Thursday, July 30, 2009

Andre Picard's Defense of Canadian Health Care

The Globe and Mail's medical reporter, Andre Picard, offers a cogent defense of our healthcare system in today's Globe and Mail. As well, he notes some interesting discrepancies in Shona Holme's 'story.' I have reproduced the article below:

André Picard

Montreal — From Thursday's Globe and Mail Last updated on Thursday, Jul. 30, 2009 07:23AM EDT

Shona Holmes has become a central figure in the bitter debate about U.S. health-care reform.

The Waterdown, Ont., woman is featured in a TV ad telling her tale of horror – how she had a life-threatening brain tumour but would have had to wait months for treatment. So Ms. Holmes remortgaged her home and flew to the Mayo Clinic in Arizona for treatment, paying $97,000 cash for her care.

“Now, Washington wants to bring Canadian-style health care to the U.S.,” the narrator says gravely in the ad, paid for by Patients United Now, an offshoot of the Americans for Prosperity Foundation, a conservative group that promotes less government and lower taxes.

Ms. Holmes has also recounted her nightmare story in countless media interviews, warning that “free” Canadian health care comes at a heavy price – lack of access – and lamenting her inability to buy private insurance to get quicker care.

“My agenda, if I have one, is to tell them [Americans], be careful what you wish for,” Ms. Holmes told The Washington Times.

Discussions surrounding the provision of health care always elicit strong emotions and outbursts of rhetoric, and Ms. Holmes's case is no exception.

She is, of course, entitled to bash medicare and promote the idea of private health-care insurance both at home and abroad. That is the beauty of free speech. (And, to be fair, Ms. Holmes has always praised the quality of care in Canada; her issue is access and timeliness.)

But a few important details are missing from the “commercial” version of this socialized-medicine-kills tale.

Ms. Holmes did not have a deadly brain tumour, she had a benign Rathkes cleft cyst. Yes, she had vision loss, but it was temporary and reversible. This is not to suggest what she went through was not awful and frightening, but it was not life-threatening.

Initially, Ms. Holmes said she had a six-month wait to see a specialist. Later, she amended that to three months. Canadian hospitals and physicians won't say how long the wait was nor comment on the gravity of her condition because of privacy rules.

For the sake of argument, let's acknowledge that the wait to see specialists like neurologists can be long. It's a problem that needs to be fixed, and the situation is already better now than it was in 2005, when Ms. Holmes had her health problems.

The reality is that, in Canada, we “ration” care. Under our state-financed insurance program, we try to provide universal care efficiently and cost-effectively. We make choices. Getting the balance perfectly right is difficult.

The United States, by contrast, has over-capacity. That is one of the principal reasons that, per capita, care costs about 50 per cent more there than in Canada.

Money buys you access, and lack of money denies you care. In Canada, we have a not-always-happy medium: Universal access with sometimes frustrating waits.

So what happens when a patient feels they are waiting too long for care? Ms. Holmes had a “gut feeling” that her life was in danger and made a radical choice to pay out-of-pocket for immediate care in the United States rather than wait for “free” (read: tax-financed) care in Canada.

Now, she wants to be reimbursed by the Ontario Health Insurance Program. She is also a party to a lawsuit against the Ontario government arguing that a “government-run monopolistic” health system that prohibits the sale of private insurance for medically necessary care is unconstitutional. (The case, very similar to the Chaoulli case in Quebec, is backed by the Canadian Constitution Foundation. It is still before the courts.)

There are complex legal issues here and competing rights that the court will need to balance. But what insurance program, private or public, would ever allow clients to determine their own treatment and reimburse them without question?

In the discussion flowing from Ms. Holmes's ad, it has been noted often that some 45 million Americans do not have health insurance. For them, the right to buy private insurance is moot because they cannot afford it and the Canadian-style system looks pretty appealing. But that is largely beside the point here.

Ms. Holmes is insured – albeit by a state-financed plan. The question is: Can insurers (and providers) delay and deny care, and can they limit and deny coverage?

Of course they can, and they do so all the time. In the United States, health insurance is expensive and it is often tied to employment. Even those with good insurance see their claims denied because of “pre-existing medical conditions,” insurers' attempts to hold down “medical losses” (the industry term for paying for care), and caps on total payouts.

Ironically, for all her lauding of private insurance, someone like Ms. Holmes would find it virtually impossible to buy insurance, given her medical history.

The infamous ad claims that Canadians have long waits and are denied all manner of care because the “government says patients aren't worth it.”

On the contrary, medicare – universal state-financed health insurance – means everyone is worthy of care and entitled to care.

If nothing else, Ms. Holmes' foray into the U.S. health-care debate should remind us of how medicare, despite some shortcomings, is worth it.

Americans can only dream of having such a system to bemoan.


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