Canadian health care survives Danny Williams’ surgery

Premier’s cross-border heart operation says nothing about the Canadian system

by John Geddes

[UPDATED BELOW WITH SURGEONS' COMMENTS]

I haven’t heard anybody say that Danny Williams shouldn’t have been allowed to travel to the U.S. for heart surgery. As the Newfoundland premier has declared in interviews published yesterday and today, it’s his heart, his health.

But accepting the personal nature of the choice hardly ends the conversation. Williams’ decision to check into Mount Sinai Medical Center in Miami to be operated on by a veteran surgeon has been seized upon by critics of public health insurance as proof of the Canadian system’s inherent weakness.

Since I support the single-payer model, I admit I was worried about how details of Williams’ condition and treatment, when he finally talked about them, might reflect on Canadian cardiac care. If it turned out he had needed some esoteric procedure not available in Canada, I figured the critics would have a field day.

But the reality appears to be the opposite of what I feared. Williams needed an operation on his mitral valve. His office admits the procedure was, in fact, available in Canada. It’s more than that, though: Canadian cardiac surgeons happen to be renowned for their expertise in valve repair.

It was two Canadian physicians who wrote the how-to paper on valve surgery published only late last year in the New England Journal of Medicine. There are famous surgeons like Toronto’s Dr. Tirone David, who’s been called a “virtuoso” valve man. Minimally invasive procedures, the style of surgery Williams chose, are offered in Canada in places like the University of Ottawa Heart Institute.

None of this is to suggest that Williams might not have had good reason to go to Miami. He might have heard impressive things about the surgeon who worked on him there. He might have preferred to be close to his Florida condo for recuperation. He might have liked the sound of the amenities and privacy offered by a pricey U.S. hospital.

But those sorts of factors don’t tell us anything about the capacity of the Canadian health care system to provide high-quality care. I’ve heard no credible claim that Williams would have faced a long wait, if any wait at all, for surgery in Canada. And now we know that his category of heart problem, far from being one Canadian surgeons can’t handle, is one of their fortes.

I’m reminded of another politician’s medical history and how it briefly made news decades ago.

When Paul Tsongas, the former Massachusetts senator, was running for president in 1992, he lashed out at the Canadian health model. Tsongas had suffered from lymphoma, and he said, rather dramatically, that the bone marrow transplant that saved his life was an example of how the American system spurred innovation that would never happen under creativity-stifling Canadian-style health care.

It was a gripping personalized take on the issue. The only problem was that the key research breakthroughs that led to bone marrow transplants were made in Toronto, and Canadians, at the time Tsongas was speaking, were receiving the procedure more often than Americans.

Case studies that initially cloud the broader issues can ultimately be quite illuminating.

UPDATES:

Getting into the details of why Danny Williams made the choice to go to Miami is delicate. Health is a personal matter, and anyway, the real issues here are about policy, not the particulars.

Still, Williams told Canadian Press that doctors in Canada suggested conventional surgery, while his U.S. surgeon did the operation through a incision under his arm that didn’t require opening up the bones in his chest.

This might create the impression that minimally invasive surgery wasn’t offered in Canada because of some limitation in the techniques available here. I put the question to the University of Ottawa Heart Institute. Quite properly, the institute stresses that its doctors can’t comment on Williams’ case.

But Dr. Thierry Mesana, chief of the institute’s cardiac surgery division, and a leading international authority on mitral valves, responded by email on the general question of how minimally invasive surgery is viewed by the experts.

“Minimally invasive mitral valve repair consists of doing an MV repair surgically through a 5 cm small side chest incision instead of a 10 cm incision in the middle of the chest. A recent survey published at the Society of Thoracic Surgeons meeting (Jan 2010) expressed some word of caution and showed it is not recommended for complex mitral valve repair and also that the rate of complication (strokes in particular) is higher.

“There are a few advantages in terms of length of hospital stay or transfusion or post-operative arrythmias. The only real benefit is cosmetic. Many world renowned experts do not advocate it, in fact. It is done in Canada, but again, with caution. I propose it only for cosmetic reasons in a young woman who dislikes the idea of having a scar visible in summer. This procedure is well publicized in the U.S. in some centres.”

ANOTHER UPATE:

I mention above the well-known Toronto heart surgeon Dr. Tirone David. From India, where David is teaching just now, he responded by email to questions I asked through his office. Here’s what he said:

“I don’t know the reasons Mr. Williams opted to have his operation in Florida. It is certainly not because minimally invasive mitral valve repair is not available in Canada. Canadian heart surgeons routinely do minimally invasive mitral valve repair including techniques involvng endoscopic and robotic approaches.

“There is absolutely no evidence that robotic mitral valve repair is superior to other minimally invasive approaches, such as a limited sternotomy or lateral thoracomy, with or without the aid of endoscopes. Moreover, when it comes to heart valve surgery, there are very few places in the world that can match the outomes we have provided at Toronto General Hospital.

“Having said all that, Mr. Williams certainly had the right to go anywhere he wanted for surgery.”





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Canadian health care survives Danny Williams’ surgery

  1. You can't use one example to indict entire system, I agree with that. But neither should you use one or two examples and claim they support your preference for single payer. So, while it is nice we have world class heart surgeons or discovered important breakthrough in bone marrow transplants, what about all the people who don't have suffer from those problems and have more mundane health issues that aren't being promptly solved because of health care rationing.

    What bothered me about Williams' case is that we have system that rich opt out of and get completely different care. I might be able to pay for personal health care if I didn't also have to own a Florida condo. The elites opt out of our system while forcing the rest of us into shoddy system they don't use themselves.

    • Similarly, you can't use one example of a wealthy individual for one procedure opting out to claim all do or that what is here is a "shoddy system" or that even Williams doesn't use our system for everything else. Evidence suggest just the opposite in fact.

      • "When King Hussein of Jordan died and leaders around the world flew to Amman to pay their respects, then Canadian Prime Minister Jean Chrétien was one of the few not to attend. Chrétien was “skiing in British Columbia” and just had no way to get to Jordan. The region where the former PM was “skiing” was close to where the upcoming Winter Olympics are being held. But the Prime Minister of Canada, with his staff and private jets just couldn't figure out how to get out of B.C. and go over to Jordan. Later on it was revealed that Chrétien hadn't been skiing at all; he had been at the Mayo Clinic in Rochester, Minnesota." Canada Free Press, Feb 4 2010.

        Here's another example for you.

        Yes, Williams is a real man of the people. He might use our system for annual check up or somesuch but when he faces serious situation off he goes to Florida. I would like options just like a small minority have but I am not rich enough to give 50% of my income to government, purchase Florida condo and pay for my own health care.

        And I don't know what you are claiming the evidence suggests.

        • What kind of elites are you talking about then? The wealthy or the political. I had assumed wealth is what you were referring to.

          I can tell you that the heart specialists in Canada, as well as the cancer specialists and pretty much every field, are busy serving elites and common folk every day. They are providing leading edge care, nothing shoddy about it. Canadian doctors are consulted on the most difficult cases and providing leading edge research and technology development. Patients from all over the world come here for treatment, just like Danny went to see those particular doctors at that particular clinic in Miami.

          If you want to go on some class rage, by all means, be my guest. But you haven't provided a single shred of evidence to sustain your indictment that we have a shoddy health care system. In fact, the evidence – Geddes example being one – is that we provide good or, according to internation reviews/ratings/statistics, better care than in the US. To me the problem is that the US should be one of the last places we compare ourselves to and we set too low a bar in doing so.

          • Quality of care is the only thing that should matter when it comes to health care. WHO studies that show Canada has better health care system are nonsense on stilts because they liberal ideology to base their decisions on.

            From Wiki:

            "In 2006, per-capita spending for health care in Canada was US$3,678; in the U.S., US$6,714."

            Do you agree with the more money the better or do you think spending less equals more?

            "One commonly-cited comparison, the 2000 World Health Organization's ratings of "overall health service performance", which used a "composite measure of achievement in the level of health, the distribution of health, the level of responsiveness and fairness of financial contribution", ranked Canada 30th and the U.S. 37th among 191 member nations. This study rated the US "responsiveness", or quality of service for individuals receiving treatment, as 1st, compared with 7th for Canada."

            What's more important when it comes to health care: "quality of service for individuals receiving treatment" where America is Number One or being 30th in "composite measure of achievement in the level of health, the distribution of health, the level of responsiveness and fairness of financial contribution"?

            What low bar has America set for the rest of us, exactly? Being number one in "quality of service for individuals receiving treatment" seems pretty good to me.

          • Class, can anyone help out jolyon here?

          • Spending: The per capita spending in the US is higher you tout as a good thing? In France it is even lower than Canada. That is government spending on health care. How much health care are US residents receiving from the government? Medicare, medicaid and, for the general population, that is pretty much it. The high cost of the overly bureaucratic American "system" is the worst story about the US healthcare "system". They waste soooo much money on bureaucracy with competing insurance companies and government plans and patchwork emergency coverage, etc. Spending by government on healthcare does in no way show whether the system is better or worse.

          • I only used American system because you claim they set low bar while they come number one in "quality of service"

            I am not advocating for American system so stop your scare mongering. It is my impression that countries which offer a mix of private and public health care, Canada and US are the two extremes while European countries, Singapore and couple of others mix public and private much more than we do in North America. That's what I would like – a much different mix of private and public than we use now.

          • Fine. But if you don't like hyperbole, don't throw it out there yourself.

            As for low bar, see my comment below about mortality rates, etc. That is what I am referring to.

            Canada is actually not the extreme. The old UK system is, where doctors became civil servants and it truly was socialized medicine with the government directly involved in patient care decisions. In Canada, we have single payer, socialized health insurance. Doctors are private practitioners. The differences speak for themselves in the results and no one I know who knows about the old UK system is advocating for that.

            The reason I keep coming back to France is for the hybrid system so we are probably not far off in mindset on this. When Canada is ranked 30 and the US ranked 37 (overall) or 7th and 1st (treatment), we are splitting hairs about who is better.

          • Ratings: Jolyon, do you think WHO ratings are bogus or not? You can't dismiss some and kist pick ones that you like. The comprehensive ranking is not just about "fairness" it is about many things including comprehensiveness and # of doctors and choice. France does well because it is a universal hybrid system, with about three times the number of doctors as the US and a quarter of the cost, covers more services, and much more sustainable because they finance it more like the CPP than just out of annual budgets.

            Let me ask you: if you've just been let go by your employer of 20 years, do you care if some rich guy can get top notch quality for service if you can't get any for you and your family? For some few people in the US, there is no question that the US will provide the best care. One of the greatest assets the US has is that there are so many extremely wealthy people there and there are so many Americans altogether providing a concentration of money and people that results in not one or a few great specialists but many. And if you are wealthy, you can travel anywhere to get the care you want.

          • But the WHO ratings are only one of the things people point to when they are critical of the US.

            If you look at mortality rates, especially infant and child mortality rates, days of work lost for health reasons, number of people without any coverage at all, bureaucratic nightmares and delays and costs and paperwork you couldn't imagine here in Canada, you begin to see the real problem in the US.

            Put another way, from observing the US healthcare "system" as I have for so long, their biggest problem is the same as their biggest problem in banking and many other areas. There is such a pull and push in American politics between no regulation at all and heavy government involvement, that you have a patchwork of regulations and solutions and laws and policies that create this Frankenstein's monster of a healthcare "system". There is no "system": there are a myriad of bandages here and there whenever a specific problem got too awful to ignore.

          • You are using France as example to prove Canada has a better health care system than US even though American finish first in quality of service. It is hard to know what you think of Canada's health care system, tedbetts.

            Do we think Canada should keep our health care system as is or are there better health care systems out there?

          • what's better, being able to provide level 1 care to a select few elits, or number 7 to everyone? The reason WHO does not go on one criterion alone is because it can not take into account average cases or overall circumstance. So you may have some of the best surgeries in the world, granted, but is it available to the general public?

          • Danny Williams traveled to Florida for his operation because it was not available in Newfoundland. That's your example of shoddy care. Mind you, as Premier, he's responsible for the situation in the first place.

            I agree that private people who can afford it, should be allowed to travel to wherever they want and pay for any procedure they want, without submitting the bill to our health system. Mr. Williams is not a private person, but a very public persona. If he doesn't like public scrutiny, he is invited to leave the limelight.

          • That argument doesn't work.

            If you were the governor of Alaska, is Alaska providing shoddy healthcare because their government goes to Miami? Alaska is a small state and likely doesn't have the population to develop leading edge clinics and doctors in every field.

            NL is no different. It is not the system. It is largely demographics and geography. You can't have a Mayo Clinic and top clinics in every field in every single province or state. In fact, that would be worse. The Mayo clinic is leading edge because they are able to concentrate expertise and research in a way that you could not if you had top notch cancer doctors spread evenly out across a whole region. Rule applies to Canada as well.

    • Uh. Did you read the OP? It in no way suggests our system is shoddy. That's purely your own opinion.

    • Did you read the article? It does not indicate that the Canadian system is shoddy. It says that Williams chose the minimally invasive procedure over the recommended procedure for his own reasons. It had nothing to do with availability, cost, quality. He chose a method that was riskier with higher potential for complications. How is that a condemnation of Canadian Health Care?

      As per most loudmouthed complainers of Canadian health care, have you experienced the health care systems from other countries. I have. I must agree that the care we received was excellent, compassionate, etc. But OMG the bureaucracy and paperwork and multiple bills that arrived was unbelievable. A cut over the eye requiring 5 stitches in Alaska resulted in bills from 5 different organizations under the same hospital roof totaling $2500 for about 1.5 hours of effort. Several of the organizations submitted multiple invoices and a debt collection agency because they couldn't get the Insurance number correct from the forms. 3 were fine, 2 were disasters.

      In Las Vegas I went to the local hospital for what ultimately turned out to be kidney stones and I was denied service because I would not let the administration keep my credit card. I told them the could take imprints, but they insisted that their policy was to demand and keep my credit card. I left and returned to Canada for service.

      In Los Angeles, my spouse fell and cracked her pelvis. Doctors and nurses were wonderful. Great service. Lousy administration. It took 9 months to resolve the billing issues.

      The Health Care system comprises more than just doctors and nurses. It includes the administration, ambulances, insurance, etc. The US system is awful, unless you pay cash, and then I am not so sure.

      • "Great service. Lousy administration."

        I would settle for that because we can't say that about Canada. We get mediocre service (30th best health care system according to WHO) and lousy admin.

        "British Columbia lacked a strategic plan as it embarked on a multimillion-dollar electronic health records project six years ago, says the province's auditor general." CP, Feb 18 2010

        "Health Canada handed out millions of dollars to a national eHealth agency without properly accounting for how the money was spent, says a new audit." CP, Feb 20 2010

        "Ontario Health Minister David Caplan has fired the head of the electronic health records agency eHealth Ontario amid a multimillion-dollar contracts scandal." CBC, June 2009

    • Your assessment is spot on. Insurance corporations, pharma conglomerates and the powerful are blocking the single payer system purely out of greed. These groups have only one agenda – amassing wealth and therefore, power, for themselves. They have disenfranchised the 'masses' and continue their rule with fear. Pretty much the same as it's been since cavemen walked the earth, other than the fact that so many 'modern' countries, our own being a noted exception, have evolved their societies for the benefit of the 'majority'. Can America lay just claim to 'enlightened world leadership' and act as it does towards its own? The rest of the World isn't buying it, nor should they.

  2. "virtuoso valve man"

    Danny Williams needed a sax player?

  3. In my personal experience, I know we have top notch leading edge medical care, medical technologies, doctors, medical equipment. The actual care provided – diagnosis, prognosis, treatment, follow-up – has never, I think, really been a problem across the country.

    It is stuff like wait times, the number of doctors or specialists in remote areas, that are problematic. We are a small population spread out over a vast country and the concentration of people and facilities is a challenge in any system.

    I personally think that the greatest barrier to any real reform of healthcare is (1) too much rhetoric of the "health card, not credit card" variety which stifles discussion and (2) too much comparison to the US "model" (which is the most costly, most inefficient, frankenstein's beast of a model you couldn't possible design).

    Far better alternatives for comparison are out there in countries that provide far better health care services. Why we aren't spending more time discussing what lessons the French or German systems can tell us, I just cannot understand.

    • canadian system of health care is far way ahead of the french own system, You have to experience it to know the true fact out there.the french waiting list is much longer than the canada.there is twice the resk for you to die in france waiting for treatment as to canada. please avoid comparing any of the europian socialistics system of health care to canada.

  4. I would imagine given his high public profile in Canada that we wasn't comfortable receiving the surgery and in-hospital recovery here. His personal health information would have been exposed to far too many people. I assume Newfoundland and Labrador's coverage of out of province non emergency procedures is simliar to Ontario and would have required prior approval. I can completely understand why he would have been uncomfortable with his application (which would include personal health information) making it's way through the bureaucracy he oversees.

    We can all whine and complain about how we don't have that luxury, but I'm sure if we had the money and the same public profile with risk of a PHI leak we would make the same decision.

    • If your theory were true, wouldn't lots of American political executives come to Canada for surgical care in order to safeguard their privacy?

      • Read this again and then explain to me why Mr. Cosh is writing a blog for MacLeans. Are you kidding me?

      • Dude, the free market means US health care providers are private businesses working to protect their patients interests, not statist commies using the apparatus of the state to gather information to use against the representatives of democracy so their bloated money-sucking bureaucracies can continue to suck freedom from the marrow of the bones of liberty.

        • The free market here means anyone with money can access the American system quickly, be they from Canada,, Qatar or New Jersey. Also, docs in canada are also private businesses. They just send their bill for service to one address, not 3000 of them.

          The facts here are these. Danny could have had this surgery in Canada. He went south, skipped the procedures the not-rich have to use to stay closer to home, and recovered at his condo. It could have been as simple as nicer weather for his recover. Nothing wrong with that…

          …but as the face of health care, the guy in charge of funneling the tax dollars in his province, he'd better be prepped to face criticism.

          • He had surgery in the South because the Canadian docs wanted to crack his sternum. Did no one read his explanation? I believe his getting care elsewhere does reflect on the Canadian system. BTW, 99% of all conservatives would confess that the US system has serious issues all of which are mostly created by Government by way of unintended consequences from abusive regulation.

        • No, free market means that us health care providers are free to offer health care services to anyone they deem fit and capable of compensating them. Patient interest is part of health care ethics and has nothing to do with free market. Think of physicians who take surveys and sell off non sensitive information to data-minign companies.

      • They do try, but most hospitals will not except out of country patients unless it's an emergency. In fact, I think Ontario had more health cards issued for a while then they had residences. Quebec also has a problematic history of people from other countries coming in and abusing their system. Practically bankrupted them. Something about Canadian malpractice insurance will not cover American lawsuties. You know, for a country with such good health care… why is it that the states has such high incidences of malpractice suits?

    • oh c'mon. now he's actually being noble!? He wanted to move up in line, he is a politician and couldn't do it in Canada without political cost so he went to US, not foreseeing the fallout. I grew up in a socialist country, and the politicians had access to foreign travel, special stores, different hospitals, etc while the working class were told we are all i this together. Same circus here, just differet clowns.

  5. Mike T, read Janice Kennedy's column disapproving of his decision in the Ottawa Citizen a couple of weeks ago. She wishes him a safe and quick recovery, after which he demands his resignation as Premier.

    • it seems that creatures from the imagination of conservatives could do even better. Why aren't they demanding that people who try to leave Canada for medical treatment in the states be rounded up and sent to re-education camps?

      Then the conservatives could knowingly shake their heads about how they knew that Jonah Goldberg was right all along.

  6. How Robert Mugabean… The ruler of his land goes elsewhere when he needs an essential service. I won’t judge him, but I think its a slap in the face to Canadian doctors.

  7. These "elites" can only be people who enjoying exorbitant amounts to be coddled during treatment which is usually only marginally superior, if that.

    A certain adage about a fool and his money comes to mind.

  8. It was probably cheaper all around for Mr. Williams to go to FL for his procedure than to have it completed in Canada. Just because a procedure is available in Canada does not mean you can get it. Cross provincial procedures are not as easy to come by as it may seem. Should he have had his procedure completed in ON, in theory, he would have had to have approval from the NF government to approve the funds for an out of province procedure. Of course, if he went this route, no doubt he would be accused of using his influence to have it approved, when perhaps others in the past have not been approved. In the end, we should thank him for saving his province what I am sure is over $100,000 in health care money that can be used on someone else that needs it and can't afford to go elsewhere.

    • Not as easy to come by? If you need it, you get it.
      http://www.health.gov.nl.ca/mcp/html/health.htm

      The procedure is the same in most provinces.The "government" would never see his application. His doc faxes it to the medical board, the med guys go "hey, yeah, dude needs this right now" and give the thumbs up, usually within a day or two. If there's a disagreement, there's a review panel. In the end, if the patient needs the surgery, and it can't be accessed where they are, the system works to bring them to it.

      As for costs of this type of surgery? Well, more likely in the range of 20,000, if you break down the surgeons billing codes and hospital stays.

      • Unless of course it was not that Urgent. In which case, if a more urgent case did come along, he'd be bumped. Then again, this brings us back the the queue thing.

    • Nonsense. It is quite routine, for example, for Newfoundlanders to be referred to Halifax for a variety of reasons – St-John's is simply too small of a centre to do everything. Similarly for Islanders and New Brunswickers. Plus, it's ridiculous to think that the actual cost of the procedure and hospital stay would be greater in Canada – that's the complete opposite of experience.

  9. He skipped the queue. No one is bothering to argue that.

    My father is still waiting for his 'routine' procedure… 10 days and counting. There he languishes in the hospital waiting… because if he is discharged, he goes onto a longer list. A list he can't afford to be on, because he'll wind up back in the hospital (or worse) for the waiting.

    But Mr. Williams has work to do and can't wait the eternity our lovely system would put him through… so, he simply skips the queue. Goes in, gets it done, and starts recovering.

    Williams is a hypocrite. But he comes from a long line of them in Government.

    • In college I worked at a hotel in Delaware (near Philadelphia) on the same street as a hospital. And I was amazed at Canadian's interest in our hotel. I typically would drive corporate guests to local businesses but I was always curious why the canadians and their families staying at our hotel needed a ride to the hospital instead of normal tourism. I knew nothing of politics & healthcare but I eventually learned of the need of canadians and "surgery tourism". where will canadians go when america's "expensive" system is abolished? if i were canadian i'd beg americans to keep the system as is.

    • You said it all…10 days and counting….If I were wealthy I'd go to the States too!

    • 10 days, less then two weeks.. If you're in any large center, then there must be more pressing matters that the O.R. time must be used for. If his situation digresses further, he will be bumped up, I'm not even worried about that. Yes, I would say the exact same thing to my father, if it where him in the hospital.

  10. I believe that the main driving force for going to Florida for this procedure was to have warm weather for the post recuperation walks.

    Obvioulsy it was more of a risk ( his operation took 3 times as long as scheduled) but perhaps he was also worried about the scar showing.

  11. He had surgery in the South because the Canadian docs wanted to crack his sternum. Did no one read his explanation? I believe his getting care elsewhere does reflect on the Canadian system. BTW, 99% of all conservatives would confess that the US system has serious issues which are mostly created by the US Government by way of unintended consequences from regulation. We need market reforms in the US not elitist's centralized command and control.

    • speaking of elitist centralized command and control how is iraq going ?

      • Pretty well, actually. Thanks for asking.

    • Did you not read the article? Cracking his sternum open was actually the safest way to do the procedure. What would happen if the poor man now died of a stroke? A possible complication of this less invasive approach?

  12. Opinion of Dr. Thierry Mesana is important, but not entirely persuasive. I'm sure if you posed the same question to the Florida doctor on the general question of how minimally invasive surgery is viewed by the experts,you might get a different opinion altogether. Second opinions are important in medicine — and they should be important in journalism and news reporting too.

  13. He is entirely within his rights to anywhere he pleases for medical care, regardless of options open to him in Nfld. or elsewhere in Canada. It's his sanctimonious defense of the Canada Health Act and his invoking of the Tommy & Shirley Douglas lowest common denominator model of health care, that I have a problem with. He's a hypocrite pure and simple.

  14. If "our US" health care system sucks so much, why are the hospitals in Buffalo, Niagara Falls and Detroit now accepting and advertising for you Canadians to come here. You can come over the boarder and get your CT scans, x-rays, MRI's etc done right away. Why do Canadians think that our system sucks. ANYBODY here that goes to a hospital must be taken care of weather they have insurance or not. If they dont have insurance guess what – we pay for them. We allready have government insurance, we dont need more!

    • At the risk of clouding this issue with facts, I will point out that most opponents of the American system decry the fact that it is not universal, while the Canadian single-payer model is.

      We all know that the care in the United States is excellent, but it is not cheap, and is only accesible to those who have expensive insurance or small private fortunes.

      Your statement that those without insurance are covered anyways is not entirely correct either. In the United States, those without insurance are cared for in emergencies and given a bill later. Once they have proven that they are in a sufficiently impoverished condition, Medicaid kicks in, but will not always cover anything.

      There are some exceptions like Masschusetts and Hawaii, but those states ironically follow a model that is closer to Canada.

    • Notably, the city of Detroit is bent on becoming the medical provider of choice for Canada as a cornerstone in their economic recovery plan. In an agreeement with the Ontario Ministry of Health and Long-Term Care, procedures performed on Canadians in the US are often covered by the Canadian government. Can there be a more vivid indictment of government healthcare? I guess only if you consider the number of US citizens who are buying drugs from Canada, subsidized by Canadian citizens.

      • You clearly don't understand how the Canadian system works – we have socialized insurance so, yes, if it is momentarily cheaper to send someone across the border, the provincial insurance authority will pay for it.

        • Notify us when the 'moment' has passed …

  15. There's a word for Danny Williams which might get my comment pulled. All I needed to learn about this guy, I did back in 2004 during the Canadian flag flap. More petulant than a Quebecois separatist. His beef is not that the procedure isn't available in Canada — it is. I believe his beef is that it isn't not available in Newfoundland. So instead of suffering the trek to Ottawa or Toronto, he went south, knowing that certain parts of the country would see that as a slap in the face.

  16. I agree wholeheartedly with Mr. Williams' decision to head Stateside to have surgery. He has earned his notable wealth and he should be able to avail of it.

    The first point, however, Mr. Geddes, is that Mr. Williams could only get timely, world-class, non-sternum-cracking treatment if he jumped the Canadian queue (which I am sure a man in his position could have forced) or got out of the Canadian queue altogether and into another. His decision is an implicit indictment of the state of rationed health care in Canada.

    The second point, Mr. Geddes, is that Mr. Williams appears the hypocrite for not subjecting himself to the "morally superior" Canadian queue, which he has publicly trumpeted. This demonstrates his endorsement of public health in Canada is empty and shallow, for when the rubber his the road he landed himself in Florida.

    Mr. Williams' choice is indeed his choice, but we, the Canadian sheeple, have every right to criticize it and its meaning.

    • Not so. A referral to another province is quite routine and does not amount to "jumping the queue". According to Williams, he had known about this problem for weeks – time was not a factor, except that he evidently failed to pursue alternatives to the initial suggestions of treatment. Consider that heart transplants are similarly not offered in NL… or in any of Saskatchewan, Manitoba, PEI, or NB. Patients are thus referred elsewhere.

  17. Hello all you sanctimonious people who think Mr. Williams is a hypocrite. How dare you decide on his Heart Health treatment. Canada is a free country. It is his business and his health alone. Our Canada health care system is one size fits all. Take it or leave it. If you don't like it go elsewhere and pay for it…

    • I'll leave it thank you. He is a hypocrite because he supports one system for the little people who die in que while he is entitled to skip the system that he imposes on the less fortunate. Unbelievable arrogance and narcissistic entitlement.

      Politicians must be held to the same system that they impose on the people. The same applies to obamacare where American politicians are afforded special treatment.

      This IS an indictment of public insurance and socialism.

      • Politicians must be held to the same system that they impose on the people. The same applies to obamacare where American politicians are afforded special treatment.

        "Obamacare" as you call it would have little effect on American politicians at the federal level. Members of Congress already have an EXCELLENT health plan, paid for by the government. No elected official is pushing "socialized medicine" because they want it for themselves… they already have it.

        • Exactly. It would degrade American medical care, as per Canadian medical care, from which the Canadian politicians flee.. When obamacare kicks in where will the Canadian politicians go?

          American politicians refuse to submit to the same inferior medical plan that they foist upon the people.

          Appparently "socialized medicine" is a two tier system, one tier for the elites, and one tier (aka death panel) for the people.

          The solution is to:

          - Stop the massive outsourcing of jobs and manufacturing overseas. This way people will be able to purchase medical care or get it through work.

          - Stop special interest groups and unions from destroying the workplace so that employers would rather outsource than hire locally because of excessive litigation and expense.

          - Deport illegal immigrants who use bankrupt hospitals and cause insurance rates to skyrocket because they over-use emergency services for free.

          - Make changes in the private insurance industry business to cut out the corruption and make insurance more available and affordable.

          Socialism sucks.

          • no, corperatisme sucks. It's the American way of blending profits and health care the lead to incidences like Vioxx and the patenting of isomer medications then claiming it's a newer, better version for increased profits. The reason Canadian may wait is because we try to maximize our resources to keep costs and taxes affordable for all. What happens when your health insurance contract is up and no insurer wants to touch you because of your new medical conditions? Loose your job, lose your coverage? Get a job, get stifled with a health care bill so large you can't pay it off? How does that work towards promoting good work ethics. In Canada, you get hurt, you get treated based on the seriousness and severity of your injury or illness. Money should NOT be a factor in health care. EVER. Otherwise, conspiracy theorist will have true reasons to fear the idea that a treatment will always take priority over a cure. More money to be made you see….

    • How dare you sanctimonious socialist Canadians go south for health care. Go elsewhere…and stay out…

    • No one is deciding for him and he can do as he damn well pleases but what you fail to note is that he is a hypocrite precisely because he supports a canadian system that forbids its citizens from availing themselves of private insurance. Something that might assist them in better quicker health outcomes even though they are not in the same income bracket as Danny boy. Get it? He says one thing, but acts differently – hypocrisy.

  18. It was fortunate that the citizen's were paying him enough money to afford this private health "choice". Viva Canada!

    • Craig – You must not know that Danny Williams does not take any pay for his position as premier. You really should check your facts before writing your opinions…

  19. You forget he is a representative of the people of Canada (albeight he represents a specific part) but nonetheless, if our system was not good enough for him and many others who have money then yes it shows that the minions can have this type of care while the wealthy go to where they think the good care is.. This really shows what kind of system we DONT have!! Its about time someone came up through the ranks and really made a difference in Canada. Our system is seriously flawed. There are many instances in which our tax money is given to friends and family of people who hold high places and they get away with it..Even when caught nothing happens..

  20. The issue isn't how good our heart surgeons are compared to those in the US.

    The issue is whether Canadians should be allowed to pay extra for premium care in Canada – i.e., a two-tier system – rather than going to the US for it.

    • Exactly. What a silly straw man Geddes has constructed.

  21. It all depends, it is FINE if his medical bills were paid by himself and not from the government's account which is the citizens' money; secondly if the rich can get help overseas or across the boarder and the ones that are on fixed budget can't then why do we have medical insurance for the country yet some just have to suffer lost of health or even life?

  22. I am glad the surgery is available in both countries if needed. That's the bottom line really.

  23. Williams should be stay in Fl. The nerve, to go back to Nfld and expect respect. Selfish, selfish, person. Another Joey Smallwood in the flesh.

  24. The medical service in this province (Ontario) sucks.
    If you are abused by a physician don't you dare complaint…you'll pay in many other ways, like denial of needed medical service.

  25. Health care in America is better. Regardless of insurance coverage Americans are treated and we don't have to wait in pain for months to have procedures done.

    Don't believe the hype Canada feeds you trying to make you happy with a mediocre health care system,

    • You're basing your opinion on what you heard Rush Limbaugh said I bet. I've lived in both nations and can tell you you are wrong.

    • Another clueless american running his pie hole. There's a shock

      • Hey idiot, the closest thing to your nose is your upper lip. Canada?…………………..if we wanted it, we'd have it.

        Did you get by the Germans tonight?

    • That's why americans die by the thousands each year and your life span is less than canadians eh?

  26. I'm an American by birth, Canadian by choice. I've lived with both systems and can say with no doubt that the 18,000 Americans who die every year from lack of health care would probably choose the Canadian style health care if they weren't dead. The US system is superior to Canada's ONLY if you ask the millionaires like Danny boy. For the rest of us – the reality is Canada got it right yet again.

    • I've never seen a death certificate with the cause of death "lack of Health Care" listed. If only millionaires get health care in America, then that's news to me. Besides, you seem to take the simplistic approach that the choice is either one system or the other. It's not. There must be good things about the U.S. or why did Mr. Williams just come here? They had to send my father-in-law by ambulance five hours from PEI to get a heart test — that's one way. President Obama has specifically said he doesn't want the Canadian model, but wants to reform the US system. So, it's a false choice — and if you think there aren't thousands who die of lack of health care or from poor health care in Canada, well, I can just make up a figure for that, too, Joe.

      To imply everyone gets the best care possible in Canada and nobody dies is simply a falsehood. We know from the survival rates of various diseases such as breast and colon cancer. For example, Mr. Williams was told to come back in six months. Had he been in the U.S., he'd have been brought back sooner perhaps — and you'd complain about the evil profit motive. Mr. Williams also "said he spoke with and provided his medical information to a leading cardiac surgeon in New Jersey who is also from Newfoundland and Labrador." (CP)

      If the Canadian system were better for doctors, there wouldn't be a brain drain driving them to the States — then everyone could have top-notch heart procedures, and not only the "millionaires" like premiers who can afford it.

      Is there no place to believe that and want the best for everyone in Canada?

    • Joe how many of the 18,000 did you know? I am no millionaire, but pay $530 a month for my family of five. My health care insurance hasnt gone up or done more than $100 per month in 15 years. Yes, I have to shop it, but it is worth it. Unlike my Canadian friends, I can "fire" my health insurance company next month and get another. You cannot fire the govt.

    • How is this an example of "Canada got it right again?" This guy had a choice and he ran to the US as fast as he could get here. Funny how he chose our "grossly inefficient" and "frankenstein-like" medical establishment over his own country's medical system, yet Joe thinks Canada got it right. If Canada was so great, he would have stayed where he was and got treated by the great Canadian healthcare system. I don't know what "lack of healthcare" as a cause of death means – was that on the death certificate?

    • There are no 18000 annual deaths from lack of health care.

  27. Joe, you are delusional if you think Americans don't wait in pain waiting to get something done. Millions of Americans go without care because they CAN'T AFFORD it. Guess how long their wait times are?? FOREVER!! Although are system is not perfect, and still needs improvement, the fact is over 90% would NEVER give it up for the U.S. style of healthcare. You are drinking the far right wing, Rush Limbaugh, American Kool-Aide. Careful you don't choke on it.

    • 50 million Americans have ZERO health care b/c their government has failed them. Show me a Canadian who thinks they would be better off in the USA and I'll show you a rich person or an idiot.

      • And you show me where it's 50% and also where it says in the Constitution that the U.S. government is responsible for providing health care. They're not. Do you take any responsibility for your wants and needs, or do you expect your neighbors to pay for everything. Oh, that's right. I'm asking socialists who've gladly let America pay for their defense for the last 100 years.

        Also, Kool-Aid doesn't have an E. Talk about an idiot.

        And as for the 90%, funny your premier just left the Canadian system for the U.S., isn't it?

        Again, relatives in Canada. I've seen it. You hear about these big cases and you hear people who may not have health care, but you never do hear about the Canadian horror stories — and if you dare mention examples, somehow you listen to the most-popular radio talk show in the history of the world.

        Wow, what a dig!

  28. This just shows the just nature of the Canadian system. If the Americans had such things as ques for health care the rich would jump to the front every time. I'm glad Danny could not push his way to the front of the line in Canada.

    • Well, I'm glad we don't have queues. You think queues are an example of a "just" system? It sounds like a symptom of an overextended system on the brink of collapse. Canada can only have socialized medicine because the US doesn't and is here to pick up the slack. You're welcome!

      • Should that ever change and we can't go to the US for medical, we'll just have to go to Cuba.

        Our queues are full of people in discomfort that isn't going to kill them…knee surgeries have a long wait list, critical, life-saving surgeries do not. Doctors keep patients stable with medication. Diagnostic testing machines seem to be concentrated in areas with a large population, so for the people who are scattered across the country living in remote areas, it's not just a long trip but a long wait to get an appointment. My tiny community did fundraising for a year and bought our 20+ bed hospital a CAT scanner. Now we don't have to fly so many people out of here on the provincial tab, just to investigate symptoms urgently that can be treated locally. There are many different contributing factors to the diagnostic queues.

  29. It is a gross misrepresentation to claim that the Canadian system is working. The Williams case is one of hundreds of thousands of examples of very serious cracks in the foundation. People wait for a year to get operated on, . . . for ONE. Lack of facilities across the country, . . . for TWO.

    AND it's getting worse, . . . http://pacificgatepost.com/2008/05/canadas-breaki

    It's a simple matter of enough money, taxes, feeding the system, and millions who pay nothing are depending on the system, . . . even when they don't live in Canada.

  30. Where Mr Williams decides to have surgery is his own business, and does not reflect one way or another on the Canadian public health care system. He is free to choose, and should be encouraged by the Canadian public to go wherever he wants. The USA has a vastly larger health care industry, with many options for the consumer, both public and private. Canada does not offer private care options, and it would be difficult for Mr Williams to access the public system in a timely fashion without being accused of "skipping the line". Public hospitals on both sides of the border are excellent; however there is no fair comparison for private hospitals offering heart surgery, because Canada doesn't have any.

  31. I don't understand the comments about a waiting list for routine surgery. In the costly, inept, frankenstien model in the US, there is a wating list for some transplants due to the lack of suitable donors. But why a waiting list for the routine. Once my mom had to wait for 4 hours to have heart surgery, but that was because the rooms were already occupied by other surgery patients. Once they cleard through, in went mom. The hospital staff was very apologetic, explaining that it was an unusually busy day. We could have transfered to a hospital in a nearby state without the approval of the governor.

  32. "I've heard no credible claim that Williams would have faced a long wait, if any wait at all, for surgery in Canada."

    Really? Is Mr. Williams himself credible enough? He said, quote: "I would've been criticized if I had stayed in Canada and had been perceived as jumping a line or a wait list." So if he'd stayed in Canada, he would have been said to cut the line. That means there's a line, doesn't it? Why else would he supposedly fear this unfair (in his mind) criticism?

    Obviously he should have shown how great the Canadian system is by staying home. If this was the reverse situation, you'd be hearing all about how U.S. health care sucks and Canada is great. In fact, Canada has the same system the Americans have: Those who can pay for it, get the care they want. Those who don't, get to wait in line and use publicly provided options.

    I know that you're not open minded enough to objectively look at it, but, that's clearly the case. Everyone wants the best care they can get, but all a socialized single-payer (is that some dude chained to a chair and you use his credit card?) can do is give everyone universally mediocre care.

    He claims, further, the procedure was NOT available in Canada. CP: "His doctors in Canada presented him with two options – a full or partial sternotomy, both of which would've required breaking bones, he said."

    • What publicly provided options are these in the US?

      Williams is lying when he claims that the procedure is not available in Canada. It's false and directly contradicted by the surgeons quoted in the article. Williams' failure to seek a second opinion within the country was his choice alone. The wait for this kind of surgery might be on the order of 2-3 weeks, at the most and least urgent. Williams evidently had time to spend several weeks hemming and hawing to consider his "options".

      And as a point of information, it is not possible to perform any kind of heart surgery (short of angioplasty) without "breaking bones", except that in the case of a sternotomy, this involves cutting slowly through the bone with a cautery device. As near I can tell, Williams' reason for opting for something else had more to do with vanity than the effectiveness of the procedure.

      • Of course you can get to the heart without breaking bones! It's right in the article — "minimally invasive" means they performed the procedure with a scope, possibly robotically. Also, you don't cut through the sternum with a cautery device, but with a sternal saw. Welcome to the 21st century!

  33. Congratulations Canada- your wealthy elites can get the best healthcare-too bad you cannot. What is pathetic is that he did not even trust the private clinics that service elite clients in his country. Where does he go??? To the screwwed up US

  34. The comment about the great outcomes Canada has in MV surgery had me thinking. If we eliminate all those who might have bad outcomes by making them wait a month or two so the risky ones drop out of the queue (by dying of course) we could very reasonably boast of a very good outcome. Why don't we do that for all procedures? Wait, we do! Those in the USA who want next day or next hour surgery are all those not willing to queue up and see if they can get surgery rather than drop out and save the tax payer all that money. Selfish people who could just die quietly and save their neighbors all that money… Goes back to the concept of the "rights of Man" (meaning the rights of the State) verses the "rights of men: (meaning the rights of the individual).

    • The term rights of man come from the French Revolution where they killed all who opposed the revolution and it's leaders. The rights of men comes from the American Revolution, where those that disagreed strongly enough resettled in Canada, but were not guillotined. The Canadian scheme is the average for everyone. If you want the best of care in the USA, you had better start by studying in school, get a real job, work hard, and then, and only then can you enjoy the best of life. Socialized societies put a real crimp on motivation.

  35. SOme of you people are either dense, or you don't read articles properly or fully.
    The procedure Williams had IS OFFERED in Canada. According to cardiology experts across the country, there are virtually no wait times for heart surgeries as well. Therefore, no que jumping. Williams could have gone to Ottawa, Toronto or London, just in the province of Ontario. There are other centres in Canada that provide this more non-invasive procedure. The lone surgeon he saw offered him the more evasive surgery. He could have done to ANY other centre in the country, if not available in his province. He claims in his interview that the non-invasive procedure was not available, which we now know NOT to be true. This tells me he didn't even check to see where else he could have gone in Canada, and simply opted to open is HUGE wallet and have it done in Florida where he owns a condo. Let's see, recover in Ontario in the middle of winter, or Florida. Hmmmmmm By the way, they told him in December he needed immediate surgery, yet still waited nearly 2 months to have it done privately.
    Some of you people are cherry picking this story and painting with an extremely broad brush.

  36. There seem to be differing opinions on the experience in the Canadian vs. US health system by those claiming to have experienced both.

    For the record, I've lived for years at a time in both countries…and there is a lot to be said for both systems. On balance, my experience was better within the US system.

    Clearly my experience isn't representative of everyone – but just as clearly, those saying Canada's is superior for all but "millionaires" (I'm not even a thousandaire) are making pretty wild generalizations.

  37. You canadians are nuts — there's more MRI machines in NYC then there is in all of Canada – and to actually try to argue that minimally invasive heart surgery is somehow more dangerous then breaking the sternum " the old fashioned way" is similarly ludicrous.

    Live in denial all you want, but the bottom line is that nobody who can afford not to is going to canada for healthcare.

    • You do realize that the state of New York alone has the equivilant of Canada's population right? So that's not exactly surprising. …

  38. A stable patient went for a cardiac angiogram and the results of the test were so severe it caused the doctors to issue a "do not dicharge" order. The stable patient remained under observation for 6 days in hospital until a surgery slot opened. He was given 3 cancelled surgery dates because there were other more critical patients who weren't stable who were given this patient's dates. That's the kind of line-jumping we have in Canada, based on actual, not perceived need. The patient, who was ripe for complications, has completely recovered and now lives with a clean, normal sized heart with a normal heartbeat and a hugely extended life expectancy.____Awww, Danny didn't want a small scar on a cracked sternum? It's less painful than if you accidentally broke an arm and the scar is hardly noticeable less that 6 months later. I don't want to see Danny Williams without a shirt on, so his secret would be safe! ____A word of caution – when you shop and pay for surgery, you usually get what you ask for, even it's not always in your best interest.

    Mr. Williams has no credible opinion on the subject of healthcare and should keep his private life at home where it belongs.

  39. I'll believe the guy with the heard problem getting on the jet plane, not the Maclean's writer commenting from his armchair.

    Geddes skirts all the controversial issues to write a puff piece that satisfied his ideological blinders. Here, instead of investigating and reporting the news, we have a writer trying to deny the news, and ignoring all the real questions people want answers to.

    Like, for instance,
    -why does he continue to insist the premier of a Canadian province is a complete idiot? The premier already claimed there were medical reasons for the decision
    -why are only those with fortunes like Williams allowed to make these decisions? If we had private care in Canada then the rest of us would have the same choices as Williams.
    -why do politicians routinely praise the Canadian system and routinely choose to avoid it?
    -why does Geddes rely on anecdotes from true believers in socialized medicine? Does he have the guts to talk to someone with an opposing position? Obviously not.

    What a puff piece.

    • No choice? Are you not paying attention? This exact (endoscopic) procedure is available in multiple centres in Canada, with minimally invasive surgeries involving partial sternotomies available most everywhere. Williams chose to go to Florida so he could hang out at his Sarasota condo. He also didn't seem to like the option originally offered by his own doctors, so he called up an acquaintance in the US to refer him somewhere south of the border.

      FYI: foreign surgeons can't just fly into another country and take up a hospital's OR time. Which "true believers" are you talking about anyhow? The cardiac surgeons quoted? I suppose you know more about heart surgery options than them?

    • Routinely avoid it? When was the last time you heard of another high profiled politician leaving Canada for medical care?

      • Off the top of my head: Chretien. Stronach.

  40. From the Globe & Mail: "The impression Mr. Williams left, that the technique he sought in Miami is not available in Canada, is reinforced by his statement that he will consider applying for reimbursement for his medical costs in Florida."

    The hypocritical Mr Millions is considering stiffing the Canadian taxpayer with the bill for this. Typical trough feeder for you — I guess that's how you get to be a millionaire: make other people pay your way.

  41. The Canada-USA immigration rate is twenty nine times higher than the USA-Canada immigration rate, with only 8,000 Americans coming to Canada every year, 7,999 of whom apparently consisting of poor bastards who met some Canadian chick online. Almost nobody from America moves to Canada, which negate's our friend Joe's narrative thoroughly.

    • Exactly the problem. Those greedy people seeking bigger fortunes will go where the money flows. For the rest of us, we're nice and comfortable living here and accepting to help anyone who would like it.

      As a leader, you have a choice. If you don't like it, then you can either fix it, or run away to somewhere else. What do you choose?

  42. Now it turns out that the procedure Danny Williams had is chosen most often for cosmetic reasons. It only leaves a small scar under the armpit instead of a large chest scar. The drawback is a significantly greater risk of stroke.

    I'm not surprised Mr Williams would choose vanity over health.

  43. We spend 5 months a year in PEI and the remainder in the USA. We see both health care systems up close and personal and, as a result, feel qualified to judge both systems.

    In PEI, far too many people do not and can not get a family doctor. I required an ultrasound this past summer which the doctor deemed "urgent" and an "emergency". I was then scheduled for one in two months!!

    There is a hospital in the local town as well as a clinic with 8 doctors. NEITHER the hospital nor clinic has an ultrasound machine!

    There are 3 ultrasound machines in this same town…………… all 3 at the veterinary clinics. Something is very wrong with this picture.

    Please, call your American friends and tell it like it is.

    Have them tell Obama to keep his hands off our world class health care system!

    • Where do you live in the States??? Is it the least populated State in the union?? Cripe, I know more people then what live in that province. Why not compare where you live to say Halifax, Ottawa, Calgary, Kingston, etc.

      I had a swollen spleen, went to the hospital, had an ultrasound right away. And that was in a small town in Ontario with population of 12,000. You can't paint a picture of entire nation based on your experience in little P.E.I.

      You do realize that more Americans don't have a family doctor then Canadians right???

  44. My dog currently receives far better medical care than I do.
    Because we can pay for it.
    I wish we had a dual system, we'd pay.

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