Posted At Toledoblade.com

BY : Toledoblade Staff

Whenever we talk about the health-care crisis in this country, conversation invariably wanders off to our neighbors to the north. Why is it that Canadians have guaranteed health coverage but we in America have a system that is not only expensive but leaves more than 40 million Americans without any coverage? And why is it that Canadians can get their medications much cheaper than we can in this country? On the surface it seems that Canada has found the magic formula where everyone in the country is happy and content.



A speaking invitation from Dalhousie University brought me to this lovely city on the east coast of Nova Scotia. What I learned and observed during my brief stay was enough to convince me that neither America nor Canada has found the touchstone for their health care. Not yet at least.

Canada has one of the world's most socialized health-care systems where government is committed to provide free health care. The care is provided in government-run hospitals; there are no private hospitals or private health insurance. It is against the law to buy health care from private sources except in areas where the government does not provide those services. These include dental care, eyeglasses, and prescription drugs. Quebec tried to permit private health insurance but the Canadian Supreme Court struck it down recently.

So what is the problem?

The problem is that the government cannot provide timely health care to all its citizens. In a complicated system the federal government pays the provinces to provide health care to its citizens. There is a lot of bargaining between the provincial governments and health-care providers. Once locked into a rigid fee/salary schedule there is no incentive to increase productivity. Most medical and surgical specialists are salaried and have developed a 9-5 attitude.

As a result the patients have to wait a long time to see a specialist. In some provinces it may take up to a year to see a neurosurgeon and three months to get an MRI test. It may take six months to see an orthopedic surgeon and another six months to have a joint replaced. Some hospitals in Ontario have cancer patients sign a waiver showing that they fully understand the danger of waiting for treatment, which in the case of breast and prostate cancer may be four months.

The cash-strapped system discourages expenditure for new facilities and equipment and there are not enough doctors and nurses to meet the ever-increasing demand. At Vancour General Hospital, for example, ambulances at times have to wait in the parking lot in frigid weather to deliver sick patients. Even heart attack victims may have to wait an hour or so for the treatment that according to accepted standards should be given within 15 minutes of arrival in the emergency department.

Canada spends about $1,533 U.S. dollars per person on health care whereas in the U.S. the expenditure is $2,168. Ratio of health expenditure in terms of gross national product is also striking. In the U.S. it is 13.6 percent; in Canada it is 9.5 percent. Diminishing health-care expenditures have invariably led to de facto rationing of health care. As a result the Canadian health system is turning into a three-tier health delivery system.

The bulk of ordinary Canadians have no choice but to put up with long delays and wait their turn in line. Then there are others, certainly a minority, who because of their connections jump the line and get prompt and timely treatment. And then there is the American connection.

About 90 percent of Canadians live within 100 miles of the American border. Those who can afford it come down and get treatment in the U.S. Topping the list are joint replacements, heart surgery, and treatment for cancer. This infusion of paying patients has turned around many hospitals and medical centers south of the U.S.-Canadian border.

Have long lines and difficult access to medical care had any deleterious effects?

Surprisingly not. Canadians live an average two and a half years longer than Americans and they have much better statistics for infant and child mortality.

But these impressive numbers are of little comfort to a woman with breast cancer or a man with coronary disease standing in a long queue. After all statistics are nothing but real patients with their tears wiped away.