05.02.2020 01:08 PM

Why Canada is doing much better than the U.S.

From today’s New York Times. Short version:

• Canada has public health care

• Canadian hospitals are publicly managed and coordinated

• Canada has had effective leadership that works cooperatively, not competitively

Massachusetts, the previous home of Professor Berman, has a population of 6.8 million and British Columbia has slightly over five million residents. But the toll of the pandemic on the two areas has been significantly different. As of Friday afternoon in Massachusetts, there have been more than 62,000 reported cases and 3,562 deaths, or 52 fatalities for every 100,000 people. In B.C., there have been just 2,112 reported cases and 111 deaths or just two victims for every 100,000 residents.

Professor Berman cautioned that those numbers reflect a wide variety of factors outside the medical system like the demographic makeup of different cities and regions.

But he noted that near his old office at Harvard “there must be thousands of the world’s best hospital beds and there are three top international top hospitals within a couple blocks.” So with resources like that, why is there such a great disparity with British Columbia?

Part of the answer, for Professor Berman, can be found in how hospitals are funded and managed by the public health care systems of Canadian provinces.

“The kind of system we have in Canada — and I think in British Columbia we have a pretty well-run version of it — allows the public health authorities to essentially commandeer the hospital system. It’s a command and control thing, it’s not a coordination thing,” he said.

In the United States, Professor Berman said, hospitals are largely private institutions without any overall control.


  1. Nick M. says:

    For the past month, I am now of the belief that the Government of BC (not necessarily the government of the day) and its bureaucracies are the best managed in the country.

    This Province never seemed to have debt issues facing other provinces in the last 30 years. ( Though they had one very unpopular government in the last 30 years.)

    Just glancing at the Covid cases in the BC Provincial Prisons in comparison to the Federal prison in BC is good evidence of that.

    • Nick M. says:

      I believe BC has and is running their bureaucracies better than the rest of Canada, as it has consistently held a good balance sheet.

      It seems like you are not happy with BC governments Big Ideas and their vision.

  2. The Doctor says:

    I find it interesting what the health economist says about the US private hospital system and its incentive to have hospital beds full for revenue maximization purposes. That is, basically, the same business model as the hotel industry and the related resort industry, i.e., the greatest sin possible is to have an empty/cold bed.

  3. Gilbert says:

    Canada is doing well compared to the US. But compared to Australia and New Zealand, Canada is not so great.

    • Being close to the US is a disadvantage in this case.

    • Walt says:

      A few other good comparisons.

      Canada (98 deaths per M) is doing worse than Germany (83/M) – even though Germany’s neighbours are worse than USA.

      If you look at the Republican States – they are actually better than Canada (92 deaths /M vs. 98/M). AUS and NZ are at 4).

      If you drew a 100 mile radius around New York – the USA rate drops in half. Also, the USA also has a 200+ year history of rebelling against gov’t imposed rules.

      • The Doctor says:

        On top of that, even talking about Canada as some sort of monolith is potentially quite misleading. Quebec, for example, got hit quite hard, certainly the hardest per capita. Saksatchewan and Manitoba not so much. BC probably does deserve some kudos because it’s the third most populous province, contains the country’s third-largest metropolitan area, has an international airport that’s basically a huge pipeline to China, and yet BC’s per capta deaths are comparatively low.

        • Walt says:

          Funny I say a poll today of the largest 6 provinces and which think their Premier is doing a good. job.

          The worst 3 were the Provinces with the fewest numbers of death (per population), and the top rated Premier was the one with the highest number of deaths.

          It’s hard to understand public opinion.

          • Fred from BC says:

            “It’s hard to understand public opinion.”

            Isn’t it, though?

            For example, I just read that if you remove Quebec (or is it just Montreal?) from the equation, Canada’s infection and mortality rates are cut in half. Scary…

  4. Dave H says:

    I really don’t follow the reasoning in this article. How does the quality or the funding or the management of hospitals have anything to do with the discrepancies in the number of COVID cases between BC and MA? Hospitals don’t see COVID patients until they’re already sick. People contract COVID based on a lot of factors, mostly related to the behaviour of the population in practising good hygiene behaviours and isolating themselves. You could argue that governmental intervention in shutting down business and keeping people at home played a role, but not the hospitals.

    Where the hospital system can affect the statistics could be in the death rate, and how many COVID patients recover, but not so much in how many people catch it in the first place. Incidentally, according to these numbers, MA (5.7%) and BC (5.3%) have about the same percentage of deaths among reported COVID cases.

  5. Yet Another Calgarian says:

    A few more probable causes on top of better health care because by the time you end up in the hospital on a ventilator its too late.

    Canada has better social cohesion. We obey the rules better than the Americans do.

    Population density is way way lower than on the East coast of the US. This is also one of the main explanations for the difference between California and New York’s number of cases. BC has a population density of 5 per square kilometre while Massachusetts has just under 900 per square mile.

    Lower rates of comorbidities in Canada such as hypertension, obesity and type II diabetes.

    • Fred from BC says:

      “Canada has better social cohesion. We obey the rules better than the Americans do.”

      That’s a really diplomatic way to say that we’re much more deferential to authority than the average American. No country in the world values their individual rights and freedoms more than they do.

  6. Yeah, what a sight it truly was to see Americans finest on the steps of the Michigan Capitol trying to quite deliberately intimidate the female governor. They looked so cocky and proud holding their best assets…trouble is, all of them forgot to bring a ruler.

    • Fred from BC says:

      ” trying to quite deliberately intimidate the female governor. ”

      What does her gender have to do with anything? She was acting like a tyrant, to these people. They would have been there even if she was a man.


      That’s the type of comment I would expect from Bill or Derek or one of those types, not from you.

      • Fred from BC says:


        (sorry Ron, that was harsher than I intended. Sometimes I forget who I’m talking to…)

  7. Tod Cowen says:

    No, it’s not the hospitals. We could have given Governor Baker control over all of the hospitals in the state, and it would not have mattered. The system in eastern Massachusetts was not overwhelmed, and as of yesterday 51% of ICU beds were occupied. The damage is done well before sick people arrive at Mass General.

    The difference in outcomes probably comes from at least three other factors:

    1) Density. We have about 6 million people in Massachusetts, and about 5 million of them live close to Boston. Not like BC. More like TO south of the 401.

    2) Yanks. Don’t tell us what to do. You would not believe the arguments on our local community site about masks. (And I live in Cambridge.) Liberals are just as allergic to authority as anyone; we just write longer posts, and reference studies from Denmark. But we still won’t listen to common sense, if it’s coming from the government.

    3) Inequality. This is probably the biggest, and saddest, factor. Death rates for people of color are higher. In Massachusetts, people who aren’t white are much poorer, more likely to have relevant comorbidities, and less likely to have access to regular medical care. When people of color finally get to the hospital in this commonwealth, they’re probably much sicker than wealthier white folks.

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