Apr 20, 2011
I recently returned from a visit of several days to an alternate universe: Canadian health care.
As a physician who has practiced in the United States for 44 years, I have experienced many aspects of our health care system, including its terrible inequities.
Although some Americans get very good health care, there are many who get little or none. Then there are others who get too much: tests, procedures and drugs that they don't need. The whole system is fragmented, chaotic, inefficient and terribly expensive. We are not getting good value for our enormous expenditure on health care.
Some years ago, having come to the conclusion that a single-payer national health program - an improved Medicare for all - is the solution to our problem, I joined Physicians for a National Health Program (PNHP). I wanted to help bring about a system that provides comprehensive coverage to everyone, removes the extremely wasteful and intrusive private insurance companies from the doctor-patient relationship, and gives every patient free choice of doctor and hospital.
Our new federal health law, unfortunately, doesn't achieve these key goals.
Over the years, in my talks about single payer, I have often cited Canada's system as an example worthy of study, if not emulation. But it wasn't until earlier this month that I paid a visit to Toronto with the express purpose of learning more about how the Canadian single-payer system actually works. I traveled there as part of an 8-member delegation of physicians, health care advocates and policy expert from New York state.
All of us wanted to see "up close and personal" what their Medicare (the name for the Canadian system) looks like and find out how they manage to provide high-quality care for all Canadians and yet spend only half of what we spend, per capita, doing so.
The trip was an eye-opener. We met with physicians in many specialties -- both academics and community-based physicians in private practice -- and got to shadow them as they went about their work in their offices. We met with health care administrators. We talked to patients. We learned a lot.
Although some of us thought we were coming to the "promised land" of single-payer health care, where everyone has access to high-quality care regardless of ability to pay, our Canadian counterparts were much more blase about their egalitarian, publicly financed system. They took it for granted. They don't know anything else and are mainly focused on what is needed to improve it.
One thing that became clear to us is that figuring out what works and what doesn't work, and how to make a change, is much easier to do in a unified system like Canada's. We also saw that the single-payer system in practice is not as simple as we thought and that there are still political realities to deal with that control the funding and who gets what part of the pot.
There are still inequities in the system. There is a shortage of physicians and there can be long waits for elective procedures and non-urgent doctor visits. For most Canadians the cost of drugs, dental care and some psychiatric services is not included in the basic package provided by the government. The benefits vary somewhat by province.
But Canada's medical outcomes are excellent; urgent needs get urgent care; and Canadians live two years longer on average than we do. Problems like medical bankruptcy are virtually unknown. The overwhelming majority of Canadians, when polled, say they'd prefer their system over ours any day.
We learned that doctors in Canada earn a good income not much different from most of those in the United States. Although most have a good quality of life with adequate free time, some are overworked and a few can't find positions due to lack of facilities in some specialties. But few Canadian physicians emigrate, and in fact each year since 2004 more physicians have returned to Canada than have moved abroad.
Canadians were totally perplexed as to why Americans have put up with our faulty and expensive system for so long. It was hard for me to explain this as I cannot understand it myself. Although polling shows that two-thirds of American are in favor of Medicare for all, their voices are not heard in the media nor in the halls of Congress. On the contrary, our legislators are now debating whether to end Medicare are we know it.
I am more certain than ever of the truth that a single-payer system, like the Canadian one, is the right solution for us. I am energized to continue advocating for such a system here. Hopefully we can soon bring the United States into this alternate universe.
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