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Letter to the editor

Canada boasts health care for all - in time

Delays make the universal system not quite as primo as 'Sicko' says.

By SUSAN TAYLOR MARTIN
Published July 8, 2007

Shortly before Christmas last year, Julie Mason of Ottawa, Ontario, received devastating news. She had ovarian cancer. Her husband's prostate cancer had returned.

The costs of surgery, chemotherapy and radiation treatments could have been as overwhelming as the diagnoses. To date, though, the Masons' out-of-pocket expenses have been a veritable pittance: $266.

"I don't like to sound like a flag waver, but if we'd been in the States, we wouldn't have survived," says Julie Mason, 62, a communications consultant. "I don't think anyone could stand the financial burden of two people with cancer."

Now cancer-free, the Masons are among the many Canadians who rave about their national health care system -- a system also extolled in Michael Moore's new movie Sicko as one of the world's best.

The controversial film slams the U.S. approach to health care, portraying it as a cold-hearted, profit-driven nightmare that dumps the uninsured out on the street and looks for any excuse to deny benefits even to those who can afford coverage.

By contrast, Moore paints the rosiest of pictures in Canada, France, Britain and Cuba, where every citizen, regardless of income or "pre-existing" condition, is entitled to necessary health care at government expense.

Among Sicko's most striking examples: When a Canadian worker accidentally severed all five fingers on one hand, the Canadian health care system picked up the entire tab of reattaching them. When an uninsured American sliced off two fingertips in an electric saw accident, he could afford to get only one reattached -- at a cost of $12,000.

But is health care in other places really as terrific as Sicko suggests? A closer look at Canada -- a country similar in history and culture to the United States -- reveals a system that while truly egalitarian suffers from doctor shortages, long waiting times and hidden costs in the form of higher taxes and "health premiums."

"It's a wonderful system, but unfortunately it's overloaded at the moment," says Gerry Brissenden, who at 75 divides his time between Ontario and St. Petersburg as president of the Canadian Snowbird Association.

Crossing the border

Under Canada's Health Act, Brissenden and his 33-million fellow citizens are entitled to all necessary physician and hospital services, including prescription drugs. They usually must pay for any drugs outside the hospital but costs are often much less than U.S. prices.

Perhaps because they can see a doctor whenever they feel the need, Canadians on average live two years longer than Americans. And Canadians tend to be healthier: The country has a far lower incidence of obesity, a risk factor for diabetes, stroke, heart disease and some forms of cancer.

Canada's health care system generally does not cover dental or eye care, however. And a shortage of diagnostic equipment - Canada has 4.5 MRIs per million people compared with 8.6 in the United States -- is one reason patients often wait months for tests and nonemergency surgery.

As a result of such delays, a growing number of Canadians cross the border for tests or pay for testing at private clinics in their own country. Despite concern that "queue jumping" undermines the system's fairness, Canada's Supreme Court in 2005 struck down a Quebec law that banned people from using private insurance to pay for MRIs, cataract operations and other government-covered procedures.

"Access to a waiting list is not the same thing as access to health care," the court said, noting that Canadians had suffered and even died because of long waits.

Brissenden, for example, had his broken wrist in a cast for eight weeks before he could get an appointment with a doctor to replace two bones with a metal plate. If he could change one thing about Canada's system, it would be imposing a small charge for doctor visits.

"Even if it was just $2, it would perhaps stop people from going to the doctor unnecessarily," Brissenden says. "Now they go when they get a sniffle instead of buying cough medicine, thereby causing longer wait periods."

Another reason for lengthy waits is a shortage of doctors in rural areas and in certain specialities like obstetrics and gynecology. Concerned that Canada might produce too many doctors, the federal and provincial governments in the early '90s cut back on medical school admissions and made it harder for foreign doctors to be licensed.

About the same time, thousands of Canadian-born doctors and nurses left the country, lured by attractive bonuses to HMOs and for-profit hospitals in the United States.

"The big problem with our system -- and part of it relates to the planning of a decade ago -- is that our waiting times are considered unacceptable for routine and elective procedures," says Colin McMillan, a cardiologist and president of the Canadian Medical Association. "There are just not enough doctor and nurses to serve the population."

Though the "brain drain" has largely stopped and medical school admissions are returning to pre-'90s levels, McMillan says patients in his province, Prince Edward Island, can still wait six months to see a consultant. "It should be four to six weeks, " he says.

A plus side

Some argue that delays are not always bad.

After waiting about a year for a hip replacement, Sharon Sholzberg-Gray dreaded another long wait - this time for two knee replacements. But as the weeks ticked by, she lost so much weight that her knees stopped hurting.

"Now I don't need my knees replaced and I've saved the health system two knee replacement operations," says Sholzberg-Gray, president of the Canadian Healthcare Association.

The association represents hospitals, which are struggling with the fearsome cost of new technology and wonder drugs, particularly for cancer treatment. A recent series in the Ottawa Citizen on how hospitals use tax money found that drug costs rose 82 percent in just three years and the cost of new medical and surgical equipment zoomed 56 percent, far outpacing any other area of hospital spending.

The pressure on hospitals will only increase as aging baby boomers demand more and better health services -- a strong argument for preventive care and healthy lifestyles, Sholzberg-Gray says.

Costs escalate

"No health system in the world is going to be able to be sustained unless people focus on keeping a healthy weight, eating healthy and reducing the amount of diabetes," she said. "But right now the problem, as with any health system, is we could use more money."

Although the United States spends almost twice as much on health care per person, Canada's costs are rising so fast that the government of Ontario, the most populous province, began deducting a "health premium" from wage and pension checks in 2004 to pay for more doctors, nurses and hospital beds. The premium is based on income and can be as much as $900 Canadian about $852 U.S..

Canadians also pay far more sales tax than Americans -- 14 percent in Ontario compared with 6 or 7 percent in Florida -- and some of that money goes to health care. But to most Canadians, it's well worth it.

When she was diagnosed with an "eccentric" form of ovarian cancer, Mason underwent treatment at Toronto's Princess Margaret Hospital, one of Canada's finest cancer centers. Her doctor was one of the country's leading specialists, assisted by a "wonderful" clinical nurse.

Though Canada's taxes are higher than those in the United States, "I honestly believe that there's not a Canadian who wouldn't accept that trade-off," Mason says. "I see people a lot wealthier than me and a lot poorer than me and I know everyone is getting the same care. And for me, that's as important as getting my own care."

Susan Taylor Martin can be contacted at susan@sptimes.com.

Health care costs: Canada vs. U.S.

The United States spends more on health care per person but Canadians see the doctor more often, live longer and aren't as overweight.

Source: Organization for Economic Cooperation and Development

[Last modified July 7, 2007, 20:53:48]