U.S. in quality of life surveys has government run health care.
    As far as Canadian Government business sense, Canada has posted budget surpluses for the past eleven years ( its probably twelve now ) while cutting taxes. What other North American country can claim that?

  • Evan

    Matthew,

    OUCH!

    That one must have left a mark.

    Good luck with your response.

  • Matthew

    Evan,

    I think you missed the point. I’m saying that there is no pharmacological difference between licit and illicit drugs, and the point is that I’m not parsing it. If we accept and use your definition of medical tourism rather than the commonly used one, then you’re absolutely right. If we use the commonly accepted definition, then your argument doesn’t work. It’s just that simple.

    The anonymous poster makes the predicatble error of thinking that by criticizing the Canadian government, I’m implying that the American government is the role model for fiscal sanity. I never said or implied that, and completely agree that the business sense of the American government is no better than Canada’s. Had you attempted to use the American government as your example earlier in the thread, I would have said precisely the same thing.

    So, had I made the argument that anon was arguing against, then it probably would have left a mark. But I didn’t. I’m disappointed but unsurprised that you missed the nuance.

    The other part of the anon comment may be valid, but doesn’t apply to this argument. Are we now including fraud as part of the definition of medical tourism? What, exactly, is not included in that term under your ever expanding definition? Do tell.

  • Evan

    Matthew,

    Odd the twists and turns that you are coiling up into.

    The original post says that there is nobody going from the US to get any medical care in Canada at all.

    Now, after all your qualifications and gesticulations, you’re trying to say that that’s not what it really says, but that it says people come from Canada to the US for expensive procedures only. Except to quote the original claim,

    “The traffic seeking health care is all in the other direction.”

    Which the subsequent comment thread has shown to be hogwash. And you sir, have had to qualify the original statement so much that now you are claiming it only states people come here for expensive surgical procedures but it doesn’t. It says that Canadians and Mexicans ONLY come to the US for HEALTH CARE and there are NO Americans going to Canada or Mexico for HEALTH CARE.

    Drugs licit and illicit can be used to treat medical problems, people can be so dissatisfied with the US system they are willing to commit fraud to go somewhere else. But as far as you’re concerned if the US system has expensive surgical procedures wealthy Canadians want, we’re the best!

  • Matthew

    The fact that you’re taking the post to mean that literally no one is going the other way tidily sums up your lack of perspective on the issue.

    If the author genuinely meant his comment in the literal sense you seem hellbent on reading into it, then I’ll agree with you wholeheartedly. Clearly, that’s not what he meant. I (along with most anyone else other than you reading it, I’m sure) understood that it wasn’t meant literally. But if you find the poster and discover that he did mean it literally, then I’ll openly admit that I misread it and will agree with you.

    You have a habit of missing nuances in things you read. It’s something that might behoove you to work on in the future.

    Thanks for the time, it’s been interesting. I’ve taken at least one valuable lesson from this (read EvanPedia before discussing issues with you, although it does change rapidly). I hope you’ve learned to read more carefully and argue against the points being made, rather than the ones you wish were being made.

    Best!

  • Mike

    I don’t think drugs and surgery are close.

    Drug companies control high costs of drugs here. Pfizer doesn’t have to compete with anyone for Viagra (well, Levitra and Cialis aren’t exactly the same, and anyway, they are also in on the game. So couterfiet drugs across the border are just ways to get around patent protection, etc here in the US.

    Surgical procedures aren’t set priced. They may be expensive, but each surgeon probably charges something different depending on the state, facility, etc. So if a surgeon in Canada is cheaper, that doesn’t violate any set pricing for intellectual property. It’s simply a service.

    So drug shopping and surgery shopping are not comparable to my mind.

  • peter

    Sure Americans come to Canada for healthcare! A few years back, all of us in Ontario were issued new health cards – with extra security features – because there were so many Americans who had fraudulently got hold of the old ones: Toronto police reported that an Ontario health card was selling for about $1000 on the street!

  • Anonymous

    ontario hos. ins. o.h.i.p. card.
    gold rated by ont. gov. means no checks! silent auction

  • JonnyG

    Uh, I don’t know if anyone has pointed out the obvious major fallacy of this “argument” yet, so I will.

    Few Americans come to Canada for treatment because Americans don’t pay Canadian taxes to cover their medical expenses within our socialized system.

    So if they did come here for treatment they’d most likely have to use our private sector health care providers, except in emergencies when they’d still be covered in the public sector.

    In order to receive free care you need to have a Health Card issued only to residents of Canada, so if you aren’t Canadian you shouldn’t have a health card or access to free care since you haven’t paid in to it.

    I swear some people are just born idiots.

  • John Murphy

    First of all according to Princeton University health economist Uwe Reinhardt, single-payer systems are not “socialized medicine” but “social insurance” systems for medical care.

    Secondly, most Canadians touch American hospitals with a ten foot pole. Most of those who do go to the US, think their condition is worse than their physicians think their condition is, If you’re seriously ill, you get care in appropriate time.

    From personal experience….. (1) hemi-nephrectomy..4 day wait, 2 of which were for cysto and IVP etc.; (2) from GP to ortolaryngologist to surgical removal of a laryngeal lesion and vocal cord reconstruction.. a total of 16 days; (3) bypass surgery …2 1/2 days…..

    Shona Holmes, Canadian in the “Patients United Now” ads went to the US, because of what she describes as a “brain tumour” from which she “would have died” which actually was a Ratke’s Cleft Cyst, a non life threatening benign cyst.
    Most Canadians who go to the US for treatment have similar misperceptions of their own condition.

  • John Murphy

    Sorry, typo… first line second paragraph should read…

    Secondly, most Canadians wouldn’t touch American hospitals with a ten foot pole.

  • Grace

    If the Canadian health care system is as bad as some people are trying to get us to believe, not one of the Canadian snowbirds who live in my neighborhood down here in FL in winter would ever give it up. NOT ONE. If they didn’t like it then why not change it, get rid of it? They could vote it out if they wanted to. Everybody is covered, Canadians have longer lifespans than we do and are healthier. When people were going up north to get cheap meds things changed down here, Walmart has $4 prescriptions and more doctors are prescibing generics. There are very few Canadians who come down here for medical care, only those who don’t want to wait and also guess what? If you need lifesaving treatment and it’s a long wait time, the Canadian government pays for you to go somewhere else for treatment. They pay for it. You don’t!

  • David

    I can only speak of one personal experience I had. When my cousin was in her late 20s she was diagnosed with a brain tumor. Her insurance carrier refused to pay for treatment. After long and excruiating turmoil she emigrated to Canada. Thankfully, she recieved great treatment and continues to teach in Canada 30 years later. So at least one person I know went to Canada for treatment.