Canadian and U.S. Health Services -- Let's Compare the Two
Wall St. Journal
LETTERS
Sunday, July 8, 2007
The commentary by David Gratzer (“Who’s Really Sicko?”editorial page, June 28) presents an extremely prejudicial view of the publicly funded Canadian health system. It highlights the unfortunate story of a man from Ontario who had difficulty accessing a head MRI scan for a malignant brain tumour. Undoubtedly there are similar anecdotes describing difficulties in accessing care experienced by the 44 million Americans who lack health insurance. However, in making a rational comparison of the Canadian and American health systems it is more reasonable to contrast service levels and costs of the systems rather than trading anecdotes.
Canadians pay about 9% of national GDP to insure 100% of citizens in our single-payer system, compared with more than 14% of GDP to insure 85% of Americans. The Kaiser Family Foundation reports that the average compound annual growth rate in U.S. health insurance costs has been 11.6% over the past five years. It is therefore not surprising that polling by Kaiser found that 75% of Americans were worried or very worried about the amount they would need to pay for health insurance in the future and that 63% were worried or very worried about not being able to afford health-care services.
There is no question that restriction of supply with sub-optimal access to services has contributed to the lower cost of health care in Canada. However, a new approach of targeting investments to reduce waiting times combined with transparent reporting of wait times is having a substantial impact on access in the Canadian system. Dr. Gratzer wrote about prolonged waits for treatment in Ontario but did not refer readers to the public Web sites that detail Ontario waiting times for cancer surgery, chemotherapy, radiation, cataract, heart, arthroplasty and imaging procedures:
(http://www.health.gov.on.ca/transformation/wait_times/wait_mn.html and http://www.cancercare.on.ca)
Canadians spend about 55% of what Americans spend on health care and have longer life expectancy, and lower infant mortality rates. Many Americans have access to quality health care. All Canadians have access to similar care at a considerably lower cost. In “Sicko,” Michael Moore has apparently exaggerated the performance of the Canadian health system — there is no doubt that too many patients still stay in our emergency departments waiting for admission to scarce hospital beds. However, Mr. Moore’s description of the advantages of the Canadian system in the film is more accurate than the jaundiced view of our system proposed by Dr. Gratzer.
Robert S. Bell, M.D.
President and CEO
University Health Network
Toronto
(The letter was also signed by Carolyn Baker, R.N., president and CEO, St. Joseph’s Health Centre, Toronto, and Catherine Zahn, M.D., executive vice-president of Clinical Programs and Practice, University Health Network, Toronto.)
The introduction of private insurance or private-for-profit health care for medically necessary services is not the answer to challenges in the Canadian health-care system. In a systematic review of 38 studies published in Open Medicine in May, 17 leading Canadian and U.S. researchers confirmed the Canadian system leads to health outcomes as good, or better, than the U.S. private system, at less than 50% of the cost.
Unwanted side-effects of competitive health care include a drain of highly trained professionals from the public system and “cream skimming” of patients by private clinics who choose the healthiest patients, leaving the most complex to the increasingly overburdened public system.
In June 2006, the Canadian Medical Association reviewed all the evidence from other jurisdictions and concluded that private insurance for medically necessary physician and hospital services does not improve access to publicly insured services; does not lower costs or improve quality of care; can increase wait times for those who are not privately insured; and, could exacerbate human resource shortages in the public system.
Medicare is not only more equitable, but more efficient and produces higher quality health care than the alternatives. This conclusion is supported by the best national and international evidence, including reports from the World Health Organization and the Organization for Economic Co-Operation and Development.
So what should Canada do about patients who do not receive timely access to essential medical care? Numerous expert reports, including the 2002 Royal Commission on the Future of Health Care in Canada, have already told us we need to restore and strengthen Medicare, not decimate it.
In May the Canadian Centre for Policy Alternatives reported that successful initiatives in team-based care and improved administration produced dramatic cuts in waiting times for surgery in B.C. Alberta, Saskatchewan and Ontario, without any need for competition.
Danielle Martin
Board Chair
Canadian Doctors for Medicare
Toronto