He discussed the need to make certain a move fits in with the lifestyle of both physician and family. To Merritt, that means being certain doctors can pursue their favourite leisure activities, and that their children can attend the right schools. It's not what Merritt and his colleagues said that should make Canadian physicians pause. It's what they didn't discuss. American society has always had a problem with institutionalized racial prejudice. Aside from tokenisni, the levers of power in the US have always been controlled by a cadre of white men. A series of civil rights endeavours have brought a measure of comfort to American blacks, but something far less than
equality. What's the difference now? Before the Los Angeles riots, in which more than 50 people were killed and another 2000 injured,
racial tension seemed manageable, even forgettable. Not anymore. The decision of a California jury to acquit four police officers of unlawfully beating a black man named Rodney King was a wakeup call for the black and Hispanic underclass in the US: the genie is out of the bottle. Collectively, they now understand that if they can't have what white society has to offer, they can at least make certain that whites can't have it either. It is beyond me how any Canadian physician could set up shop in the US after watching those horrific images on television. But there's another more compelling reason to stay in Canada. The seeds of inequality are among us, too. We have our problem with racial inequality - the May 4 riot in Toronto proved that - and we face social pressures that threaten to divide us into a
nation of regions, of rich and poor, of class and underclass. But even if our social system is damaged, the damage is not irreparable. We also have an overburdened health care system that is straining to provide a humane level of health care to everyone, damn the cost. The situation is becoming critical, but again, the damage is not irreparable. Unlike our American counterparts, we still have time to address these problems. We, who were educated at great public expense by this country, have a duty to participate in the reform of our health care system. If governments and Canadians aren't listening to us, it's our duty to try to make them understand that our expertise is not merely self-serving. And the best way to do that is to stay right here.u
Lack of health insurance takes tragic toll among US patients Milan Korcok W hen my brother Les died of colorectal cancer in a Cincinnati hospital last year, he pre-empted a typical American tragedy by beating his insurance company to the finish. Les, who was 61, managed to die before his benefits ran out. As much as he treasured life with his family, he would have enjoyed the irony of this race. It was a close one, and certainly similar to the race hundreds of thousands of middle-class Americans run every year. Many lose. They leave behind not only mourning families and friends but also a legacy of bills and debt that Milan Korcok is a freelance writer living in Fort Lauderdale, Florida. JUNE 1, ,992
leaves their families bankrupt and destitute. Others, who have no insurance or cannot afford to pay the hospital, simply die unattended. Such was the widely publicized fate of a Miami woman who was turned away last year by hospital after hospital and doctor after doctor because she had no insurance and no way to pay for expensive breast cancer treatment. Because she had a diagnosed cancer, her employer was asked to pay insurance premiums he could not afford. He had to fire her. She eventually died with her family around her, but the American health care system was nowhere in sight. She never did get the medical care she needed. Several months before my
brother died, his insurance company informed him that it would not renew his policy, one that was already providing reduced benefits and that forced him to pay increasing copayments during his frequent admissions to hospital. He has been insured through his employer and carried on the policy himself after illness prevented him from working. Having lived in Canada most of his life, where he raised his family under the protection of universal health coverage, he thought it unfair that insurers could suspend or change their obligations unilaterally, part way through the game. Unfair it may be, but he quickly learned that it is done all the time. Les knew that when his insurCAN MED ASSOC J 1992; 146 (1 1)
2043
ance ran out, he would join the growing ranks of the uninsurable - those who will not get health insurance no matter how much they are willing to pay for it. The only solution left would be pay-asyou-go health care, and that is one sure route to poverty in the US. In his final days he worried a lot about what would happen, as if it wasn't tough enough just trying to keep his spirits together while being fed through a stomach tube. Dealing with uninsured patients is a growing problem for many American hospitals, and as the recession drags on more and more of them are arriving at the hospital door. This is inevitable in a society where health insurance is tied primarily to a job. Lose the job, lose the insurance, and in this recession a lot of Americans are losing their jobs. When Pan American Airlines went bankrupt last December it dumped 19 000 people into the uninsured category, virtually overnight; the same thing happened with Eastern Airlines a year earlier. These actions affected not only current employees but also thousands of retirees - people who had counted on Pan Am to provide health care benefits in their "golden years." With the bankruptcy they were forced to find health maintenance organizations (HMOs) that would accept them as members. And HMOs are not cheap. Although most Americans over 65 have Medicare coverage, this is but a stopgap measure. For instance, hospital coverage under Medicare is free of premiums, but patients must pay a $600 deductible for each hospital stay. Premiums for doctors' services under Medicare will cost a patient about $50 a month, depending on age and other enrolment factors; there are limitations and a $100 a year deductible. The American Association of Retired Persons estimates that out-of-pocket medical expenses average about $1600 a 2044
CAN MED ASSOC J 1992; 146 (1 1)
year for Americans 65 or over. But not just patients are complaining. Since the mid- 1 980s, when the federal government put Medicare on a prospective payment basis - this means that rates of payment are fixed and lengths of stay are tightly regulated - hospitals here have been crying the blues. They have seen revenues and lengths of stay drop, and in many cases occupancy rates have sunk below 50%; the exceptions are the large, countyfunded hospitals that must treat all comers, indigent or not. They stay full. The American Hospital Association reports that in the first quarter of 1991, hospital admissions, surgical procedures and revenue margins all fell in comparison with 1990 levels. It blamed the decline on the recession, which added to the growing list of uninsured patients and caused some people to postpone elective procedures. Although rules vary from state to state, all US hospitals must admit and at least stabilize all patients with immediately lifethreatening emergencies, whether insured or not. Not all hospitals have to treat these patients once the immediate danger has passed, however, and many shuffle them off to county-funded institutions that act as repositories for those who can't pay and don't have private insurance, Medicare or Medicaid. (Medicaid is a federalstate program designed to cover the poor, but standards vary from state to state and only 40% of the poor are covered. Doctors who accept Medicaid patients - many refuse to - receive only about 66% of Medicare rates.) Thus, the only way most of the nation's poor can get care is to be sick enough to go to a county hospital emergency room. Today, that is becoming an increasingly real prospect for the middle classes as well. Even county-funded institu-
tions are being criticized for refusing to admit patients who cannot pay. Patients at imminent risk of death - those suffering heart attacks or massive trauma - will get in. "Noncritical" cancer patients may not. Jackson Memorial Hospital, the Miami area's leading public hospital, recently turned away Anne Marie Lane, a hotel maid who needed surgical removal of a large tumour growing in her uterus, because she could not provide a $200 deposit. As her tumour grew, so did the size of the deposit being demanded. Lane finally received her surgery after heavy media coverage and public outcry brought private contributions on her behalf. Those who followed her case learned that Jackson Memorial had refused admission to about 1 00 patients during a 6-month period because they could not provide a deposit; about 250 others who were scheduled for admission as long as a deposit was provided never showed up. The frightening thing is that Jackson Memorial has a proud tradition of providing indigent care, much of it to the thousands of refugees who come ashore in Florida each year. But the hospital is strapped. Administrators say they cannot do more without a bigger budget. And unlike many of the private hospitals in the area, which have occupancy rates in the 50% to 60% range, Jackson Memorial is always bursting at the seams. The story is the same across the continent at the University of Southern California (USC) Medical Center, the largest teaching hospital in the country. It is funded by Los Angeles county, and its emergency room handles an average of 600 patients a day. Many of them are uninsured and can pay nothing. Billed as the "hospital of last resort," USC rejects no one on the basis of ability to pay: as long as For prescribing information
see
page 2082
-
you are a resident of the county, you'll receive care. But be prepared to wait, sometimes for 24 hours or more, and be prepared for longer lines, too. As the number of county residents without jobs increases, so do lineups at USC. The emergency room here, like those in many other publicly funded hospitals, also serves as a replacement for the physician's office: for many uninsured, it is the only source of health care they have. Although many hospitals actively seek Medicare and Medicaid business, they make their money through private insurance. They do this through a device called cost shifting - they charge those who can pay to make up for those who can't or won't. A recent study commissioned
by the National Association of Manufacturers says that in 1991 hospitals overcharged US employers, who provide most private health insurance, by $10.8 billion to make up for the "uncompensated care" they provided. They charged an additional $10.6 billion to make up for the shortfall from Medicare and Medicaid business. The New York Times says that the average hospital lost almost $3.2 million in 1989: $1.4 million because of charity cases, $1 million to Medicare, $745 000 to Medicaid and $33 000 on other underfinanced government programs. However, these losses were handsomely offset by private insurers, who were charged 128% of costs, as well as by nonoperating and "other" revenues. The average hospital ended that year with
an average net surplus of $1.2 million. Furthermore, says the Times, although hospitals continue to pressure nonpayers to pay for care, many are reimbursed for these losses by local governments. Private hospitals, both nonprofit and for-profit, may be moaning about low government reimbursements, growing numbers of uninsured patients and the shrinking occupancy rates brought on by tight-fisted private insurers, but the private sector health care industry in the US is booming. Costs are expected to rise by more than 10% this year, and $1 in every $7 of the nation's wealth is going to be spent on health care. That total, 14% of the US gross national product, is far higher than in any other nation. The irony, of course, is that
... .. :-I..aa ,. ...- ....--., ,.--,
F
For pinworms and roundworms, the first dose Combantrin is the last course. In up to 97% of
ases.
Generally well tolerated' and non-staining, rmbantrin is easily administered in pleasantisting suspension or tablets. Wlhich can also iean
choice for patients of all ages as designated by Letter.' And Coombantrin is also highly effective in the treatment of hookworms. Combantrin. To treat parasitic worms to their just desserts.
The Medical
the end of non-compliance.
A combination of high efficacy and a favourable afety profiletat makes Combantrin the drug of CZ_ * PFIZER CANADA INC. (RU.) Comsumer H Came DPv IiiMan
Prod
HWl
Qc. 2MS (TAJL) Pfiz Inc monrapha vaile on reqest.
_ NTEL PAMOATE {PA^BI
X~~;
4
despite this orgy of spending, congressmen began convening health care insurance (Can Med more and more Americans cannot "town meetings" in order to focus Assoc J 1992; 146: 1011-1013). get care. That enigma has pushed public and media attention on the Small businesses, meanwhile, growing numbers of people here need for health care reform and to claim that they cannot afford the to question the value of the catapult that issue into the middle existing high insurance premiums. money that is being spent. And to of this year's presidential and con- In fact, 75% of US businesses look closely at the Canadian sys- gressional elections. employ fewer than 10 people, and tem. Because many Democrats fa- most do not offer health insurA recent Public Broadcasting vour a "single-payer" approach to ance. In a public forum, before teleCorporation documentary, Bor- health care reform, with governderline Medicine, compared the ment acting as the single payer, vision cameras, arcane arguments Canadian system with the US the Canadian model is being free- about tax credits or other such free-for-all. It showed Americans ly discussed as the way to go. incentives do not play nearly as routinely being denied treatment Legislators, both incumbent and well as lump-in-the-throat testiand care by both hospitals and aspiring, are taking positions: they mony by hard-working, middledoctors because they either had are definitely learning a lot about class Americans who have been no, or not enough, insurance. it. stripped of their savings and asThe show focused on one Of course, the George Bush sets by unforeseen medical bills. pregnant California woman who administration, its Republican Whether for good or bad, there is had hypertension and was turned supporters and the health insur- no shortage of these compelling away by more than 50 doctors ance industry do not see it the witnesses willing to go public because she had only Medicaid same way and offer their own about their harrowing encounter coverage. Although the program options. with pay-as-you-go medicine. outlined problems within the CaThey favour leaving the em- There are plenty of horror stories, nadian system, such as waiting ployer-based system in place and and unless the health insurance lists and maldistribution of high using various fiscal incentives and safety net is cast wider there will technology, it came off very well tax lures to get employers to pro- be many more. by comparison with the US and vide better health care coverage. Health care reform has been struck a nerve among American But how much additional cost can dragged into presidential elections viewers. The program has already employers bear? Already, large before, of course, but never has it been rebroadcast several times. manufacturers such as auto pro- been quite the middle-class issue The message appears to have been ducers claim they're losing ground it is today. My brother Les, and heard by politicians. to international competitors many other Americans, learned On Jan. 14, 1992, Democratic whose governments subsidize that lesson firsthand.u
The US should be wary of Canada's health care system Brian Shamess, MD A udrey McLaughlin, federal leader of the New Democratic Party (NDP), recently addressed a congressional breakfast in Washington. "No one facing life-threatening circumstances is forced to wait in Canada," she told the American politicians. Brian Shamess is a physician with a limited referral practice in orthopedic and sports medicine in Sault Ste. Marie, Ont. 2046
CAN MED ASSOC J 1992; 146 (1 1)
I beg to differ. My father, a practising ophthalmologist, died in 1989 while waiting for heart surgery in Ontario. His wait could be directly linked to our vaunted socialized health care system. My father was not the only Canadian to die while waiting for heart surgery. Since his death the waitinglist problem has been partly rectified, but this is hardly proactive behaviour. While my father's condition
was being investigated in London, Ont., I spoke to the Ontario Health Watch Group. It was pushing for better cardiac surgery facilities so that patients would not have to wait, and possibly die, before getting the surgery they needed. Many members of this group had seen family members die before surgery could be performed, or wait an excessive amount of time for it. Perhaps McLaughlin was not aware of the LE I er JUIN 1992
equality. What's the difference now? Before the Los Angeles riots, in which more than 50 people were killed and another 2000 injured,
racial tension seemed manageable, even forgettable. Not anymore. The decision of a California jury to acquit four police officers of unlawfully beating a black man named Rodney King was a wakeup call for the black and Hispanic underclass in the US: the genie is out of the bottle. Collectively, they now understand that if they can't have what white society has to offer, they can at least make certain that whites can't have it either. It is beyond me how any Canadian physician could set up shop in the US after watching those horrific images on television. But there's another more compelling reason to stay in Canada. The seeds of inequality are among us, too. We have our problem with racial inequality - the May 4 riot in Toronto proved that - and we face social pressures that threaten to divide us into a
nation of regions, of rich and poor, of class and underclass. But even if our social system is damaged, the damage is not irreparable. We also have an overburdened health care system that is straining to provide a humane level of health care to everyone, damn the cost. The situation is becoming critical, but again, the damage is not irreparable. Unlike our American counterparts, we still have time to address these problems. We, who were educated at great public expense by this country, have a duty to participate in the reform of our health care system. If governments and Canadians aren't listening to us, it's our duty to try to make them understand that our expertise is not merely self-serving. And the best way to do that is to stay right here.u
Lack of health insurance takes tragic toll among US patients Milan Korcok W hen my brother Les died of colorectal cancer in a Cincinnati hospital last year, he pre-empted a typical American tragedy by beating his insurance company to the finish. Les, who was 61, managed to die before his benefits ran out. As much as he treasured life with his family, he would have enjoyed the irony of this race. It was a close one, and certainly similar to the race hundreds of thousands of middle-class Americans run every year. Many lose. They leave behind not only mourning families and friends but also a legacy of bills and debt that Milan Korcok is a freelance writer living in Fort Lauderdale, Florida. JUNE 1, ,992
leaves their families bankrupt and destitute. Others, who have no insurance or cannot afford to pay the hospital, simply die unattended. Such was the widely publicized fate of a Miami woman who was turned away last year by hospital after hospital and doctor after doctor because she had no insurance and no way to pay for expensive breast cancer treatment. Because she had a diagnosed cancer, her employer was asked to pay insurance premiums he could not afford. He had to fire her. She eventually died with her family around her, but the American health care system was nowhere in sight. She never did get the medical care she needed. Several months before my
brother died, his insurance company informed him that it would not renew his policy, one that was already providing reduced benefits and that forced him to pay increasing copayments during his frequent admissions to hospital. He has been insured through his employer and carried on the policy himself after illness prevented him from working. Having lived in Canada most of his life, where he raised his family under the protection of universal health coverage, he thought it unfair that insurers could suspend or change their obligations unilaterally, part way through the game. Unfair it may be, but he quickly learned that it is done all the time. Les knew that when his insurCAN MED ASSOC J 1992; 146 (1 1)
2043
ance ran out, he would join the growing ranks of the uninsurable - those who will not get health insurance no matter how much they are willing to pay for it. The only solution left would be pay-asyou-go health care, and that is one sure route to poverty in the US. In his final days he worried a lot about what would happen, as if it wasn't tough enough just trying to keep his spirits together while being fed through a stomach tube. Dealing with uninsured patients is a growing problem for many American hospitals, and as the recession drags on more and more of them are arriving at the hospital door. This is inevitable in a society where health insurance is tied primarily to a job. Lose the job, lose the insurance, and in this recession a lot of Americans are losing their jobs. When Pan American Airlines went bankrupt last December it dumped 19 000 people into the uninsured category, virtually overnight; the same thing happened with Eastern Airlines a year earlier. These actions affected not only current employees but also thousands of retirees - people who had counted on Pan Am to provide health care benefits in their "golden years." With the bankruptcy they were forced to find health maintenance organizations (HMOs) that would accept them as members. And HMOs are not cheap. Although most Americans over 65 have Medicare coverage, this is but a stopgap measure. For instance, hospital coverage under Medicare is free of premiums, but patients must pay a $600 deductible for each hospital stay. Premiums for doctors' services under Medicare will cost a patient about $50 a month, depending on age and other enrolment factors; there are limitations and a $100 a year deductible. The American Association of Retired Persons estimates that out-of-pocket medical expenses average about $1600 a 2044
CAN MED ASSOC J 1992; 146 (1 1)
year for Americans 65 or over. But not just patients are complaining. Since the mid- 1 980s, when the federal government put Medicare on a prospective payment basis - this means that rates of payment are fixed and lengths of stay are tightly regulated - hospitals here have been crying the blues. They have seen revenues and lengths of stay drop, and in many cases occupancy rates have sunk below 50%; the exceptions are the large, countyfunded hospitals that must treat all comers, indigent or not. They stay full. The American Hospital Association reports that in the first quarter of 1991, hospital admissions, surgical procedures and revenue margins all fell in comparison with 1990 levels. It blamed the decline on the recession, which added to the growing list of uninsured patients and caused some people to postpone elective procedures. Although rules vary from state to state, all US hospitals must admit and at least stabilize all patients with immediately lifethreatening emergencies, whether insured or not. Not all hospitals have to treat these patients once the immediate danger has passed, however, and many shuffle them off to county-funded institutions that act as repositories for those who can't pay and don't have private insurance, Medicare or Medicaid. (Medicaid is a federalstate program designed to cover the poor, but standards vary from state to state and only 40% of the poor are covered. Doctors who accept Medicaid patients - many refuse to - receive only about 66% of Medicare rates.) Thus, the only way most of the nation's poor can get care is to be sick enough to go to a county hospital emergency room. Today, that is becoming an increasingly real prospect for the middle classes as well. Even county-funded institu-
tions are being criticized for refusing to admit patients who cannot pay. Patients at imminent risk of death - those suffering heart attacks or massive trauma - will get in. "Noncritical" cancer patients may not. Jackson Memorial Hospital, the Miami area's leading public hospital, recently turned away Anne Marie Lane, a hotel maid who needed surgical removal of a large tumour growing in her uterus, because she could not provide a $200 deposit. As her tumour grew, so did the size of the deposit being demanded. Lane finally received her surgery after heavy media coverage and public outcry brought private contributions on her behalf. Those who followed her case learned that Jackson Memorial had refused admission to about 1 00 patients during a 6-month period because they could not provide a deposit; about 250 others who were scheduled for admission as long as a deposit was provided never showed up. The frightening thing is that Jackson Memorial has a proud tradition of providing indigent care, much of it to the thousands of refugees who come ashore in Florida each year. But the hospital is strapped. Administrators say they cannot do more without a bigger budget. And unlike many of the private hospitals in the area, which have occupancy rates in the 50% to 60% range, Jackson Memorial is always bursting at the seams. The story is the same across the continent at the University of Southern California (USC) Medical Center, the largest teaching hospital in the country. It is funded by Los Angeles county, and its emergency room handles an average of 600 patients a day. Many of them are uninsured and can pay nothing. Billed as the "hospital of last resort," USC rejects no one on the basis of ability to pay: as long as For prescribing information
see
page 2082
-
you are a resident of the county, you'll receive care. But be prepared to wait, sometimes for 24 hours or more, and be prepared for longer lines, too. As the number of county residents without jobs increases, so do lineups at USC. The emergency room here, like those in many other publicly funded hospitals, also serves as a replacement for the physician's office: for many uninsured, it is the only source of health care they have. Although many hospitals actively seek Medicare and Medicaid business, they make their money through private insurance. They do this through a device called cost shifting - they charge those who can pay to make up for those who can't or won't. A recent study commissioned
by the National Association of Manufacturers says that in 1991 hospitals overcharged US employers, who provide most private health insurance, by $10.8 billion to make up for the "uncompensated care" they provided. They charged an additional $10.6 billion to make up for the shortfall from Medicare and Medicaid business. The New York Times says that the average hospital lost almost $3.2 million in 1989: $1.4 million because of charity cases, $1 million to Medicare, $745 000 to Medicaid and $33 000 on other underfinanced government programs. However, these losses were handsomely offset by private insurers, who were charged 128% of costs, as well as by nonoperating and "other" revenues. The average hospital ended that year with
an average net surplus of $1.2 million. Furthermore, says the Times, although hospitals continue to pressure nonpayers to pay for care, many are reimbursed for these losses by local governments. Private hospitals, both nonprofit and for-profit, may be moaning about low government reimbursements, growing numbers of uninsured patients and the shrinking occupancy rates brought on by tight-fisted private insurers, but the private sector health care industry in the US is booming. Costs are expected to rise by more than 10% this year, and $1 in every $7 of the nation's wealth is going to be spent on health care. That total, 14% of the US gross national product, is far higher than in any other nation. The irony, of course, is that
... .. :-I..aa ,. ...- ....--., ,.--,
F
For pinworms and roundworms, the first dose Combantrin is the last course. In up to 97% of
ases.
Generally well tolerated' and non-staining, rmbantrin is easily administered in pleasantisting suspension or tablets. Wlhich can also iean
choice for patients of all ages as designated by Letter.' And Coombantrin is also highly effective in the treatment of hookworms. Combantrin. To treat parasitic worms to their just desserts.
The Medical
the end of non-compliance.
A combination of high efficacy and a favourable afety profiletat makes Combantrin the drug of CZ_ * PFIZER CANADA INC. (RU.) Comsumer H Came DPv IiiMan
Prod
HWl
Qc. 2MS (TAJL) Pfiz Inc monrapha vaile on reqest.
_ NTEL PAMOATE {PA^BI
X~~;
4
despite this orgy of spending, congressmen began convening health care insurance (Can Med more and more Americans cannot "town meetings" in order to focus Assoc J 1992; 146: 1011-1013). get care. That enigma has pushed public and media attention on the Small businesses, meanwhile, growing numbers of people here need for health care reform and to claim that they cannot afford the to question the value of the catapult that issue into the middle existing high insurance premiums. money that is being spent. And to of this year's presidential and con- In fact, 75% of US businesses look closely at the Canadian sys- gressional elections. employ fewer than 10 people, and tem. Because many Democrats fa- most do not offer health insurA recent Public Broadcasting vour a "single-payer" approach to ance. In a public forum, before teleCorporation documentary, Bor- health care reform, with governderline Medicine, compared the ment acting as the single payer, vision cameras, arcane arguments Canadian system with the US the Canadian model is being free- about tax credits or other such free-for-all. It showed Americans ly discussed as the way to go. incentives do not play nearly as routinely being denied treatment Legislators, both incumbent and well as lump-in-the-throat testiand care by both hospitals and aspiring, are taking positions: they mony by hard-working, middledoctors because they either had are definitely learning a lot about class Americans who have been no, or not enough, insurance. it. stripped of their savings and asThe show focused on one Of course, the George Bush sets by unforeseen medical bills. pregnant California woman who administration, its Republican Whether for good or bad, there is had hypertension and was turned supporters and the health insur- no shortage of these compelling away by more than 50 doctors ance industry do not see it the witnesses willing to go public because she had only Medicaid same way and offer their own about their harrowing encounter coverage. Although the program options. with pay-as-you-go medicine. outlined problems within the CaThey favour leaving the em- There are plenty of horror stories, nadian system, such as waiting ployer-based system in place and and unless the health insurance lists and maldistribution of high using various fiscal incentives and safety net is cast wider there will technology, it came off very well tax lures to get employers to pro- be many more. by comparison with the US and vide better health care coverage. Health care reform has been struck a nerve among American But how much additional cost can dragged into presidential elections viewers. The program has already employers bear? Already, large before, of course, but never has it been rebroadcast several times. manufacturers such as auto pro- been quite the middle-class issue The message appears to have been ducers claim they're losing ground it is today. My brother Les, and heard by politicians. to international competitors many other Americans, learned On Jan. 14, 1992, Democratic whose governments subsidize that lesson firsthand.u
The US should be wary of Canada's health care system Brian Shamess, MD A udrey McLaughlin, federal leader of the New Democratic Party (NDP), recently addressed a congressional breakfast in Washington. "No one facing life-threatening circumstances is forced to wait in Canada," she told the American politicians. Brian Shamess is a physician with a limited referral practice in orthopedic and sports medicine in Sault Ste. Marie, Ont. 2046
CAN MED ASSOC J 1992; 146 (1 1)
I beg to differ. My father, a practising ophthalmologist, died in 1989 while waiting for heart surgery in Ontario. His wait could be directly linked to our vaunted socialized health care system. My father was not the only Canadian to die while waiting for heart surgery. Since his death the waitinglist problem has been partly rectified, but this is hardly proactive behaviour. While my father's condition
was being investigated in London, Ont., I spoke to the Ontario Health Watch Group. It was pushing for better cardiac surgery facilities so that patients would not have to wait, and possibly die, before getting the surgery they needed. Many members of this group had seen family members die before surgery could be performed, or wait an excessive amount of time for it. Perhaps McLaughlin was not aware of the LE I er JUIN 1992
