Critics of the Canadian health system (particularly from the USA) tend to bring up rationing.

“I’m 59. In either Canada or Great Britain, if I broke my hip, I couldn’t get it replaced.”

Rep. Roy Blunt (R-MO), 8/12/2009

Blunt was pants-on-fire wrong about the Canadian government explicitly denying hip replacements to 59-year-olds.

“At least 63 percent of hip replacements performed in Canada last year and two-thirds of those done in England were on patients age 65 or older. More than 1,200 in Canada were done on people older than 85.”

St. Louis Post-Dispatch, 8/16/2009

But the real problem is how long he would have to wait to get it. An editorial by The Toronto Sun spells out the problem.

One of the reports, by the Canadian Institute for Health Information, found that among other medical procedures, 30% of patients across Canada in 2018 requiring hip or knee replacement, or cataract surgery, did not have their procedures done within recommended wait times.

But that’s only half the story because the recommended wait times for hip and knee replacement are themselves excessive — 182 days or six months — and 112 days or almost four months for cataract surgery.

…In reality, Canada’s health care system could not function without excessive wait times for medically necessary care, as a way of rationing health care to Canadians.

The Toronto Sun, 3/30/2019

According to a Kaiser Family Foundation analysis of OECD data, Canadians spend less than half of what Americans spend per capita in total healthcare costs. And, yes, some of those savings come from reducing the overhead from multiple payers, but some of it is also from rationing.

The Canadian government places limits on the number of medical facilities built in a given area (sort of like certificate-of-need laws in some states), and their ratio of primary care physicians to specialists is much higher than it is in the USA. The Canadian government isn’t so much “pulling the plug on Grandma” (as Senator Chuck Grassley might say) or convening “death panels” (as former Alaska Governor Sarah Palin might say), but they are engaging in implicit rationing.

We Americans ration healthcare too, but we do it based on each individual’s ability to pay the out-of-pocket expenses for a given medical procedure. People with rich health insurance benefits and/or deep pockets get much better access to healthcare than people with fewer resources. So, Rep. Blunt with his excellent benefits could get a much faster hip replacement in the USA than in Canada, but an uninsured or underinsured person might never get it…or go bankrupt.

And affluent people get more medical facilities and physicians closer to them. Just as a real-world example, Exit 210 of Interstate 69 in Fishers, Indiana hosts two competing hospitals within sight of one another…0.9 miles apart. A little to the west in Carmel, those same two hospital chains built hospitals 2.6 miles apart along U.S. 31. Indiana has no certificate-of-need laws, so these two chains are building hospitals so close together — just like a CVS and a Walgreens — because Hamilton County is the richest county in Indiana, and they’re competing for those large private health insurance dollars. There are currently 10 hospitals in Hamilton County, and possibly two more on the way.

Meanwhile, Fayette Regional Health System in rural Connersville, Indiana found itself in bankruptcy in 2018 and nearly closed before being bought out by Reid Hospital, a larger system based in the next county over. It is the only hospital in Fayette County, Indiana. It simply wasn’t bringing in enough revenue from the area’s heavy Medicare and Medicaid populations to stay afloat on its own…something single-payer advocates need to consider.

(Fayette Regional Health System has since been renamed Reid Health Connersville.)

There is no perfect health system. There are always tradeoffs to make. At least in Canada, the misery is spread equally.