As omicron sweeps through North America, the U.S. and Canadian responses couldn’t be more different. U.S. states are largely open for business, while Canada’s biggest provinces are shutting down.

The difference partly comes down to arithmetic: The U.S. health care system, which prioritizes free markets, provides more hospital beds per capita than the government-dominated Canadian system does.

“I’m not advocating for that American market-driven system,” said Bob Bell, a physician who ran Ontario’s health bureaucracy from 2014 to 2018 and oversaw Toronto’s University Health Network before that. “But I am saying that in Canada, we have restricted hospital capacity excessively.”

The consequences of that are being felt throughout the economy. In Ontario, restaurants, concert halls and gyms are closed while Quebec has a 10 p.m. curfew and banned in-person church services. British Columbia has suspended indoor weddings and funeral receptions.

The limits on hospital capacity include intensive care units. The U.S. has one staffed ICU bed per 4,100 people, based on data from thousands of hospitals reporting to the U.S. Health and Human Services Department. Ontario has one ICU bed for about every 6,000 residents, based on provincial government figures and the latest population estimates.

Of course, hospital capacity is only one way to measure the success of a health system. Overall, Canadians have better access to health care, live longer than Americans and rarely go bankrupt because of medical bills. Canada’s mortality rate from Covid-19 is a third of the U.S. rate, a reflection of Canada’s more widespread use of health restrictions and its collectivist approach to health care.

Still, the pandemic has exposed one trade-off that Canada makes with its universal system: Its hospitals are less capable of handling a surge of patients.

The situation is especially stark in Ontario. Nationally, Canada has less hospital capacity than the U.S. has, as a proportion of the population. But even among Canadian provinces, Ontario fares the worst. It had one intensive-care or acute-care bed for every 800 residents as of April 2019, the latest period for which data is available, according to the Canadian Institute for Health Information. During the same period, the average ratio in the rest of Canada was about one bed for every 570 residents. (The state of New York has about one inpatient hospital bed per 420 residents.)

That leaves the province’s health care system in a precarious position whenever a new wave of Covid-19 arrives.

“The math isn’t on our side,” Ontario Premier Doug Ford said Monday as he announced new school and business closures this week to alleviate pressure on the province’s hospitals. The province has nearly 2,300 people hospitalized with Covid-19.

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