Saturday, August 08, 2009

Dr. Bill Roy: "Health Care: Learning from those who have done the heavy lifting"

If reason trumped prejudices, 535 American visitors and their staffs and families would be spreading out over Canada this month of congressional recess here and cool weather there, seeking to learn how they provide health care for everyone at two-thirds what we spend to cover only 5/6 of our residents.

These are the men and women designated by this country to improve health care access and cut costs, tasks that have them completely bamboozled to date.

They would come home scratching their heads, dismayed the Canadian system is so darn simple and works so well. They would wonder why we have not done something similar sooner.

The first thing they would find out on their trip is about 8 of 10 Canadians think their health care system is better than ours. With 75% of their 33 million souls living within 90 miles of the border, and total American media access, they are in position to know.

Our congress-people also would find most Canadians are experts on health care, anxious to tell how their health care system could be better.

According to my college roommate, an Episcopal priest who somehow migrated from Upper Michigan into Ontario many years ago, their cherished health care makes or breaks most Canadian politicians. And, that is how it should be, because what is more critical to each of us than our family’s health and wellbeing?

Early on representatives and senators would probably wander into a medical clinic. They may feel disoriented because they cannot find a big, bustling business office run by more employees than are providing medical care.

Someone will tell them phone booth-size business offices are the standard around the world, because doctors and staffs are not dealing with 1300 private health insurance companies, American-style, each trying to siphon as many dollars as possible off the system--with success, 10-30% of premium, which is why there are 1300 of them.

They will find each Canadian has choice of physician, and, if necessary, choice of hospital or long-term care facility. They will also find patients who had trouble getting timely appointments, or have had to wait for some diagnostic procedures, specialty appointments, or non-emergency surgery. And don’t like it.

Some less-sophisticated congress-people may be abashed to find American residents in the waiting room. Canadian women who marry American men usually keep their Canadian citizenship because with it comes universal health care. Also, it gives them two chances at finding a primary care physician who is a coveted person on both sides of the border.

They will likely have lunch with doctors and health administrators. They will find physicians, who are mostly paid fee-for-service, earn about two-thirds that of their American counterparts, which is about four times the Canadian industrial wage. But they are very happy they can get pat ients the care they need without worrying about sending them into bankruptcy.

Among physicians, they will find many from nations of the British Commonwealth and other nations that train physicians in English-speaking medical schools. They will hear opinions about the pros and cons of going to the United States, and that they are staying in Canada because they like other things about their home, often having to do with education, natural beauty and a presumed tranquility.

Most hospitals are private religious or community-owned. They tend to be old by American standards, And most are paid on negotiated annual budgets, which are never enough.

Some members of Congress first would want to follow the money. Others would want to talk to small business-owners and their employees, or maybe visit a GM plant and talk to UAW members. Others should be off to public health clinics and learn from their personnel.

Each stop there would be much to learn. But how many will do it?

Nearly all will stay home and be yelled at by constituents who don’t like any health legislation, any so-called government-run health care.

As long as they are going to be yelled at either way, they might as well try to do something worthwhile, like actually cut costs, accomplish universal coverage, and save a few thousand lives. It’s remarkably easy. The Canadians have done all the heavy lifting.

Dr. Roy may be reached at

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