Face Long Waits for Health Care
By BETH DUFF-BROWN
Associated Press Writer
(AP) -- A letter from the
heart patient in need of an electrocardiogram said the appointment would be in
three months. It added: "If the person named on this computer-generated
letter is deceased, please accept our sincere apologies."
The patient wasn't dead, according to
the doctor who showed the letter to The Associated Press on condition of
anonymity. But there are many Canadians who claim the long wait for the test and
the frigid formality of the letter are indicative of a health system badly in
need of emergency care.
Americans who flock to
for cheap flu shots often come away impressed at the free and first-class
medical care available to Canadians, rich or poor. But tell that to hospital
administrators constantly having to cut staff for lack of funds, or to the
mother whose teenager was advised she would have to wait up to three years for
surgery to repair a torn knee ligament.
"It's like somebody's telling you
that you can buy this car, and you've paid for the car, but you can't have it
right now," said Jane Pelton. Rather than leave daughter Emily in pain and
a knee brace, the
family opted to pay $3,300 for arthroscopic surgery at a private clinic in
, with no help from the government.
"Every day we're paying for health
care, yet when we go to access it, it's just not there," said Pelton.
The average Canadian family pays about
48 percent of its income in taxes each year, partly to fund the health care
system. Rates vary from province to province, but
, the most populous, spends roughly 40 percent of every tax dollar on health
care, according to the Canadian Taxpayers Federation.
The system is going broke, says the
federation, which campaigns for tax reform and private enterprise in health
It calculates that at present rates,
will be spending 85 percent of its budget on health care by 2035. "We
can't afford a state monopoly on health care anymore," says Tasha
director of the federation. "We have to examine private alternatives as
The federal government and virtually
every province acknowledge there's a crisis: a lack of physicians and nurses,
state-of-the-art equipment and funding. In
, more than 10,000 nurses and hospital workers are facing layoffs over the next
two years unless the provincial government boosts funding, says the Ontario
Hospital Association, which represents health care providers in the province.
In 1984 Parliament passed the Canada
Health Act, which affirmed the federal government's commitment to provide mostly
free health care to all, including the 200,000 immigrants arriving each year.
The system is called Medicare (no relation to Medicare in the
Despite the financial burden, Canadians
value their Medicare as a marker of egalitarianism and independent identity that
sets their country apart from the
, where some 45 million Americans lack health insurance.
Raisa Deber, a professor of health
policy at the
's system is one of the world's fairest.
"Canadians are very proud of the
fact that if they need care, they will get care," she said. Of the
, she said: "I don't understand how they got to this worship of markets, to
the extent that they're perfectly happy that some people don't get the health
care that they need."
does not have fully nationalized health care; its doctors are in
private practice and send their bills to the government for reimbursement.
"That doctor doesn't have to worry
about how you're going to pay the bill," said Deber. "He knows that
his bill will be paid, so there's absolutely nothing to stop any doctor from
Deber acknowledges problems in the
system, but believes most Canadians get the care they need. She said the federal
government should attach more strings to its annual lump-sum allocations to the
provinces so that tax dollars are better spent on preventive care and
improvements in working conditions for health-care professionals.
, a conservative province where pressure for private clinics and insurance is
strong, a nonprofit organization called Friends of Medicare has sprung to the
system's defense. It points up the inequities in
health care and calls the
's "the most moral and the most cost-effective health care system there is
in the world." "Is your sick grandchild more deserving of help than
your neighbor's grandchild?" It asks.
Yes, says Dr. Brian Day, if that
grandchild needs urgent care and can't get it at a government-funded hospital.
Day, an English-born arthroscopic
surgeon, founded Cambie Surgery Center in Vancouver, British Columbia - another
province where private surgeries are making inroads. He is also former president
of the Arthroscopy Association of North America in
He says he got so frustrated at the long
delays to book surgeries at the public hospitals in
that he built his own private clinic. A leading advocate for reform, he
testified last June before the Supreme Court in a landmark appeal against a
ruling upholding limits on private care and insurance.
George Zeliotis told the court he
suffered pain and became addicted to painkillers during a yearlong wait for hip
replacement surgery, and should have been allowed to pay for faster service. His
physician, Dr. Jacques Chaoulli, said his patient's constitutional rights were
couldn't provide the care he needed, but didn't offer him the option of getting
A ruling on the case is expected any
If Zeliotis had been from the
anywhere, in fact, except
- he could have bought treatment in a private
clinic. That's one way the system discourages the spread of private medicine -
by limiting it to nonresidents. But it can have curious results, says Day.
He tells of a patient who was informed
officials that since
couldn't help him, they would spend $35,000 to send him to the
Day said his
clinic could have done it for $12,000 but the
officials "do not philosophically support sending an individual to a
nongovernment clinic in
Canadians can buy insurance for dental
and eye care, physical and chiropractic therapy, long-term nursing and
prescriptions, among other services. But according to experts on both sides of
are the only countries with laws banning the purchase of insurance for
hospitalization or surgery.
Meanwhile, the average wait for surgical
or specialist treatment is nearly 18 weeks, up from 9.3 weeks in 1993, according
to the Fraser Institute, a right-wing public policy think tank in
. A Fraser study last year said the average wait for an orthopedic surgeon was
more than nine months.
Prime Minister Paul Martin's Liberal
government has pledged $33.3 billion in new funding to improve health in all
provinces and territories over the next 10 years. But critics aren't impressed.
"It won't make a difference,"
C. Pipes, a Canadian who heads the conservative Pacific Research Institute in
. "They need to break the system down, or open the system up to
Pipes is a big supporter of the Bush
administration proposal to allow Americans to divert some of their payroll taxes
into medical savings accounts. She claims the two-tiered system feared by
Canadian liberals already exists because those with connections jump to the head
of the medical queue and those who can afford it can get treated in the
"These are not wealthy people;
these are people who are in pain," said Pipes.
Another watershed lawsuit was filed last
year against 12
hospitals on behalf of 10,000 breast-cancer patients in
who had to wait more than eight weeks for radiation therapy during a period
dating to October 1997.
One woman went to
for treatment. Another, Johanne Lavoie, was among several sent to the
. Diagnosed with invasive breast cancer in 1999, she traveled every week with
her 5-year-old son to
, a four-hour bus ride.
"It was an inhuman thing to live
through," Lavoie told
's Globe and Mail.
"This is the first time someone has
decided to attack the source of problems - the waiting list," said
attorney Michel Savonitto, who is representing the cancer victims. "We're
lucky to have the system we do in
," he told the court. "But if we want to supply proper care and commit
to doing it, then we can't do it halfway."
An estimated 4 million of
's 33 million people don't have family physicians and more than 1 million are on
waiting lists for treatment, according to the Canadian Medical Association.
Meanwhile, some 200 physicians head to the
each year, attracted by lower taxes and better working conditions.
has 2.1 physicians per 1,000 people, while
has 3.9, according to the Organization for Economic Cooperation and
The World Health Organization in 2000
's health system as the best, followed by
came in 30th and the
Alberta Premier Ralph Klein is pushing
what he calls "the third way" - a fusion of Canadian Medicare and the
and many other nations, where residents can supplement their government-funded
health care with private insurance and services.
But some Canadians worry even partial
privatization would be damaging.
"My concern is that the private
clinics would only serve to further drain the scarce physician resources that we
already have," said Dr. Saralaine Johnstone, a 31-year-old family physician
in Geraldton, a papermill hamlet in northern
"We first need to guarantee that everybody
has access to quality health care," she said, "and we just don't have