http://www.ibdeditorials.com/IBDArticles.aspx?id=299282509335931
Canadian Health Care We So Envy Lies In Ruins, Its Architect Admits
By DAVID GRATZER | Posted Wednesday, June 25, 2008 4:30 PM PT
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.
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