VANCOUVER, British Columbia - Last month the Ontario government announced that it was entering into a contract with private U.S. health care providers to deliver essential cancer treatments to Canadians. Under the terms of the agreement, Ontario will spend a total of $20.1 million to buy radiation therapy for patients who would otherwise have to face unacceptable waits for treatment. U.S. suppliers were said to be competing aggressively, even cutting their costs to attract the business.

Well, how come the Canadian system, long the health-care lodestone for political wannabes, is relying on the greedy, private, for-profit U.S. health care system? Is this a leading indicator that the Canadian system is approaching some sort of crisis?

Well, first of all, this is not new. Canadians have been purchasing health care service in the U.S. for at least 15 years. In the early 1980s, cardiac-bypass surgeries were regularly purchased from U.S. hospitals by Ontario residents. In those days the Ontario Health Insurance Plan was still pretending to be a real insurance program and actually paid the full cost of such procedures. But the trickle of emigrant patients soon turned into a flood and the Ontario government changed the rules. They now only pay the Ontario “cost” of such procedures. It doesn’t matter that the government-determined cost was an arbitrary allocation of an incomplete set of actual costs.

In other provinces, like British Columbia, it was the provincial government itself which initiated the purchases of services. Initially, as in Ontario, it was for cardiac-bypass surgeries that the government went shopping.

For the past decade, the most frequent treatment purchased by the government of British Columbia has been radiation treatment for prostate cancer. Wait times became so lengthy that patients in one city actually formed a Society for those Awaiting Therapy for Prostate Cancer. The government responded by purchasing treatment in the small border town of Bellingham, Wash. In some cases the providers are former Canadian doctors who are not permitted by law to sell such services to Canadians within Canada.

The prostate cancer treatment problem is part of a general cancer therapy deficiency that was brought to light in a 1993 comparative study of waiting times for cancer therapy centers in Canada and the U. S. by Dr. Bill Mackillop, Head of Radiation Therapy, Kingston Regional Cancer Center in Ontario. Since the taxonomy of cancers is highly refined, it is possible to say with some confidence that the comparatives were indeed comparable. The findings were devastating.

First, Canadian patients were waiting an average of three times longer than patients in the U.S. for treatment. This varied from 17 days for bone metastases to 44 days for breast cancer. The comparison was made for government cancer treatment centers in both countries; thus it compared “free” cancer treatments in both countries. Dr. Mackillop, a determined advocate for Canadian-style socialized medicine, pointed out that the problem was not only a shortage of treatment centers operating at sufficient capacity. Indeed, Dr. Mackillop noted that there were serious staffing shortages and no prospect that sufficient staff could be trained.

It is possible to count the number of patients who are kept waiting but more difficult to count those who have prematurely died or have failed to achieve possible remission. As Dr. Mackillop’s study showed, not only were Canadian patients kept waiting much longer than patients in the U.S., they were also kept waiting one third longer than their doctors thought was clinically reasonable. As an illustration of another subtle effect that socialized medicine can have, the waiting time that Canadian doctors thought was clinically reasonable was from 33% to 56% longer than U.S. physicians thought was reasonable.

Nevertheless, when Dr. Mackillop was asked by a U.S. congressional committee studying health care what he would do if he had cancer, he quickly replied, “I would go to Buffalo or someplace else in the U.S. to get prompt treatment.” When asked whether he supported the continuation of a Canadian-style health care system, he replied that he did. Such contradictions are common in Canada.

Cancer therapy is not the only area where Canadians are waiting longer than is clinically reasonable. In fact, as the annual Fraser Institute Survey of Hospital Waiting Lists shows, protracted waiting for medical care is now the norm. The weighted average wait (weighted across the various surgical interventions) for surgery in Canada is 6.8 weeks. And, that wait begins only after the patient has been seen by a general practitioner and is referred to a specialist. The wait to see the specialist is a further 5.1 weeks.

If the patient needs diagnostic assessment using a sophisticated scanning device there may he an additional wait. For an MRI the current wait varies from 3.7 weeks in New Brunswick to 11.1 weeks in Ontario. The main implication about this is not the shroud waving conclusion that more Canadians die because of it. In fact, Canada’s life expectancy figures compare, quite favorably to other countries. The real implication is that the quality of life is steadily eroding - especially for the elderly, who find that they cannot get reasonable access for the hip replacement or the angioplasty or the cataract surgery they require.

And it’s not as though the political process is indifferent to the plight of those affected. In fact, the most recent Canadian federal budget was dubbed the health-care budget by Finance Minister Paul Martin -  who coincidentally is seeking to be prime minister. Billions more will be added to health care spending to alleviate the waiting-list problem. And so, you might think, the problem will be solved.

Not quite. A six-year Fraser Institute study across the ten Canadian provinces shows that changes in health-care spending have not been very successful is changing the hospital waiting times. In fact, the prediction is that the billions of new spending will only reduce surgical waiting times - which, remember, average 6 weeks - by a maximum of 3 days.

Billions in new spending won’t change the outcome because before it gets to the patients’ needs it has to go through the provincial governments, hospital bureaucrats, health care support workers, physicians, nurses and technicians. And, none of the intermediaries are driven by patient outcomes.

Instead of throwing more money at it, the Canadian government should be asking why the Canadian system, in spite of being the world’s second most expensive, is constantly producing shortages of care while the U.S. system is producing a surplus for use by Canadians.

Mr. Walker is the executive director of the Fraser Institute in Vancouver.