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June 18, 2005

Oh Canada

Growing up just a few miles from the Canadian border I've always had an appreciation for the beauty of the country. If you ever have a chance to travel through British Columbia & Alberta, do it. Unfortunately, the country now has poor health system and there are those in this country (U.S) who wish to emulate it.

Recently the Canadian Supreme Court, by a one vote margin, acknowledged that fact. When Canadian politicians established the country's single-payer health system they were concerned that if private insurance was allowed, only the sick would participate in the government health plan. So they banned private insurance and forced the public to participate only (with some rare exceptions)in the public health care system. The arguments were the same as what we see in the U.S., by spreading the cost across all citizens and by providing equal access to health care the total cost would be better managed and the care would be better. Didn't happen.

As is par for the course in these matters, total costs started to rise. Patients started visiting their doctors for ailments that didn't warrant a visit in the past. The government didn't have an endless supply of money so big-ticket purchases such as MRI machines were postponed in order to pay for the increased clinic costs. Waiting lists started to develop for the use of the expensive diagnostic equipment. Lower medical salaries, the bureaucracy and the workload took their toll as fewer people entered the health care field and more moved out of the country. Waiting lists started to develop to see a doctor. There was equal access to health care, but it is equally poor and becoming poorer.

Last year, more than 800,000 Canadians, 2.5 percent of the population, were waiting for health procedures. The average wait to see a specialist, according to the Vancouver-based Fraser Institute, is nearly 10 weeks. The institute pegs the estimated cost to these patients at $2.2 billion, or roughly $2,700 a person.

Canada ranks 20th of 25 industrialized countries in the number of MRI machines. It ranks 16th of 25 for CT scans, and 8th of 22 for access to radiation therapy machines. As for the relatively new Positron Emission Tomography (PET) Scans, at least one province flat-out refuses to invest in them.

Although touted by U.S. admirers as cost effective, the Canadian system is not inexpensive, it's merely cheap. Financed through heavy taxes, the average Canadian spends $7,350 a year to support the system. Yet for all this spending, Canadians are increasingly discovering they can't even get an appointment with a family physician. "It's like winning the lottery to get in and see the doctor," grouses Whitby, Ontario, Mayor Marcel Brunelle. Only 63 family doctors serve Whitby's 110,000 residents. According to a recent poll, 4.2 million Canadians are without a primary care physician.

Which brings us back to the Canadian Supreme Court.

The Supreme Court found that waiting lists have become so long that they violate patients' right to "life and personal security, inviolability and freedom" under the Quebec charter of human rights and freedoms, which covers about one-quarter of Canada's population.

"The evidence in this case shows that delays in the public health care system are widespread, and that, in some serious cases, patients die as a result of waiting lists for public health care," the Supreme Court ruled. "In sum, the prohibition on obtaining private health insurance is not constitutional where the public system fails to deliver reasonable services."

Canada will now have to alter their health care system to adjust for this ruling. Done wisely, overall health care will improve. England modified their system to allow more private care and the quality of health care significantly improved.

So what does this have to do with those living outside of Canada with Huntington's Disease? There is no incentive in these single-payer health care systems to spend their limited treatment money on 'incurable' diseases such as HD. Communities like ours are hit hardest by these systems.

We need better solutions to health care, but a Canadian-style system is no solution.

Posted by Dave at June 18, 2005 06:03 AM

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