Michael Arnold Glueck, M.D., and Robert J. Cihak, M.D.
Wednesday, June 9, 2004

On the other side of the border, Americans like Representative James McDermott, MD (D-WA) fantasize about importing the Canadian health care dream to the U.S. so that every citizen has "equal access" to medical care.

But more and more Canadians are awakening - not from a dream - but from a nightmare. The results are coming in. After years of government-controlled health care, the ordinary Canadian patient is noticing his health care system is ailing badly. Plus it's bleeding money - his hard-earned tax dollars.

Comparing Canada with other industrialized countries in the Organization for Economic Cooperation and Development (OECD) that provide universal access to health care, a study released by The Fraser Institute in May revealed that Canada spends more on its system than other nations while ranking among the lowest in several key indicators, such as access to physicians, quality of medical equipment, and key health outcomes.

The study identifies one of the major reasons for this discrepancy. Unlike other countries in the study that outperformed Canada - such as Sweden, Japan, Australia, and France - Canada outlaws virtually all private health care. If the government says it provides a medical service, it's illegal for a Canadian citizen to pay for and get the service privately. In practice, this means a patient must linger in line for hospital treatment - an average of 17.7 weeks in 2003, according to an annual survey on hospital waiting list published by the Fraser Institute.

In 1999, Richard F. Davies, MD, described how delays affected Ontario heart patients scheduled for coronary artery bypass graft (CABG) surgery. In a single year, for this one operation, 71 patients died before surgery and another "121 were removed from the list permanently because they had become medically unfit for surgery;" 44 left Ontario and had their CABG elsewhere, such as in the USA. In other words, 192 people either died or were too sick to have surgery before they worked their way to the front of the waiting line.

One of the reasons Canadians are slow to acknowledge the problems with their system is that general practitioners have been relatively easy to access and reasonably efficient at providing everyday services for common complaints, such as colds, sprains, aches and pains.

As time passes, however, more and more Canadians are confronted by the halting quality of their system when they face complex and expensive medical problems. They often cannot get timely or appropriate care for bone fractures, prompt treatment for cancer, or non-emergency surgery such as hip replacements. Their doctors complain that they are unable to help them and the government pleads shortage of funds.

International and Canadian data confirms their concerns. In a 2004 article in the journal "Health Affairs," Robert Blendon reports an international survey of hospital administrators in Australia, New Zealand, Great Britain, the USA and Canada. When asked for the average waiting time for biopsy of a possible breast cancer in a 50-year-old woman, 21 percent of administrators of Canadian hospitals said more than three weeks; 1 percent of American hospital administrators gave the same answer.

Half (50 percent) of the Canadian hospital administrators said the average waiting time for a 65-year-old man who requires a routine hip replacement was more than six months; in contrast, no (as in zero) American hospital administrators reported waiting periods that long. 86 percent of American hospital administrators said the average waiting time was shorter than three weeks; only 3 percent of Canadian hospital administrators said their patients have this brief a wait.

Canadian physician frustration with their inability to provide quality and timely care is resulting in a brain drain. According to one poll, one in three Canadian doctors is considering leaving the country. A doctor shortage looms, as the nation falls 500 doctors a year short of the 2,500 new physicians it needs to add each year to meet national health needs, according to Sally Pipes, a policy expert formerly with the Canadian Fraser Institute.

Another casualty of the lengthy waiting periods is Canada's much-vaunted equal access to medical treatment. Even though medical emergencies allow some people to jump ahead in the waiting line - making others wait longer - a survey published in the Annals of Internal Medicine medical journal found that more than 90 percent of heart specialists had "been involved in the care of a patient who received preferential access" to cardiac care based on non-medical reasons including the patient's social standing or personal connections with the treating physician.

Luckily, 90 percent of Canadians live close to the border with the States and can come south to fill in the gaps in their health care system with American doctors and hospitals.

If the U.S. adopts the Canadian health care dream and it turns into a nightmare, where will we go for medical services? To Mexico?

The Medicine Men think we already suffer from enough Canadian-style, centrally-controlled government health care. For example, American Medicare's slow acceptance of medical innovation, exacting paperwork requirements, delayed and low payment of claims, and the threat of overzealous prosecution by Medicare cops are driving doctors out of the Medicare system. As a result, patients on Medicare find they have fewer medical options.

We believe more patient choice - such as in the new Health Savings Account (HSA)/catastrophic insurance options - rather than government control, better fulfills the American Dream of life, liberty and the pursuit of happiness for all.

Editor's Note: Robert J. Cihak wrote this week's column.

Robert J. Cihak, M.D., is a Senior Fellow and Board Member of the Discovery Institute and a past president of the Association of American Physicians and Surgeons. Michael Arnold Glueck, M.D., is a multiple-award-winning writer who comments on medical-legal issues.

Contact Drs. Glueck and Cihak by web e-mail.