David Gratzer: The Ugly Truth About Canadian Health Care

(2018-01-31 12:07:08) 下一个


The Ugly Truth About Canadian Health Care

Socialized medicine has meant rationed care and lack of innovation. Small wonder Canadians are looking to the market.

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.

But if Canadians are looking to the United States for the care they need, Americans, ironically, are increasingly looking north for a viable health-care model. There’s no question that American health care, a mixture of private insurance and public programs, is a mess. Over the last five years, health-insurance premiums have more than doubled, leaving firms like General Motors on the brink of bankruptcy. Expensive health care has also hit workers in the pocketbook: it’s one of the reasons that median family income fell between 2000 and 2005 (despite a rise in overall labor costs). Health spending has surged past 16 percent of GDP. The number of uninsured Americans has risen, and even the insured seem dissatisfied. So it’s not surprising that some Americans think that solving the nation’s health-care woes may require adopting a Canadian-style single-payer system, in which the government finances and provides the care. Canadians, the seductive single-payer tune goes, not only spend less on health care; their health outcomes are better, too—life expectancy is longer, infant mortality lower.

Thus, Paul Krugman in the New York Times: “Does this mean that the American way is wrong, and that we should switch to a Canadian-style single-payer system? Well, yes.” Politicians like Hillary Clinton are on board; Michael Moore’s new documentary Sicko celebrates
the virtues of Canada’s socialized health care; the National Coalition on Health Care, which includes big businesses like AT&T, recently
endorsed a scheme to centralize major health decisions to a government committee; and big unions are questioning the tenets of employer-sponsored health insurance.
Some are tempted. Not me.

Iwas once a believer in socialized medicine. I don’t want to overstate my case: growing up in Canada, I didn’t spend much time contemplating the nuances of health economics. I wanted to get into medical school—my mind brimmed with statistics on MCAT scores and admissions rates, not health spending. But as a Canadian, I had soaked up three things from my environment: a love of ice hockey; an ability to convert Celsius into Fahrenheit in my head; and the belief that government-run health care was truly compassionate. What I knew about American health care was unappealing: high expenses and lots of uninsured people. When HillaryCare shook Washington, I remember thinking that the Clintonistas were right.

My health-care prejudices crumbled not in the classroom but on the way to one. On a subzero Winnipeg morning in 1997, I cut across the hospital emergency room to shave a few minutes off my frigid commute. Swinging open the door, I stepped into a nightmare: the ER overflowed with elderly people on stretchers, waiting for admission. Some, it turned out, had waited five days. The air stank with sweat and urine. Right then, I began to reconsider everything that I thought I knew about Canadian health care. I soon discovered that the problems went well beyond overcrowded ERs. Patients had to wait for practically any diagnostic test or procedure, such as the man with persistent pain from a hernia operation whom we referred to a pain clinic—with a three-year wait list; or the woman needing a sleep study to diagnose what seemed like sleep apnea, who faced a two-year delay; or the woman with breast cancer who needed to wait four months for radiation therapy, when the standard of care was four weeks.

I decided to write about what I saw. By day, I attended classes and visited patients; at night, I worked on a book. Unfortunately, statistics on Canadian health care’s weaknesses were hard to come by, and even finding people willing to criticize the system was difficult, such was the emotional support that it then enjoyed. One family friend, diagnosed with cancer, was told to wait for potentially lifesaving chemotherapy. I called to see if I could write about his plight. Worried about repercussions, he asked me to change his name. A bit later, he asked if I could change his sex in the story, and maybe his town. Finally, he asked if I could change the illness, too.

My book’s thesis was simple: to contain rising costs, government-run health-care systems invariably restrict the health-care supply. Thus, at a time when Canada’s population was aging and needed more care, not less, cost-crunching bureaucrats had reduced the size of medical school classes, shuttered hospitals, and capped physician fees, resulting in hundreds of thousands of patients waiting for needed treatment—patients who suffered and, in some cases, died from the delays. The only solution, I concluded, was to move away from government command-and-control structures and toward a more market-oriented system. To capture Canadian health care’s growing crisis, I called my book Code Blue, the term used when a patient’s heart stops and hospital staff must leap into action to save him. Though I had a hard time finding a Canadian publisher, the book eventually came out in 1999 from a small imprint; it struck a nerve, going through five printings.

Nor were the problems I identified unique to Canada—they characterized all government-run health-care systems. Consider the recent British controversy over a cancer patient who tried to get an appointment with a specialist, only to have it canceled—48 times. More than 1 million Britons must wait for some type of care, with 200,000 in line for longer than six months. A while back, I toured a public hospital in Washington, D.C., with Tim Evans, a senior fellow at the Centre for the New Europe. The hospital was dark and dingy, but Evans observed that
it was cleaner than anything in his native
England. In France, the supply of doctors is so limited that during an August 2003 heat wave—when many doctors were on vacation and hospitals were stretched beyond capacity—15,000 elderly citizens died. Across Europe, state-of-the-art drugs aren’t available. And so on.

But single-payer systems—confronting dirty hospitals, long waiting lists, and substandard treatment—are starting to crack. Today my book wouldn’t seem so provocative to Canadians, whose views on public health care are much less rosy than they were even a few years ago. Canadian newspapers are now filled with stories of people frustrated by long delays for care:

   vow broken on cancer wait times: most hospitals across canada fail to meet ottawa’s four-week guideline for radiation
   patients wait as p.e.t. scans used in animal experiments
   back patients waiting years for treatment: study
   the doctor is . . . out

As if a taboo had lifted, government statistics on the health-care system’s problems are suddenly available. In fact, government researchers have provided the best data on the doctor shortage, noting, for example, that more than 1.5 million Ontarians (or 12 percent of that province’s population) can’t find family physicians. Health officials in one Nova Scotia community actually resorted to a lottery to determine who’d get a doctor’s appointment.

Dr. Jacques Chaoulli is at the center of this changing health-care scene. Standing at about five and a half feet and soft-spoken, he doesn’t seem imposing. But this accidental revolutionary has turned Canadian health care on its head. In the 1990s, recognizing the growing crisis of socialized care, Chaoulli organized a private Quebec practice—patients called him, he made house calls, and then he directly billed his patients. The local health board cried foul and began fining him. The legal status of private practice in Canada remained murky, but billing patients, rather than the government, was certainly illegal, and so was private insurance.

Chaoulli gave up his private practice but not the fight for private medicine. Trying to draw attention to Canada’s need for an alternative to government care, he began a hunger strike but quit after a month, famished but not famous. He wrote a couple of books on the topic, which sold dismally. He then came up with the idea of challenging the government in court. Because the lawyers whom he consulted dismissed the idea, he decided to make the legal case himself and enrolled in law school. He flunked out after a term. Undeterred, he found a sponsor for his legal fight (his father-in-law, who lives in Japan) and a patient to represent. Chaoulli went to court and lost. He appealed and lost again. He appealed all the way to the Supreme Court. And there—amazingly—he won.

Chaoulli was representing George Zeliotis, an elderly Montrealer forced to wait almost a year for a hip replacement. Zeliotis was in agony and taking high doses of opiates. Chaoulli maintained that the patient should have the right to pay for private health insurance and get treatment sooner. He based his argument on the Canadian equivalent of the Bill of Rights, as well as on the equivalent Quebec charter. The court hedged on the national question, but a majority agreed that Quebec’s charter did implicitly recognize such a right.

It’s hard to overstate the shock of the ruling. It caught the government completely off guard—officials had considered Chaoulli’s case so weak that they hadn’t bothered to prepare briefing notes for the prime minister in the event of his victory. The ruling wasn’t just shocking, moreover; it was potentially monumental, opening the way to more private medicine in Quebec. Though the prohibition against private insurance holds in the rest of the country for now, at least two people outside Quebec, armed with Chaoulli’s case as precedent, are taking their demand for private insurance to court.

Rick Baker helps people, and sometimes even saves lives. He describes a man who had a seizure and received a diagnosis of epilepsy. Dissatisfied with the opinion—he had no family history of epilepsy, but he did have constant headaches and nausea, which aren’t usually seen in the disorder—the man requested an MRI. The government told him that the wait would be four and a half months. So he went to Baker, who arranged to have the MRI done within 24 hours—and who, after the test discovered a brain tumor, arranged surgery within a few weeks.

Baker isn’t a neurosurgeon or even a doctor. He’s a medical broker, one member of a private sector that is rushing in to address the inadequacies of Canada’s government care. Canadians pay him to set up surgical procedures, diagnostic tests, and specialist consultations, privately and quickly. “I don’t have a medical background. I just have some common sense,” he explains. “I don’t need to be a doctor for what I do. I’m just expediting care.”

He tells me stories of other people whom his British Columbia–based company, Timely Medical Alternatives, has helped—people like the elderly woman who needed vascular surgery for a major artery in her abdomen and was promised prompt care by one of the most senior bureaucrats in the government, who never called back. “Her doctor told her she’s going to die,” Baker remembers. So Timely got her surgery in a couple of days, in Washington State. Then there was the eight-year-old badly in need of a procedure to help correct her deafness. After watching her surgery get bumped three times, her parents called Timely. She’s now back at school, her hearing partly restored. “The father said, ‘Mr. Baker, my wife and I are in agreement that your star shines the brightest in our heaven,’ ” Baker recalls. “I told that story to a government official. He shrugged. He couldn’t fucking care less.”

Not everyone has kind words for Baker. A woman from a union-sponsored health coalition, writing in a local paper, denounced him for “profiting from people’s misery.” When I bring up the comment, he snaps: “I’m profiting from relieving misery.” Some of the services that Baker brokers almost certainly contravene Canadian law, but governments are loath to stop him. “What I am doing could be construed as civil disobedience,” he says. “There comes a time when people need to lead the government.”

Baker isn’t alone: other private-sector health options are blossoming across Canada, and the government is increasingly turning a blind eye to them, too, despite their often uncertain legal status. Private clinics are opening at a rate of about one a week. Companies like MedCan now offer “corporate medicals” that include an array of diagnostic tests and a referral to Johns Hopkins, if necessary. Insurance firms sell critical-illness insurance, giving policyholders a lump-sum payment in the event of a major diagnosis; since such policyholders could, in theory, spend the money on anything they wanted, medical or not, the system doesn’t count as health insurance and is therefore legal. Testifying to the changing nature of Canadian health care, Baker observes that securing prompt care used to mean a trip south. These days, he says, he’s able to get 80 percent of his clients care in Canada, via the private sector.

Another sign of transformation: Canadian doctors, long silent on the health-care system’s problems, are starting to speak up. Last August,
they voted Brian Day president of their national association. A former socialist who counts Fidel Castro as a personal acquaintance, Day has nevertheless become perhaps the most vocal critic of Canadian public health care, having opened his own private surgery center as a remedy for long waiting lists and then challenged the government to shut him down. “This is a country in which dogs can get a hip replacement in under a week,” he fumed to the New York Times, “and in which humans can wait two to three years.”

And now even Canadian governments are looking to the private sector to shrink the waiting lists. Day’s clinic, for instance, handles workers’-compensation cases for employees of both public and private corporations. In British Columbia, private clinics perform roughly 80 percent of government-funded diagnostic testing. In Ontario, where fealty to socialized medicine has always been strong, the government recently hired a private firm to staff a rural hospital’s emergency room.

This privatizing trend is reaching Europe, too. Britain’s government-run health care dates back to the 1940s. Yet the Labour Party—which originally created the National Health Service and used to bristle at the suggestion of private medicine, dismissing it as “Americanization”—now openly favors privatization. Sir William Wells, a senior British health official, recently said: “The big trouble with a state monopoly is that it builds in massive inefficiencies and inward-looking culture.” Last year, the private sector provided about 5 percent of Britain’s nonemergency procedures; Labour aims to triple that percentage by 2008. The Labour government also works to voucherize certain surgeries, offering patients a choice of four providers, at least one private. And in a recent move, the government will contract out some primary care services, perhaps to American firms such as UnitedHealth Group and Kaiser Permanente.

Sweden’s government, after the completion
of the latest round of privatizations, will be contracting out some 80 percent of Stockholm’s
primary care and 40 percent of its total health services, including one of the city’s largest hospitals. Since the fall of Communism, Slovakia has looked to liberalize its state-run system, introducing co-payments and privatizations. And modest market reforms have begun in Germany: increasing co-pays, enhancing insurance competition, and turning state enterprises over to the private sector (within a decade, only a minority of German hospitals will remain under state control). It’s important to note that change in these countries is slow and gradual—market reforms remain controversial. But if the United States was once the exception for viewing a vibrant private sector in health care as essential, it is so no longer.

Yet even as Stockholm and Saskatoon are percolating with the ideas of Adam Smith, a growing number of prominent Americans are arguing that socialized health care still provides better results for less money. “Americans tend to believe that we have the best health care system in the world,” writes Krugman in the New York Times. “But it isn’t true. We spend far more per person on health care . . . yet rank near the bottom among industrial countries in indicators from life expectancy to infant mortality.”

One often hears variations on Krugman’s
argument—that America lags behind other countries in crude health outcomes. But such outcomes reflect a mosaic of factors, such as diet, lifestyle, drug use, and cultural values. It pains me as a doctor to say this, but health care is just one factor in health. Americans live 75.3 years on average, fewer than Canadians (77.3) or the French (76.6) or the citizens of any Western European nation save Portugal. Health care influences life expectancy, of course. But a life can end because of a murder, a fall, or a car accident. Such factors aren’t academic—homicide rates in the United States are much higher than in other countries (eight times higher than in France, for instance). In The Business of Health, Robert Ohsfeldt and John Schneider factor out intentional and unintentional injuries from life-expectancy statistics and find that Americans who don’t die in car crashes or homicides outlive people in any other Western country.

And if we measure a health-care system by how well it serves its sick citizens, American medicine excels. Five-year cancer survival rates bear this out. For leukemia, the American survival rate is almost 50 percent; the European rate is just 35 percent. Esophageal carcinoma: 12 percent in the United States, 6 percent in Europe. The survival rate for prostate cancer is 81.2 percent here, yet 61.7 percent in France and down to 44.3 percent in England—a striking variation.

Like many critics of American health care, though, Krugman argues that the costs are just too high: “In 2002 . . . the United States spent $5,267 on health care for each man, woman, and child.” Health-care spending in Canada and Britain, he notes, is a small fraction of that. Again, the picture isn’t quite as clear as he suggests; because the U.S. is so much wealthier than other countries, it isn’t unreasonable for it to spend more on health care. Take America’s high spending on research and development. M. D. Anderson in Texas, a prominent cancer center, spends more on research than Canada does.

That said, American health care is expensive. And Americans aren’t always getting a good deal. In the coming years, with health expenses spiraling up, it will be easy for some—like the zealous legislators in California—to give in to the temptation of socialized medicine. In Washington, there are plenty of old pieces of legislation that like-minded politicians could take off the shelf, dust off, and promote: expanding Medicare to Americans 55 and older, say, or covering all children in Medicaid.

But such initiatives would push the United States further down the path to a government-run system and make things much, much worse. True, government bureaucrats would be able to cut costs—but only by shrinking access to health care, as in Canada, and engendering a Canadian-style nightmare of overflowing emergency rooms and yearlong waits for treatment. America is right to seek a model for delivering good health care at good prices, but we should be looking not to Canada, but close to home—in the other four-fifths or so of our economy. From telecommunications to retail, deregulation and market competition have driven prices down and quality and productivity up. Health care is long overdue for the same prescription.

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Margie Rasmussen · 
I a very interesting article and made me realize that our health care needs over half.
Patrick Wright · 
I find it interesting that this article is laced with Hilary Clinton references, yet not a single mention to Bernie Sanders, who has been with Hilary in this fight. Yet he takes it a step further in wanting to stop price gouging by pharmaceutical companies. Something Clinton is reluctant to do seeing as she has received huge campaign contributions to not go after them. She is bought at paid for.
Tadashi Ehara · 
This is an old article from 2007.
Mike Allen · 
Tadashi Ehara 2007 or 2000 or 1973 doesnt make any difference what time period it is. Socialized medicine is the same today in canada as it was when it was first was adopted. Socialized medicine in canada hasn't gotten any better in canada. They are still killing off the old people and when you get old under hillarys socialized medicine maybe then you'll get pissed off because they dont want to treat you. Then the realization will be real to you and what are you going to do? Huuuum? die.
Mike Allen · 
Tadashi Ehara But it's a true article that is still in effect today.
Phillip R Guidry
Michael Moore he's a joke - so I stopped reading there......
Stacey Fabrizio · 
You should keep reading. It does bot glorify Michael Moore. It shiws the disgusting treatment of people under socialized medicine
Laureano Leone · 
Every system has the plus and mines. We have to loook with a general view. The most ipotrtant factor in healt care is "money" In the United States and every where you find the best treatment with your choice of doctores and hospitals. But when we look at the majority of our population especially at the lower class any kind of socialized medicine is appreciated. In Italy for example people at lower social scale they have the choice and assistamce of doctors and most of the drugs. And the same in other countries of the E.U. and if you look at the north Europe, Norway, Swedes, Germany, and other ...See More
Mike Allen · 
If you remember, hillary wanted socialized medicine back when bill clinton was president but he couldnt get it passed. Yes for all you bernie fans he is a socialist and he admitted it and we definately would of had socialized medicine with him but not to worry, when hillary get to be president then those of you who didn't trust her and voted for bernie will realize that both of them wanted socialism. And you still vote for hillary, the most untrusted politition ever. Did you know her and bill have billions of money stashed away through the Panama Papers to hide and avoid paying tax? Noooooooooo. So enjoy your life for as long as you can. No matter how fit you are, how old you are or young you are you can still get cancer and die and socialized medicine wont help you live.
Gerald Meazell · 
When Hillary approached Congressional leaders about socialized health care in 1993, the Democrats had been in control of Congress for forty years. They told her that in order for something like that to pass and succeed, you'd need at least 70% of the public behind the idea. Since it enjoyed no such support, they refused to even bring it up for a vote.

Unfortunately for them, the damage had been done. Just for talking about it, the public gave control of Congress to the GOP the next year. The Democrats spent the next twelve years wandering in the desert.

After Obama was elected, they got ano...See More
John MacGregor Newman · 
Moron. Ignorant. The rest of the civilized world has health care for all their citizens and they love it. The US citizen paysa more gets less. The difference if I get cancer and you get cancer, I have a chance of serviving without the hundreds of thousands of dollars that still don't assure you of life, just leave your family crippled with dept! If I need some drug beyond what our system pays for, that is one expense, and our drugs cost less! You have to pay for everything and usually have a deductible (like it's car insurance!) then there is still limits on what your provided in most health insurance. Sorry but I spend my life enjoying it knowing I'm protected and EVERY MEMBER of my family, and friends are as well. You are last in health care among civilized countries! You didn't get health care with Clinton or Obama because big money, big pharma, don't want you to stop all that spending! Land of the lambs to the slaughter. You are our cousins, we want you to have the best!
John MacGregor Newman · 
PS. this guy was going to a subsidized Canadian University for his education.
Emil Szegner
Bottom line is when government handles healthcare there is no accountability. If you want proof just look at the Veterans hospital in the USA. they have a list of veterans who were denied treatment... to save money, and politicians did nothing about it. that is government healthcare, rationing care to fit budget and let the sickness take its toll on our heroes...
Stuart Ball · 
The author forgot to mention the cause of the decline in Canadian health care. Perhaps he is a millennial and wasn't around before Brian Mulroney and the conservatives , followed by years of Liberal and then Harper gutting the system to create favors for the privatization proponents. Fact is, it ran great without the Laizze Fairre capitalists meddling in it to squeeze a profit from the misery of sick people JUST LIKE IN THE USA!
Rob Price
Ummm - the one who cut healthcare was Chrétien' finance minister - you may remember him- the Canada steamships line guru Paul Martin. Health care spending was increased every year under Harper . Which is why he replaced martin
Laurella Desborough · 
Now, how is it that costs for operations and medicines even in third world countries is more reasonable than in the US. After a year of fooling with a bad knee under the care of a local doctor in Florida, on a trip to Indonesia my knee started bothering me. I went to a local doctor who examined the knee, gave me to prescriptions which cost $10. After taking these medicines my knee not only improved, it remained cured from that time forward! Now, if a doctor in Indonesia can provide a better diagnosis and better medication than a doctor in the US and for a great deal less money, what does that say about US medicine? Over priced and under quality. (With the exception of Mayo Clinic which IMO is fabulous!)
George Scott Leon
Because in Indonesia the cost of healthcare is subsidized by the government. SO you paid $10, but the citizens there cvovered the rest of the cost, as did the US & every other country that send low to no interest loans & monetary aid packages.
Elizabeth Toal Crawley
What were the prescriptions? I'm interested to find out what prescriptions are available that can cure chronic pain? Do you continue to take the same medications or did you just take a month supply?
Joe Cole · 
There is something wrong with your story. One dosage of medicine cured your problem I would love to know the name of the medicine and what it cured
Anthony Stafford · 
Singapore among a lot of other countrirs jave universal healthcare without wait times. Canada is not true Universal coverage. The US is wealthier huh, maybe the top 1%. Everyone else goes in debt to pay for big pharm medication.
Kevin McDonald
When the article says the U.S. is wealthier it's referring to GDP per capita. thats how relative wealth between countries is measured, FYI.
Matt Godana · 
Singapore is also smaller than most major US cities.
Ken Iverson · 
Works at Self-employed
There's always a few, and many Americans listen to their stories. In Canada, cases are taken by the severity of the problem. Maybe some provinces are better than others. No one that I know has had a big problem with the system. Some smaller hospitals may have a extensive ER waiting time. I've waited forever in some U.S. hospitals, too. Gotta look at the whole picture. Alternative medicine is not the most reliable treatment, so I can see why the Canadian system wouldn't pay for the treatment of the woman in the article. I can make a doctor's appointment tomorrow, and be in in a few days or so. If not, I can go to a "clinic."
Rosemary Nykoruk · 
Never had a problem with health care...never had to wait for specialized treatment....sure there are exceptions but I am very happy with my country and my health care...I even know a place where you can get "pay what you accupunture" ....ya ya I live in the city ...but my relatives live in smaller towns and no prob...LOVE CANADA
Hugh Anderson · 
Check today's stats that compare systems on CNN
Darlene Livingston · 
We have long waits, and bad diagnosis, filthy hospitals infected with staphylococcus plus physicians who are pretty much drug dealers because they are poorly trained. I know what you mean but we also don't have any means to find out prices before treatment. I had a Colonoscopy and endoscopy 8,500.00 here. How about Canada?
Ryan Garrett
Ryan Garrett
With taxes paid through out your life
Michelle Vedros
Well if you are in the US mostly the wealthy get proper healthcare. That's why the waiting isn't as long. Instead of dying in the hospitals they die at home, because they can't afford the hospital. I will tell you the solution. We need to get more Dr.'s and lots of nurse practioners, have policies and guidelines in place. Once we get the staff(I'll tell you more about that), we have a time limit a patient should wait for certain illnesses. Gov. can always get more funds either through taxes or cutting unnecessary expenditures. They can get the funds.The colleges have been filtering students an...See More
Gerald Meazell · 
I'm middle class and when my daughter's appendix started actiing up, she was admitted to the hospital that day.
Matt Godana · 
I'm not wealthy and I have no issues. Thing is I paid attention in school, didn't mess around in college, and got a good job with benefits.
Maricel Richter
We also need people to start taking better care of themselves, skip the big mac, stop smoking and drinking, do some exercise and stop trying to outdo the neighbors and take sometime for your kids and family.
Randy Roberts · 
Basically, in the US, you can get care, but then go bankrupt if your not rich. And if your not rich, you can not get the very best treatment. There should be a better way, without complete govt backed healthcare. One thing for sure, healthcare is like a fire department, a police dept, etc, it is something everyone should be able to afford
Nancy Arseneault-Heald · 
I think getting the very best treatment is a luxury people expect but don't want to pay anything for... not one single dollar. We need to come to a common understanding of what can be considered reasonable healthcare before we can move forward on who pays for it.
Gerald Meazell · 
The better way is to get government out of the equation and make health care providers compete for patients. Prices will drop like rocks.
Matt Godana · 
My cousin makes $40,000 a year and has full health benefits at his job. Damn those rich people making 17 dollars an hour.
Jennifer Robison · 
This is such a classic piece. I've lost count of how many times I've linked to it in discussions about the perils of a government-run healthcare system (including just today). My only quibble is that it is now 10 years old. Time for an update on some of those wait-time and outcome statistics. I'm a longtime health journalist in the U.S. with a Canadian dad and a summer home in Ontario. We've experienced both systems. Let me know if I can help. This is such an important topic, and it's now obvious that both Republicans and Democrats in America are content to tinker at the margins of this issue with only small changes in health insurance -- which, as this article so beautifully illustrates, is not the same thing as access to actual care.
Misty Harris
Well stated
Allen McGath · 
Stopped reading the minute I read socialized healthcare. Canada is single payer is not the same as socialized healthcare. The fact that the author doesn't understand that basic concept tells me this isn't worth reading.
Bruce Junker · 
"GOD HELP YOU" if you suffer significant injury in the workplace in Canada, why? because the workers compensation board in Saskatchewan are LIARS. In FACT: Deliberately deny requested operation to treat workplace injury; These people @ WCB are Psychopathic Perverts who falsify / fabricate lies to deny,deny,deny;
Elan Rosen · 
David Gratzer knows very well that all Single Payer health care systems have allocation problems from time to time. That's true of 58 countries, not just Canada. So EVERY health care system has its horror stories. In fact a Google search will reveal more health care horror stories from the US by a factor of 10. The problem David first encountered in Winnipeg became known as 'the hallway medicine crisis' and it received adverse publicity around the world for a time. Big health care organizations, whether public or private move slowly, but the issue was eventually cleaned up by expanding capacit...See More
David Caskey · 
IS healthcare is expensive. Why? Well for the last 30 years prices have been strictly controlled by the Federal government. Government sets prices of Medicare and insurance indexes off that. It is actually against the law to give free medical care in the US and even to give low cost care. With Obamacare, administrators were put in charge of this and prices went extremely high. Add in malpractice defense practices and patients excessive in demands and the mix is bad. At least half the people that I see daily do not need to see me. But legal requirements and restricted medications make them come. We need to deregulate all drugs. Allow people to care for themselves and get the government out.
Gary Randall · 
This article is unadulterated bull-hockey. I've lived in both countries and the Canadian system, although not perfect, is far superior to the US system, in which a staggering number of people in the United States simply cannot afford. In Vancouver, I could see my GP same or next-day, at times. Prescription drugs were a fraction of the cost of US prices. I had an elective surgery that I could have waited more than a year for, but had it in two months thanks to putting my name on the surgeon's cancellation list, as directed.
Sandy Price · 
The piece that is missing from this is the "access to care" piece. Everything you say about American care is true - e.g. outcomes for cancer, etc, - only so far as the system allows you to have access to it - which in this country means you can afford good insurance coverage. A very good friend of mine - a teacher - died for want of timely treatment right here in the US, not because of government queus, but because her insurance coverage was so meager that she avoided doctors (really she was avoiding doctor's bills, not doctors) until she couldn't ignore her symptoms any longer, and discovere...See More
Irene · 
My views will not change our Canadian Health Business so why bother. Left for dead in BC Canada.
Peter Meis · 
The article could have used more specifics about errors and waiting periods for certain noticable illnesses. A real horror story would have scared people here about the cruelty of socialized medicine. When Hillary Clinton tried to promote it, it would have been 17% of the national debt in 1997 or so, and it was shot down in a hurry.
Gerald Meazell · 
Charlie Gard died today at the hands of single payer in the UK. God rest your soul, Charlie and send your bureaucratic executioners to a special place in hell where they're constantly in pain but refused care.
Michael Keaton · 
Was this written 10 years ago? Has nothing changed since then?
Jaime Lenz · 
Since this article there has been more money put into the health care system. More purchases of MRI and CT machines which reduced wait lists across the country. In BC's lower mainland the ER wait is at most 8 hours at its height. That time frame though is based on where is ER is and what cases are coming in. Someone with severe acid reflux will have to wait if there is a car accident. Etc. In BC we also have a few small Private medical facilities that people can use to jump the cue and have things like knee surgeries but they are costly and not widely used. What doesn't happen in the US (that ...See More
Becky Wegner-Kempl
and yet they still pay the tax
Ramon Prado · 
When people get old is when they really need help with their healthcare expenses. This is the time insurance plans start refusing coverage.
Brian Henry Dingle · 
A nicely exaggerated article. Sure we have problems, but we still have better survival stats then the states. Our govt run system does require the treatments to be proven to be effective; hence Erbitux for Colon Ca is not funded when it is known not to work (when the tumour pathology dictates). Only reasonable.
Adam Reaume · 
did you read the article? they literally list multiple cases where we do not have better survival stats than USA. or did you just scroll down here to comment?
Jaime Lenz · 
Adam Reaume I don't know what your province is like but survival rates for Cancer in BC are some of the best in Canada. My brother was diagnosed with Testicular cancer in 2000 he was diagnosed, had two surgeries and chemo in 4 weeks!! The tumor that was removed was the size of a human head. He has been Cancer free ever since. Sure there are waits for hip and knee surgeries and waits for ERs but people out here take responsibility for their health care and use preventative systems. Some of the numbers quoted in the article are very general and open to interpretation like number of Canadians who...See More
Jaime Lenz · 
Adam Reaume what I also forgot to mention was a story about my neph who was diagnosed in 2007 (the time of this article) with a rare cancer at age 6 mos. His parents did everything the could in BC then opted to raise money and travel to Boston for treatment. They did several trips back and forth until he finally succumbed at age 3. I wouldn't say that was a better outcome would you?
Debi Bergseng Allison · 
45 percent of their annual income goes to their health insurance. We would never be able to do anything FUN if 45 percent of our SS was taken from us for our health insurance. Less Government PLEASE!
Virginia Watson · 
This is a very informative and interesting article. The "Prescription" in the last two sentences is exactly what needs to happen for Health care to get back on track here in America.
Sean Kerr
I still perfer our system/Most of this is rare and better than what happens in the US. More fall through the cracks there.
James Turner
I'm Canadian, and I had the exact same experience as the author, also a Canadian. We were brought up to believe we had the greatest system. It was brainwashing. I moved to work in the US and shocked to reality. What? No 3 or 4 month wait to see a specialist? There are lots of variables and it is a controversial issue. But the best system, in my view is one that is free market based with some carefully constructed regulation.


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