The Ugly Truth About Canadian Health Care

Mountain-bike enthusiast Suzanne Aucoin had to fight more than her Stage IV colon cancer. Her doctor suggested Erbitux—a proven cancer drug that targets cancer cells exclusively, unlike conventional chemotherapies that more crudely kill all fast-growing cells in the body—and Aucoin went to a clinic to begin treatment. But if Erbitux offered hope, Aucoin’s insurance didn’t: she received one inscrutable form letter after another, rejecting her claim for reimbursement. Yet another example of the callous hand of managed care, depriving someone of needed medical help, right? Guess again. Erbitux is standard treatment, covered by insurance companies—in the United States. Aucoin lives in Ontario, Canada.

When Aucoin appealed to an official ombudsman, the Ontario government claimed that her treatment was unproven and that she had gone to an unaccredited clinic. But the FDA in the U.S. had approved Erbitux, and her clinic was a cancer center affiliated with a prominent Catholic hospital in Buffalo. This January, the ombudsman ruled in Aucoin’s favor, awarding her the cost of treatment. She represents a dramatic new trend in Canadian health-care advocacy: finding the treatment you need in another country, and then fighting Canadian bureaucrats (and often suing) to get them to pick up the tab.

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The Top Ten Things People Believe About Canadian Health Care, But Shouldn't

Number Three: Canadian Medicare Is Sustainable

On the contrary, Medicare is not sustainable on its present course. A modest slowdown in the rate-spending increases has been bought chiefly through reductions in services, closure of facilities, fewer health professionals, dissatisfaction among those who remain, increased waiting times, and forgoing innovative (but expensive) new technologies.

Medicare as we know it can only be "sustainable" if Canadians are willing to accept less service or more taxes. Polls, as I have already mentioned, indicate that neither is acceptable. And given increasing consumer expectations for expensive health technologies, drugs and procedures, and the expected health demands from an aging population, Medicare's problems are only going to grow. In fact, a paper6 by Bill Robson, the Vice President at the C.D. Howe Institute, a very prestigious think tank in Toronto, has argued that the unfunded liability of Medicare (i.e., promises to pay for services for which normal increases in the take from the existing tax load will not cover) is in the $500-billion to $1.2-trillion range. Canada's entire national debt, by comparison, is currently about $530 billion.

Yet Roy Romanow has already publicly rejected these arguments and has recommended not only retaining, but even expanding, the centrally planned, government monopoly model of health care in Canada. Those recommendations are now being acted upon by Ottawa and the provinces.

Virtually every other major inquiry into health care, including the Kirby Report (by a committee of the Senate of Canada), the Mazankowski Report (by the Alberta Premier's Advisory Council on Health, of which I was a member) and the Fyke Report for the Government of Saskatchewan (where Mr. Romanow was premier), identifies sustainability of the health care system as the challenge we face. Mr. Romanow's own former Minister of Finance in Saskatchewan underlined this when she appeared to testify before his commission.

But Mr. Romanow denies there is a problem. We are spending the same share of gross domestic product (GDP) today on public health care as 30 years ago. If a little more than 7 percent of GDP was sustainable in 1972, why is that same percentage unsustainable today?

It is the wrong question. It is not how much we are spending, but how we are paying for it and what we are getting in return. For years we borrowed and spent on health care (and other services), so we got more than we were willing to pay for. Today, as the only G7 country consistently in budgetary surplus, we pay the full cost of today's services, plus the interest on money we borrowed for health care and other things in the past. So while the spending has remained constant as a share of GDP, the tax burden has grown and quality has declined.

The irresistible force of demand for "free" services is running headlong into the immovable object of unavoidably limited health budgets. To date, the pressure has been relieved by crumbling health infrastructure, loss of access to the latest medical innovations, declining numbers of medical professionals, and lengthening queues. By and large, people have access to ordinary, relatively low-cost services like general practitioner office visits, but find it increasingly difficult to get vital services such as sophisticated diagnostics, or many types of surgery and cancer care, where the waits can be measured in months, if not years.

This is the exact reverse of what the rational person would want. We should use the public sector to pool everyone's risk of expensive interventions, ensuring that they are available when needed, but leaving ordinary interventions (whose cost can easily be borne by the average person) to individuals, supplemented by private insurance and subsidies for those on low incomes. Hardly anyone can afford cancer care, bypass surgery, gene therapy, or a serious chronic illness on their own. These are the things that, without insurance, destroy people's finances.

But as much as 30 percent of the services consumed under Medicare are unnecessary, not medically beneficial or even harmful. No one would be financially ruined by having to pay for an ordinary doctor's office visit if we ensured that people on low incomes were subsidized and there was a reasonable maximum anyone would be called on to pay. No one would be harmed by an incentive not to go to the emergency room when a visit to the family clinic would do just as well. The biggest health care study in the world, the RAND experiment, found that people who had to pay something towards the cost of their care consumed less of it, but that their health was, with very slight qualifications,7 every bit as good as those who got totally free care.

The extra infusion of taxes Mr. Romanow recommends will merely put off the day when we realize that we must concentrate scarce public health care dollars where they will do the most good, and give users of the system incentives to be prudent about how they spend them. We spend vast sums on procedures of little or no value, while we place patients whose conditions endanger their lives in lengthening queues.


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Canadian Health Care In Crisis

(AP) A letter from the Moncton Hospital to a New Brunswick heart patient in need of an electrocardiogram said the appointment would be in three months. It added: "If the person named on this computer-generated letter is deceased, please accept our sincere apologies."

The patient wasn't dead, according to the doctor who showed the letter to The Associated Press on condition of anonymity. But there are many Canadians who claim the long wait for the test and the frigid formality of the letter are indicative of a health system badly in need of emergency care.

Americans who flock to Canada for cheap flu shots often come away impressed at the free and first-class medical care available to Canadians, rich or poor. But tell that to hospital administrators constantly having to cut staff for lack of funds, or to the mother whose teenager was advised she would have to wait up to three years for surgery to repair a torn knee ligament.


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Or maybe there is another reason.

There is no established cause and effect here just speculation. Any bills that are due during a bankruptcy all get included. Most bankruptcies are a result of mismanagement.

The number quoted by libbies is misleading and often includes non-Americans and those who choose to do without coverage but have the means.

 

You seem to forget this is a debate forum.

 

You seem to have a need to tear down doctors who do not want your own health care system as being greedy. Not sure how you came to your assumption about them.

You also imposed several ideas about my visit to India. You should go back and reread what I said and then represent it correctly.

If you like Canadian health care wonderful! But most Americans do not want the founding of this country changed to a socialist state.

If you have a problem with debate then stay out of the debate forums. Of course you actually know more about me from my forum than you represent here.