Having watched President Obama’s health reform speech to Congress yesterday and the subsequent analysis from both the left & right-leaning media sources, I felt inspired to write about the two solitudes of the Canadian and U.S. health care models and why neither extreme works.
In his 2007 film Sicko, Michael Moore painted a rosy picture of health care in Canada relative to the U.S. However, the context of much of the content was very focused on his own agenda. While in small-town Canada, the quality and availability of health care is reasonable, anyone living in a large urban center such as Toronto is well aware of the extreme delays incurred in Emergency Rooms, the long waiting times for certain medical procedures that in other countries would be considered urgent, and ongoing erosion to what is covered by our public health option.
This is not to say that the public model should be scrapped – I am a firm believer that it is the responsibility of contributing citizens to help support those who cannot afford their own health care and in that respect, the public model works. Those that are below the poverty line or that would not be able to afford private health insurance in a non-public model can expect to get the same level of health care that is made available to 99% of the rest of us.
A basic challenge with our public model is that it simply does not scale well – it is predicated on the idea that the majority of the population can fund (through taxes) the health care for the totality. Canadian personal taxes are excessive, and the percentage of the population that does not contribute to the bucket of tax dollars reserved for health care has steadily increased.
Other complementary challenges we are experiencing include:
+ The “brain drain” of highly qualified medical specialists to other countries that operate for profit models. Given the extremely high costs of medical education in North America, is it any surprise that specialists would choose to cross the border to more rapidly recoup this investment?
+ Lack of coverage for “elective” services that come back to bite us in the long run – for example, the cost of travel inoculations is not covered under the public health model. Some people risk not getting vaccinated prior to going on vacation to a tropical destination due to the high costs of vaccinations and this can translate into a much larger burden on the health system if they become ill with malaria, Hepatitis A or B, or other such diseases.
+ Abuse of the “free” system – anyone living in a Canadian city that has visited a clinic in the Winter season is well aware of how many people will consume scarce doctor availability to diagnose simple respiratory viruses.
+ Mismanagement of health care tax dollars – for anyone living in Ontario, have we ever seen a report card on how our “Health Tax Premium” dollars have been used?
+ Loss of potential tax revenue to other countries for so-called “surgery vacations” and potential for impacts to our health system if these surgeries are not performed well or cause complications that require medical treatment in Canada
A great myth of our public model is that all citizens should be treated the same. Unfortunately, we provide a good example of Orwell’s famous line “All animals are equal, but some animals are more equal than others”. The top 1% (financially or influentially) of our citizens do not have to wait as long as the rest of us for health care. Sports teams have their own private clinics where so-called “discretionary” medical services are available immediately.
If we tolerate this hypocrisy, why do we shy away from a well administered, properly regulated, two-tier model?
More about the U.S. model tomorrow…