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Comment & Response
November 19, 2019

Canada’s Single-Payer Health Care System—Reply

Author Affiliations
  • 1Hunter College, City University of New York, New York
JAMA. 2019;322(19):1922-1923. doi:10.1001/jama.2019.14406

In Reply Dr McKee’s complimentary and critical comments about Canada’s health care echo those of many Canadians, whose system is, in our view,1 properly structured but inadequately funded. In 2018, Canada spent $5445 less per capita on health care than the United States.

Administrative bloat in the United States—excess spending on insurance overhead and clinicians’ billing-related bureaucracy—accounts for half of the overall disparity. The modest differences in physician income explain little of the cost gap; relative to average wages, US physicians earn only slightly more than physicians in Canada, where net income for surgeons (after paying overhead) was about $350 000 and net income for internists was about $265 000 in 2017,2 and few incur massive educational debt. But clinical services have been affected by constrained hospital budgets that limit operating room time and timely access to some expensive, technologically sophisticated care.