The following was received by a Canadian reader who disagrees strongly that the Canadian Health System is flawed:
“Wrong. First of all you need a health system before you can begin to enter the discussion. You don’t have one. You have one for the select and none for the bulk of your people. Your objective is quite clear; the protection of your medical monopoly.”
The Burton Report® certainly agrees that the present U.S. system is not a “health” system but a dysfunctional “disease” system. We wait until people get sick and then treat them. Neither system is good at prevention or placing the patient in the “driver’s seat” regarding their health care decisions. However, consider the following reality:
On a Bus to Bangor, Canadians Seeking Health Care
By MERRILL MATTHEWS, JR., Wall street Journal, July 5, 2002
A dozen Canadians took a bus last week for a day trip from Saint John, New Brunswick, to Bangor, Maine. It wasn’t a pleasure trip. The 12 were all suffering serious medical maladies and desperately seeking healthcare solutions — doctors’ appointments, treatment and prescription drugs — that couldn’t be had in Canada.
Fifty-year-old Rod has chest pain and shortness of breath. He also has a heart murmur and X-rays suggest he has a hole in his heart. His cardiologist referred him for an echocardiogram but he was told he had to wait until November to get one in Canada. A fellow traveler was a 66-year-old breast cancer patient. Her family physician had recently left his practice and without him she couldn’t access the system. A third patient had had an MRI in Canada which revealed a disk pushing on her spinal cord. When her doctor referred her to an orthopedic surgeon, she was put on an eight to 12 month waiting list.
Washington politicians have made much recently of bus trips to Canada to buy cheap prescription drugs but what about the buses loaded with sick Canadians, going the other way? When it comes to responding to the challenges in today’s U.S. healthcare system, it is clearer than ever that Canada is not the place to look.
Even Canadian government officials have accepted that Canada has a problem meeting healthcare needs. In March 2000, the Toronto Star reported on Canadian Health Minister Allan Rock’s view of the situation: “There are people who are waiting too long, waiting hours in the emergency ward, waiting months for referral to a specialist, waiting a year for a long-term bed, waiting what seems to be an eternity for someone to answer the call button in an understaffed hospital.”
One of the most acute problems in New Brunswick is the shortage of family physicians. Saint John has a population of about 100,000, and 10,000 don’t have a family physician. But it’s not by choice; Saint John doctors are already overloaded with patients and are not accepting new ones. That’s a real difficulty because without the family physician, which in the Canadian system serves as a gatekeeper to specialists, a patient cannot get a referral.
Dr. Anthony Lordon, who helped set up the referrals and tests in Bangor, and is the family physician to eight of the 12 patients, told me that it wasn’t always this way. When he began practicing medicine 15 years ago, Saint John had so many physicians that he had to advertise in order to attract more patients. But cutbacks in government funding during the early 1990s led to a decline in newly trained doctors, creating a nationwide shortage. A report released by the Ontario government three years ago said that province needed 1,000 more doctors. Of course, as the orthopedic patient on last week’s bus trip demonstrated, family physicians are not the only doctors that are in short supply.
The bus trip was organized by the Treatment Access Alliance and the Consumer Advocare Network, a Canadian alliance of patient advocates whose members include several patient-care groups like the Canadian Breast Cancer Network, the Hepatitis C Society, the Multiple Sclerosis Society and the Canadian Arthritis Society.
While the primary purpose of the journey was to help these patients get the care they need, it also sought to bring attention to a fact largely ignored by the U.S. media and denied by numerous members of Congress. The government-funded Canadian health care system is self-destructing and leaving Canadians few options but to travel to the states for care and even for prescription drugs.
A 37-year-old female on the bus has persistent depression. She has tried a number of antidepressants, but the side effects were unacceptable. Her doctor thinks that Paxil Control Release might help, but the drug is unavailable in New Brunswick, according to the Alliance. A diabetic on the bus takes Glucophage three times a day, but compliance and side effects create problems for him, so he would like to try the newest drug — Glucophage XR, a once-daily treatment for non-insulin dependent diabetes. He can’t find it in Canada either.
One reason is that drugs must be approved both by the Canadian federal government and the provincial governments, causing significant delays. Moreover, according to Dr. William McArthur, a Canadian physician and formerly chief coroner for the city of Vancouver, if the panel considering a new drug doesn’t think it is a significant improvement over an existing drug, it may not approve the new one. While that can be a way of holding down costs, it also rations care. Those who might benefit from the drug simply go without — or go to the U.S.
Lest anyone assume this trip was intended to push the Canadian health care system towards free markets, the trip’s coordinator, Chris Ward, a former member of Parliament, rejected such notions. He says that his beef is with the fact that patients need choices and the Canadian system doesn’t provide them. In Canada, as in North Korea and Cuba, it is illegal to pay for care covered by the government system. So there are no alternatives apart from going outside the country.
There is a message here for U.S. politicians and patients who see Canada as a model for U.S. reform. Spending less money on health care — 9% of GDP in Canada vs. 14% in the U.S. — is possible, but don’t expect high quality and equal access. Its also worth pointing out to proud Canadians who like to boast about their compassionate system, that without the U.S. market-based system providing a safety valve, a good number of their compatriots would go untreated.
Mr. Matthews is a visiting scholar for the Institute for Policy Innovation in Dallas and director of the Council for Affordable Health Insurance in Alexandria, Va.