Health care: Canada’s system can no longer be considered a point of pride

Canadians have an enormous attachment, almost equivalent to national self-definition, in our universal health care system. Life expectancy in Canada has risen since 1950 a full decade from 69 to 79. Girls born today can expect to live to 83; boys, 79, partly thanks to our health system. Its genesis was Swift Current, Saskatchewan, in 1947, when residents created the first public health care insurance program on the continent. Health care in the town was thereafter a public service, not something purchased in the market.

A year later, Premier Tommy Douglas of what is today the New Democratic Party extended the Swift Current model to the entire province. A decade later, Liberal Prime Minister Louis St. Laurent introduced North America’s first national hospital insurance plan; his successor, Progressive Conservative John Diefenbaker, applied a new law to all health services in hospitals across the country.

The cost savings of Canada’s single-insurer vs. the American multiple insurer competitive system are clear. A study reported by the International Journal of Health Services concluded that reducing American administrative and promotional costs to Canadian levels would save at least $209 billion a year, “enough to fund universal coverage.” President Obama’s Affordable Care Act of 2010 is designed to maintain private health insurance, extend accessible/affordable insurance to perhaps 16 million Americans, ban policies which disfavour high-risk patients and incur no additional cost for taxpayers.

A Canadian physician relocated several years ago to the U.S. eastern seaboard became so distressed at having to treat patients there not according to their medical needs but instead on what medical coverage they owned, that she moved back to Canada, where she practises today. To be sure, Americans with superior private health care insurance paid mostly by employers are no doubt satisfied that excellent health services are rapidly available to them.

Nationals in both countries often demonize medical practices in the other, although many now recognize that better health could be achieved with behaviour modification. A recent survey in the Globe and Mail indicated that 62% of Canadians are overweight, with resulting greater risk of heart disease (90%), diabetes (38% for women; 32% for men), and cancer (41% for women; 46% for men).

Traditionally, our health care system was a major source of national pride. Unlike our southern neighbour, we provided equal access to our entire population. Attitudes seemed to change with media stories and personal experiences. There is now major concern across Canada about long waiting periods, availability of services, shortages of nurses and physicians, specific illnesses (especially cancer and heart disease) and caring for our aging population.

Many other nations today, while providing universal access, charge small user fees for hospitals, GPs, or specialists. Canada is the only member of the rich nations’ club, the OECD, to bar privately funded purchase of core services. Other nations have user-pay private provision of health care. Many OECD nations insist that only public hospitals offer publicly insured services, but more than half of them allow private providers to deliver publicly-funded care.

Canada has fewer doctors relative to comparable nations: we ranked 24th out of 27 countries five years ago, with only 2.3 doctors per 1,000 persons and a total of 66,289 physicians. A study at Harvard indicated that Canadians were more likely than any other universal-access country surveyed to wait more than a month for non-emergency surgery and to find it difficult to see a specialist.

Former heart surgeon Wilbert Keon and Senator Michael Kirby make three suggestions:

• Provincial and federal legislators should abandon their fixation with the ownership of health care agencies in favour of a range of delivery options in order to obtain the best results for Canadians from a mix of public and private features.

• Hospitals must be given the flexibility they need to make the most efficient use of their resources. This includes “eliminating the complex and rigid work rules that permeate the hospital(s).”

• Members of the medical profession (should) “stop dragging their feet on reforming primary care delivery ... (and recognize) the critical importance of having primary care services delivered through multi-disciplined clinics that are mainly funded on a capitation rather than fee-for-service basis.”

A report several years ago indicated that 3.5 million Canadians lacked a primary care physician, which means that many of them must resort to hospital emergency rooms. Canadians contrast our system with the 4o million or so Americans who lack health care insurance and also use hospital emergency rooms. The practical difference between Canadians who have the right to free health care but can’t get it, and Americans who must pay for the care and can get it becomes minimal.

The most important approach that could be taken to improve longevity involves behavior modification. In short, if we don't smoke, keep our weight down, follow a healthy diet, exercise regularly, consume alcohol in moderation, and practice “safe sex,” we are likely to enjoy longer and healthier lives in either country.

David Kilgour is co-chair of the Canadian Friends of a Democratic Iran and a director of the Washington-based Council for a Community of Democracies (CCD). He is a former MP for both the Conservative and Liberal Parties in the south-east region of Edmonton and has also served as the Secretary of State for Latin America and Africa, Secretary of State for Asia-Pacific and Deputy Speaker of the House.