Those are pretty staggering figures and ones that, in all likelihood, underestimate the extent of the phenomenon. The reasons patients offer for engaging in medical tourism run the gamut from direction by their physician, to lack of available resources in their home jurisdiction to excessive wait times prior to an elective procedure.

Have nonemergent medical condition, will travel.

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The notion that even many Canadians believe their own system to be inferior – along, of course, with the specter of lengthy waits for elective procedure – is the salient fact that defines medical care in Canada, at least according to parts of the American media.6 This view is probably a bit overwrought; after all, as we’ve seen, Canada continues to outperform the United States on nearly every global healthcare metric, to say nothing of the many thousands of Americans who regularly travel to Canada to take advantage of more affordable prescription drug prices. But the persistence of medical tourism does speak to capacity and resource-utilization concerns that Canada’s single-payer system has been unable to effectively address.

It stands to reason that an American iteration of a single-payer system would have some of the same concerns, along with many others.7 Presumably, market forces, blunted as they may be, or intelligent top-down governmental direction would eventually solve some of these problems. We could perhaps expect, for instance, a push to recruit more neurosurgeons or that resources would be shifted to areas with high rates of tourism – although, it’s worth asking why similar correction hasn’t yet occurred in Canada. 

But the stark reality is that these are vexing problems that likely lack simple solutions. And a hypothetical American single-payer system wouldn’t have a benevolent neighbor to act as a release valve, as the United States does for Canada. The transition to single-payer, at least for a while, would be a daunting challenge.

Of course, none of this is to say that we shouldn’t pursue something like Canada’s single-payer structure; the promise of a more egalitarian and cost-effective system makes for a worthy fight. And the grass probably is, in fact, greener. But we shouldn’t forget that, if all you have to go by is the North Star, it’s going to be hard to avoid a few bumps in the road along the way.


  1. Lalloo R. Healthcare access and quality index based on mortality from causes amenable to personal health care in 195 countries and territories, 1990-2015: a novel analysis from the Global Burden of Disease Study 2015. Lancet. 2017;390(10091):231-266.
  2. Organization for Economic Cooperation and Development. OECD Health Statistics 2015. Available at: Accessed September 5, 017.
  3. Brautigam T. ‘My heart, my choice,’ Danny Williams says of U.S. Updated February 22, 2010. Available at: Accessed August 30, 2017.
  4. Picard A. Williams’s heart surgery choice was based on ignoranceThe Globe and Mail. Updated March 27, 2017. Available at: Accessed August 30. 2017.
  5. Barua B, Ren F. Leaving Canada for medical care, 2015. Fraser Institute. 2015. March Bulletin: 1-7. Available at: Accessed September 5, 2017.
  6. Druzin R. Crossing the border for Updated August 3, 2016. Available at: Accessed August 30, 2017.
  7. Khazan O. Are you sure you want single payer? The Atlantic. Updated August 21, 2017. Available at: Accessed August 30, 2017.

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