Does Public Always Beat Private?

Canada’s health system needs

by Alicia Priest

American documentary filmmaker Michael Moore has accomplished the near impossible: he has Americans talking about Canada. His latest film, Sicko, has triggered a firestorm of public discussion about the pros and cons of the Canadian health care system versus the American system.

In the Washington Post, the New York Times, and countless other papers, reporters, columnists, and letter-writers are flinging anecdotes, myths, and selected facts back and forth in the battle to prove their points. With health care emerging as a major topic in the current presidential campaign, Moore has obviously hit a national sore spot.

From the dominant Canadian perspective, any comparison of our system to theirs is a slam dunk—our public and universal health care plan trumps their private-insurance company scheme hands down.

But is the picture really as black and white as Moore paints? What about the complaining Canadians have been doing for decades about how long we have to wait for some types of care? Many Canadians are anxious, frustrated, and angered by untimely waits to see a specialist, get diagnostic tests, or undergo elective surgery. As the head of the Royal Commission on the Future of Health Care in Canada, Roy Romanow reported to the federal government in 2002: “Long waiting times are the main, and in many cases, the only reason some Canadians say they would be willing to pay for treatments outside the public health care system.”

That reality explains the recent proposal by the Canadian Medical Association—a group representing more than 59,000 doctors—that they be allowed to work in both public and private systems, and that patients be permitted to buy private insurance for some publicly funded services covered by Medicare. It’s a blatantly self-serving move, catering to the baser instincts of both doctors and patients.

Provincial and federal governments are acutely aware of lengthy wait times. Yet there is no easy way to solve the problem. Health care systems are extremely complex. On the one hand, they can be described as a jumble of jurisdictional politics, professional turf wars, corporate clashes, and academic positioning. On the other, they can be seen as systems led by teams of compassionate and committed professionals engaged in furthering the public good. Given that scenario, it’s no wonder timely access to care is a challenge.

Still, some countries do better than others, and that’s what the Sicko-inspired debate is all about. The discussion demands a little evidence. A May 2007 survey of health systems by the U.S.-based Commonwealth Fund found that compared with five other nations—Australia, Canada, Germany, New Zealand, and the U.K.—the United States ranks last or next-to-last on five criteria: quality, access, efficiency, equity, and healthy lives. The study is titled Mirror, Mirror on the Wall: An International Update on the Comparative Performance of American Health Care. The big drawback in the U.S., of course, is that it is the only country in the study without universal health insurance. But Canada, which prides itself on its public system, ranks next-lowest overall.

That’s the bad news. But before berating our system any further, consider that, unlike the American system, which seems to be caught in a structural paralysis, Canada’s system is in the midst of change. A range of strategies such as better management, improved surgical efficiencies, and team-based practices are cutting wait times in certain areas significantly. Earlier this year the Canadian Institute for Health Information reported surgical teams across the country performed 40,000 more procedures in 2005-2006 than in 2004-2005 in certain high-profile areas. In one year, hip and knee replacements jumped 12 per cent and cataract operations rose 10 per cent.

This good news, commented a recent Globe and Mail editorial, suggests “Medicare is turning the corner.” If anyone has any doubts about this upbeat turn of events, check out a recent Canadian Centre for Policy Alternatives study I co-wrote entitled Why Wait? Public Solutions to Cure Surgical Wait Lists. The report profiles several projects that are transforming health care. The results are dramatic. For instance, the Richmond Hip and Knee Reconstruction Project introduced surgical innovations that slashed median wait times by up to 75 per cent. And at North Vancouver’s Lions Gate Hospital, the Joint Replacement Access Clinic—a one-stop, centralized booking service for pre-op and post-op appointments—the waiting time for a patient’s first surgical consultation fell from 11 months to just two to four weeks. There are many other examples in B.C. and elsewhere. The point is the public needs to know about these successes and pressure the federal and provincial governments to fund more of them.

The CMA leadership would like us to believe Canada’s health care system is terminally ill and in need of drastic medicine. But Sicko it is not. With some long-overdue interventions our governments could make things even better—more fodder, perhaps, for Mr. Moore’s next film.

Alicia Priest is a Victoria-based writer whose last experience with Canadian health care was mostly but not all positive.