Canadians are remarkably masochistic. Year after year, the United Nations reports that Canada is the most livable country in the world; yet we seem to discuss nothing but how to dismember the elements that makes it so. Canada has one of the world's most successful health care systems. Yet we cannot shake the belief that, despite all evidence, the grass is greener south of the border. Although our system is fundamentally sound, we dwell on its problems and insist on looking for magical fixes from the Americans, whose health care system is generally recognized as being among the least satisfactory in the developed world.
The truth is, there is no shortage of good news about the Canadian health care system; why we hear this so rarely is a matter that should concern us.
For example, Canadians are healthy. On average, we are among the healthiest people in the world, and we are becoming healthier. Wide variations exist by region and social group, and we rightly hear much about these. However, Canadians' general health is high and rising. In particular, on the standard measures of life expectancy and infant mortality, we outperform the United States, which records eight infant deaths per thousand live births, placing it in the same league as the Czech Republic and Greece; the Canadian rate is six per thousand. Canadians also live longer, and our advantage is growing. From 1990 to 1995, the gap in life expectancy between Canadian and American males grew from 2 to 2.8 years; for women, it went from 1.6 to 1.9 years.
The widening gap in life expectancy, with Canada pulling ahead, is true not only for the entire population but also for the elderly. Even the one group of Americans with access to Medicare, those 65 years and older, find their health improving more slowly than do the elderly of any other major country. Elderly people living in the United States only gained three years of life expectancy between 1960 and 1996 (going from 14.3 to 17.3 years), whereas the median gain for the elderly in countries that belong to the Organisation for Economic Development and Cooperation was 3.4 years. Canadian elderly also experienced a 3.4 year increase in life expectancy over this period (going from 14.9 years to 18.3 years).
Different health care systems are not the whole, or even the principal, explanation for Canadians' better health. The American social environment is more brutal for the less successful. In simple economic terms, for example, everyone knows that Americans enjoy higher incomes, on average, than do Canadians. Little known, and rarely reported in either country, is the fact that in the United States a much larger-and growing-proportion of total income goes to those at the very top of the income distribution. Thus, although the rich in America are much richer, the poor are much poorer than their Canadian counterparts. In 1995, although the top 20 percent of U.S. families were substantially better off than their Canadian counterparts, most of the rest-roughly half of all families-were absolutely worse off than the corresponding socioeconomic groups in Canada. The difference is largely attributable to Canada's structure of tax-financed social programs.
