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
waiting lists, or maybe she chose not to highlight them. As Michael Walker of the Fraser Institute in Vancouver has reported, lengthy waiting lists are used as a control instrument by state-sponsored medical care systems anxious to control overall costs in the face of high demand caused by the nonexistence of a pricing mec'hanism. I doubt that I am the only Canadian to find our socialized
market. For example, my father not only was a practising ophthalmologist but also was involved in numerous business enterprises in a consultative and administrative capacity. The loss of his wisdom and shrewd advice has, in all probability, resulted in decreased tax revenue for Ontario. I am glad that our health insurance system gives some of our industries, such as General Motors of Canada, a competitive
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.
health care system immoral. My father dedicated 39 years of his life to providing medical care in Ontario. Yet, when he was in need of urgent medical care his life ended because the care was not provided. At that time, cardiac surgeons were being asked to play Russian roulette with peoples' lives. I wonder if those in power would have waited in line like my father did. Or would they have jumped the queue, or perhaps headed to private facilities in the US? This would not surprise me. There is already a special clinic for federal politicians in Ottawa, and it was reported that the last Labour minister of health in Great Britain attended a private ophthalmologic clinic for cataract surgery. At the time, the National Health Service waiting time for similar surgery was 2 to 3 years. She stated that she had too much to do and couldn't wait. Hypocrisy? A government-dominated health care system does not appreciate the intricacies of the free 2048
CAN MED ASSOC J 1992; 146 (1 1)
advantage over their US counterparts. Nonetheless, I believe our system encourages mediocrity among physicians. If Canadian doctors are motivated from within they will do their best to offer optimum health care. I believe that the US would be committing health care suicide if it adopted our system. Indeed, the US free-market system has helped save ours. For many years, those dissatisfied with care here have been able to obtain it in the US. Thus, twotiered medicine is already a reality in Canada. Many people in the Sault Ste. Marie, Ont., area where I practise have travelled to Petoskey, Mich., for cardiac surgery. Why aren't we developing expertise in cardiac surgery in more of our cities? Or is community-based health promotion and preventive care going to wipe out coronary heart disease? Canadians like to tout the benefits of their health care system, but they cannot afford to ignore the system's problems. If
they do, they are like the patient who ignores his chest pain and confidently states how well he eats, exercises and handles stress. Ignoring the true fact of his chest pain in the midst of the greater truth concerning his health status could result in his death. Our system does have many redeeming qualities, but I must agree with the American Medical Association when it states that Canadian-style medicine means income caps, less autonomy for physicians, rationed services and waiting lists. The elimination of extra-billing in Ontario is a case in point. It stopped many physicians who wanted to offer better services to their patients (who probably would have been willing to pay extra for better care) from investing in the equipment that would have made the better service possible. Most countries have already discovered that a mix of private and public payment systems ensures the best health care for the greatest number of people at the same time it is ensuring consumer responsibility. For instance, if deductibles were introduced in our system, Canadians would not be threatened with bankruptcy but they would share directly in paying a portion of their health care bill. I pray that the US learns from our mistakes. I hope it will use a creative mix of private and public insurance systems that will limit the possibility of personal bankruptcy while ensuring medical provider and consumer responsibility. The US continues to be one of the epicentres of medical research in the world today, and many Canadians are grateful for the excellent health care the country provides. We should accept that. Let's take the best that our health care system has to offer and blend it with the best from other countries. I believe that many Canadian lives depend on such action.u LE ler JUIN 1992
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
waiting lists, or maybe she chose not to highlight them. As Michael Walker of the Fraser Institute in Vancouver has reported, lengthy waiting lists are used as a control instrument by state-sponsored medical care systems anxious to control overall costs in the face of high demand caused by the nonexistence of a pricing mec'hanism. I doubt that I am the only Canadian to find our socialized
market. For example, my father not only was a practising ophthalmologist but also was involved in numerous business enterprises in a consultative and administrative capacity. The loss of his wisdom and shrewd advice has, in all probability, resulted in decreased tax revenue for Ontario. I am glad that our health insurance system gives some of our industries, such as General Motors of Canada, a competitive
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.
health care system immoral. My father dedicated 39 years of his life to providing medical care in Ontario. Yet, when he was in need of urgent medical care his life ended because the care was not provided. At that time, cardiac surgeons were being asked to play Russian roulette with peoples' lives. I wonder if those in power would have waited in line like my father did. Or would they have jumped the queue, or perhaps headed to private facilities in the US? This would not surprise me. There is already a special clinic for federal politicians in Ottawa, and it was reported that the last Labour minister of health in Great Britain attended a private ophthalmologic clinic for cataract surgery. At the time, the National Health Service waiting time for similar surgery was 2 to 3 years. She stated that she had too much to do and couldn't wait. Hypocrisy? A government-dominated health care system does not appreciate the intricacies of the free 2048
CAN MED ASSOC J 1992; 146 (1 1)
advantage over their US counterparts. Nonetheless, I believe our system encourages mediocrity among physicians. If Canadian doctors are motivated from within they will do their best to offer optimum health care. I believe that the US would be committing health care suicide if it adopted our system. Indeed, the US free-market system has helped save ours. For many years, those dissatisfied with care here have been able to obtain it in the US. Thus, twotiered medicine is already a reality in Canada. Many people in the Sault Ste. Marie, Ont., area where I practise have travelled to Petoskey, Mich., for cardiac surgery. Why aren't we developing expertise in cardiac surgery in more of our cities? Or is community-based health promotion and preventive care going to wipe out coronary heart disease? Canadians like to tout the benefits of their health care system, but they cannot afford to ignore the system's problems. If
they do, they are like the patient who ignores his chest pain and confidently states how well he eats, exercises and handles stress. Ignoring the true fact of his chest pain in the midst of the greater truth concerning his health status could result in his death. Our system does have many redeeming qualities, but I must agree with the American Medical Association when it states that Canadian-style medicine means income caps, less autonomy for physicians, rationed services and waiting lists. The elimination of extra-billing in Ontario is a case in point. It stopped many physicians who wanted to offer better services to their patients (who probably would have been willing to pay extra for better care) from investing in the equipment that would have made the better service possible. Most countries have already discovered that a mix of private and public payment systems ensures the best health care for the greatest number of people at the same time it is ensuring consumer responsibility. For instance, if deductibles were introduced in our system, Canadians would not be threatened with bankruptcy but they would share directly in paying a portion of their health care bill. I pray that the US learns from our mistakes. I hope it will use a creative mix of private and public insurance systems that will limit the possibility of personal bankruptcy while ensuring medical provider and consumer responsibility. The US continues to be one of the epicentres of medical research in the world today, and many Canadians are grateful for the excellent health care the country provides. We should accept that. Let's take the best that our health care system has to offer and blend it with the best from other countries. I believe that many Canadian lives depend on such action.u LE ler JUIN 1992
