In government we trust

Issue: BCMJ, vol. 52 , No. 4 , May 2010 , Pages 170 Editorials

Over the past 20 years Canadian governments have failed to anticipate the need for evolution in our health system. While many may criticize President Obama’s health reforms in the US (recent polls show only 37% support), he did at least take on an issue that was cont­roversial and difficult—an attitude rarely displayed by politicians in Canada. 

His plan is, in many ways, flawed. It will leave 17 million uninsured. It does not address the enormous cost of “defensive medicine” forced on health workers and institutions by the malpractice issue (some specialists pay over $300000 a year for insurance). It is perhaps significant that trial lawyers are major donors to the Democrats. 

The bill will be administered by a treasury chief who didn’t pay his tax­es and includes a clause exempting members of Congress who passed the bill from its negative parts. While Obama promoted the savings that will arise through disease prevention, his arguments are tarnished by the fact that he is a chain smoker. Not the way to build public confidence. 

None of this should surprise us. In Canada hypocrisy on the part of opponents of change is widespread. Such hypocrisy is evidenced when our politicians preach the gospel of the status quo, and then apply a double standard to their own care. The late Quebec premier Robert Bourassa went to Bethesda, Maryland, for melanoma treatment. 

The doctor of former prime minister Paul Martin is head of Canada’s largest chain of private clinics. Former prime minister Jean Chrétien flew to a Minnesota private clinic on a Canadian government jet, paid for by Canadian tax dollars. Opposition leaders Joe Clark and Jack Layton opted for surgery at the private, for-profit Shouldice Clinic. Senator Ed Lawson (former Teamsters Union lead­er) had heart surgery in the US, and, more recently, former member of Parliament Belinda Stronach and New­foundland premier Danny Williams sought surgical treatment there also. 

Dare I even opine that many phy­sician promoters of the status quo in Canada also exhibit hypocrisy? Many are beneficiaries of private “two-tier” insurance (drugs, dentistry, physiotherapy, ambulance care, etc.) that provides them with superior health coverage. If they truly believe in equitable health care they should opt out of their private plans. 

Others, including some of the most vociferous proponents of “equality” in our system, repeatedly use the queue-jumping technique of the personal phone call to expedite care for themselves or their loved ones. And patients treated at our Cambie Surgery Centre include a “who’s who” of union leaders and politicians of all political stripes.

American doctors and their patients do not have the same trust in government that Canadians do. In Canada, doctors are compelled by law to share confidential medical files with government inspectors who have the right to inspect any patient’s file. A Canadian’s health record is considered public property. Patients are not only denied the right to block government access, but their consent is not needed, nor are they even notified when their private records are examined. I have personally witnessed a situation in which a defeated provincial cabinet minister had his medical file reviewed by the newly elected government.

The good result of the debate in the US has been that health care has been catapulted to its rightful place as the most important area of public policy. Canadian politicians will soon have to deal with the need for health reform. Unfortunately, the US debate sidetracked us into the tiresome de­bate of which system is better, American or Canadian, when, in reality, neither performs well. A hybrid solution—universal care without a monopoly funder and provider—is clearly the option both countries need to explore. 

The lessons are there to be learned from countries like Switzerland, the Netherlands, Belgium, Germany, and many others that offer universal care, including coverage for drugs, dentistry, and ambulance. These social democracies, like Canada, believe that those without resources require good basic health care. They have achieved that with a government role and oversight, but without the monopolistic control that Canadians suffer under. 

The US health care debate should drive home to Canadians (including some in our profession) that we need to transform our system and we need to act now. As 30 million additional Americans acquire health insurance, there is a strong probability that our health workers will be recruited to service these newly insured patients. 

With 5 million Canadians already lacking access to a family doctor and, in our system of specialist access by referral only, having limited access to specialist consultations, an expanded brain drain could spell disaster. 

Newfoundland premier Danny Williams, in responding to critics of his trip to the US for heart surgery, said, “It’s my heart, my health, my choice.” Yet his, and other governments in Canada, deny that same choice to Canadians in their own country. 

An Angus Reid poll in February 2010 revealed that 68% of Canadians believe that many changes or a complete rebuild of our health system is necessary. When will governments begin to listen to the people?
—BD

Brian Day, MB. In government we trust. BCMJ, Vol. 52, No. 4, May, 2010, Page(s) 170 - Editorials.



Above is the information needed to cite this article in your paper or presentation. The International Committee of Medical Journal Editors (ICMJE) recommends the following citation style, which is the now nearly universally accepted citation style for scientific papers:
Halpern SD, Ubel PA, Caplan AL, Marion DW, Palmer AM, Schiding JK, et al. Solid-organ transplantation in HIV-infected patients. N Engl J Med. 2002;347:284-7.

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