Canadian Waiting Lists Getting Longer Dispite More Money

As part of my irregular perusal of Canadian media, I came across an interesting article by George Jonas in the National Post. The article reports on a Frasier Institute study showing Canadians waited on average 18.3 weeks for non-emergency surgery in 2006, about half a week longer than in 2005. This despite the provinces  spending more tax dollars to reduce unacceptable waiting times.

Mr. Jonas can’t understand Canadians’ tolerance of this, although he notes it “gives new meaning to the word ‘patient.'” He has no problem, or hesitation, in describing the predictable result of this situation, what he calls a three-tier medical system. The first tier is the traditional provincial health plan available to everyone, the “second tier is called the ‘inside track’ and the the third, the United States. Anyone who thinks that wealthy or well-connected Canadians stand meekly in line and wait 18.3 weeks to see a specialist doesn’t live on this planet. The well-connected jump the queue, while the rich hop on a plan … and get themselves looked after in Cleveland, Austin, Phoenix or Rochester.”

Mr. Jonas laments Canada’s lack of private health insurance. “No one can guarantee health, but people should be able to buy therapy. Making therapy a government monopoly, and then doling it out on whatever basis — first-come-first served, lottery, status, connections or some murky bureaucratic set of priorities — combines iniquity with inefficiency.”

Recent events in the debate over changes to California’s health care system will embolden single-payer advocates to push their legislative package, Senate Bill 840 (Kuehl) even harder. They’ll be out in force at the Assembly Health Committees hearing on the Governor’s bill currently scheduled for October 31st. Maybe someone will ask them about the three tier Canadian version of their proposal. I doubt it, but one can always hope. 

In the meantime it’s kind of fun to read both Californian and Canadian newspapers. In the former, liberals are seeking Canadian-style health care reforms; in the latter conservatives are seeking private coverage such as available in the California. Perhaps we could bring them together in one room, sell tickets and finance health care reform with the proceeds.

OK, perhaps not, but it would be entertaining. And maybe even enlightening.

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Canadian Health Care as Reported by Canadians

We read so much about the problems facing the American health care system I began wondering what folks in other countries complain about. After all, advocates for single-payer systems are always pointing to Canada or Europe to show how much better things are elsewhere. Yet reports on other health care systems are always filtered through the political prism of the presenter.

So I found a Canadian news service — CNW Group (“the nation’s number one resource for time-critical news and information from more than 10,000 sources coast to coast and around the world.”) It’s sort of a Canadian Associated Press. On eof the recent headlines caught my eye “Ontario Party Leaders message to cancer patients: Keep waiting.” It seems a grass roots campaign launched a cancer patient support group sent letters to the leaders of the province’s three major parties. They noted Ontario ranks poorly in funding new intravenous cancer drugs (British Columbia funds 20 while Ontario fully funds only four). Further, Ontario ranks last among Canadian provinces when it comes to funding PET scan imaging (Quebec funded 209 PET scans per 1000,000 population; Ontario only six).

The party leaders failed to commit to improving Ontario’s ranking, instead offering reassurances of their commitment to health care for all Ontarians. Or as one of the consumer advocates noted, “All three leaders have been talking about their commitment to health care on the campaign trail, but none of them seem to be willing to be accountable for measurable results.” The consumer group intends to demonstrate at public meetings of the candidate to educate their fellow citizens on the subject.

This all got me thinking about how a politicized health care system would work in America. Would we have candidates making the round of disease-focused associations pledging increased funding? Would incumbants be attacked for long waits for services? When health care costs continued to rise (as they will given the aging population, the cost of new technologies, and the like) would the rascals in charge be thrown out of office?

Even if voters punished politicians for failures in the health care system, I’m not sure much would change. The challenges facing the American health care system is about far more than the financing mechanism. It’s about making tough choices about what adequate health care is. It’s about making objective investigations into waste in the system and having the skill and tools to eliminate that waste.

A wise man once told me you never really fix problems, you just replace them with new ones. Folks who look to Canada and Europe for answers should subscribe to services like CNW. Because health insurance reform is only the beginning, not the end, to the challenges we face.

Canada’s Health Care System: One Doctor’s View

Proponents of a single payer system cite Canada as a role model for America. Bruce Benton, Regional VP for the National Association of Health Underwriters, recently forwarded me a column which appeared in Investors Business Daily. It was written by a Canadian doctor David Gratzer and describes his disillusionment with the system.  [Edit 8/17/07: the link to this article is no longer valid. Fortunately, Dr. Gratzer wrote an even more detailed article for City Journal Magazine which covers much of the same ground.]

The column also takes on some of the urban legends surrounding both the Canadian and American health care systems. For example, every single payer advocate cites the true statistics that the average life expectancy of Americans is less than that of Canadians and Europeans, except for Portugal. Dr. Gratzer points out that a life can end due to murder, a car accident or a fall. He then cites a study which factors out intentional and unintentional injuries from life-expectancy statistics. The result: “Americans who don’t die in car crashes or homicides outlive people in any other Western country.”

Dr. Gratzer’s is an opinion worth considering, especially by those in California supporting Senate Bill 840 (Keuhl), which would establish a Canadian-style system in the state.