Message from the President of the Canadian Medical Association

How Canadians run their health care system is a concern to Americans only to the extent that some American supporters of nationalized medical care have pointed to Canada’s “single payer/universal coverage” system as a model. Those of us who think health care reform requires more individual control and less government intervention therefore naturally look for lessons from Canada’s experiment. President Obama, though he favors a SP/UC system, does not want to acknowledge we can learn something by looking north. He has said Canada’s model is not appropriate for the US. He does not say what details of Canada’s system are inappropriate for us. Because there are necessarily broad similarities to his own preferences, he does not want to talk about it. It’s to remain “mystery meat” until served.

Like Obama, Canadians can be very defensive about discussing health care, and resent foreigners who do not recognize the superiority of Canada’s health care system. Many Canadians routinely deny there are any problems with their system. Several have left comments on this blog claiming I don’t understand the Canadian system despite; a) I lived there for 22 years and, b) 95% of the criticisms documented here are from Canadian sources. Some examples:

Lessons from Canada???

Canada: health care rationing review

Canada: health care wait times

Canadians criticize Canadian health care wait times

Canadian analysis

The point is recently reinforced by the new President of the Canadian Medical Association:

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.

…”We all agree that the system is imploding, we all agree that things are more precarious than perhaps Canadians realize,” [Dr. Anne Doig, see also this interview] said in an interview with The Canadian Press.

…The pitch for change at the conference is to start with a presentation from Dr. Robert Ouellet,

…His thoughts on the issue are already clear. Ouellet has been saying since his return that “a health-care revolution has passed us by,” that it’s possible to make wait lists disappear while maintaining universal coverage and “that competition should be welcomed, not feared.”

In other words, Ouellet believes there could be a role for private health-care delivery within the public system.

…”(Canadians) have to understand that the system that we have right now – if it keeps on going without change – is not sustainable,” said Doig.

Politically, Ouellet can’t come right out and say there must be a larger role for private health-care – he dare not risk comparison to the US system. South of the border, however, there are lessons from which Canada could benefit. The most important is our thriving private care option, a safety valve for Canadians when their system fails them: Canadians visit U.S. to get care

Agreements between Detroit hospitals and the Ontario Ministry of Health and Long-Term Care for heart, imaging tests, bariatric and other services provide access to some services not immediately available in the province, said ministry spokesman David Jensen.

…Canada’s U.S. backup care “speaks volumes to why we don’t need government to take over health care,” Scott Hagerstrom, the state director in Michigan for Americans for Prosperity, said of the Canadian arrangements with Michigan hospitals. “Their system doesn’t work if they have to send us their patients.”

But Dr. Uwe Reinhardt, a Princeton University health economist who has studied the U.S. and Canadian health systems, said arrangements with cities like Detroit “are a terrific way to manage capacity” given Canada’s smaller health care budget.

“This is efficient,” he said. “At least in Canada, you don’t worry about going broke to pay for health care. You do here.”

Dr. Reinhardt apparently thinks that even if the US starts rationing health care it will still provide Canadians with a safety valve. His praise of Canada’s efficiency depends on the status quo. That some services simply are not available to Canadians in a timely fashion would look less like prudent fiscal management if people were actually dying due to unavailability of care. Providing such care is a political decision forced by proximity to a market where the care is quickly available. If Canada refused to pay for such treatment and Canadians were dying every day from its lack, what politician would be safe? Refusal to pay would be possible only if the US health care system did not exist.

In Canada, you don’t have to worry about going broke, but without access to US care, you do need to worry about suffering and even dying while waiting for treatment. This is not an argument that US health care does not need reform – it does – but moving in Canada’s direction is the wrong way to go about it for BOTH countries.

Health care is rationed in Canada; no reasonable observer can dispute it, and despite President Obama’s assurances to the contrary, choice will be ever more restricted in the US if “the public option,” shows up in any health care bill here: Fighting false health care claims, Obama repeats one of his own


American view
Wall Street Journal:
We Don’t Spend Enough on Health Care

Mr. Obama has said that “the cost of health care has weighed down our economy.” No one thinks the 20% of our GDP that’s attributable to manufacturing is weighing down the economy, because it’s intuitively clear that one person’s expenditure on widgets is another person’s income. But the same is true of the health-care industry. The $2.4 trillion Americans spend each year for health care doesn’t go up in smoke. It’s paid to other Americans.

…The U.S. health-care economy should be viewed not as a burden but as an engine of growth. Medical and orthopedic equipment exports increased by 65.1% from 2004 through 2008. Pharmaceutical exports were up 74.6%. The unprecedented advances expected to come out of American stem cell, nanotechnology and human genome research—which other countries’ constricted health sectors cannot support—will send these already impressive figures skyward.

A study by Deloitte LLP has found that more than 400,000 non-U.S. residents obtained medical care in the U.S. in 2008, and it forecasts an annual increase of 3%. Some 3.5% of inpatient procedures at U.S. hospitals were performed on international patients, many of them escaping from Canada’s supposedly superior health system.

“Inbound medical tourism,” Deloitte stated, “is primarily driven by the search for high-quality care without extensive waiting periods. Foreign patients are willing to pay more for care within the United States if these two factors play a large role.” The deficiencies of the foreign health-care systems the Obama administration wishes to emulate can be counted on to generate ever-increasing revenues for U.S. providers and employment for Americans.

Canadian view
London Free Press
Problems in health care won’t be fixed just by cash

Many jurisdictions are still woefully short of family doctors and the country need another 16,000 nurses. Canadians still rely on their own personal finances, or company benefit programs, to pay for their pharmaceuticals. Emergency rooms remain clogged. Patients are still waiting agonizing weeks for diagnostic scans to learn if they have cancer. Rural and northern communities are concerned about their access to services. We still lack an efficient electronic health records system.

Yet we continually spend more. According to Statistics Canada, the federal government, provinces and territories will spend a combined $121 billion on health care this year, an increase of 28% since 2005.

If anything, it shows the old solution of throwing money at a problem is incredibly ineffective in our health-care system. All of the benefits of state-run, publicly-financed health care are offset by an onerous, bureaucratic, bloated and expensive system.

What is needed is true systemic change that will ensure every dollar invested in health care benefits patients.

It’s inexcusable that patients have to wait to find out if they have a potentially fatal disease. It’s mind-boggling that people can wait more than a year to have life-altering surgeries like hip replacements.

Indeed. And that’s with a US safety valve in place. If the US moves toward a government run health care system it will be terrible news for us and a death sentence for some seriously ill Canadians.

3 thoughts on “Message from the President of the Canadian Medical Association”

  1. Our recent town hall had as attendees three doctors. (2 retired)The still practicing MD made it very clear his concern about the current set of proposals on the table. When asked if he would STOP practicing, he said NO. However, he made it also clear that we would lose the potential doctors who would be happier in health care to other professions where the government plays less of a role.The dynamics are very clear if our leaders wish to pay attention. However, the partisan gatherings that limit the exposure of our elected types tends to the truths at hand; most don't WANT expanded government in their health care model.

  2. People will always complain about the health care no matter what you do. So even though a lot of Canadians criticize the system and there is a lot to be fixed about it, even if all the issues we're fixes (impossible), there still would be plenty of problems that people would complain about. It's not a matter of what people say, it's a matter of statistics. That's how a system should be recognized as. Take care, Elli

  3. Elli,I agree people will complain, and that's why the majority of the notes on TOC are statistical and/or quote Canadian sources like the President of the CMA making general comments about what needs to be changed.I will also note that statistics can be deceiving. For example, one oft quoted criticism of US health care is infant mortality. It turns out that in many countries a “live birth” is a baby who is carried to term and lives at least several days. Preemies who die within a few hours are not counted in the infant mortality figures.It is also fair to say, I think, that mortality in general – life expectancy – is only loosely correlated with the quality of care. You may have a situation where people in a given country regularly act in a far more risky fashion. Deaths from drunk driving, smoking, obesity and participating in drug deals that go bad are not a reflection on health care, but upon individual behavior. In any case, most of those deaths would be considered “premature,” and therefore actually reduce health care costs which are far higher among the “normally” aged.It's too complex for such simple statistics, but I'd agree that closely controlled, and examined, stats are useful.