Canadian Health Care We So Envy Lies In Ruins, Its Architect Admits

[GaryC 7]

Canadian Health Care We So Envy Lies In Ruins, Its Architect Admits

BY DAVID GRATZER

Posted 6/25/2008

As this presidential campaign continues, the candidates' comments about health care will continue to include stories of their own experiences and anecdotes of people across the country: the uninsured woman in Ohio, the diabetic in Detroit, the overworked doctor in Orlando, to name a few.

But no one will mention Claude Castonguay — perhaps not surprising because this statesman isn't an American and hasn't held office in over three decades.

Castonguay's evolving view of Canadian health care, however, should weigh heavily on how the candidates think about the issue in this country.

Back in the 1960s, Castonguay chaired a Canadian government committee studying health reform and recommended that his home province of Quebec — then the largest and most affluent in the country — adopt government-administered health care, covering all citizens through tax levies.

The government followed his advice, leading to his modern-day moniker: "the father of Quebec medicare." Even this title seems modest; Castonguay's work triggered a domino effect across the country, until eventually his ideas were implemented from coast to coast.

Four decades later, as the chairman of a government committee reviewing Quebec health care this year, Castonguay concluded that the system is in "crisis."

"We thought we could resolve the system's problems by rationing services or injecting massive amounts of new money into it," says Castonguay. But now he prescribes a radical overhaul: "We are proposing to give a greater role to the private sector so that people can exercise freedom of choice."

Castonguay advocates contracting out services to the private sector, going so far as suggesting that public hospitals rent space during off-hours to entrepreneurial doctors. He supports co-pays for patients who want to see physicians. Castonguay, the man who championed public health insurance in Canada, now urges for the legalization of private health insurance.

In America, these ideas may not sound shocking. But in Canada, where the private sector has been shunned for decades, these are extraordinary views, especially coming from Castonguay. It's as if John Maynard Keynes, resting on his British death bed in 1946, had declared that his faith in government interventionism was misplaced.

What would drive a man like Castonguay to reconsider his long-held beliefs? Try a health care system so overburdened that hundreds of thousands in need of medical attention wait for care, any care; a system where people in towns like Norwalk, Ontario, participate in lotteries to win appointments with the local family doctor.

Years ago, Canadians touted their health care system as the best in the world; today, Canadian health care stands in ruinous shape.

Sick with ovarian cancer, Sylvia de Vires, an Ontario woman afflicted with a 13-inch, fluid-filled tumor weighing 40 pounds, was unable to get timely care in Canada. She crossed the American border to Pontiac, Mich., where a surgeon removed the tumor, estimating she could not have lived longer than a few weeks more.

The Canadian government pays for U.S. medical care in some circumstances, but it declined to do so in de Vires' case for a bureaucratically perfect, but inhumane, reason: She hadn't properly filled out a form. At death's door, de Vires should have done her paperwork better.

De Vires is far from unusual in seeking medical treatment in the U.S. Even Canadian government officials send patients across the border, increasingly looking to American medicine to deal with their overload of patients and chronic shortage of care.

Since the spring of 2006, Ontario's government has sent at least 164 patients to New York and Michigan for neurosurgery emergencies — defined by the Globe and Mail newspaper as "broken necks, burst aneurysms and other types of bleeding in or around the brain." Other provinces have followed Ontario's example.

Canada isn't the only country facing a government health care crisis. Britain's system, once the postwar inspiration for many Western countries, is similarly plagued. Both countries trail the U.S. in five-year cancer survival rates, transplantation outcomes and other measures.

The problem is that government bureaucrats simply can't centrally plan their way to better health care.

A typical example: The Ministry of Health declared that British patients should get ER care within four hours. The result? At some hospitals, seriously ill patients are kept in ambulances for hours so as not to run afoul of the regulation; at other hospitals, patients are admitted to inappropriate wards.

Declarations can't solve staffing shortages and the other rationing of care that occurs in government-run systems.

Polls show Americans are desperately unhappy with their system and a government solution grows in popularity. Neither Sen. Obama nor Sen. McCain is explicitly pushing for single-payer health care, as the Canadian system is known in America.

"I happen to be a proponent of a single-payer health care program," Obama said back in the 1990s. Last year, Obama told the New Yorker that "if you're starting from scratch, then a single-payer system probably makes sense."

As for the Republicans, simply criticizing Democratic health care proposals will not suffice — it's not 1994 anymore. And, while McCain's health care proposals hold promise of putting families in charge of their health care and perhaps even taming costs, McCain, at least so far, doesn't seem terribly interested in discussing health care on the campaign trail.

However the candidates choose to proceed, Americans should know that one of the founding fathers of Canada's government-run health care system has turned against his own creation. If Claude Castonguay is abandoning ship, why should Americans bother climbing on board?

Gratzer is a senior fellow at the Manhattan Institute and a physician licensed in both the U.S. and Canada, where he received his medical training. His newest book, "The Cure: How Capitalism Can Save American Health Care," is now available in paperback.

http://www.investors.com/editorial/editori...299282509335931

[Kathryn41 3,205]

Asking Castonquay for his opinion on health care in Canada today is like asking George Bush his opinion on weapons of mass destruction in Iraq - they have their own personal opinions that have long been proved to have little relationship to the truth. Castonquay has been an advocate for the US style of health care for many many many years now and while his initial participation was in the early years of Quebec medicare, he was in no ways one of the founders of the Canadian Health care system. The founder is much more accurately Tommy Douglas, Premier of Saskatchewan http://en.wikipedia.org/wiki/Tommy_Douglas back in the 1940s. Castonquay is now president of a health insurance company - can we say "Conflict of Interest" here? Of course he says the current system doesn't work - it doesn't work for him because his company can't make a big enough profit as long as the Canada Health Act guarantees all Canadians equal access to quality health care regardless of location, financial status or health needs. Come on now, how CAN anyone take him seriously?

http://www.canada.com/montrealgazette/colu...2f-5bb8cd0ca6aa

http://en.wikipedia.org/wiki/Claude_Castonguay

http://www.theglobeandmail.com/servlet/sto...uebechealth0219

Edited June 27, 2008 by Kathryn41

[w¡n9Nµ7 §£@¥€r 123]

Asking Castonquay for his opinion on health care in Canada today is like asking George Bush his opinion on weapons of mass destruction in Iraq - they have their own personal opinions that have long been proved to have little relationship to the truth. Castonquay has been an advocate for the US style of health care for many many many years now and while his initial participation was in the early years of Quebec medicare, he was in no ways one of the founders of the Canadian Health care system. The founder is much more accurately Tommy Douglas, premier of Saskatchewan back in the 1940s. Castonquay is now president of a health insurance company - can we say "Conflict of Interest" here? Of course he says the current system doesn't work - it doesn't work for him because his company can't make a big enough profit as long as the Canada Health Act guarantees all Canadians equal access to quality health care regardless of location, financial status or health needs. Come on now, how CAN anyone take him seriously?

http://www.canada.com/montrealgazette/colu...2f-5bb8cd0ca6aa

http://en.wikipedia.org/wiki/Claude_Castonguay

http://www.theglobeandmail.com/servlet/sto...uebechealth0219

pwned!

[SaadBell 0]

Asking Castonquay for his opinion on health care in Canada today is like asking George Bush his opinion on weapons of mass destruction in Iraq - they have their own personal opinions that have long been proved to have little relationship to the truth. Castonquay has been an advocate for the US style of health care for many many many years now and while his initial participation was in the early years of Quebec medicare, he was in no ways one of the founders of the Canadian Health care system. The founder is much more accurately Tommy Douglas, premier of Saskatchewan back in the 1940s. Castonquay is now president of a health insurance company - can we say "Conflict of Interest" here? Of course he says the current system doesn't work - it doesn't work for him because his company can't make a big enough profit as long as the Canada Health Act guarantees all Canadians equal access to quality health care regardless of location, financial status or health needs. Come on now, how CAN anyone take him seriously?

[MrsCat 6]

Asking Castonquay for his opinion on health care in Canada today is like asking George Bush his opinion on weapons of mass destruction in Iraq - they have their own personal opinions that have long been proved to have little relationship to the truth. Castonquay has been an advocate for the US style of health care for many many many years now and while his initial participation was in the early years of Quebec medicare, he was in no ways one of the founders of the Canadian Health care system. The founder is much more accurately Tommy Douglas, Premier of Saskatchewan http://en.wikipedia.org/wiki/Tommy_Douglas back in the 1940s. Castonquay is now president of a health insurance company - can we say "Conflict of Interest" here? Of course he says the current system doesn't work - it doesn't work for him because his company can't make a big enough profit as long as the Canada Health Act guarantees all Canadians equal access to quality health care regardless of location, financial status or health needs. Come on now, how CAN anyone take him seriously?

http://www.canada.com/montrealgazette/colu...2f-5bb8cd0ca6aa

http://en.wikipedia.org/wiki/Claude_Castonguay

http://www.theglobeandmail.com/servlet/sto...uebechealth0219

boo-yah!

[GaryC 7]

Asking Castonquay for his opinion on health care in Canada today is like asking George Bush his opinion on weapons of mass destruction in Iraq - they have their own personal opinions that have long been proved to have little relationship to the truth. Castonquay has been an advocate for the US style of health care for many many many years now and while his initial participation was in the early years of Quebec medicare, he was in no ways one of the founders of the Canadian Health care system. The founder is much more accurately Tommy Douglas, Premier of Saskatchewan http://en.wikipedia.org/wiki/Tommy_Douglas back in the 1940s. Castonquay is now president of a health insurance company - can we say "Conflict of Interest" here? Of course he says the current system doesn't work - it doesn't work for him because his company can't make a big enough profit as long as the Canada Health Act guarantees all Canadians equal access to quality health care regardless of location, financial status or health needs. Come on now, how CAN anyone take him seriously?

http://www.canada.com/montrealgazette/colu...2f-5bb8cd0ca6aa

http://en.wikipedia.org/wiki/Claude_Castonguay

http://www.theglobeandmail.com/servlet/sto...uebechealth0219

Well, since I am not Canadian I am only getting things like this from the news. But, from what I read in your links nothing in the original story seems misleading or wrong. Castonquay was the person that chaired the commitee that wrote the original health plan for Quebec. After doing so he did change his mind. Also, is any of the things the story states about the current condition of Canada's health care in question?

I have seen stories like this about the health care situation in the UK. The system is breaking down and they are moving to privatization to help fix it. Please disprove the content of the story rather than casting doubt on the persons motives.

[one...two...tree 2,762]

Gary, why is the U.S. the only industrialized nation that doesn't guarantee healthcare to its citizens?

[Kathryn41 3,205]

Having had the opportunity to experience both the US and the Canadian health care systems - both doctors and hospitals -(I have a chronic medical condition) I can confidently say that I got better medical attention in Canada, have had to wait longer for medical treatment here in the US than I ever did in Canada in both emergency treatment in the hospital and appointments with my family doctor and specialists (and I was from a medically under-serviced area in Ontario), and on top of this have had to pay for that privilege here in the US, and play intermediary between the insurance company and the doctor's offices correcting their repeated filing and coding errors. I will take the Canadian system over the US system any day of the week. The reason the health care system is breaking down - at least in Ontario - has nothing to do with the Canada Health Act and a lot to do with the Ontario College of Physicians and Surgeons, who license doctors, refusing to grant more spaces in medical schools to train doctors, and refusing to recognize foreign credentials - yes, even credentials from the US! - in order to 'protect' the earning capacity of their member doctors. Ontario isn't the only province with the problem but it is one of the worst. There is a doctor shortage in Canada - that is what the health care crisis is primarily about - not because the system won't support them, but because the licensing bodies want to ensure a degree of control - similar to what insurance companies do in the US - private agendas putting the health of the public at risk. Yes, there are other problems of funding going to pay high priced CEOs rather than nurses and medical facilities, but the doctor shortage is the biggest one.

Edited June 27, 2008 by Kathryn41

[GaryC 7]

Gary, why is the U.S. the only industrialized nation that doesn't guarantee healthcare to its citizens?

Because we are a lot bigger than all the other industrialized countries with a more diverse population. The systems that other countries use just will not work here. Another reason is our system of government is different than all the other countries. It is incompatable with government run or single payer systems.

[GaryC 7]

Having had the opportunity to experience both the US and the Canadian health care systems - both doctors and hospitals -(I have a chronic medical condition) I can confidently say that I got better medical attention in Canada, have had to wait longer for medical treatment here in the US than I ever did in Canada in both emergency treatment in the hospital and appointments with my family doctor and specialists (and I was from a medically under-serviced area in Ontario), and on top of this have had to pay for that privilege here in the US, and play intermediary between the insurance company and the doctor's offices correcting their repeated filing and coding errors. I will take the Canadian system over the US system any day of the week. The reason the health care system is breaking down - at least in Ontario - has nothing to do with the Canada Health Act and a lot to do with the Ontario College of Physicians and Surgeons, who license doctors, refusing to grant more spaces in medical schools to train doctors, and refusing to recognize foreign credentials - yes, even credentials from the US! - in order to 'protect' the earning capacity of their member doctors. Ontario isn't the only province with the problem but it is one of the worst. There is a doctor shortage in Canada - that is what the health care crisis is primarily about - not because the system won't support them, but because the licensing bodies want to ensure a degree of control - similar to what insurance companies do in the US - private agendas putting the health of the public at risk. Yes, there are other problems of funding going to pay high priced CEOs rather than nurses and medical facilities, but the doctor shortage is the biggest one.

To address the first part of your comments about the wait time: I haven't witnessed or experienced any major wait times here in the US for any services. When I go to see my doctor and he recommends a test I usually get that test within days. I am sure that there are some areas that have longer wait times but it just hasn't been my experience.

For the second part of you comments about the shortage of doctors. That kind of sucks. Here in America if you want to be a doctor, have the grades and the money there really isn't any restriction. Why would they limit space like that and create a shortage? Is this a government body doing this or a private one?

And a question brought up in the OP. Is the Canadian government looking to privatize parts of the health care system and allow private insurance? If that is true then why are they doing it if the only problem is one of a shortage of doctors? It would seem that if their system is working as well as you say then they wouldn't be trying to change it.

[Kathryn41 3,205]

Some personal examples: In Canada, an ultrasound diagnosed a potential ovarian problem - I was in hospital undergoing diagnostic laparoscopy within a week. In Canada, I went to emergency with horrible back pain, cramps, fever. I was admitted and in a room within 5 minutes of arrival at the counter - diagnosis, kidney infection. In Canada, my brother went to emergency with severe abdominal pain and fever. He was immediately rushed in, had a CTscan, and within 15 minutes was in surgery for a ruptured bowel. Individual costs? $0.00. In the US, I went to emergency at 11:30 pm with the whole right side of my body having become numb in 5 minutes and presenting all the symptoms of a stroke. It took half an hour to see some one in registration, another half an hour to get to a room. I didn't see anyone else until 4 am when a nurse arrived to take my vitals - and that was after my husband was storming up and down the emergency corridors demanding someone to see me. I first saw a doctor at 6:30 am - 6 hours after admission for a condition that requires treatment within 40 minutes if it isn't to be reversible. I then had a CT scan, was immediately admitted for a probable stroke, and scheduled for an MRI. 1 1/2 days later with the MRI having ruled out a stroke I was discharged - the whole right side of my body still numb - and no diagnosis - but a bill for $14,000 (insurance covered 80% of it). Earlier this year, I accidentally overdosed my insulin (mixed up the two different types) and went to emergency with my blood sugars plummeting. I waited an hour - although they did give me a sandwich! - before I was admitted and hooked up to an IV for glucose. My blood sugars were 101 on admission, and in the 35 range before I received treatment - and again it was only by my friend going constantly to tell them my blood sugars were plummeting. Cost - bills are still coming in but it is around $1000.

In Canada, I call to make an annual check up with my doctor - no cost. I get an appointment 3 weeks later. I wait about an hour in the waiting room. In the US, I call to make an annual check up with my doctor - he is part of a medical Practice. The first appointment with my doctor is 7 months in the future for a physical. With another doctor at the facility it is only a 4 month wait. I can get an appointment with a PA in about 2 months. I take the PA. I have to wait 1 1/2 hrs for my appointment. 1 1/2 hour is a short wait - the usual for most of my medical appointments is between 2 to 3 hours. . I receive the bill for the services not covered by insurance - it will be several hundred dollars - after I phone the insurer and find out why certain things are not covered and find out that the doctor's office put the wrong code - so call the doctor's office to have them re-submit the correct code to the insurer.

I had to wait 4 months to see my endocrinologist for the first time here - fortunately I was able to get an emergency prescription renewal for my insulin - I had only brought enough to cover 3 months with me from Canada. Now I get to book my appointments 3 months in advance. Appointments with him are actually quick- I usually get in to see him in about 30 minutes. My Canadian endocrinologist had about the same amount of waiting time for appointments, but I could call her up on one day and get in to see her the next day.

Does it get any more specific than this?

Edited June 27, 2008 by Kathryn41

[Ilya R. 0]

BLAME CANADA, BLAME CANADA!!

[Trumplestiltskin 5,791]

This is the reason why there has been debate in the UK about a hybrid system, and indeed this is pretty much what we already have. You have national care under the NHS and you can get supplemental insurance from one of several health plans. Yes it does have a problem with government mandated targets - involving waiting lists, bed availability, the time to get patients into beds etc. and some creative jiggery-pokery to make things look better than they really are (the Blair Government's infamous "waiting list to get on the waiting list".

I would contend that for basic care you really can't beat the publicly funded systems - as others have mentioned, having experienced both the UK and US systems I can honestly say that the standard of care I received in this country was not significantly better than I have received in UK NHS hospitals. The big difference between those and the US is in terms of certain specialist or experimental procedures that aren't provided for under the NHS, or because the treatments are so new they haven't been approved for use by the medical association.

Specifically the article mentions the comparison between cancer survival rates in the US Vs. the UK and Canada. This is a fair criticism - but before we start pouring scorn on the publicly funded healthcare systems it should be remembered perhaps that survival rate for certain conditions in the US (like certain aggressive cancers) depends largely on how much money you have. Its not uncommon for a bout with cancer to shred a persons assets, force them to sell their home or declare bankruptcy. Its far from ideal.

Of course while the US is ahead in terms of that sort of advanced care (if you can afford it), it does fall behind most other developed countries on several measures of general public health. Infant mortality, life expectancy - all much lower than either Britain or Canada.

[GaryC 7]

Some personal examples: In Canada, an ultrasound diagnosed a potential ovarian problem - I was in hospital undergoing diagnostic laparoscopy within a week. In Canada, I went to emergency with horrible back pain, cramps, fever. I was admitted and in a room within 5 minutes of arrival at the counter - diagnosis, kidney infection. In Canada, my brother went to emergency with severe abdominal pain and fever. He was immediately rushed in, had a CTscan, and within 15 minutes was in surgery for a ruptured bowel. Individual costs? $0.00. In the US, I went to emergency at 11:30 pm with the whole right side of my body having become numb in 5 minutes and presenting all the symptoms of a stroke. It took half an hour to see some one in registration, another half an hour to get to a room. I didn't see anyone else until 4 am when a nurse arrived to take my vitals - and that was after my husband was storming up and down the emergency corridors demanding someone to see me. I first saw a doctor at 6:30 am - 6 hours after admission for a condition that requires treatment within 40 minutes if it isn't to be reversible. I then had a CT scan, was immediately admitted for a probable stroke, and scheduled for an MRI. 1 1/2 days later with the MRI having ruled out a stroke I was discharged - the whole right side of my body still numb - and no diagnosis - but a bill for $14,000 (insurance covered 80% of it). Earlier this year, I accidentally overdosed my insulin (mixed up the two different types) and went to emergency with my blood sugars plummeting. I waited an hour _ although they did give me a sandwich! - before I was admitted and hooked up to an IV for glucose. My blood sugars were 101 on admission, and in the 35 range before I received treatment - and again it was only by my friend going constantly to tell them my blood sugars were plummeting. Cost - bills are still coming in but it is around $1000.

In Canada, I call to make an annual check up with my doctor - no cost. I get an appointment 3 weeks later. I wait about an hour in the waiting room. In the US, I call to make an annual check up with my doctor - he is part of a medical Practice. The first appointment with my doctor is 7 months in the future for a physical. With another doctor at the facility it is only a 4 month wait. I can get an appointment with a PA in about 2 months. I take the PA. I have to wait 1 1/2 for my appointment. 1 1/2 hour is a short wait - the usual for most of my medical appointments is between 2 to 3 hours. . I receive the bill for the services not covered by insurance - it will be several hundred dollars - after I phone the insurer and find out why certain things are not covered and find out that the doctor's office put the wrong code - so call the doctor's office to have them re-submit the correct code to the insurer.

I had to wait 4 months to see my endocrinologist for the first time here - fortunately I was able to get an emergency prescription renewal for my insulin - I had only brought enough to cover 3 months with me from Canada. N I get to book my appointments 3 months in advance. Appointments with him are actually quick- I usually get in to see him in about 30 minutes. My Canadian endocrinologist had about the same amount of waiting time for appointments, but I could call her up on one day and get in to see her the next day.

Does it get any more specific than this?

I understand that you specificly have had a bad experience with waiting times here. Fair enough. I can relate stories about when Luz got sick a few months ago and had zero waits for cat scans, x-rays and other tests. I can relate to you stories about when I had problems with my shoulder and needed a MRI scan and had it 2 days later. But as we both know personal stories don't always relate the full picture.

Don't get me wrong here, I am not Canada bashing or trying to cast a bad light on your country. But if what you tell me is true then why is the Canadian government and other countries that have government run health care moving away from centralized administration and moving towards privitazation if there isn't any problem?

[Trumplestiltskin 5,791]

Gary, why is the U.S. the only industrialized nation that doesn't guarantee healthcare to its citizens?

Because we are a lot bigger than all the other industrialized countries with a more diverse population. The systems that other countries use just will not work here. Another reason is our system of government is different than all the other countries. It is incompatable with government run or single payer systems.

Well not really - the US outstrips pretty Canada and pretty much every European country in economic terms. While the public healthcare plans of other countries might not be compatible when applied directly to this country, that doesn't really mean that the way those countries do it is the only way to do it.