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Originally published November 24, 2009 at 3:28 PM | Page modified November 24, 2009 at 5:31 PM

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Bruce Ramsey / Times editorial columnist

Canadian health care: free, but not without complications

A hip-replacement surgery in British Columbia tells a story of Canada's medical system.

Seattle Times editorial columnist

An American friend lives in British Columbia with his wife, who just had hip-replacement surgery, paid by the Canadian taxpayer.

In Canada there is universal coverage, though the care itself is limited by squeezes on provincial budgets. Says my friend, "You should hear the Canadians talk. They say, 'We've got an OK system. If it's really serious, they take care of you.' "

And it's free, too, though don't expect always to have the newest technology. You pay in taxes, of course.

Compare "tax-freedom days" — the day of the year in which, if you had to pay all your taxes first, you would be done with them. For Washington, the Tax Foundation calculates that day at April 16; for British Columbia, according to the Fraser Institute, it is June 8.

Of Canada's economic output, 11.9 percent goes to medical care, compared with 17.6 percent in the United States. Canada may be more efficient. It also saves money by making its people wait for things like hip replacements.

Osteoarthritis destroys the hip joint over time. The symptom is pain. My friend's wife appealed to her primary-care doctor in April. He gave her pain pills.

In August she sought out a new doctor. He said she needed a hip replacement right away and referred her to a specialist. She was told the specialist might see her in three months.

She was lucky: He had a cancellation. He approved her for surgery. She was told it would be three months, and to wait for a call from the scheduler.

She didn't want to wait. She was willing to pay — but in British Columbia paying privately is not allowed. In Canada, though not in most other wealthy countries, using your own money is considered queue-jumping, an anti-social act.

My friend didn't care about that, nor will 5,300 other B.C. residents (a Fraser Institute estimate) who will leave Canada this year for medical treatment. Some are emergency cases paid by the government but many are medical refugees.

Hip replacement is a common reason for leaving. The operation, first done in the 1960s, involves cutting off the ball at the top of the thigh bone, replacing it with a metal or ceramic ball, and putting a new lining in the cup on the edge of the pelvis. It takes about two hours.

My friend priced it out, sending his wife's X-rays to providers. Two Seattle-area providers quoted prices around $40,000, though a third, Virginia Mason, quoted $32,000 after examining the patient.

The lowest price was $8,500 at a clinic in India. Others included $17,060 in Quebec (at the only clinic that does private-pay hip replacement in Canada), $21,000 in Belgium, $25,000 in Los Angeles (no overnight stay), and $29,000 in New Zealand, including airfare, room and physical therapy.

She was about to sign up for New Zealand when the scheduler called. Luck, again. The specialist did the surgery earlier this month, and it went well.

The patient's room, however, was a four-bed ward, common in Canada. Two of her roommates were men — she was not happy about that — mixed-gender rooms being cheaper to administer.

The price was right: only $2,100, all of it for an upgrade to a new ceramic hip, which probably will last her lifetime. The older metal-on-plastic technology, which ran a much higher risk of wearing out and causing her trouble, would have been free, courtesy of the government.

Bruce Ramsey's column appears regularly on editorial pages of The Times. His e-mail address is

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