Jewish World Review June 11, 2004 / 22 Sivan 5764
Drs. Michael A. Glueck & Robert J. Cihak
Canada's health system dream turns to nightmare
For decades our Canadian friends and relatives cast pitying glances at their
poor American neighbors who have to pay for heath care while Canada's
medical insurance is "free".
On the other side of the border, Americans like Representative James
McDermott, MD (D-WA) fantasize about importing the Canadian health care
dream to the U.S. so that every citizen has "equal access" to medical care.
But more and more Canadians are awakening not from a dream but from a
nightmare. The results are coming in. After years of government-controlled
health care, the ordinary Canadian patient is noticing his health care
system is ailing badly. Plus it's bleeding money his hard-earned tax
Comparing Canada with other industrialized countries in the Organization for
Economic Cooperation and Development (OECD) that provide universal access to
health care, a study released by The Fraser Institute in May revealed that
Canada spends more on its system than other nations while ranking among the
lowest in several key indicators, such as access to physicians, quality of
medical equipment, and key health outcomes.
The study identifies one of the major reasons for this discrepancy. Unlike
other countries in the study that outperformed Canada such as Sweden,
Japan, Australia, and France Canada outlaws virtually all private health
care. If the government says it provides a medical service, it's illegal for
a Canadian citizen to pay for and get the service privately. In practice,
this means a patient must linger in line for hospital treatment an
average of 17.7 weeks in 2003, according to an annual survey on hospital
waiting list published by the Fraser Institute.
In 1999, Richard F. Davies, MD, described how delays affected Ontario heart
patients scheduled for coronary artery bypass graft (CABG) surgery. In a
single year, for this one operation, 71 patients died before surgery and
another "121 were removed from the list permanently because they had become
medically unfit for surgery;" 44 left Ontario and had their CABG elsewhere,
such as in the USA. In other words, 192 people either died or were too sick
to have surgery before they worked their way to the front of the waiting
One of the reasons Canadians are slow to acknowledge the problems with their
system is that general practitioners have been relatively easy to access and
reasonably efficient at providing everyday services for common complaints,
such as colds, sprains, aches and pains.
As time passes, however, more and more Canadians are confronted by the
halting quality of their system when they face complex and expensive medical
problems. They often cannot get timely or appropriate care for bone
fractures, prompt treatment for cancer, or non-emergency surgery such as hip
replacements. Their doctors complain that they are unable to help them and
the government pleads shortage of funds.
International and Canadian data confirms their concerns. In a 2004 article
in the journal "Health Affairs," Robert Blendon reports an international
survey of hospital administrators in Australia, New Zealand, Great Britain,
the USA and Canada. When asked for the average waiting time for biopsy of a
possible breast cancer in a 50-year-old woman, 21% of administrators of
Canadian hospitals said more than 3 weeks; 1% of American hospital
administrators gave the same answer.
Half (50 percent) of the Canadian hospital administrators said the average
waiting time for a 65-year-old man who requires a routine hip replacement
was more than six months; in contrast, no (as in zero) American hospital
administrators reported waiting periods that long. 86 percent of American
hospital administrators said the average waiting time was shorter than three
weeks; only 3 percent of Canadian hospital administrators said their
patients have this brief a wait.
Canadian physician frustration with their inability to provide quality and
timely care is resulting in a brain drain. According to one poll, one in
three Canadian doctors is considering leaving the country. A doctor shortage
looms, as the nation falls 500 doctors a year short of the 2,500 new
physicians it needs to add each year to meet national health needs,
according to Sally Pipes, a policy expert formerly with the Canadian Fraser
Another casualty of the lengthy waiting periods is Canada's much-vaunted
equal access to medical treatment. Even though medical emergencies allow
some people to jump ahead in the waiting line making others wait longer
a survey published in the Annals of Internal Medicine medical journal
found that more than 90 percent of heart specialists had "been involved in
the care of a patient who received preferential access" to cardiac care
based on non-medical reasons including the patient's social standing or
personal connections with the treating physician.
Luckily, 90 percent of Canadians live close to the border with the States
and can come south to fill in the gaps in their health care system with
American doctors and hospitals.
If the U.S. adopts the Canadian health care dream and it turns into a
nightmare, where will we go for medical services? To Mexico?
These Medicine Men think we already suffer from enough Canadian-style,
centrally-controlled government health care. For example, American
Medicare's slow acceptance of medical innovation, exacting paperwork
requirements, delayed and low payment of claims, and the threat of
overzealous prosecution by Medicare cops are driving doctors out of the
Medicare system. As a result, patients on Medicare find they have fewer
We believe more patient choice such as in the new Health Savings Account
(HSA)/catastrophic insurance options rather than government control,
better fulfills the American Dream of life, liberty and the pursuit of
happiness for all.
Editor's Note: Robert J. Cihak wrote this week's column.
Michael Arnold Glueck, M.D., is a multiple award winning writer who comments
on medical-legal issues. Robert J. Cihak, M.D., is a Discovery Institute
Senior Fellow and a past president of the Association of American Physicians
and Surgeons. Both JWR contributors are Harvard trained diagnostic radiologists.
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