The incoming president of the Canadian Medical Association says this country’s health-care system is sick and doctors need to develop a plan to cure it.
Dr. Anne Doig says patients are getting less than optimal care and she adds that physicians from across the country – who will gather in Saskatoon on Sunday for their annual meeting – recognize that changes must be made.
“We all agree that the system is imploding, we all agree that things are more precarious than perhaps Canadians realize,” Doing said in an interview with The Canadian Press.
About 4 years ago, I was on one of my many trips to Canada, and happened to catch news coverage of a delegation of Canadian doctors and other professionals who were going to the US to study better ways to provide medical care. The reporter and the anchors were both confused and angered at the very idea that Canada had anything to learn from the US. Returning home, I was amused to find that the delegation was visiting my hometown, and getting a lot of local coverage. However, the local reporters and anchors sounded, except for the accents, exactly like their Canadian colleagues. Their assumption was that Canadian health care was necessarily superior in all respects, and that the visitors should be missionaries rather than students.
Canada’s a great place to do something simple, like break an arm or cut your foot on a broken bottle. You’ll be cared for fairly quickly, competently, and more or less for “free.”
To call it a national system — instead of a [i]nationwide[/i] system — is misleading. The federal government supply part of the funding and set basic rules, but it’s up to the provinces as to how it’s carried out. Some places ( [i]e.g.[/i] Alberta and Ontario ) the province charges a premium on a sliding income scale. In Québec employers (only) pay a substantial payroll tax. In other provinces it comes out of general tax revenues, and so on.
There are elements worth duplicating, such as Québec’s fantastic system of small community clinics for basic services. Interestingly, that system is beginning to be duplicated here in the States by Wal-Mart and Walgreen’s.
If you’ve got a real problem, however, Canada is generally not a good place to seek care. Horror stories from Québec’s hospital system (some public, some non-profit) where hundreds have died from filth, infections, and sloppy sanitation control are reminiscent of Britain’s NHS.
A couple of years ago a couple in Calgary (pop ~1.2 mil) was on the verge of delivering quads. All the NICUs in Calgary — neonatal ICUs — couldn’t come up with four specialty incubators. Neither could Edmonton (pop ~1.1 mil), Vancouver (pop ~2.2 mil), Winnipeg (pop ~750 K), or amazingly Toronto (pop ~5.6 mil) or Montréal (pop ~3.6 mil).
Instead, the couple drove to Great Falls, Montana — population 55,000 — and delivered the babies without unexpected problems. Lest someone attempt to dismiss Great Falls as an aging population no longer in need of specialty incubators, it has a larger percentage of its population in their child-bearing years than does Calgary.
Furthermore, the notoriously liberal Supreme Court of Canada has declared many elements of the Canadian health care system to be unconstitutional because they violate the constitutional guarantee of “security of the person” on account of unconscionable waits for treatments and the unnecessary pain, suffering, and needless death they cause.
And if you want to talk about “death panels,” try getting approved for interleukin treatments (typically Stage IV cancer) if you’re over age 35 …
In Québec at least, and probably in other provinces, the Ministry of Health are trying to figure out how to make their system more like that in the USA. Unsurprisingly, entrenched interests are fighting that very hard, which should be a strong cautionary note on our side of the border.
Much of what we hear is anecdotal and not particularly helpful to this debate. My relatively worthless anecdotal evidence? I’ve experienced health care systems in both countries, and more recently in Canada (Ontario) have had some relatively major issues to deal with, which were addressed quickly and fully. I had a good experiences in the US too. But I’m in the class of people who will get access one way or the other (at least for the moment!) More importantly, as a pastor, I have dealt with families and individuals in both countries and can say without hesitation that lower-income people would much rather be sick in Canada than in the US, mainly for financial reasons.
But as for systematic issues, this is complicated stuff. Wikipedia, of all places, has a rather full introductory article comparing US and Canadian systems, fairly well referenced, which demonstrates the complications involved: http://en.wikipedia.org/wiki/Canadian_and_American_health_care_systems_compared
To my mind, a key quote in this article comes from a Canadian healthnetwork CEO in the Wall Street Journal: “In a letter to the Wall Street Journal, the President and CEO of University Health Network, Toronto, said that Michael Moore’s film Sicko “exaggerated the performance of the Canadian health system — there is no doubt that too many patients still stay in our emergency departments waiting for admission to scarce hospital beds.” However, “Canadians spend about 55% of what Americans spend on health care and have longer life expectancy, and lower infant mortality rates. Many Americans have access to quality health care. All Canadians have access to similar care at a considerably lower cost.” There is “no question” that the lower cost has come at the cost of “restriction of supply with sub-optimal access to services,” said Bell.”
Societies make choices about priorities in spending and the services they provide: we are facing some rather major ones. I must say that I find the current publicized posturing singularly unedifying of the real issues.
There’s a lot of good analysis out there. For example it’s fairly clear that some of the differing life-expectancy (at birth) is the result of American urban violence amongst the young, because life-expectancy at birth is simply the average age of all deaths that year.
Some, but not all. Canadian life-expectancy at age 40 (which factors out youth violence) is [i]still[/i] more than a year better than that in the States. One excellent analysis points towards the probable culprit:
[blockquote][i] But comparisons of obesity rates between the two countries (with obesity defined as a BMI over 30) tell a sharply different story. In 1998, American men were twice as obese as Canadian men (28 percent of the total U.S. male population versus 13 percent for Canada). American women were three times as obese as Canadian women (34 percent versus 11 percent). Recent estimates of remaining life expectancy for people who are overweight and obese suggest that the consequences of these conditions are substantial.
And a 40-year follow-up of the famous community health study of Framingham, Mass. reported that life expectancy at age 40 there was reduced because of excess weight.7 The findings suggest that obesity can account for much of the 1.5-year difference in life expectancy between Canadian and American women at age 40 and more than half of the 1.3-year difference between Canadian and American men.
While a number of other factors—such as disparities in health care coverage—may be important in explaining the differences in death rates between Canadians and Americans, this analysis provides an important perspective on our own mortality. The comparisons of data on mortality and risk factors in Canada and the United States reinforce the validity of widely expressed concerns over obesity. [/i][/blockquote]
from: Barbara Boyle Torrey and Carl Haub’s “A Comparison of U.S. and Canadian Mortality in 1998†Population and Development Review 30, no. 3 (2004).
Their review is consistent with this [url=http://www.plosmedicine.org/article/slideshow.action?uri=info:doi/10.1371/journal.pmed.0030260&imageURI=info:doi/10.1371/journal.pmed.0030260.g001]cartographical representation[/url] which shows America’s Crisco-Belt very clearly for both whites and blacks.
When I moved to Arkansas in 1992, after many years in Canada, I was completely shocked by the overwhelming trans-racial obesity in the US South.
I (a Canadian) think Pres Obama’s right in saying that they have to come up with an American solution. I think that generally our values around this issue are somewhat different than those of most Americans, e.g. a greater commitment in the US to capitalism and free enterprise. So the corporate interest must be considered in US discussions and solutions or else the reform could bring on another major economic meltdown. Having said that, what I hear from my family and friends in the US is that they spend far more out of pocket on healthcare that we do in taxation.
Oh, and someone mentioned sanitation in Canadian hospitals. Yes, I picked up a case of cellulitis from surgical infection in my foot two years ago. It seemed to have been happening way too often in my province (New Brunswick), but seems to have largely been dealt with. You can’t put a low price on that kind of vigilance.