Our health care delusion

One study ranked Canada dead last in timeliness and quality care

Our health care delusion

Peter Power/Toronto Star

On Jan. 26, Maclean’s is hosting “Health Care in Canada: Time to Rebuild Medicare,” a town hall discussion at the Sir James Dunn Theatre, Dalhousie University, Halifax. The event, in conjunction with the Canadian Medical Association, will be broadcast live by CPAC. The conversation on health reform continues in the coming months in the magazine and at town halls in Toronto, Edmonton, Vancouver and Ottawa.

A distraught 41-year-old man from West Kelowna, B.C., arrived at the emergency department of Kelowna General Hospital on the night of Dec. 28. “He was broken mentally,” his wife later told the local Daily Courier. “He wanted help.” By her account, he waited 90 minutes without seeing a doctor, minor by today’s emergency room standards. Kelowna RCMP put the wait at just 45 minutes. Regardless, he snapped, warning staff that he’d drive his truck into the hospital if he didn’t get treatment. When threats didn’t get results, he stormed out and returned at the wheel of his Chevy Blazer. As promised, he smashed through the ER’s double doors, narrowly missing two elderly people (one assumes they were elderly before their wait in emergency) and came to a halt in a hospital hallway.

Police arrived to find him waiting co-operatively in his truck. The bed he was assigned that night was in the RCMP detachment cell; he faces several charges including dangerous operation of a motor vehicle. While his strategy was extreme, his cry for attention resonates with many who’ve had the misfortune to trade germs and waste time in one of Canada’s overstressed emergency wards.

It’s a Canadian conceit that ours is one of the best public health care systems in the world, a defining characteristic of nationhood; something that separates us from the Americans. In a poll by Angus Reid Public Opinion in June, 69 per cent of Canadians said they’re proud of the health care system, edging out the state of Canadian democracy, multiculturalism and bilingualism.

Yet the reality, based on any number of international comparisons, shows that pride in a supposedly world-beating standard of care is often misplaced, an “illusion,” as Liberal MP and medical doctor Keith Martin puts it. The sorry state of the nation’s emergency wards is just one indicator of trouble today and trouble to come. ERs are just “the canary in the coal mine,” says Dr. John Ross, Nova Scotia’s adviser on emergency care.

Martin, a former family and emergency room doctor and an MP from Vancouver Island, has been saying as much since he entered federal politics 17 years ago as a Reform party member. He practised medicine part-time until about three years ago, experiencing the same things that first spurred him into politics: the indignity of examining patients on gurneys in hospital hallways; people enduring such agonizing waits for hip or knee replacements that they suffered heart attacks; tumours that grew to inoperable sizes as people waited months for diagnostic scans. “Those,” he says, “are the casualties of our health care system, and the casualties of the inaction of modernizing the system, that people don’t talk about.”

Emergency wards are all too often the first point of contact with the health care system, a problem exacerbated by the fact that five million Canadians don’t have a family physician, and because acute-care beds are often stuffed with elderly patients who would be better served in long-term care facilities. Often the waits are excruciating. For a man in the throes of a mental breakdown, driving to, and through, the ER of Kelowna General should have been the last, worst option. “He was at the end of his rope,” his wife said. “You can’t see a psychiatrist. It takes a while to get an appointment. That’s why people go to the hospital.”

And what they often find in maxed-out ERs is a chaotic environment and waits, of six, eight hours and more. The consequences can be deadly. In Edmonton’s Royal Alexandra Hospital this September, Shayne Hay reported to the hospital’s emergency ward, telling staff he was suicidal. He was placed in a room on an emergency stretcher and checked periodically, though repeated requests to see a counsellor went unanswered, his family says. Some 12 hours later he was found dead, hanging from a strap of his backpack. In Montreal, long waits in the ER at Maisonneuve-Rosemont hospital were blamed by families for contributing to the deaths of two people last year. Mariette Fournier, 86, spent four days on a stretcher in the hallway waiting for a bed in the geriatric department. She contracted pneumonia, developed a blood clot, and died on Feb. 23, a day after finally getting a bed. That same month, 75-year-old Mieczyslaw Figiel died beside the triage nursing station, with his daughter banging on the station’s window as he gasped for breath. The ER was at 180 per cent capacity.

The problems in ERs across the country are symptomatic of a wider malaise. Numerous international comparisons suggest our iconic universal health system is not the world leader of the national imagination. “Canadians are selling themselves short,” says a report card produced last June by the Wait Time Alliance, comprised of 14 national medical associations. “Unfortunately, Canada is one of the few developed countries with universal health care systems where patients face long waits for necessary care,” says the report, aptly titled “No Time for Complacency.”

More and more voices are calling for health care to be put on the agenda. Former Tory prime minister Brian Mulroney and former Liberal senator Michael Kirby alluded recently to the challenge of a badly needed “national adult conversation” on health reform. “Unfortunately, intelligent debate about what should be done has basically ground to a halt by incendiary claims that any attempt to update the system amounts to treason—a repudiation of sacred Canadian values.” The Canadian Medical Association (CMA), representing 74,000 doctors, has undertaken a massive review and public consultation, including a series of televised town hall meetings across Canada. The first, in conjunction with Maclean’s and CPAC, is set for Halifax on Jan. 26. “I think it’s time for all Canadians to get involved in this discussion,” says CMA president Dr. Jeff Turnbull, who sees many of the fault lines—maxed-out emergency wards, cancelled surgeries, strained budgets, frustrated patients and stressed staff—at the Ottawa Hospital where he is chief of staff.

The evidence of a looming crisis comes not from comparing Canadian to American health care—a unique and expensive beast—but by taking a world view, as assessed by the Paris-based Organisation for Economic Co-operation and Development (OECD), the U.S.-based Commonwealth Fund, the Health Council of Canada and other groups. “We believe our own rhetoric around ‘we’re the best in the world.’ What these [international] surveys and our own work are telling us is: no,” says John Abbott, CEO of the Health Council, an independent national agency mandated to monitor and encourage health reform. “If you look at cost, we’re maybe in the middle of the pack. If you’re looking at overall quality indicators, quality of life, longevity, on these factors we can learn from others. When you look at how we can access the system in a reasonable and timely way, we rate quite low,” he says.

Neither Canada nor the U.S. come close to being the gold standard for health care. Canada placed second last in a comparison last June of seven countries by the Commonwealth Fund, a U.S. charity that promotes health policy reform. The U.S. ranked last, scoring dismally on access, efficiency, equity and quality care, despite per-capita health spending of US$7,290. That’s vastly more than the spending in top-ranked countries: the Netherlands, the U.K. and Australia. (Germany ranked fourth, New Zealand fifth.) Canada, sixth in results, was the second most expensive at US$3,895 per capita.

Canadians scored well on leading “long, healthy productive lives,” but it was mid-pack or worse on every other measure. The report, based on national statistics, and patient and doctor surveys, shows Canada scored poorly on chronic care and use of electronic records. Canadian patients reported the second highest rate of perceived medical errors. Canada was dead last on two key measures: quality care, defined as “effective, safe, coordinated and patient-centred,” and timeliness of care. While cost prohibits millions of uninsured Americans from accessing needed health care, wait times, not finances, are the impediment in the U.K. and Canada, the report says. “There is a frequent misperception that such trade-offs are inevitable; but patients in the Netherlands and Germany have quick access to specialty services and face little out-of-pocket costs,” the report notes. Poor access to primary care contributes to Canada’s overuse of emergency wards, it adds: “Of sicker respondents, those in Canada and the U.S. were most likely to visit the emergency department for a condition that could have been treated by a regular doctor had one been available.” Canadians and Americans use the ER at rates three to four times that of Germany and the Netherlands.

Canada scored no better in a Commonwealth study in November of 11 wealthy countries, released with the Canadian Health Council. The lack of a publicly funded drug program, unlike most countries surveyed, raised affordability issues. One in 10 Canadians reported not filling a prescription or skipping a dose because of cost. The study also focused on Canadians’ overreliance on emergency departments. Canadians have the greatest difficulty accessing care on weekends and holidays. “As a result, Canadians are the biggest users of emergency departments, compared with the other 10 countries,” the report said.

Canadian wait times—“widely regarded as the Achilles heel of the system”—are just one of many concerns raised in recent OECD studies. Making patients wait is really a means of rationing health care—a blunt, ineffective way of dealing with a looming health-driven fiscal crisis faced by Canada and other countries, say OECD economists. “In the absence of adaptations,” an analysis said in September, “costs are expected to mount relentlessly in coming decades because of population aging, technological progress and relative price developments, putting a potentially unsustainable burden on public budgets.”

Canada has the sixth highest rate of health expenditures as a share of the economy among 32 OECD countries. Nor is health care as “free” as some Canadians think. When public spending is combined with the 30 per cent spent privately on health (for such things as drugs, vision care, dental, long-term and home care), Canadians personally, and as taxpayers, face the fifth highest per-capita costs among the 32. For all that, Canada has fewer doctors, fewer hospital beds and fewer high-tech diagnostics (CT scanners and MRI units) than the OECD average. Canadian life expectancy, at 80.7 years, is more than a year higher than the OECD average, but the Japanese, Swiss, Italians and Australians outlive us. Our infant mortality rate, while better than the U.S., is slightly worse than the OECD average. All told, as a foundation for Canadian values, it needs work.

Bumping against the Canadian health care system can be a bruising experience for patients. Last year, the Regina-based Frontier Centre, a conservative think tank, joined forces with the Belgium-based Health Consumer Powerhouse for its third annual comparison of the “consumer friendliness” of Canadian health care against that in 33 European countries. The survey tracks cost, medical outcomes, wait times, access to new technologies and drugs, among other measures. Canada ranked 25th among the 34 countries, just ahead of Slovakia, just behind Portugal.

“Canadians are paying for a world-class health care system but for a variety of reasons they are not getting one,” the Frontier report said. Waits for such diagnostic tests as MRIs can last months; “in comparison the typical wait time in top European countries is less than a week.” Drug costs are higher in Canada than subsidized plans in most European countries, and approval times for new drugs lag considerably. It takes an average 314 days for approved medicines to be entered into provincial subsidy programs, an improvement from a more than 500-day wait of six years earlier, but still far behind the standard of 150 days or less in Ireland and Germany.

The Frontier Centre, a champion of free markets, puts most of the credit for the success of the Netherlands and Germany, which finished second, on their competing system of private health insurers. (In Germany, competing insurers offer a standard benefit package, and higher-income earners can opt out of the mandatory plan to purchase private coverage. The Netherlands requires the purchase of a mandatory comprehensive health insurance package provided by a mix of nonprofit and for-profit insurers.) Still, it notes Canadian universal medicare produces impressive survival rates for heart attacks and various cancers. “In Canada you may wait a very long time to see your doctor, but once you do,” it notes, “[the] quality of care you receive will generally be quite good.”

The coming years present both challenge and opportunity for Canadian health care. The next opportunity for profound change comes in 2014 with the expiration of a 10-year health accord among the federal government, provinces and territories. That deal, which then-prime minister Paul Martin optimistically said would fix health care for a generation, provided $41 billion in additional federal funding, and contained a commitment that provinces cut wait lists and account better for spending. But a health care system that cost $192 billion last year has only slightly shifted course, though there are improvements in wait times in areas like cataract and bypass surgery, and cancer treatment.

If politicians, especially the federal Conservative government, seem reluctant to engage, it’s perhaps understandable. U.S. President Barack Obama’s health care reform bill was passed last year at enormous political cost, and with a bruising national debate that refuses to die. British Prime Minister David Cameron is drawing fire for announcing this week plans to add greater private sector involvement in the National Health Service, one of the world’s best performing systems. Prime Minister Stephen Harper has cautiously avoided revealing details of the federal plans for a renewed accord. In his previous role as vice-president, and then president of the National Citizens Coalition until 2002, he was no fan of the blueprint of Canada’s public health care system.*

The CMA’s consultation, including a dedicated website already filling with thousands of comments, is an attempt to engage the public—their patients—in writing a prescription; one that will spur governments to update and expand the Canada Health Act. The CMA’s Turnbull wants to move beyond doctrinaire positions on private versus public health care delivery. “I think we’re going to have a mélange, a mix, as we currently do, but we’ve got to have something that delivers service to Canadians when we need it. I’m afraid unless we do something we won’t be able to do that.”

The OECD offered its prescription in September, some of which would violate the existing Canada Health Act. It says Canadians should pay small fees or deductibles for using health services, as most other OECD countries require, to limit overuse of the system. It also wants competition from the private sector and performance benchmarks for doctors and hospitals. Conversely, it recommends expanding medicare as most OECD countries have, to publicly pay an array of health and drug costs beyond doctor and hospital visits, a position also backed by the CMA. While this could add costs, the report notes, “government may need to devise a statutory (or decent minimum) care package determined by the public’s willingness to pay the necessary taxes.”

Until a consensus on national standards emerges, if such a thing is possible, provinces are charting their own course, sometimes with rocky results. In Alberta, MLA and emergency doctor Raj Sherman was suspended in November from the government caucus for criticizing the Conservative health policy, and the backlogged state of emergency wards. As the controversy flared, Stephen Duckett was fired as CEO from Alberta Health Services, the super-board of 90,000 health care workers the government instituted two years ago in hopes of getting a grip on spiralling costs and poor outcomes.

Duckett delivered a defiant farewell speech last month, but one tinged with regret. ER wait times have only grown worse, he said. At the start of the last decade 60 per cent of patients were admitted within eight hours. Now that happens just 25 per cent of the time. “Neither level [is] acceptable, of course.” He warned of “a chronic disease tsunami” that requires fresh thinking. Care needs to happen first outside of hospitals, at home, or via telephone consults, and in community settings. “This requires a transformation of the Alberta mindset, which still seems to be to equate health care progress with more acute beds.”

Nova Scotia is also attempting reform, spurred by the state of its emergency departments. Ross, a veteran emergency care physician, issued a series of recommendations in October to correct a litany of problems uncovered in a year-long investigation. Patients, waiting up to six weeks for appointments with family doctors, end up in emergency. So, too, do chronic care patients, those with mental health issues, and far too many with minor complaints. Emergency wards are clogged with everything but emergencies. Almost 90 per cent of ER visits can be better handled at less cost in clinics, Ross found. Just 1.1 per cent of ER cases are severe, and 0.1 per cent threaten life or limb, he found. The problem feeds on itself, consuming hospital budgets and resources. As a result, cash-strapped hospitals closed ERs across the province for the equivalent of 795 days last year.

By year end, Health Minister Maureen MacDonald accepted all 26 of Ross’s recommendations, setting standards for emergency care, and diverting patients to more appropriate services. There is a need to flip priorities and put the patient first, Ross concluded. “We have allowed the system to see the patient more as a burden than its very reason for being. To some, patients are ‘cost drivers’ and to others they border on being nuisances who get in the way of a smoothly functioning bureaucracy.”

A recommitment to patient-centred care, as obvious as that sounds, is also the goal of the CMA. One of Turnbull’s roles as chief of staff at Ottawa Hospital is fielding public complaints. They are easy enough to come by in a hospital that has not run below 100 per cent capacity for about a year; where this day there are 38 admitted patients with no beds; where the daily morning discussion is not if surgeries will be cancelled today, but how many.

It’s long past the time for that national adult conversation, not just about the health of a system but about the needs of the people. History shows a national consensus can be achieved, though it was a torturous journey. After years of acrimonious debate, and incalculable human cost, the blueprint was finally drafted in 1964 when Justice Emmett Hall tabled his royal commission report recommending medicare for all of Canada. Fifty years later, 2014 represents a chance once again to make that vision truly world-class.

The Halifax town hall on Jan. 26 will be moderated by Maclean’s Ken MacQueen, with opening remarks by Dr. Jeff Turnbull, CMA President. The panel features Dr. Jane Brooks, President, Doctors Nova Scotia; Dr. John Ross, Nova Scotia adviser on emergency care; Maureen Summers, CEO of the Canadian Cancer Society, Nova Scotia; Andrew Coyne, National Editor, Maclean’s. For tickets and information on this event and the series, visit macleans.ca/healthseries.

*****

*A previous version of this story incorrectly attributed a 1997 quote about scrapping the Canada Health Act to Stephen Harper in his role then as vice-president of the National Citizens Coalition. The statement was actually made by David Somerville, then president of the NCC, in the June 1997 issue of The Bulldog, the organization’s newsletter.




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Our health care delusion

  1. Maybe. I did not get that intention however. It appears the article merely states that we have some major concerns with health care in Canada. It should be a given that health care costs are going to be rising in Canada as well.

  2. I was unaware that we thought we had the best healthcare system in the world. I've never read or heard anyone saying that. Do we think we've got a better one than the US? Sure. But we're aware that our system has issues and that other countries are delivering better healthcare than we are.

    And "One study ranked Canada dead last in timeliness and quality care". Really? Reporters really have to stop reporting on the results of one study; it's embarrassing.

    • Did you read more than one paragraph? The article cited several studies.

      It's one thing to criticize reporters. It's another to blindly and wrongly criticize reporters for something that isn't true.

      • Note the lead line of the story. I was quoting it.

        • Well you were wrong, the lead line does not say what you claim it says. You cannot put the whole article in the lead line.

          • Actually, the lead line says exactly what he claims it says. Go ahead. Try actually reading it rather than just spouting words from where you sit.

            Or what do *you* read it as saying?

            Hint: Lead line is the line right under the title.

    • In 2000 our system was better than that of the USA, ranked 36th, we were ranked 30th, just behind Columbia.

      Lies and half-truths to keep the current system in place.

      We do not have a true public system.

      • Yeah, and look who did the ranking – WHO. If the US system was so horrible, then why do most Canadian doctors head there? Heck, for that matter, why do most Canadians who need urgent medical care go the US? Yeah, thought so. The US has far better care than Canada ever dreamt of having.

  3. As pointed out in the article we need to follow other jurisdictions who have adopted a user fee on physician office visits. Norway is one. That country is well off and yet they introduced a user fee, which, I am told, has been very effective in reducing frivolous demands on their health care system.

    • Studies have shown user fees are not cost effective.

    • If our per capita income/PPP/GDP were nearly DOUBLE what it is in Canada (as is the case with Norway), then this might make sense.

      Put another way: Pay Canadians what Norwegians make and THEN ask them for user fees.

      • A bit of context, the Norwegian fees, ie 'gate-keeper' fees are similar, and if memory serves, inspired by similar fees in Sweden. I lived in Sweden and spoke to one of the people responsible for the decision so let me just give the debate a few details.

        There are fees to see a clinic but not a specialist. The fees are around 200-300SEK ($25-40) depending on your county (län), low income people and seniors are exempt, and there is an upper cap to what you have to pay in a year. These are not meant to be a cost-recovery method, are only meant to discourage hypochondriacs and unnecessary visits.

        A couple key differences between here and Sweden's system:
        - Universal pharma care, you cannot spend more than approximately $1000 per year on medicines. Everything over the government will pay. This is recorded by a national data base tracking all prescriptions to each patient and proscribing physician/nurse.
        - More generous sick day benefits. People are more likely to take a day off or two to get better instead of working through an illness (and thus prolonging it).
        - A national wait time guarantee. In law, you cannot wait more than 2 hours for an ER visit, more than 3 days for a primary care visit, more than 30 days for a specialist visit or more than 90 days for an operation deemed medically necessary. If you wait more than this you can go to a neighbouring county and your home county will get billed the service. If there is no service in Sweden that can take you then your home county must pay for you to go elsewhere in the EU.
        - Better coordination and better data. Each county keeps the same records, same metrics and same methods, and all reports to one central national ministry. There system is so good they can tell you how many people ages 20-23 had a heart attack in Stockholm from 1971 to 1990 in about 10 seconds.

        In short, everything needs to be looked at IN CONTEXT. Even if Sweden there is still a debate about user fees, and Canada we do not have the same social safety net that would make this yet another hardship for those hard off.

    • The context in which these user fees are introduced in Norway and other countries is never discussed by individuals and groups proposing their introduction in Canada. To begin with, Norway, Sweden, Finland, Netherlands and several other European countries spend vastly more on social benefits beyond universal health care (ie, national child care, post secondary education, affordable housing, pharmacare etc etc). In such a context, asking someone to pay 15Euro out of pocket for some health services is not as much of an issue as it would be in Canada, where we have progressively stripped the population of social benefits over the past 20 years.

      Tell you what, let's introduce a national Pharmacare program, a national affordable housing plan, a national child care plan and beef up social insurance in Canada and THEN let's discuss asking Canadians to pay user fees for a visit to the health care provider. All this to say, we must look at the broader social context when we compare health services in Canada to other countries please!

  4. "Emergency wards are clogged with everything but emergencies. Almost 90 per cent of ER visits can be better handled at less cost in clinics, Ross found. Just 1.1 per cent of ER cases are severe, and 0.1 per cent threaten life or limb, he found."

    If they could implement something to address just this it would be a good start. Those statistics are mind-boggling. A fee for a non-emergency could be charged if there was a walk-in clinic open and reasonably close by.

    • I agree that the overuse of ER's is likely one of the more significant contributing factors to the ailing state of our healthcare system.

      A good start would be to improve access to walk-in clinics – particularly in lower income areas.

      Clinics that are open on weekends are few and far between. Add that to the decreased frequency in public transit – particularly on weekends and it's really not surprising that alot of people – however irresponsible – tend to use the ER as a walk-in clinic.

    • The physicians at the University of Alberta hospital in Edmonton say the problem in the emergency dept. is NOT that patients who do not have real emergencies are showing up there but rather that the beds in the dept. are filled with patients who are admitted to hospital and have no way to move into the wards because they are full. With 8% of beds on units in Alberta filled with long-term patients waiting for placement, the govt. fell down on the job when it came to building nursing homes.
      Yes, we have a lot of people without family docs. In Calgary it became cost prohibitive for family physicians to maintain their practices and many moved out. Not to mention that the system did not graduate enough of them.

      • Just to let you know, in Edmonton and Calgary, a visit to the ER can result in a wait of 20 hrs. No one goes there without being really sick!

        • But, hey, your taxes are low, right?

          • Ah, Dave it's way longer in QC and their taxes are the highest in Canada.

            However they DO have two system. One you pay directly and get in quickly and the other you wait for over 18 – 28 hours in ER's and ALL day in clinics and months and months for any kind of referral and as in ONT they only want to refer as then they get more money from your visit.

  5. User fees must be implemented or costs will never be controlled.

    • I think we discussed this before, you do not want to believe what the studies show Philanthropist, however, user fees are not cost effective because they stop people from seeing the doctor in a timely fashion and we taxpayers end up footing the bill to treat illnesses in a more advanced stage which is far more expensive.

      • And yet, EVERYBODY trying to see the doctor whenever they feel like it stops people from seeing the doctor in a timely fashion rather effectively, too. They call it the tragedy of the commons.

        • Yes, but that can be addressed by increasing the number of doctors, whereas increasing the number of doctors does nothing to address the delays imposed by user fees.

      • Maybe if the studies weren't done by the health care industry for the health care industry they would have more credibility?

        • Do you mean "health economists"? Check out that article in the British Medical Journal 2010-341 regarding whether user fees make the medical system effective. I found it on google. I don't know if you can call these people bias, after all, the same economists work for the "for profit" groups. If we were in the "for profit" medical business, we would introduce user fees because we would want to keep people away until they were really sick and we could treat them for serious illnesses and make lots of money off of them.

    • User fees would rightfully take away the mindset of many that medical care is "free". We all pay for it, but most of us know someone who goes to the doctor every time they get a runny nose.Then other pepole who are really ill can't get in to see a doctor because they are not on the right list. A small user fee might help with that. Also, such things as "well baby visits" where someone just has to measure and weigh a new baby to make sure they are making progress could be well handled by a nurse or physician assistant. Doctors should tending to things that require advanced knowledge.

      • In Alberta, the new baby visits are done by the public health nurses who are paid by the hour. As for people who go to the doctor often – those with chronic illnesses do and they would be punished by user fees.

    • Get an objective third opinion of the system. It is medical mafia, lies, half-truths, controlling quality, number of doctors, and hiding mistakes instead of learning from them….

  6. I'm more inclined to blame the apathetic, the ignorant… the voters, but point taken.

  7. And you don't think the best should be paid more? What incentive does anyone have to be the best if they get paid the same as the worst? No wonder our health care system is not very innovative!

    • I do my very best at what I do. I am not paid as much as I would like. What's your point?

    • Regarding pay and merit and so on, there is at least one chapter in this book titled Filthy Lucre that somewhat addresses that topic. Read the book? If not, you should try to track it down…very interesting read for both righties and lefties. :-)

  8. "…had the misfortune to trade germs and waste time in one of Canada's overstressed emergency wards."

    There is no more objective way to say it. I cant imagine anyone having gone through that experience and not considering it a misfortune, a waste of time, and a risk of infection.

  9. The truth is the canadian health care system sucks no matter how good or bad this article is. It is actually unbelievable how sub-standard our system is. Of course when comparing with Zimbabwe, Nigeria, etc, the canadian health care system is wonderful. However, Canada is not a third world country and therefore our system should be compared with UK, Germany, France, Italy, Switzerland, etc. Of course it is easy for those who actually never had a health problem to claim that we have the best health care in the world. This system may be wonderful for those on welfare and low income because unlike the USA, in Canada they can get the care they need, however for the middle class this system is a joke.
    According to STATS canada 40% of all taxes we pay, not just income taxes, goes towards the health care. Guess what? For my 40% of just income tax let's say I can get top health care insurance in USA, and I am middle class only.

    • I agree. While it's appalling that a third of the US population is uninsured, I believe that the US HEALTHCARE system is exponentially better than the one in Canada. Doctors are treated as assets, not civil servants. There is money to do research (that doesn't come from taxes), the hospitals are run like businesses, and the administrators and doctors have a personal interest. In Canada, doctors are paid terribly low incomes, have no incentive to be better, have to fight to get research grants, because the hospitals they work with are government funded….
      While private health care would eliminate those problems, we're then faced with the issue of taking care of the third of the population that is, for whatever reason, uninsured…

      • You've been misinformed. A third of the US population would be over a hundred million uninsured. The highest figure bandied about even by American lefties is 45 million. Subtract illegal immigrants (or do you think Americans owe Mexican citizens who break their laws health care?) and you're below 30 million. (Even President Obama had to use this corrected figure). Many of those are people who can afford health care but choose to spend their money elsewhere, on a second car for example. They are mostly young and healthy and play the odds.

        You make an important point. The American health care system that Canadians smugly denigrate is the source of most cutting edge medical and pharmaceutical research. Research is very expensive. American taxpayers pay for the research, and smug Europeans and Canadians get the use of it without bearing the initial costs. Without that American subsidy (coming to an end with Obamacare), our health care will be less comfortable. In addition, American doctors and hospitals are used constantly by Canadians as a safety valve for timely care that cannot be accessed in Canada. Some pay privately, sometimes the provincial governments pick up the tab. Again, without this safety valve, Canadian health care will suffer. So everyone should get off their high horse and lay off the Americans.

    • Sure you pay 40 percent more in taxes for universal coverage…but it is an absolute joke when you claim that you can get the best health insurance in the United States…I know…I am an American. Moreover,when someone who is NOT COVERED AT ALL in America gets sick, those with insurance (like me) pick up the tab in the form of higher premiums and co-pays to cover the cost of that person's hospital visit or surgery, etc. The American health care system is NOT the model. If Canadians want to dramatically overhaul their system, look to France or Germany, not the U.S.A.

    • I live in the US and to get good health insurance on the free market with quotes I was given last month from Blue Cross Blue Shield, for my wife and myself. $2800 t0 $4300 dollars a month. My taxes would have to increase to more than my wages and I still would end up owing money!! 80% of the bankruptcies in US are from medical bills. Fix your system but do not use USA for a health care model. I have had waits here as long as some of the complainers in the blog and I have had two close relatives die from lack of care. I am not low income and I have Insurance: I found a deal at $1500 a month but I still have to pay $125 a week for medical expenses for co-pays & 20% of all diagnostics. The only people in USA with good coverage are the politicians,

    • The misconception if you don’t have healthcare you get turned away is stupid. It`s illegal for hospitals to turn away patients at risk

  10. I live in Cambridge Ontario, I have been waiting since mid-December 2010 to get an appointment for a gastroenterologist. And I got it. It's on March 04-th. Why???? Because there are only two of them in Cambridge, Ontario. Two gastroenterologists for a population of 100,000 people? Meanwhile, the College of Surgeons Ontario together with the Ministry of Education can not find enough obstacles to put in the path of doctors immigrating to Canada from other countries and trying to work here as physicians or specialists.
    This is what we get for living in a socialist country like Canada. Trying to make life level and equal for all people does not work. The socialist health care system does not work.
    FOR ALL THOSE INTERESTED HERE IS THE FRASER INSTITUTE REPORT ON THE CANADIAN HEALTH CARE SYSTEM – SEE BOTTOM OF PAGE: http://www.fraserinstitute.org/research-news/disp

    • Well, if you're going to go all anecdotal on us: I live in downtown Toronto and have never had to wait more than 48 hours for any test, nor 2 weeks to see a specialist — because I live near multiple teaching hospitals. Perhaps if you journeyed through the wilds of the 905 and sought an appointment in the 416, your wait might not be so long? What is that, 40 minutes?

      Access to healthcare is influenced more by where you live than the type of insurance/delivery system. I grew up in the rural USA and had crap access. When I moved to cities, I had access, but paid a fortune in deductibles and co-pays over and above my insurance. Ontario's system needs help, but it's not as bad as what's available south of the border. As for European models, if we all lived closer together, we'd have more doctors per 100,000 in our communities, too.

      • What does the square mile have to do with the number of doctors per capita? How would you have more doctors if we lived close together? Let's assume the following scenario: Toronto has a population of 2M people and let's say 1,000 doctors and Cambridge a population of 100K people and two doctors. If these two cities were one big city then you would have 2.1M people with 1002 doctors this would be more doctors per capita?
        You are not serious, are you?

        • I'm serious about distribution impacts on per capita averages.

          • You can not have uniform distribution. Never ever. Not even within Toronto. And that's not the point. I should not have to travel from Cambridge to Toronto just for a regular specialist appointment. Obviously if someone needs top notch procedures or Stargate medical equipment I understand that may only be available in large cities with medical universities and research centres. But this is not the case. All rural areas or whatever you want to call Cambridge and even the city of Toronto are under-served. Every single canadian city is underserved. I will not take half a day off work or use my vacation day to travel to Toronto for what should be a regular appointment and ON MY DIME. I am not getting what I am paying for and that includes the McGuinty health care premium.
            And I used to live in Toronto, I should say North York and had to wait 1 week to see my family doctor. I was actually one of the lucky people who had a family doctor. Obviously you are a canadian born citizen and you inherited your family doctor. Depending on the test you require you may get it in 48hrs or 6 months and that includes downtown Toronto. When did you need an MRI last time and got it in 48 hrs?

          • Alex, how in a country as large as Canada are we possibly going to provide services so no one has to travel any distance to see a specialist? You have no idea what under-served is. My family lives in northern Alberta. My parents had to rent an apartment in the city of Edmonton, 6 hours away from their home in a rural community for 2 months so my father could have radiation treatments for cancer. They paid out of pocket for the apartment.

          • That was exactly my point. However, basic services should be accessed anywhere. How? By opening the tap for the foreign trained doctors who have been lining up at our universities for 5-8 years to get their studies recognized, ruining their lives and the lives of their spouses and children trying to get in the system when they are 40 years old already. There are a lot of things the government could do and some of these things do not even cost money. Why these things are not done? Because of corruption, because of the unions and because of the various medical associations who are trying to protect the non-competitive medical environment.
            And you know what? Whe do live close together in Canada. Look at the map.
            And you haven't answered my question. When did you have your MRI done in 48 hrs?

          • "I will not take half a day off work or use my vacation day to travel to Toronto for what should be a regular appointment and ON MY DIME."

            If you're not willing to be an advocate for your own health or to make such a minor sacrifice (half a day?) of your time in order to travel to obtain care sooner, then you really have no business complaining about a 3 month wait to see someone locally at a time that's convenient for you. Moreover, YOUR DIME will buy you less under a for-profit insurance system (they have shareholders who want profits, yo).

            "Obviously you are a canadian born citizen and you inherited your family doctor. Depending on the test you require you may get it in 48hrs or 6 months and that includes downtown Toronto. When did you need an MRI last time and got it in 48 hrs?"

            You're working yourself into an irrational tizzy. I was born in the US and emigrated to Canada 12 years ago. Compared to the care options in the US (in 4 states, under several different health insurance schemes), I have received great service and value in Ontario. My wife and I have a family doctor at a downtown practice group — who we found on our own — no inheritance required. That clinic, like many others in the downtown, regularly advertise that they have family physicians who are accepting new patients.

            You can also find family doctors using Health Connect or by searching the College of Physicians and Surgeons:
            http://www.health.gov.on.ca/en/ms/healthcareconnehttp://www.cpso.on.ca/

            When choosing a family doctor, be sure to research which hospitals they have privileges at, as this will affect your access to specialist referrals and care!!!

            As for the last time I needed an MRI — it wasn't an emergency (critical), so I could wait. Because I was willing to take a cancellation appointment and could come in for an MRI at night, I only waited 4 days. In at 9:30 PM, out at 10:15PM.

            If you want care fast you must be willing to be flexible and put your health needs before your desire for convenience. Be an advocate for your own health. This is the case under ANY system.

          • depends who u know in the crap bankrupt mediocre lacking system…

      • You've obviously never had to see a rheumatologist, or a neuroendocrinologist, or any one of a number of specialists who have similar wait-times. Try waiting six months to see a rheumatologist at one of those teaching hospitals rated "shouldn't be allowed to treat animals" on ratemd.com (that was an acccurate comment btw), 8-12 months to see a human version.

        • Yes, I have had to see specialists — a few times. Some are available on a weekly rotation at my family doctor's clinic. Others are available at the hospitals in which he has privileges. For something urgent, my wait times have been less than a week. For something not urgent, less than six weeks. Again, I live near several large hospitals, have a family doctor for referrals and several walk-in clinics nearby. Proximity matters. When I lived in the rural US, specialist care was often 2-3 hours drive away and wait times could be just as long– whether you had money or not.

    • Because there are only two of them in Cambridge, Ontario. Two gastroenterologists for a population of 100,000 people?
      Interesting fact: Doctors are private employees and free to go where they want. If you want more in Cambridge, convince your council to start up a program to sell them on the idea it's someplace they'd actually want to live.

      I should not have to travel from Cambridge to Toronto just for a regular specialist appointment.
      In a perfect world, sure. The world's not perfect. Learn to accommodate and abuse the system. Hell, I've been going to college in Peterborough, asked my FD in North Bay for a reference to a specialist to have a look at my knee because of some recurring issues, been told he wouldn't know any in Peterborough and gone: "Well, send me to Toronto then. It's a bus ride away and I'll visit fam/friends" and had an appointment in about 2 weeks.

      That said, remember: sitting in a corner wailing and pouting because daddy won't give you a pony isn't going to get your problem solved.

  11. i'm not going to touch that with a ten foot pole.

  12. I don't know that we are proud of our healthcare system in its current state but I think we are proud of what our healthcare system aspires to be. I believe that the majority of Canadians believe that healthcare is a right and not a privilege. That is why we think Tommy Douglas was truly a hero. I met an American on a holiday once and he was telling me about his Canadian friend and how he complained about our system. He waited too long for a knee replacement. Of course, he also had open heart surgery which the system paid entirely for and he has a completely subsidized education – he's an engineer. His career as an engineer in Calgary has allowed him to buy a 2nd home in Mexico….but those Canadian taxes are a killer. Of course, nobody will be disqualifying him from his medical insurance.

    • He had completely subsidized education? In Canada?
      Most of my friends who were brave enough to decide to study at universities, graduated with debts of 40 000-50 000$!
      No any gov. subsidies aside of repayable student loan.
      There are countries in the World that subsidize education completely – most of European countries does (that would be often the countries that also have better than Canada health care system), along with the costs of living, but last time I checked, it wasn't Canada.

      • pablo, yes it is subsidized in most European Countries, but the highest income tax rate in Germany ( where i paid ) is 48%. And HST , or there called MWST , is 19% ,and my monthly private health care plan was 1,400 C$ etc. etc. It has to come from somewhere ..

      • Yes, I know people who had student loan debt too. First, the tuition is a fraction of what it is in the US. Secondly, it is typical at least in Alberta where I am from, that if you may your payments for your student loan religiously, they will only make you pay off a portion of the loan. Either way, think about it. If tuition for one semester is $5,000.00. How much of the cost of the university education is an individual paying? Who is picking up the rest of the tab? Yes…the Canadian taxpayer. Then these educated people go on to earn big dollars and complain that they have to pay such high taxes in Canada. If they lived in the US, they probably could not have afforded the education in the first place. I do know about those European countries – Denmark, etc. You should check out what they pay for income taxes!

      • Pablo nothing is for free, it has to be taken somewhere. If you expect freebies, ask your parents, see where it will get you. I can't believe common sense has left the country and passing the buck becomes the norm.

  13. I forgot to mention something very important:
    CANADA IS THE ONLY COUNTRY IN THE WORLD THAT OUTLAWS PRIVATE PARALLEL HEALTH CARE.

    • Except for North Korea.

      • and Cuba. That's the company Canada keeps on this issue. North Korea and Cuba.

    • Let's keep it that way. I can't afford to get into the fast pay as you go line with the big money guys or my Visa. I'll be in that second tier line up, the slow one that ends with the least skilled doctors and out dated equipment. When are poor people going to realize what they are about to lose?

      • Funny how it doesn't work that way with dentists. Or food. Or electricity. Or every other essential private good and service. Your socialist scare-mongering is wrong.

        • Do not kid yourself. The working poor without benefits do not go to the dentist and do not take their children to the dentist. Luckily there are optometrists who provide glasses for free to kids whose parents aren't on social assistance but cannot afford glasses.

          • You're arguing something different now. I've responded to you below. Stick to one argument please. Now you're arguing that dentistry should be part of the public system. Fine. I'm not against that. I'm arguing we should have both a private and public system. That's two different things.

        • You're joking, right? Yes, it's a wonderful system for all those poor people who want to get a quick appointment with that great dentist with the nice office. Too bad so many of them have so few teeth left to fix – being that it's so quick and all… Cause, hey, scarcity of dentists is their main problem…

          • You're arguing something different now, but unlike Healthcare Insider, at least you admitted it in your final sentence. Now you're arguing that dentistry should be part of the public system. Fine. I'm not against that. I'm arguing we should have both a private and public system. That's two different things.

            My example of dentists, is that there is absolutely no shortage of them. In fact, each time I've moved somewhere, I've had choices between hundreds of them. There is no shortage of dentists, even if everybody who had doesn't have one today, got one tomorrow. That's because in the free market, supply meets demand. In Canada's socialist health care market, supply does not even come close to demand, in pretty well every single category, and that's because there exists no free market, so it is impossible for supply to meet demand. For pretty well every procedure, exam, diagnostic test, consultation, you name it, there is not enough supply, by a country mile, and it is glaring when our country is compared to every other advanced country in the world, all of which have both public and private systems. You want a root canal? Choose between hundreds of dentists that could do it tomorrow. You want an MRI? Wait four months, if you're lucky, then wait another four months for a qualified doctor to take a look at it. You want everyone to have a root canal? Fine, add it to medicare, but for God's sake, don't nationalize the dental industry! Allow the private market to continue to exist, or we'll end up with shortages there too.

            The fact that our country fares worst when it comes to meeting demand, while countries that have private and public systems fare much better (in both private and public availability), that shoots a gigantic hole in the nonsensical argument that opening up a private system in Canada will cause shortages! In fact, it will do the opposite, it will solve the problem of shortages, as has been shown absolutely everywhere. You people should get out of your house.

          • Access to != Ability to access

            You're the one who conflated the two subjects when you brought in the example of dentists with the explicit comparator of "Funny it doesn't work that way with.."

            I mean, if you're gonna play grammar cop you could at least be consistent.

          • Well, I've clarified exactly what I meant by bringing up dentists, and in fact I was keeping with the duscussion at hand, which was about shortages, outdated equipment, and least skilled doctors (as expressed by WB), that would apparently plague the public system if we had a private system too.

            Dentistry the perfect example, because it's a private health care market in Canada, it was not nationalized like most of the rest of health care. The discussion was about shortages, so I pointed out that shortages don't exist in private markets, and dentistry is the perfect example. Denitists are available everywhere, all the time, for everybody, and they are not saddled by outdated equipment and poor skills at all.

            Another example is pharamacists. Ever had to wait months for an appointment with a pharmacist? Ever had to wait a half hour? Have you noticed that the typical pharmacist is available to discuss your medications at length, personally, for as long as you like, for no extra charge? Ever felt that pharmacists for the rich have better equipment and more skills? No.

        • What world are you living in? Poor people don't haver regular dental care only in emergencies when the pain is unbearable. Then it's a quick cheap extraction. The dentist offices are full of people with private insurance, teachers etc. Dentistry is our version of the American health care system.

          • Now you've changed your argument, and so has Guest and Healthcare Insider. Previously you claimed the poor would have access to poor doctor care (which has been proven false in almost every other OECD country, including almost every European country). Now you're trying to claim that there will no longer be any doctors available in the public system (which, strangely enough, IS THE PROBLEM WE HAVE TODAY, THANKS TO CANADA'S SYSTEM), which has also been debunked in every other country that has both private and public access, which includes all of Europe, Japan, and so on. Make up your mind!

            And puhleaze, read the article, nobody wants America's system, it's actually ranked lower.

        • Yes. Competition brings choice and brings prices down in all goods and services. It's government and union monopolies that mess the downward trajectory up.

    • If they would allow the people that want to pay extra to see someone else, wouldn't that free up the one long lineup a bit? a win-win if you ask me.

      • Who is this someone else you are going to see when you pay more? We are short of physicians & nurses and OR times and hospital beds. Somehow though, when they contract out the services to private providers, things get humming along more efficiently – at least that is what seems to happen with laser eye procedures and hip surgeries. Why is that? Could it be things are bogged down in administrative red-tape?

        • In a private system, nurses and other health care personnel go where they are needed i.e. the system has flexibility. In the public system unionized nurses have negotiated all kinds of things they prefer so it is quite common to see three nurses sitting around picking their noses in one department while another department is overloaded with patients and could use one or two of those idle nurses. Another major saving is in ancillary personnel like cleaning staff. Unionized cleaning staff in hospitals are paid over twice what the same job is paid in the private sector. Hospitals have started contracting out laundry for this reason. But the major useless cost in public hospitals is administration. Cut that fat and no one will notice. But those same administrators never cut themselves, but some service that's in the public's face.

          • I know you may not realize this but even nurses specialize. A nurse who works in the emergency department has taken extra courses and done specific clinical training to work there. Different sorts of medical interventions require expertise. That is why nurses generally do not float from one area to another. Now, as for nurses sitting around – Do you know that unfortunately nurses must spend a vast amount of their time in recording everything that happens to each and every patient they care for. These are legal documents and are part of the requirements of the job. Hospitals in Calgary did turn to a private laundry service – no money was saved…they do not pay big money for cleaning in Alberta. It is another place that has been cut back – some of the areas are filthy.

      • What you pay extra for is to get the best doctors.

    • I love when brain-washed Canadian sheep counter with "But our doctors actually control the whole thing and they are private."

      Pure delusion. A common Canadian self-deception.

      Who pays these doctors? You or government bureaucrats?

      Who decides what they shall be paid and what will be reimbursed? You or governement bureaucrats?

    • Except in QC.
      Head to Gatineau, and they have bi-lingual services, $200 a pop to see a primary physician. But you get 30 mins, not 5 and indifference and BS.
      If you're really sick, you'll pay on credit cards or anythig else to get well….I did for an acute illness that damaged my heart because I had to wait and wait and wait until I had developed another health issue from the initial one – a serious stubborn infection.
      I paid over 800 for medications as well as the four visits.
      ~stillsickinONT

  14. "Our health care delusion"

    Hello, strawman.

    • Healthcare Insider is not offering a straw man; he describes our national silliness over health care rather well: I don't know that we are proud of our healthcare system in its current state but I think we are proud of what our healthcare system aspires to be.

      We suck, but geez, on paper, we should be pretty swell. There's a slogan!

      • I wan't referring to Healthcare Insider, but rather to the author and headline of this article.

        • You're right, I blew this one. Sorry.

  15. "…those who were in the social sciences were there by default – not intelligent enough for engineering or science"

    There might be a good campaign slogan in that – Stephen Harper, too dumb for engineering or science

  16. It would be a good thing if we had people who were willing to run for office and state openly and honestly what we need to do to fix the system and ask for the support to do it.Then if Canadians fail to support these people than they get what they deserve,i know the rest of us have to live with it as well but a point has to be made some way. To many people in this counrty refer to our health system as free and therefore fail to take any responsbility for visiting emergency rooms for non-emergency issues.People on welfare roles really do pay nothing while the rest of us pay threw the nose, i don't know what it will take to fix the system but if Canadians don't get the heads around the fact that change is needed for it to survive or nothing will be left when its needed most.

  17. The conservatives should be drawn and quartered for the damage they have done to health care in Canada.

    You need a remedial constitutional law course.

  18. Anyone who's spent anywhere near the average 8 hour wait would consider it a misfortune and waste of time. And anyone who's followed the news of the last 10 years know that the transfer of antibiotic-resistant germs in hospitals is a big problem.

    What you call a lack of objectivity, others call fact.

  19. Before I believe anybodies study, I want to know the political makeup of the 'studiers'. I already know which way the MacLeans writers bend so until I see the complete picture I will file this in the 'ficiton' section.

    • Not to mention the Fraser Institute!

      • How childish the both of you. Look at the source material cited. The source OECD is usually considered impeccable by lefties. The fact that a conservative think tank uses the figures doesn't change them. This attitude, that you can ignore facts you don't like simply because conservatives use them to make their point it is like sticking your fingers in your ears and singing lalalalala like a three year old.

  20. There is significant room for improvement in Canada's "health system". However, far too little attention is paid to the 90% of the iceburg beneath the surface. First and forement, across the provinces, our health system is an "illness treatment system" and not an actual "health system". We need to change this orientation and heed the wisdom of "an ounce of prevention…".

    How? Invest in more preventive health and health care to ensure that we support individuals to stay healthy in the first place and provide better, more timely care when it is needed. Some of this depends on public policy shifts, like reducing the skyrocketing poverty rate in Canada. But key reforms can also be made at the level of our actual health care services. For example, taking the burden for health care off of doctors alone by giving more Canadians access to local healthcare teams, like those at Canada's Community Health Centres (CHCs), where doctors, nurses, dietitians, counsellors, physiotherapists and others work in a team dynamic to provide better and more timely patient care.

    • There's lots of work to be done, but we also have lots of examples of what needs to be done – and it doesn't mean spending more money, it usually means spending money better! It's time for us to get back to the basics of shared responsibility and investment in social wellbeing that used to make Canada the envy of the world. What better call to action and celebration could there possibly be for Canadians from coast to coast to coast!

    • Thanks for highlighting the role of prevention and the need for us to do a better job at this, across the board. As a Community Health Centre in Toronto, every day we see the impact on people's health of poverty, inadequate housing, lack of access to nutritious food, poor environmental health, etc, and the way these factors conspire against individuals and families. Much more of our effort needs to be place upstream, absolutely, to build a health system rather than the illness treatment system we currently have. I know for our part, Community Health Centres across Canada are playing a major part to foster this shift – but we're only one partner in this larger need for systemic change!

      • It is not only the poor that have terrible eating habits and don't exercise . We have to take responsibility for our own health and not blame someone else for all our problems.Look at what Taylor BC is doing and see the lack of co- operation from some of the town people.Some people do not want to live a healthier life style but run quickly for medical help when they have a problem.Quit blaming the social system and Gov't .I agree it is necessary to educate the people.Most of us want the "goodies" even though we know it is not good for us.

      • There is no lack of access to nutritious food in Canada at any level of income, including Welfare. There are poor choices. Track what Welfare clients buy. Booze that has no nutritional value whatsoever, and a lot of convenience foods that are expensive, fatty and salt loaded. They could have very nice meals for the same money if they bought inexpensive cuts of meat and cooked them right, canned fish, whole wheat pasta and brown rice, as well as fresh produce and cooked these things themselves. After all, the one thing they have more of than anyone else is leisure. Stop making excuses for the merely lazy. And as for people who smoke on the taxpayers' dime…

        • Guest, I suggest you google the term "food desert" which refers to the phenomenon of grocery stores moving out of low income neighborhoods. For many low income people, the only place to buy food without having to drive or cab is a convenience store.

          Not everyone who is poor is drunk and lazy as you seem to believe.

    • There is no "skyrocketing poverty rate" in Canada. This false alarmism is what loses lefties their credibility.

      However, the prevention point is a good one. If Canadians at all levels of income would eat less, especially lazy man convenience foods and exercise more, there would be a significant drop in cardiac disease and diabetes to name just two.

  21. Canadians might take comfort in the fact that a number of the obstacles we face right now were already foreseen by Tommy Douglas when Medicare was founded. He said that providing universal coverage was only the first step in healthcare and that we needed to gradually move to what he termed the "Second Stage of Medicare", reforming health services to do a better job keeping people well and providing better health "care" when it's needed. Let's bring achieving the SECOND STAGE OF MEDICARE back into our national health system discussion!

    You can learn more here. Please spread the word: http://aohc.org/index.php?ci_id=2203&la_id=1

    • Glad to see AOHC raising this issue. Why aren't more Canadians talking about the original vision for Medicare, especially when we have so many of the solutions right in front of us already? Agreed! Let's all start talking again about how to achieve Tommy Douglas's original vision for the Second Stage of Medicare.

    • Agreed! Great to hear us talking again about achieving the Second Stage of Medicare. Hopefully more Canadians start to get involved in this shared movement for health and effective health care!

  22. If govt. 'care' is such a good thing, why not turn lawyers into public servants, too? And architects. And engineers. And plumbers.

    Wake up, people: socialism doesn't work! Apart from being evil, it doesn't work! A free market of medical care is the solution.

    Dismantle the State system. Eliminate the cartels and regulations. If someone is really poor and can't afford an operation, there's always charity: a donor freely offering his services or money to purchase services on behalf of the unfortunate.

    • Also, eliminate the evils of socialized policing, fire fighting, national highway system, etc. These should all be run by corporations whose main focus is to generate and maximize profit to most benefit the shareholders who invest in them…

      • Don't forget pay as you go education. Freedom. Education optional for all, those who want to educate their children in some central locale can pay for it.

    • Health care is not a commodity. Typical supply and demand scenarios do not work well for critical care needs.

      After all, when you need a heart surgery, there is no maximum cost beyond which you'll say, "Nah, I'l wait a while"

      Similarly, when you don't need a heart surgery, there is no minimum cost at which you'll say, "Ah what the hell, I'll get one anyway."

      As for your charity situation, the problem with it is that those who are inclined toward charity place themselves at an economic disadvantage compared to those who do not. It doesn't take much foresight to see how that puts us in a place where those who want to perform charity don't have the resources, and those who have the resources are not interested in charity.

    • The United Kingdom has somehow soldiered on with having doctors as direct public servants, but they do that.

      And we already have doctors as 'public servants', such as those affiliated with the Canadian Armed Forces, and too a lesser degree those working on salary at community health centres.

    • Are there no workhouses?

  23. An excellent report about the financial status of Medicare in Canada and some strong recommendations on how to improve our public, single-tier health system is something I would recommend to all Canadians.

    Hugh Mackenzie and Michael Rachlis: "The Sustainability of Medicare". A must read and you can find it here: http://www.una.ab.ca/news/archive/medicaresustain

  24. I think it became clear after the obvious, albeit quite funny sarcasm in the first paragraph. "…narrowly missing two elderly people (one assumes they were elderly before their wait in emergency) and came to…"

    • I think you missed the point. An elderly person is unable to dodge a van coming at him/her.

  25. I live in a region with more than half a million people in Ontario near Toronto. I pay the highest "Health Tax" but now my doctor no longer performs annual physicals-the Nurse Practitioner does it. This same Nurse Practitioner had to look up the side effects of the birth control pill for me. This is something most girls know in high school. Unbelievable the level of care I get for my money.

    • To be fair to nurse practitioners, they typically have 6 years of university schooling & clinical training. Nurses in this country have the highest averages entering university of any faculty. Maybe he/she just wanted to be thorough and give you the full list according to the pharmaceutical directory. Obviously the physicians in the clinic trust this person's level of competence.

    • I have a an excellent doctor with many yea in a drug manual (online now) while I'm in his office. This is thoroughness and caution and I appreciate it.

      • Something happened to my post. Here it is again. I have an excellent doctor with many years of experience. He often looks up information on drug side effects and interactions (online now) while I'm in his office. This is thoroughness and caution and I appreciate it.

        • She genuinely seemed unsure of the side effects and read very high-level, general ones. As most women know, side effects can be specific per the brand and formulation. She should have known that and discussed the various hormonal blends and types and their ensuing potential side effects. I have no faith in this nurse practitioner and I resent paying top dollar for a nurse to do an annual. She is unqualified in my opinion to perform this. Consequently, I paid to have a proper physical in a private clinic in Montreal. It was wonderful and thorough.

          • Sorry, I may have misunderstood your comment and focused on your concern about the practitioner having to look something up. I live in a different province and have not had any similar experience. A complete physical once a year by a GP is fully covered in my province. I hope that never changes.

          • Don't move to Ont. then.

    • would you rather one who didn't look up side effects? Really what DO you want?

  26. The problem is that the only "public" part of the system is the payer — everyone else in the system from doctors to administrators to staff is trying to extract the maximum benefit to themselves regardless of their contribution and feeling justified in this because they're "healers".

    We have previously paid university tuition and expenses for those deemed fit to serve as officers in the military, why not a similar deal for medical students who agree to spend a stipulated period working on salary as doctors (instead of fee for service).

    Why not a simplified funding formula for hospitals so huge salaries and more big salaries for support staff staff don't have to be paid for administrators who function more like CEO's / fund raisers than leaders of a medical team.

    In short we need to either give up entirely, or have MORE involvement by and accountability demanded from our elected representatives.

    • I completely agree. Why is it that tuition for professional programs was deregulated to ensure that only the wealthy could afford these degrees for their kids or the students graduate so heavily in debt. Why would anyone become a doctor with the cost of medical school and the resultant salaries? GP's make less than I do!

    • Some physicians are paid a salary. Some prefer fee for service as they can generate more income that way.

  27. Why shouldn't a foregone conclusion be stated right at the beginning? It's a waste of time to be objective when the results are already known. Especially through international comparative studies of repute.

    Most Canadians who think they have it good are the ones who haven't travelled much. Are the ones who have not lived anywhere else. Are the ones who don't know any better!

    • Or have never had to deal with our crappy health care system. Life is good for these folks and are oblivious. UNTIL the time comes and they have reality bite their butt. So sad how complacent Canadians are. One example ….. WE HAVE TO VOTE TO GET WHAT WE NEED. Otherwise sit back and wait it out. Maybe after a few years people will get it. Sooner than later I HOPE.

  28. Canada has a two tiered health care system but most Canadians think that health care is 'free for all' and that everything is publically funded – this is not true. Many employers do not provide extensive benefits so anything you need you will most likely pay for out of your own pocket. Many casual/temporary employees do not qualify for Health and Dental so you are on your own there too. The major difference between Canada and the other OECD countries (and please can people stop the comparisons to the States – it doesn't take much to have better health care then them) is that they have made available private hospital coverage. As an Australian living in Canada, I can state that private hospitals do not result in less care for those going in the public system, it actually free's up may of the acute care beds for those who really need them can now have access too.Those that can afford private pay for it and if you can afford it and dont then you pay an additional 1.5% tax. And dont worry, you can choose your level of privage coverage (yes an actual choice!) and private health costs are about equivalent to what I was paying per month for Alberta Health and my benefits package with my employer in Canada.

    • Thank you, Marina. Great points all around.

    • The many problems with our system is that there is no real quality control in the system, the services provided by private enterprises, profit from volume, and the doctors union, creates a doctor shortage to protect its members.

      Look to Italy or France for a better system. (they are a combination of both a core true public system, again our system is only publicly funded, and more expensive private systems…)

      Problem here in Canada, is our half public half private system, where illness creates profit….volume, profit, mistakes, more volume, more profit….

      To tell you the truth, the reason we have such bad health care, IS BECAUSE OUR LEGAL SYSTEM DOES NOT WANT TO BITE THE HANDS THAT FEED THEM.

  29. The most important thing is,

    I'm committing a crime if I spend $10,000 of my own hard earned dollars to buy my mother a new hip to stop her horrid anguish,

    but am A OK if I choose to spend that amount on booze cigarettes and bubble gum.

    Gotta love our socialst medicine. Where we all have an "equal" right to languish in painful cues.

    • Oh, you could take your mom south of the border. It is not against the law. I hear the hospitals, like the one Danny Williams went to, are very nice there. The problem here is that you can't bump your mom up the que because you have $10,000.00 and the next guy does not.

    • You say you're spending 10,000 to buy her a new hip. What you're really doing is spending 10,000 to make sure somebody else who needs a new hip has to wait even longer.

      • So instead of one suffering, it is way better to have 2 or more suffering. Misery does love company. Why should there be only two choices, why can't both of them be free from their suffering? By putting ourselves in a small box of only "either/or", why can't we think of other options? Why are we so narrow minded when it comes to health care? Can you imagine a world of just black and white?

        • Because we don't live in la-la land with limitless doctors and resources.

  30. "One study ranked Canada dead last in timeliness and quality care"

    If you are insane enough put your healthcare under the control of the same people who run the post office and the motor vehicle bureau, you get exactly what you deserve.

    • It's not. The doctors actually control the whole thing and they are private.

      • "The doctors actually control the whole thing and they are private."

        Pure delusion. A common Canadian self-deception.

        Who pays these doctors? You or government bureaucrats?

        Who decides what they shall be paid and what will be reimbursed? You or governement bureaucrats?

        • And who decides if there's more doctors or not?

          • In Canada, that would be the government.

  31. I live in Port Aberni BC and have been waiting for kidney surgery for a very long time. I have been in pain for over a year as every time I went to emerg I got the run around. Have told them that this problem runs in the family but no one listens. Im getting very fusterated and still waiting. This heathcare is like being in a third world Country .

    • So go south and take advantage of private care.

      Can't afford it? What on earth makes you think it'd be cheaper here?

    • Hey, don’t go south, but keep waiting. Soon your pain will disappear but your family has to visit your grave.

  32. People should get, say, 3 free doctor's visits per year, then be charged $15 or $20 for each subsequent visit in that same year. It may not seem like a lot, but it adds up and people might think twice before making an appointment just for a little tickle in their throat!
    But the same method should be used for ER visits, so that people don't clog up one place in favour of the other because the fee is lower (ER visits vs. doctors' offices). This is not a crippling cost like in the States, but I'll bet it would cut down on quite a few visits! Let's face it, after having a free medical system for so long, a pay-per-visit system might just be enough to make us think more carefully about our own health. Just a thought . . .

    • I like this idea! as long as it contains a caveat for low income earners. This would be an excellent way to get the baby boomer (i am one of them) bubble to help with their rising health care needs.
      My only concern would be, like an increase in taxes, the extra money would be placed in the hands of, to be dwindled away by, an already broken sytem desperately in need of a shake up.

      • It costs money to run a user-fee system. Somebody has to collect, someone has to make the rules about who gets exempted, and somebody has to enter the data. The sickest are usually the poorest, so right off the top your majority of multiple visit users won't be paying, anyway.

    • A reasonable idea, however it would require an electronic health records system that we just don't have right now. Not only that the provincial systems would need to talk to each other, to avoid people on provincial borders just driving an extra 10 minutes (e.g. National Capital Region).

    • Some countries are already doing what Linda suggests. However, they have exempted the poor and those with chronic illnesses from paying. What they found is that rich people will pay the money no matter what so if your hypochondriacs have money, they will pay and still clog up the system. Again, the will tell you to read the article in the British Medical Journal 2010-341, about user fees and whether they make the system more efficient.

  33. Oh please. That's like saying that Ethiopians have more food than they need; whether people can afford it is the issue.

  34. Don't disagree with your first line, not at all.

    But I remain confident that if a number of different options – options which are unlikely to be mutually exclusive – are presented and fully explained (ie explained with a frank assessment of the benefits and drawbacks of those options, saving the hyperbole for some other issue) Canadians will be willing to implement changes that will truly enhance our current system.

    Telling Canadians that their health care system is the worst and that only this or that solution can save it and so on will only serve to further delay necessary changes.

  35. Excellent and honest article based on fact and not ideology.

    Canadians need to understand not only health care realities but economic realities and they are very closely linked. One affects the other.

    Politicians are short term planners because of election cycles but health care requires at least a decade to implement significant change-that means we need to deal with 2020 NOW.

    Unfortunately, members of the public who feel they are getting reasonably good care now have a hard time fathoming the extent of the very serious difficulties ahead.

    More articles like this are needed to give Canadians a wake up call and responsible and less self-serving leadership is needed to make difficult decisions.

  36. I don't think you read the whole thing, why don't you click on pages 2, 3, and 4 and then make a new comment.

    It's all very fair and objective. The main points I got from it were:

    1) We're spending lots of money for poor results.
    2) We can save a lot (and cut ER wait times) by treating people elsewhere, like at their family doctor, or in a seniors home.
    3) Small user fees can also save us money on unnecessary visits.
    4) Having a mix of public and private options (like the leading countries in all these reports do) would also make our public system more efficient and competitive.

  37. They didn't say that at all. But if that's what it takes to get us from second last, up to the top, then maybe we should have a second system. Because right now we're ALL in the slow and overcrowded line, and it has no competition and no reason to improve.

  38. I sat overnight a couple of times with my Mom before she died. When I arrived with her (and trust me you don't go to sit overnight in Emerg when you have to be at work the next day unless someone is very sick), there was only 1 or 2 people ahead of us. The nurses ignored everyone and after a while of course, the room filled up and they started to turn ambulances away. No one at all was looked after.

    I thought the first time that perhaps there was a shortage of doctors until the 2nd night when a local pediatrician came into emergency complaining of chest pains. Amazingly missing doctors and beds materialized. 3 doctors arrived in Emerg quick as a flash and Dr G was whisked off to a bed. They even got his wife a coffee. I had to sit and hold the garbage under my 80 yr old, cancer-stricken Mom's chin as she vomited while nurses ignored her. Turns out on that visit that she had suffered a heart attack but sat for 10 hours in agony.

    Someone should be paying "covert" visits to these ERs to check if they are really as over capacity as they claim. Maybe the problem at some hospitals (not all) is bad supervision, procedures and attitudes.

    • I guarantee you the hospital is full. The reason the guy with the chest pain got in is because he was having a heart attack, which is deadly. It has nothing to do with the fact that he was a physician. Had your mom presented with the classic symptom of chest pain, she would have been whisked into a bed and treated for her heart attack.

  39. That's a very slippery slope. Perhaps that bacon you ate caused your stomach cancer. What about that red food dye you consumed as a youngster in your licorice? Should you pay for the ensuing cancer if they can trace that as a possible source? Who pays for the asthma resulting from the Ohio Valley smog we suffer from in Southern Ontario?

    • Not to mention that if you know smoking will kill you, why would fear of financial ruin make you any more likely to quit?

    • The slippery slope argument is always one for doing nothing by taking outlandish examples. Removing all personal responsibility from the equation is NOT the answer. It is easy enough to stay within reasonable parameters and make a big impact on the over all health care bill. For example, a GP can document that a patient's obesity is impacting his health (blood sugars and lipids moving into the danger zone) and that he's been told the treatment is self-managed weight loss by eating fewer calories and increasing his activity level (there's really no more to it than that). He can be aided by the new preventive health clinics with education and monitoring of weight loss by non-doctors. If the patient chooses not to comply, he's diverted to a private clinic where he pays up front for his medical care (or a government funded clinic for the indigent). In other words, if he shirks his responsibilities, the free ride is over one way or another. All those spouting about Tommy Douglas should know that he never envisaged a system that would encourage sloth, unhealthy habits and shirking of all personal responsibility.

      • I am with you in that. As an incentive why not give tax credits to those who are healthy? Just like ICBC for car insurance in British columbia, you get extra deduction if you have no accident for a certain number of years. They even give you one accident pass(no increase on your premiums) if you happen to have no accident for a long time. And ICBC happens to be a very profitable public institution in BC.

  40. After the system collapses in thirty years due to the locusts on a feeding binge (obese baby boomers entering old age) people may decide to stay as healthy as possible on their own. Herbal remedies, naturopathic, chiropractic, and other ways of healing (spiritual as well as innovative) might offer better solutions. And $ bonuses for being healthy and NOT going to the Doctor over every little thing as well as encouraged fitness would reduce the strain on the system. Could be good when what we have now self implodes.

    • Are these the same baby boomers who helped build this country, who grew our manufacturing capacity to create middle class jobs and incomes which raised our living standards astronomically, who invented the Internet, who fought for public education and universal health care and yes, who fought for social programs to make us a more egalitarian society with better health outcomes, as all egalitarian societies demonstrate, and whose openness to new ideas paved the way for alternative health care ideas such as the ones you are espousing , and who no doubt, produced you? . Just asking?

  41. Oh, and by the way, if those binge feeding, locust, baby boomers actually did produce you, it's unfortunate that they didn't binge feed on you at birth. sorry, this is why I cannot blog – idiocy drives me to distraction.

    • Thanks for the intelligent response. One of the few on this blog!

  42. "Do you have a reference" -You people are always so skeptical. The British Medical Journal – 2010 – 341 (found it on google). "Do user fees make the medical system more efficient". In Germany, they charged people for their first visit to the family doctor each quarter but had to stop. It doesn't work – people put off going to the doctor until they are so sick they end up in the hospital…hence no money saved. The article explained that most of these European countries are introducing user fees as a way to make people choice more cost efficient medical alternatives – family doctor v. ER. If you go to the family doc you pay nothing – if you show up at the emergency with a non-emergency, you pay a user fee.

  43. My 20 yr old son David died Sept 3rd in my wife and my arms in hospital. Canada's stem cell registry didnt have a blood type match for him. Testing now is so simple too – a cue tip type swab in your mouth enables a person to get their blood type into the registry, plus if a match, a straight forward blood procedure is used to save the patient's life. When our health care care system determines a way to save a life how do we not implement effectively so we actually save many lives. I understand the Canadian Blood Services (ex Red Cross Canada) is strapped for cash and focused to get enough blood from us to send to our hospitals each day, but they have to educate us about the new advances in stem cell testing and surgery procedures so we can all decide if wish to get tested. I saw 4 people die in the 3 month period this summer when my son was in the McMaster University Hospital. Our federal govt has recently told me they have allocated resources to give the provinces, hospitals and CBS (great news..) Please see Facebook "SavingDavidSmyth" if you wish to learn more. from a father, Mike Smyth

  44. The system is easy to fix… just spend a few millions on PR and convince people again that the system is the best in the universe. Could do some sponsored studies as well.

  45. I am not sure where the perception comes from that Canada has the best health care system. I am also not sure how all these rankings and comparisons were generated in the first place and which sort of data was used. I am 100% sure that the comment …' but patients in the Netherlands and Germany have quick access to specialty services and face little out-of-pocket costs,” the report notes '' is complete nonsense. I am German and have lived there for 40 years and my ( 2 adults and 1 child ) MONTHLY health care bill for my private family plan was 1,400 C$ with an Exchange Rate of 1.35 to 1 Euro. My government plan would have been app. 1,000 C$ / month. Did we have quick access to specialty services ? Yes we did. Did we have a family doctor that would see us before we needed to see a specialist ? Yes we did. Did we have to pay an arm and a leg for it ? Well, you tell me and by the way, the average yearly increase for my private plan was 4% – you do the math of how much the MONTHLY bill is for a retired couple in 25 years ! I think the discussion needs to be more along the lines of , what kind of health care system do we want in Canada, how much do we want to pay for it and most importantly, how much energy and money do we put into sickness prevention ?

    • In Germany, you were paying 1400$C a month for basic health care insurance? If you did not pay that you would have not been insured?

      • The 1400 we paid was a family insurance as mentioned ( 2 adults and 1 child ). As Leo mentioned above comparable to the 121 / month in BC right now. I could have had a government plan , but as mentioned that would have also been app. 1000 $. Without paying the 1400 , I would not have been insured ! Germany has a 2 Tier system of Government and various private Insurers. One can only go into private plan above a certain income. The private plan starts out cheaper as a single , young person, but when one gets older and in my case with family it is higher than the basic government, see above. The private includes such things as 80% dental, eye care with new prescription glasses every 3 years , 2 bedroom guarantee in a hospital and guarantee to see the headhoncho specialist in a hospital and not the student that just finished. Even with the amounts above , the first 500 Euro of expenses i had to cover myself. Only above that , everything was covered. The system is completely different and in my opinion not comparable to the canadian system. Trust me, if every candian , on average would pay 400 a month , most of the issues raised in the article would be adressed. It is with everything else in life , you get what you pay for ! Ever since I came to Canada I have actually been amazed at how good the system works or is , considering how little people really pay. I have read through some of the comments and some are truly tragic, but mistakes happen everywhere, even in countries where healthcare is very expensive.

  46. Nice to hear from the "troops". We need people like you on the panels of these townhall discussions. I remember having to pay $10 at emergency in the late '70's. The last time I went, (phoned first to see if they felt it necessary) the person in front of me had a cold sore!!!

  47. I was injured in a car accident before the Canadian medical system was created. I did not receive any kind of medical treatment at the time and grew up with related, chronic health problems. I am also old enough to recall when health care systems in Ontario and BC provided excellent care to my family.

    Just a few decades ago, we all had access to a doctor, we could wait a few short minutes for Emergency treatment, not so many errors occurred, a specialist wait might be 6 weeks (instead of the current 17 months in BC). I am speaking about the days before AIDS and other infectious diseases were identified, so stresses on the medical system were different. Also different then was the fact that the federal government in Ottawa took much more responsibility for ensuring quality health care was available for all Canadians in all provinces, while they restrained private health care profit seekers. Historically, it was the federal government role to equalize medical care in all provinces and protect us from the profit-generating groups.

    We now live with a business model of federal regional fracturing, transferring responsibility to provinces by arguing over, and sending, transfer payment cheques and nothing else. Perhaps the lesson is that the current evolved medical model does not work.

    Elected federal and provincial representatives need to work together again to fix our national medical system. Individual provinces can be expected to waste limited resources duplicating efforts (especially costly trial-and-error mistakes). Much more is to be gained by working together (which is what I thought Confederation was about). If we are to preserve our precious medical system, the feds must return to assuming a greater and more responsible organizational role. Just sending cheques for transfer payments is not enough anymore…

  48. In both Canada and the United States, roughly 15 per cent of the population has no access to primary care physicians. In the US, because these people have no medical insurance. In Canada, because these people might as well not have medical insurance. That means that emergency rooms bear the brunt when people need treatment that normally could be provided by family doctors. The obvious solution is more doctors. It also goes without saying that we need more hospitals and emergency rooms. Canada could alleviate the problem by making it easier for immigrants to practise medicine rather than drive cabs in Toronto and Vancouver. The situtation is further aggravated in Quebec by the fact that French-speaking immigrants are given preference over English-speaking immigrants when the need for primary care physicians is more acute there than it is in the rest of Canada. However, any solution will be a long time in coming. Expect the problem to get worse before it gets better.

  49. If people thought of the potential consequences of their actions, our jails and prisons would be empty, and there would be no drug addicts or smokers. However, people don't think of the consequences. Most cigarette smokers start their habits when they are young and presume themselves to be immortal. The same goes for drug addicts. And if you ever take a tour of the federal penatentiary in Kingston, Ontario, for example, you will scarcely find a genius among the prison population, let alone someone capable of foreseeing the consequences of his actions.

    • For some reason people are listening with regard to skin cancer…they are putting sun screen on – especially in places like Australia. If we could only figure out why that message is successful and roll into other healthy behaviors….

      • Mentioning about sun screen, I developed severe acne by using one. It took me years to find out that it was what's causing it. It was only when I ran out accidentally of sunscreen that my acne stopped. I wonder what is the long term side effects of sun screen. Has somebody ever made a long term study on sun screen's side effects? Is there any safe alternative to sunscreen other than not going out?

  50. You majored in rocket science, didya allnerd?

  51. The Fraser Institute is shilling for the health industry.Keep that in mind when you read anything from them.

  52. I'm Canadian and I recently moved to Germany. I got a family doctor without even trying. I called her office and she saw me the next day, just to meet me! And she asked me if I had any concerns. I told her about my concerns, although they didn't seem to be very threatening. She then said to me: ok. We might as well check everything that we can: within two weeks, I had an appointment with an ENT, an orthodepist, a gynecologist and a cardiologist – all within 2 weeks!! This is unimaginable in Canada!! And there's no separate trip to the lab for bloodwork. The doctors do it all in their offices!
    Makes me think twice about moving back to the Great White North!!

    • Marie Andree
      And yet a few comments up the thread there is a discussion about the cost in Germany which seems very high!

  53. Thanks for sharing your experience. You are right that many people think the system is fine because they received decent care. The system is not fine.

  54. Health Care becomes Canada's religion. Are we becoming universal health care extremists that tinkering of it, results in outcries as vocal as blasphemy is to Islam?

  55. Why not charge user fees for unemergency visit to ER, enough to discourage those with ordinary colds and simple cuts to instead visit their GPs? Are our GP's here in Canada trained to stich cuts and treat open wounds without referring patients to hospital care? And as for GP visits, why not make first numbers of visit absolutely free. After exhausting certain yearly number of visits , user fees has to be applied to discourage abuse of the system unless one has terminal illness or recurring serious problems. And why do Doctors' offices have no simple testing equipments handy in their clinics? Running around (referral back and forth) for simple tests seem unnecessarily inefficient and expensive?

    • To repeat what has already been pointed out, user fees have been implemented in a number of countries and it does not save money!

      • They actually did not give it time to work. The application in the past is more on red tape than abuse deterrence. It was not properly organized and applied.

  56. Bull. The engineers and scientists have deep specific knowlege of one area, but no ability to see the bigger picture.
    But they're they're too dumb to even realize what it is they don't know.

  57. Canada is different from the other OECD countries in at least 2 pertinent ways on bringing in a parallel private system.

    1) a small population spread across a large geographic area – profit-driven, private operators would never locate in the remote areas because it would not pay them to do so. The number of medical practitioners being the same (and already stretched), those remote areas would almost certainly be even more under-served than they are now.

    2) proximity to the US with its massive insurance, pharma and private medical industries ready to 'Walmart' the existing public system.

    We need to recognize the unique and innate difficulties in serving the greatest number of Canadian citizens with regard to health care and develop made-in-Canada solutions to those difficulties.

    • 1) Having a banned parallel health care system also prevents remote communities from setting up their own health care initiatives (such as co-operative medical care) that they fund themselves. Make no mistake, it would be nice to put your resources into medical care where the government can't or won't, even in remote areas.

      2) As long as the public health care remains in place, I don't really see a problem with people choosing to use the private health care system if they cannot or will not wait for the public system to solve all their problems. Nor do I see a particular problem with people mixing private and public care. All that banning public and private care side by side does is screw over the middle class.

  58. Amen!!!!!

  59. The line, "The evidence of a looming crisis comes not from comparing Canadian to American health care—a unique and expensive beast—but by taking a world view" summarizes the Canadian problem so succinctly. And not just in health care but everything. Canadians have a near fanatical obsession with what the US is doing and in comparing ourselves to them, usually in a sad self-depricating way. The way many public Canadians regularly say "Toronto, Canada" and "Miami, Florida" rather than "Toronto, Ontario" and Miami, USA" is a quick illustration of our embarrassingly skewed identity. Macleans is as guilty as anyone – needlessly tying in the States on the majority of articles. The US is big but they are only one country. Let's pay far less attention to them and far more to other countries as we fabricate our perception of the world and how it works. Let's watch more Canadian movies and ignore more from the States. Let's not look for anyone's approval. Let's fix our own problems without the slightest interest of whether anyone outside is watching or noticing.

  60. So it`s ILLEGAL in Canada if it`s my body and my RIGHT, to go buy insurance and seek immediate medical care at a private hospital ? I go to JAIL !?

    THAT is a direct violation of numerous statutes of the Canadian Charter of Rights.

    A previous case in Quebec true freedom was successfully litigated by a patient and his doctor that individuals do have a RIGHT to care for their own bodies and seek timely care. As the majority stated in the case, "Access to a waiting list is not access to health care…" (Chaoulli V. Quebec )

    Canada`s draconian DeathCare monopoly is illegal, it`s obvious, and only a strident ideologue on the Supreme Court bench could argue otherwise

    • Sounds like you need mental healh treatment – is there an insurance company providing that?

  61. That sounds like a pretty serious hierarchy. I'd hate to be the guy showing up to fix your plumbing.

  62. Anyone feel offended by our dental? Or am I rubbing an elephant in the room?

  63. Canada's Health system is based on a half-truth. It is publically funded with MOST all services provided by private enterprises.

    It is not a true public system. This creates a problem, for the profit incentive is on volume, not quality care, not prevention, not good health; in fact there is a reverse relationship.

    There is also no outside objective quality control mechanism, and the pharmaceuticals have taken total control of the educational system, promoting 'their brand' of health care.

    There is more….look up half-truths on wikipeida….truths can lie when they are part of the truth.

  64. Problem is half-truths.

    Our so called public system is merely publicly funded, most services provided by private enterprises. THIS IS IMPORTANT.

    More problems, more billing, more delays, more billings….etc.etc.etc.

    We do not have a core public system.

  65. there is no system it was tommy douglas utopia with user fees by social party tommy who copied englands system it was perverted and on the road to bankrupt us all in canada from the liberal twisted freebie beginning in saskachewan windsor and son in law sutherland double 90's recession martin montreal quebec idea…
    u get what u legislate a dino 1960 system…no innovation illegal ontario p.e.t. scan ontario…

  66. I am Canadian and have been living in Germany for the past 4 years. I think the health care system here works better than in Canada, despite costing less per person than in Canada. It is a mix of public and private, with everyone required to have insurance. There is a 10 euro user fee whenever you go to see a doctor (except for pediatric cases), acting as a small disincentive to visit for non threatening injuries.
    People only go to an expensive ER for serious acute cases. Otherwise they go to their family doctor/specialist. How is this possible? Over the evening and weekends, family physicians and pediatricians for each region to rotate to 'on call'. Patients can either call for a phone consult, or if the doctor deems the situation serious, they come into the office, or less frequently, are directed to the ER. Wait times to see a specialist are typically 2-3 weeks, never longer. For getting an MRI, the same day or within the week. Drugs are heavily subsidized. An example- a years worth of birth control pill costs about 20 euros, in comparison to nearly $200 in Canada. Basic dental treatment is also covered as part of the standard health plan.
    There are many more doctors here than in Canada, something like double the number Canada has per 1000 people. Important to note about doctors: medical school/university is essentially free (entrance directly out of high school), meaning students graduate debt-free (vs. $150,000+ in Canada)… And the doctors here earn substantially less than those in Canada.

    People in Canada need to wake up to the fact that allowing private health care does not mean the beginning of the end for public health care system. It introduces competition leading to better outcomes and more innovative treatment systems. I think people would be hard pressed to argue that Germany's system (shorter wait times, faster treatment, better outcomes) is less equitable because it is a mix of private and public than Canada's fully 'public' system (long wait times and worse outcomes).

    • An important caveat to remember.. Germany doesn't have a college of physicians artificially restricting the number of people who can become doctors.

      This is the brick wall which health care debates in Canada need to acknowledge before we can get any further. Until that system is dismantled, we will have limited pool of doctors. Opening up the private option will simply pull more of that pool out of the public system.

  67. I believe that an effective way to start fixing our health care system would be to start opening community health care centres across this country. If you google " Association of Ontario Health Care Centres" you will see what I mean.

    I have been fortunate to be referred to the Port Hope Health Care Centre and have been very pleasantly surprised by the excellent care that my family has received there in the past year.

  68. His acts made us worried about health care in the country. It`s a pity we could only see this this <a rel="follow" href="http://www.unimedia.md ">now .

  69. Who cares about health care? You are going to die anyway.

  70. Well certainly if the American health care system is so great then there should be large numbers of Canadians taking advantage, that is the bottom line.Truth is it is not,not just a few hundred but hundreds of thousands and there is not on a monthly basis. Truth is we cannot afford the monthly insurance fee or the deductibles for health care. However any Canadian who can afford american medical service is free to do so it is not illegal to do so. The system works for the middle class and the poor not for the rich, That is what is happening, now a more efficient service is needed, to cut costs and overexpenditures due to care that may not actually be needed.Also pay structure for staff to keep them in Canada would be of great benefit, in this situation you cannot afford to be cheap.

  71. A friend who is a wonderful public health nurse to schools has quite because she is so tired of the bureacrats telling her how to do her job and not asking for her opinion on how to do the job well. There is only one boss – the government so she does even have a choice about where she works. In the private world you can chose to work for an Apple or a Microsoft.
    Also, we have not even looked at what one public health care sector is doing to the business side of health care. You have one buyer and Health Ontario has set up Buy Ontario. This program only buys from large suppliers so as to save money purchasing. So GM and 2 other US firms provide all the supplies and shut out Canadian companies. One of the health care companies who won the exporters award and told me that was because they had to find buyers or go bust. So now they supply US and South American hospitals.
    GE has set up a sales office in Canada but there are no manufacturing facilities, no jobs developing new products, no intellectual property development. Our Venture Capitalist market has gone too. These are big issues.

  72. The healthcare system in Canada is dependent on prioritizing the severity of illness of the person. And probably the age of the person. 90 year old Grandma who had a heart attack might not be seen before the younger person who arrived from a car accident. It's a matter of prioritizing in Canada.

    Also recently, my 82 year old mother who had a severe heart condition had heart surgery within a week, in Montreal, of all places.
    So don't say the system is broken because it is not.

  73. Thank God-so refreshing to read a thoughtful post.

  74. Canada health system ranks 30th in the world (no its not the best system, France and Italy ranks in the top two).

    Why…one simple reason, the payment system rewards repeat visits, penalizes quality, efficient treatments, and cures.

    Doctors services are priceless, but by paying per visit, you promote volume of visits. (simple systemic flaw) that creates an inverse relationship between your doctors income and your health; not a good thing.

    Look to Italy, pay my doctors an annual fee per patient, so we reward good health.

    Caesar J. B. Squitti
    H. B. Commerece: LU

  75. The Diseae Conspiracy.

    There is an author of a book, of that name, who suggests that our publically funded, for profit system has created a system that seeks not to find cures, but to create disease boxes; foundations to promote 'research' and avoid simple cures.

    I have to agree.

    Some 20 years ago I did some research on probably causes of several symptoms and came across "Lymes' Disease'.

    I checked with the local health department and found to my amazement that NOT ONE CASE OF LYMES DISEASE WAS FOUND IN THUNDER BAY. Odd ?

    Lymes disease is carried by dear ticks, and across the border, in Minnesota, there was alot of cases.

    Could it be that 'the deer' did not have passports and were not able to cross into Canada and transfer the disease ?

    Again paying doctors a fee per visit, does not encourage finding the cause of many diseases, nor a simple cure.

    (PS my cousin in Rome, has found a connection between metals/fat cells and the ability of 'these compounds' to cross the blood/brain barrier. Please note there is not standard for aluminum in drinking water and SOME water treatment system use flaked aluminum to filter the water resulting in a high level of aluminum in drinking water)

    Parkinsons ? Drug cocktails often create symptoms that resemble Parkinsons: any connection ?

    Mental diseases? Many bacterial, viral infections can cause these symptoms, why is not the general public aware of these simple 'organic causes' Sure would remove the stigma of mentall illness; since it is caused by infections or over the counter drugs; ie PPA.

  76. Come to New West. If you hit a busy night you can get treated as you sip a double-double in the Tim Hortons attached to the hospital that got used as extra space.

  77. As a Canadian living in the US, I can say I’d rather have the healthcare that was even dead last than having to pay and pay and pay and pay and pay and.. be denied healthcare like I have been in the US (and that’s even with private insurance through my company). I miss Canadian health care and so wish I could still get it here.

    Sigh.

    I need to convince my wife that we should move to BC. :P

  78.  As a victim of a cover up that happen in  Nova Scotia hospitals I would  beg to differ with any recommendations given by Dr.John Ross..
    The quality of care here in the ER’s is very poor.
    Don’t get Meningitis because they are too clueless to know what the standard of care,test or treatment is.After a spinal tap the mental illness diagnosis can be quickly put in place to hide incompetent care and you can find yourself being put in a psychiatric hospital..Even though you are medically ill not mentally ill..Doctors can be brought over to treat you medically in a psych hospital and all will be willing to go along with this fraud..Damage is easy to conceal..They just stop you from getting the necessary tests.Then they get away with it.
    This is what goes really goes on here in NS…

  79. Canadian Health System is worst thing ever!!!

  80. Some times I want to shake the human race. Our treatment of seriously mentally ill citizens shows little knowledge of the need for timely and appropriate treatment they need.

    Long waits are unendurable for them when they are in crisis and they reach such an apex of terror that causes them to rush to hospitals for relief.

    Even if admitted they are too soon released, usually with no planning for their discharges.

    I agree that other serious chronic illnesses usually are appropriately cared for when finally they are hospitalized, but experiences shows us that seriously mentally ill people receive short shrift, and early discharges in a health system that doesn’t even recognize that schizophrenia, manic depression and related psychoses are chronic biological diseases of the brain, and deserve the same medical services as other severe illnesses.    

  81. The greatest threat to health-care is the policies of the NDP.   They have in the past thwarted innovation.   They are hard-wired to a socialist model, where all must suffer equally and all must get the same poor standard.   They ensure that private enterprise efficiencies and accountability is kept out of the mix.   The health-care unions ensure they control many local elections.   The bottom line is that the NDP is a menace.   The phrase about, ‘lets have an adult conversation about Medicare’, arises from the NDP disease of how they have poisoned the debate, and how they hold Canada back.

  82. But we’re aware that our system has issues and that other countries are delivering better healthcare than we are. And “One study ranked Canada dead last in timeliness and quality care”. Really?
    oh…..

    http://youtu.be/zXKV78VERio

  83. Please do not compare Canada healthcare to that of US. That’s comparing apple to banana. Please look at other countries (or does Canada’s world consists of only US?) which has similar healthcare like Canada’s and look at me, into my eyes, tell me how does Canada have a “good” healthcare system when OECD ranked Canada 30th? There are 29 countries perform way better than Canada. It’s not because Canada’s healthcare is great, but US sucks. If one day US is to disappear from this world, I believe some will stop self-deception.

  84. Aside from the many casualties in our health care system, the fact that five million Canadians don’t have a family physician is quite alarming and certainly needs to be addressed. I read an interesting article recently; “Canadians live longer and spend more on health care, but are we healthier?” http://www.caahealth.ca/caa/whats-new/whats_new.jsp?lang=E that addresses how life expectancy has increased but also discusses how disturbing lifestyle trends and an increase in chronic diseases are more prevalent.

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