(Photo: Michal Porebiak / flickr)
Don't get sick! Those were the last words my grandfather said to me as I left Vancouver for the United States. It was 1964. Canada was in the process of implementing a universal health care system. I hadn't noticed, because I was young, healthy and restless.
Now, these many years later, as I witness the health care reform "debate," my grandfather's words have returned to haunt me. He had been a pioneer farmer in Saskatchewan on the Canadian prairies. That's where Canada's universal health care system was conceived during the hard years of the depression and its aftermath.
Medicare (Canada's health care plan) was largely the brainchild of a Baptist minister turned politician, T. C. (Tommy) Douglas. He and others founded a new party in Saskatchewan (which later became the New Democratic Party) based on "humanity before private interests." Universal health care was at the top of their agenda. By 1964, Saskatchewan implemented a health care plan that treated everyone according to their needs regardless of their ability to pay. Despite a doctor's strike that tried to kill it, the farmers - including my grandfather - made sure that this new health care plan survived. Then, just as now, there were those who thought it made total sense and others who thought it was a Communist conspiracy. However, it proved so popular in Saskatchewan that within a few years the federal government adopted it for the entire country. Imagine the audacity of this during a raging cold war. The year the plan went into effect was the year of the Cuban missile crisis.
In 2004, the Canadian Broadcasting Corporation conducted a poll to determine whom Canadians thought was the greatest Canadian of all time. It was not Pierre Trudeau, Joni Mitchell, Dan Aykroyd, Leonard Cohen, Margaret Atwood, Lorne Michaels, Oscar Peterson, Peter Jennings, Celine Dion, Neil Young, Keanu Reeves, nor Wayne Gretzky. It wasn't even Keifer Sutherland or his dad, Donald. No, it was Keifer Sutherland's grandfather, Tommy Douglas, who is credited with making sure that Canadians would have universal, government-funded health care. When Canadians are periodically polled and asked what they are most proud of, in addition to peacekeeping, it is their national health care system.
What irritates me - depresses me the most in fact - is that Americans seem so unwilling to learn from any other country. "We would never want to have a plan like the Canadians" is a comment I heard from an interviewee on NPR the other day. Sadly, this speaker has never visited Canada, because if they had they would probably witness that the average working-class or middle-class person in Canada lives longer, works less, is a tad wealthier and has better sex. And, of course, they have that single-payer health care plan.
I'd like to say I'm joking, but you can check the sources of these claims in MacLean's, Canada's weekly news magazine. In Canada there are endless efforts to compare the happiness of Canadians vs. Americans and the Canadians were tickled to read that they might have it better in a 2005 MacLean's feature, which began like this:
"Like the perpetual little brother, Canadians have always lived in the shadow of our American neighbors. We (the Canadians) mock them (the Americans) for their uncultured ways, their brash talk and their insularity, but it's always been the thin laughter of the insecure. After all, says University of Lethbridge sociologist Reginald Bibby, a leading tracker of social trends, 'Americans grow up with the sincere belief that their nation is a nation that is unique and special, literally called by something greater to be blessed and to be a blessing to people around the globe.' Canadians can't compete with that."
So, hubris prevents Americans from learning about Canada's health care system - or any others for that matter - just when it could be helpful as American citizens try to reform their own unfair and costly system dominated by private interests. Admittedly, NPR has, in this late stage of the debate, been reporting about some other health care systems in Europe. Finally. As a citizen of both the US and Canada, I am perplexed by the ignorance of so many comments I hear and read. Many interviewees don't seem to know that the US already has huge government-funded health care programs called Medicare, Medicaid or the Veterans Health Administration that together cover more than 80 million people! That's more than the populations covered by Canada's or any one European country program!
Principles of Canada's Health Care Plan
But let's get back to what might be helpful for Americans to know about Canada's program. Here are some essential facts.
1. It is a single-payer system, meaning that the government - federal and provincial - pays the bills. But many providers - clinics, hospitals, diagnostic services, etc. - are privately owned. They are reimbursed for services just as doctors - who are mostly incorporated - submit for fees.
2. You get to choose your doctor.
In 2005, all the provincial government leaders reconfirmed their commitment to The Canada Health Act's key principles: that Canadians have the right to timely, high quality, effective and safe health services on the basis of need, not ability to pay, and regardless of where they live or move in Canada. They also committed to a system that is sustainable and affordable and that will be there for future generations.
There is a lively debate in Canada about how well this system is meeting those principles. On the right, is the Fraser Institute, a think tank based in Vancouver that regularly releases reports outlining the extensive wait times for operations and procedures and plugs the benefits of a private market driven system. From the left, come worries about creeping privatization within the system. There is a tug of war between those who wish to preserve the public system and those who want more private options. And everyone worries about costs. The conservatives want to put less into the system; the liberals want to put more in and get more out of it.
The outgoing president of the Canadian Medical Association (a doctors' organization like the AMA), Dr. Robert Ouellet, was a champion for privatization. During this month's annual meeting, he wanted to "pull out all the stops" to push for private health care. But that effort flew in the face of the most recent poll by Nanos Research, which found that more than 85 percent of Canadians want to strengthen their public health system rather than expand for profit services. Dr. Anne Doig, the new CMA president, vowed a commitment to quality care rather than privatizations. The debate will not go away, but Americans could learn from this.
Canada's System Under Stress
Whether seen from the right, left or middle, Canada's system is under stress for similar reasons that our health care costs have skyrocketed here. Like most advanced industrialized countries, Canada is facing a demographic bubble of seniors - an aging population. Senior health care costs more. A recent New York Times article reports that treating the medical needs of seniors with chronic diseases during the last two years of their lives consumes a third of the US Medicare budget. Canada has lowered some of those costs by making generic drugs available through its system. As anyone in the US Medicare system knows, the drug program is a complicated, expensive mess. And some Americans go without drugs because they simply cannot afford them. Recently, US seniors have expressed concern that by extending Medicare to the currently uninsured (40 plus million folks in the US) that somehow their own services will be compromised. They could look at this differently. The power that an expanded Medicare would have to negotiate better deals for services and drugs could benefit everyone.
Other developments in health care force costs up in Canada just as in the United States, like the overuse of advanced diagnostic tests. Canadian health care specialists have been trying to tackle that issue. And the discussion has begun among reformers in the US. But one area where Canada's single-payer system really cuts costs is in the bureaucracy. While American hospitals typically hire dozens of people to handle claims for hundreds of insurance companies, in Canadian hospitals only a handful of people are required to keep track of expenditures.
The Anecdotal Story - Wait Lists
We often hear anecdotal complaints about the waiting time for operations in Canada. And that is a serious issue. I saw a TV ad on cable, as I was cruising stations recently, that said if you fall off a horse in Canada and break your back you will wait six months to see a specialist. This is nonsense. And since so many of the negative stories are anecdotal, I will tell mine. I recall my mother's experience with several hip operations. (She lived in Vancouver.) The first was for a hip replacement. Yes, she had to be put onto a waiting list. In the early '90s she waited some six months to get her operation. Yes, she was uncomfortable and a bit impatient, but she also knew she was getting a doctor with a brilliant reputation for fine work and she would need to get in line for him. She lived in a retirement community where demand was high. (Recent Canadian studies have shown that the waiting times are costing the Canadian system more than finding solutions to shorten the waits. And in 2005, Health Canada invested some $4.5 billion to reduce waiting times during the next six years. Also in 2005, after a Supreme Court decision allowed private clinics with private patients, Quebec province promised it would send patients to those clinics and pay for them if they had to wait longer than six to nine months for operations.)
But back to my mother's experience. Some eight years later, when my mother fell and broke the part of her hip device that extended into her leg, she was operated on within a few weeks. Since I was working out of the country when this happened, the operation was scheduled for when I could get to Vancouver in order to care for her. She walked with difficulty until the operation. Then in 2005, when she became very sick and weak, she fell and broke her other hip. She was operated on that night. Just as you would be in the US - if you had insurance or could pay.
Canada's system is always under scrutiny from various factions and frequent analyses of abuses or problems are matched by eagerness to reform. Americans could learn from Canada's reform efforts to address rising costs. In some provinces, they are experimenting with creating more neighborhood, 24-hour clinics in heavily populated communities to take the expensive pressure off of hospital emergency rooms. Some clinics are run by nurse practitioners and focus on preventative care. They are also promoting midwifery and hospital birthing centers to increase the quality of care and reduce maternity costs.
Finally, resistance to health care reform is driven by a combination of corporate and political interests. Tommy Douglas understood this well and had a famous stump speech he used to deliver when trying to organize a new political party on the prairies that put humanity first. Over the years, that speech has become known as Mouseland. He told the story about mice who every few years held elections. Sometimes, they elected the White Cats, who would proceed to pass legislation favoring their interests including building a mouse hole large enough to get their paw into. So, when the next election came around, the mice voted in the Black Cats. These Cats also passed legislation to favor themselves. They wanted to build a mouse hole even larger so cats could get two paws in. The mice tried everything at subsequent elections, like mixing up the Black Cats and White Cats. Finally, they decided to elect a mouse. But that mouse was immediately arrested and jailed as a Bolshevik. Douglas concluded that this fable illustrated why the two party system only works for the Cats. He was stumping for a third party that he successfully introduced to the Canadian political landscape - a party that pushed and won universal health care. You can go to to see an animated version of this speech introduced by Keifer Sutherland.
What Can We Americans Do?
First, we can learn as much as we can from other countries about their health care systems. (And, perhaps, why a two-party system keeps building bigger mouse holes.) We can speak up for humanity before private interests. And we can let all of our representatives know our thoughts.
Meanwhile, in Canada, a petition is circulating that registers Canadian concern about the lies and attacks on their health care system funded by corporate interests in the US. If you are a Canadian you may wish to check out the petition at this link.