David R. Henderson  

Dr. Ouelett on Canada's Medicare

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Canadian Defender of Medicare Admits that Waiting Lists in Canada are Long

Early this morning (PDT), C-SPAN carried an interesting interview and call-in show with Dr. Ouelett, outgoing president of the Canadian Medical Association. Although Ouelett defended Medicare, Canada's system of government-payer medical care, he admitted that there are long lines for medical care. He said that this is, in fact, the main problem with Canada's system.

Yet, when shown an ad in which a Canadian woman, Shona Holmes, stated that getting treated in the U.S. for a brain tumor saved her life, and asked to comment, Ouelett commented that her case was said but that "people are not dying in the streets in Canada." That was interesting because Ms. Holmes's complaint was consistent with Dr. Ouelett's complaint and Ms. Holmes had not claimed that "people were dying in the streets."

Ouelett also stated, in response to one caller, that people in Canada don't even have to think about money when deciding to seek health care. Exactly. In other words, people treat a costly good as if it's free. He saw that as a virtue rather than a defect.

The moderator of the show, Steve Scully, played a segment from a forthcoming show in which the speaker, T.R. Reid, stated that a Canadian had told him that the poor people in Canada don't mind waiting for health care as long as the rich do too. Two things are interesting about that: first, both Reid and the guy he talked to admit that there are line-ups and second, the Canadian guy and, according to the Canadian guy, Canadians in general, think line-ups are fine as long as everyone lines up. Should we have everyone line up for food too?

BTW, here's Ouelett giving Canada's Medicare an F for line-ups (with Europe as his favorite model.) A highlight from the good doctor:

People were very surprised when I told them our target for hip replacement was six months. They said, "This is your target?" and they couldn't believe that.

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COMMENTS (7 to date)
Pedro writes:

In Ouelett's defense, Shona Holmes had Rathke's Cleft Cysts, which are benign cysts that are in no way life threatening (a 0% mortality rate). The symptoms of gradual vision impairment and headaches would have stunk for a few months, but its not the life-or-death case that the ad makes it out to be.

Tom West writes:

He admitted that there are long lines for medical care. He said that this is, in fact, the main problem with Canada's system.

That is because he is principled and is willing to admit the trade-offs that his preferred system involves. Are you?

Personally, I consider being able to publicly admit both the strengths and the weaknesses of a system you admire to be a strength. Perhaps it is different south of the border. (Sorry, gratuitous snipe. However, I am sick and tired of the rhetorical sophism that prevents any rational discussion. Where any deviation from the "talking points" is an admission of defeat that should be used to beat your opponent up.)

Personally, I'm disappointed that you felt it necessary to indulge in the same game. No-one here in this blog has tried to hide the fact of Canadian wait lists. As perhaps the most ardent defender here of the Canadian system (for Canadians, at least), I have never failed to mention the trade-offs. The fact that you feel the need to play the "if the opponent admits *any* cost or downside, his side loses" game is a strong indication that you consider playing 'gotcha' more important that a rational discourse about the strengths and weaknesses of alternate systems. (Or does the system you support have no trade-off or cost?)

Among politicians, such games are understandable, if saddening, as politicians often feel their constituents are too stupid to be able to judge all the facts. On a blog, that same attitude towards one's readers is disappointing.

Every system makes trade-offs, and wait lists are a trade-off that is acceptable to most Canadians in return for all the other benefits that our system brings. (And yes, equality of health-care *is* important to a lot of people. The sense of commonality and community it brings to Canadians is an important part of our culture.)

Dr. Ouelett is to be admired for looking at ways to reduce waiting times that don't involve extra government spending, while retaining the aspects of our health care system that are important to Canadians.

RL writes:

It can be worse than you describe, Pedro. If a Rathke Cleft Cyst ruptures while waiting for surgery, the patient can have a life-disabling chemical meningitis with chronic non-obstructive hydrocephalus leading to the need for shunts in one's head and life-time followup for infectious complications.

You also neglect to mention that the chronic pressure effects the the Cysts on the optic chiasm leading to the partial blindness may not completely resolve after surgery.

BB writes:

Having a neighboring country to the south that is free, easy to enter, 10x as large, with unlimited medical resources available, probably takes a lot of pressure off the Canadian system of free socialized care. The Canadian govt uses American hospitals and pays for their citizens' care in them. What happens if the US system is degraded to the Canadian level and therefore no longer available to Canadians, will they start booking medical procedures in Thailand? Eastern Europe?

Grant writes:

Ummm, Mr. Henderson?

I believe in her commercial attempting to scare Americans about the terrifying horrors of "socialized medicine" Shona Holmes exact words were that she "would be dead now" if she had stayed in Canada for care. Which is a bald faced lie considering her condition wasn't even life threatening in the first place as Pedro has already pointed out.

And BB: What planet do you live on exactly? The US has UNLIMITED MEDICAL RESOURCES? Is your US the same as the US I live in? The one with tens of millions of people left totally uninsured because they've been priced out of the health insurance system? The one with tens of millions more left so inadequately insured for the same reason that they're facing financial distress or bankruptcy if they commit the cardinal sin of becoming seriously ill or injured? The one where doctors are forced to ask insurance corporation accountants for permission to treat their patients about a million times a day? The one with the worst record in the entire industrialized world at preventing medically preventable deaths in it's population? THAT US???

In your world this all happens in a nation with UNLIMITED MEDICAL RESOURCES?

Are you perhaps posting from a psychiatric care facility in which you are a patient? And do the nice doctors try to spend their days getting you to realize that the imaginary limitless legions of doctors and nurses all carting around truckloads of medical supplies in their back pockets aren't there? If so... *listen to them*.

And FYI, the Canadians occasionally contract out those medical services they *fully pay for* to some American facilities because, for the most part, those cases are where the treatment required is relatively rare and building significant treatment capacity for them in smaller population centers is just... stupid. Why spend millions of dollars building a facility you're going to spend most of the time letting sit empty because your population is too small to have to be dealing with the condition it was built to treat very often when, on the rare occasion that you get a random surge in those cases that exceeds a reasonable capacity you have constructed you can simply sub-contract out the needed procedures to a nearby location for a fraction of the cost?

And that has NOTHING TO DO with Canada's health insurance system. No matter how they insured their population it would always be the same size so it would always make more sense to do things that way you genius. Just like if the US switches to a cheaper, more effective universal insurance system IT isn't suddenly going to shrink and have all it's treatment facilities vanish into thin air for some inexplicable reason.

Pedro writes:

RL,
Your right those are rare complications; I was just commenting on what a typical case is.

Tom West writes:

Having a neighboring country to the south that is free, easy to enter, 10x as large, with unlimited medical resources available, probably takes a lot of pressure off the Canadian system of free socialized care. The Canadian govt uses American hospitals and pays for their citizens' care in them.

A note: American hospitals occasionally use Canadian facilities when it makes sense to do so. Administrators are usually pretty bright on either side of the border.

There is no doubt that the presence of the USA is very helpful to the Canadian medical system. Not so much for contracting out work (that's fairly minimal) but because it relieves the pressure of those wealthy or desperate enough who would establish a second tier, with all the long-term danger that entails.

What happens if the US system is degraded to the Canadian level and therefore no longer available to Canadians?

Um, our system suffers. However, I'm not certain why Canadian medical concerns should be so important to Americans :-).

Truthfully, it means that the Americans can never have a medical system as successful (my Canadian standards) as the Canadian system. This might be a tragedy, except that by generally held American standards, the Canadian system is not ideal. The ideals of equality of health-care matter less for Americans, and the ideal of freedom to use your money as you wish matter more.

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