To critics of the American health care system, Shangri-la is not a fantasy but a shimmering reality, though it goes by another name: Canada.
Any debate on health care eventually arrives at the point where one participant says, "We should have what Canadians have. Free care, universal access and low cost who could ask for more?"
Well, plenty of people could ask for more starting with the Supreme Court of Canada. This past week, ruling on a challenge to the health care in the province of Quebec, the court sent a clear message south: Don't believe the hype.
The program, said the court, has such serious flaws that it is violating constitutional rights and requires fundamental change. And the flaws, far from being unique to Quebec, are part of the basic structure of Canada's health care policy.
No one doubts that the American model has serious defects, particularly rising costs and lack of access to medical insurance. But anyone who thinks the Canadians have come up with a magical solution is doomed to disappointment.
The dirty secret of the system is that universal access is no guarantee of treatment. Sick Canadians spend months and even years on waiting lists for surgery and other procedures. In 1993, the average wait to see a specialist after getting a doctor's referral was nine weeks. Since then, according to the Fraser Institute of Vancouver, it's increased to 18 weeks.
The typical patient needing orthopedic surgery has time to get pregnant and deliver a baby before being called. The Supreme Court cited the testimony of one orthopedic surgeon that 95 percent of patients in Canada waited over a year for knee replacements with many of them in limbo for two years.
In some cases, the delay lasts longer than the person enduring it. Or as the Supreme Court put it: "Patients die as a result of waiting lists for public health care."
Not only does the government subject its citizens to painful and even fatal delays in the public system; it also bars them from seeking alternatives in the private market. You see, it's illegal for private insurers to pay for services covered by the public system.
That policy is what forced the Supreme Court to order changes. "The prohibition on obtaining private health insurance," it declared, "is not constitutional where the public system fails to deliver reasonable services."
The usual story we hear is that the health care system next door provides first-rate care to all, at low cost. The realities dangerous delays, bloated expenditures and mediocre results are not so appealing. American liberals may not welcome evidence that the single-payer model works far better in theory than in practice. But for that, they can blame Canada.