The health debate beyond the Danny Williams story -

The health debate beyond the Danny Williams story

Why Canada should be looking for ways to adapt, not revolutionize, health care


The story of Newfoundland Premier Danny Williams’ trip to Florida for heart surgery hasn’t exactly elevated the argument about health care. To try to shift to a more useful debate, I suppose it would seem even-handed of me to insert here a diplomatic comment about how both advocates and opponents of universal insurance went overboard. But I think the mistakes mostly came from the right, in the form of hasty claims that Williams’ decision somehow proved the Canadian system is fatally flawed.

As more facts emerged, that gleeful assertion just didn’t hold up. All evidence suggests that excellent heart surgery of  exactly the sort Williams needed was readily available in Canada. The other factors that might have legitimately influenced his choice—the amenities of a U.S. hospital where the rich can pay out-of-pocket, the skills of a particular surgeon recommended to Williams by his own doctor, the proximity of a Miami hospital to the premier’s Florida condo—don’t matter much.

Still, even though I was relieved to see that this entertaining case didn’t serve as a vivid lesson about some failing of a Canadian model that I broadly support, I’m left uneasy about how the argument has gone.  Rather than forcing us really examine the Canada-U.S. contrast, the Williams story has been a grand diversion. At first, it put wind in the sails of conservative opponents of public care; in the end, it buoyed up liberal supporters of universal insurance like me.

There’s much more to be learned by making international comparisons. A good staring point, I think, is the research conducted by the Commonwealth Fund, a private U.S. foundation that backs study into health issues. Broadening beyond the stark Canada-U.S. contrast to include other countries is a good idea. But since the Danny Williams story highlighted only the North American fault line, let’s start with a few points on the two-country comparison.

The Canadian system’s clearest advantage, not surprisingly,  is that it doesn’t leave anybody without insurance. That’s reflected in how often Americans don’t seek care because they’re worried about cost. Here’s a Commonwealth Fund stat that jumps out: in a 2005 survey, 34 per cent of “sicker” American adults reported instances when they had a medical problem but did not visit a doctor, compared to only 7 per cent of Canadians.

On the other hand, our Canadian insistence on equal access has led to sluggishness. A 2009 survey by the fund found that 47 per cent of Canadian primary care physicians reported their patients having difficulty getting specialized diagnostic tests, compared to just 24 per cent in the U.S. In that 2005 study, 36 per cent of sicker adults in Canada reported having to wait six days or longer for a necessary medical appointment, compared to just 23 per cent of Americans. Worse, 57 per cent of Canadians who needed to see a specialist had to wait more than four weeks, compared to 23 per cent of Americans.

(It’s worth noting, though, that these waits were reported before progress on shrinking Canadian waits began in earnest, following the 2004 deal that saw Ottawa inject $5.5 billion over ten years into shortening queues.)

The numbers often back up some of what we might assume about the differences between public and private systems: more fairness in the public, faster service in the private. Widen your view to take in other countries with mostly public systems, however, and that neat picture becomes more complex.

For instance, only 37 per cent of Canada’s primary care physicians use electronic patient records, compared with 46 per cent of U.S. doctors. That U.S. edge must reflect business-style thinking among U.S. docs, right?  Maybe not: in European countries with mainly public systems, the rate of electronic patient record-keeping is far higher still—72 per cent in Germany and 96 per cent in Britain.

Other Commonwealth Fund stats challenge assumptions, widely held even in Canada, about the advantages of free-market motivations in the U.S. system. Consider this: just 30 per cent of U.S. primary care doctors report that’s there’s any financial incentive in their practice for improving the quality of care to their patients; in Canada, it’s 41 per cent.

No statistic taken alone is definitive. But together they point us in the direction of nuance. Canada should be looking for ways to adapt, not revolutionize, health care. If the path from primary physician to specialist is shorter in the U.S., learn from that. If, as I’ve been told recently by Canadian doctors, Britain has done better at cutting wait times within a public system, learn from that. If Europe is broadly better at computerized records, there’s our classroom.

None of these potential lessons, I’m afraid, has zing to match of the saga of a millionaire politician jetting south for surgery. Personal stories are fun to tell. Policy requires charts and graphs.


The health debate beyond the Danny Williams story

  1. I think you are missing the point here: as premier Williams has consistently stood behind the Canadian healthcare system as it CURRENTLY exists. This is the system where no introspection, no criticism, and no PRIVATE competetive system are allowed Furthermore, as Premier he has also led the fight against the two-tiered system he just used. What a joke, now left wingers are coming to his defence and he is probably privately laughing with his new heart valve in place….Too bad you can't get the same level of service…ha ha.

  2. Boring!!!!

    So, if I'm reading you correctly, your point is that Canada should work harder at making slow, incremental improvements by learning how other health care systems do things.

    Christ. I almost fell asleep writing that. What is this: a graduate seminar? Who has time for incremental change anymore?

    You want Canadians to learn? Never!! Learning didn't get us this far and it sure as hell won't get us to where we are going.

    How about instead we just go communist!! Communist Russia had great health care. So let's copy them and ship everyone to a gulag.

    What about Pearl Harbour?

  3. A good start to getting the best of both the private and public systems would be for Canada to permit those who wish to buy additional insurance to access private services, to do so. One benefit would be to release resources to the public system and if I wish to to buy better health rather than a new car, why should the government have any say in the matter.

    • If we're only putting out so many Drs. per year, how are we going to supply Drs. to the public sector? Won't this create less Drs. in the public sector and, therefore, create greater wait times in the public sector? I grew up prior to universal health care. It was a bitch. Only the wealthy and those who had insurance could really afford health care. I recall a lot of Drs. had a hard time getting paid by their patients. If those persons who go into Medicine and want to go into private practive then their tuition fees, etc. should not be 'subsidized' by the govt. They should bare the total real costs of their training.

  4. Thank you very much for this John. I sincerely hope you keep at this and it becomes a full-fledged article in the magazine.

    As I noted in the comments here just yesterday, debate about our healthcare system is shackled by mindless discussion-closing rhetoric like "health card not a credit card" and of course "no two tier healthcare".

    Well, the fact of the matter that we've never had single-tier healthcare and we've done OK. If you define single tier as providing universal coverage for essential medical service, then we are leaving medically necessary pharmaceuticals, eye glasses, prosthetics, etc. completely in the private system.

    But anytime someone points that out or suggests some an alternative, the stock slogans come out and you are accused of wanting a private US-style system. What we really need is a much better understanding of what is going on in Europe where there is no debate about tiers: there is universal coverage and their is private coverage, side by side.

    • Well said.

      No debate is allowed and many of us get branded.

    • Half the countries in the EU are broke or almost broke. What do you think caused that? How about overspending? How about living beyond the means of the taxpayer?

      You socialists are all alike. Feed on the teat of the taxpayer and pontificate about how WE should spend our money. Realistically, it is theft.

      • Who are you arguing with, King? Obviously not reading what you are criticizing.

        "It is theft". That moronic line of thinking means every single dollar of tax is theft. If that is your argument, you can have it.

        And by the way, the US had a much larger debt ratio than countries like Germany even before the recession because of its war debt and military spending. Does that make Bush a socialist? Feeding on the teat of the taxpayer to wage his wars? Realistically, it is theft.

    • Not only Europe. I saw many things in the Japanese health care system that can and should be applied in Canada. Too many people in Canada don't want to open their eyes to improvements because they are so afraid that Canada might adopt the worst elements of the US system. I've never met anybody – right or left – that wants Canada to adopt the worst of the US.

  5. I like more than 20% of Canadians do not have a family doctor. After getting a cold that developed into pneumonia, I spent 10 days quite unsucessfully trying to see a doctor to get antibiotics. I finally paid $175 to see a doctor at one of these new private clinics which was the most pleasant health care experience I've ever had in my life.

    Our public health system is probably great if you can access it.

    • It helps if you get a family doctor before you suddenly need it.

      It is tough for newcomers in anyplace to find a family doctor when they move and don't know anyone. This is a matter of doctor shortage though. In France, for example, I think they have 5 times the number of doctors as in the US.

      Our doctor shortage results from a myriad of factors, including a short-sighted decision in Ontario (and other places) to save money by restricting the number of new doctors graduating when we came out of the last recession. It does not, however, result from a brain drain to the US as some like to claim. And there are a ton of competent doctors around who were trained, licensed and practiced for many years abroad but face too difficult burdens to getting licensed here.

      • What a laugh. Do the math. The shortage is so severe it is literally impossible to get one in most places. You can't split doctors in half or clone them. You're boilerplate humdrum is wrong.

        • So funny to be accused of "boilerplate" by someone who types in "it is literally impossible to get one in most places".

          If you aren't interested in having a discussion, scf, why bother with the empty simplistic and usually incorrect talking points?

    • Not sure where you live but first off I have a family doctor (one of my own choosing) so this would not have been a problem for me. On the other hand there are at least a half dozen hospitals where I live and I could go to the emergency department and be taken care of. Also, again where I live there are about a dozen Medicentres where you can walk in and see a doctor. Perhaps you need to understand what services are available to you before forking out another 175.

      • Have you ever waited in an emergency room? The average wait is 8 hours, and it's worse after hours, and it's worse for non-emergencies. Everybody know they are trying to get non-emergency cases out of ER to get the ERs unclogged. If any of us actually earn more than $20 per hour, it's cheaper to pay the 175 than to spend all day in the emergency room.

        • Where on earth do you get this stuff?

          The average wait is 8 hours?

          With kids, I'm into the emergency room often. I've never waited more than 2 hours and I've never been moved ahead in line just because I'm there with a kid.

          • My wife had a brain tumour and was told by her down doctor to go to the Emergency Room as he could access a bed for surgery. We then waited 12 hours before being admitted. Any other times I've been to the Emergency Room I've waited no less than 6 hours. And this is in Ottawa.

          • Please don't mistake me for thinking that there are no problems. I've said wait times are a problem. I would also not deny the personal experiences of any individual.

            SCF however makes a specific assertion that the average wait time in ER is 8 hours. It bears no resemblance whatsoever to my own experience or what I have read on this issue. I suspect she just made it up entirely which is not terribly surprising. But I will wait, without holding my breath, for her to provide some evidence or source for that, other than the Journal of Liberals = Bad, Conservatives = Good.

          • It is. The fact that the average wait time is 8 hours was published in the press a little while ago.

            This is a well known fact, you should read the news more often. Here, this took me a few seconds:


            As of January 2009, the provincial
            average is 14.6 hours for
            complex conditions and 4.8 hours
            for minor ones



            In Toronto, emergency room waits for minor conditions range from five to six hours and for serious conditions from 11 to 22 hours>/i>


            Outaouais region Quebec:

            If you visit an emergency room in western Quebec's Outaouais region, prepare to wait an average of 20 hours and 42 minutes before being discharged or admitted to another ward in the hospital


            In fact, almost half of all patients (48 per cent) reported their length of stay exceeded 12 hours


          • It is. The fact that the average wait time is 8 hours was published in the press a little while ago.

            This is a well known fact, you should read the news more often. Here, this took me a few seconds:


            As of January 2009, the provincial
            average is 14.6 hours for
            complex conditions and 4.8 hours
            for minor ones



            In Toronto, emergency room waits for minor conditions range from five to six hours and for serious conditions from 11 to 22 hours>/i>


            Outaouais region Quebec:

            If you visit an emergency room in western Quebec's Outaouais region, prepare to wait an average of 20 hours and 42 minutes before being discharged or admitted to another ward in the hospital


            In fact, almost half of all patients (48 per cent) reported their length of stay exceeded 12 hours


          • But I will wait, without holding my breath, for her to provide some evidence or source for that, other than the Journal of Liberals = Bad, Conservatives = Good

            Go take a long walk off a short pier, toad.

          • Since you value personal anecdotes so much, I'll give you mine.

            I have never in my life waited only two hours in an emergency room. I've been to the ER a total of maybe 4 or 5 times in Ontario and Quebec (appendicitis, broken arm, deep cut, etc), and those waits ranged from 5 hours to 12 hours. I have received the average experience.

        • "and it's worse for non-emergencies"

          Let me get this straight: non-emergencies are treated more slowly than emergencies in our emergency rooms in this country, and that disappoints you?

          • Of course it does, ,the guy thinks that everyone can easily earn a wage of 20$ or more… because you know, minimum wage isn't half that amount.

            Yim, I'm sorry to hear about the long wait, but since the tumor did not pose an immediate danger, the people who did need that immediate care thanks you for your patience.

          • I'm not saying it's better or worse. Why are you insinuating I said something that I did not say at all.

            I am saying that to get any care at all, whether serious or not serious, no matter what the situation, you have to wait a ridiculous amount of time, the only exception being fatally dangerous emergencies, and even then there have been cases of people waiting with heart attacks and other fatally dangerous conditions.

    • william g dont know where you live but here in toronto we have plenty maybe to many

      • You're wrong. There is shortage in most regions of Toronto. It took me a couple of years to find one in the Annex in the 90s and none of the doctors my friends had were accepting patients any more.

        • My experience has been the exact opposite.

        • Oh, god. You live in my neighbourhood?

          Don't know how you were going about getting a family doctor, but it took me all of, oh, 30 minutes after I finished school. And about the same time when he left the country and I needed to find another. Took me a single call to find a pediatrician and family doctor for my kids. Took my wife a couple of days when her doctor went on mat leave but that was only because she was more picky: she found a male doctor right away but wanted a female doctor.

          This is not to say there is no shortage. But as always, problems are solved by looking at facts and reality, not hyperbole and rhetoric.

          • I had no problem getting a family Dr. We actually have a website that lists Drs. who are willing to take on new patients.

            My sis' daughter had 'panic disorder'. Forget the actual name. My SIL – a chemist – was a pharma rep (yeah I know) suggested many bilingual Drs. would have been willing to see her. Did they contact any of those Drs.? No, instead she waited for hours in a clinic. My sis probably hasn't been to a Dr. in 30 years. Some of the Drs. my SIL recommended were family Drs. but were very aware of 'mental health problems' . BTW, my SIL also experienced some 'depression' issues. I finally gave up. I don't have sympathy for someone who won't even try and help themselves.

          • I don't think you are acquainted with reality. I tossed your fantasies to shreds above, I don't intend to waste my time proving you wrong again, you're not worth the time. If you happen to know how to pull strings, good for you, but don't believe that the average person has the insider connections that you had.

        • I moved to Toronto, checked a website, found a list of nearly 100 doctors within a few blocks of my neighbourhood who were listed as taking new patients. The site proved to be slightly out of date, but by the 6th or 7th call I had a new family doctor and an appointment 48 hours later.

          I found it eaier to find a doctor here than anywhere else I had ever lived before.

    • It helps if you get a family doctor before you suddenly need it.

      It is tough for newcomers in anyplace to find a family doctor when they move and don't know anyone. This is a matter of doctor shortage though. In France, for example, I think they have 5 times the number of doctors as in the US.

      Our doctor shortage results from a myriad of factors, including a short-sighted decision in Ontario (and other places) to save money by restricting the number of new doctors graduating when we came out of the last recession. It does not, however, result from a brain drain to the US as some like to claim. And there are a ton of competent doctors around who were trained, licensed and practiced for many years abroad but face too difficult burdens to getting licensed here.

  6. "The Canadian system's clearest advantage, not surprisingly, is that it doesn't leave anybody without insurance."

    Insurance policies don't do heart surgery. Coverage is not service. The payment of premiums – i.e., steep taxes – is not the receipt of health care services.

    Charts and graphs merely describe what IS. Policy is a matter of what OUGHT to be decided, given what IS. The proper basis for policy is: morality, not math. It is morally wrong to force a person to pay for a public insurance plan that he does not want, especially when it means – as it does for almost all Canadians – that he will thereafter lack the money he needs to buy the insurance or services he does want. Your neighbour's need is not his licence to expropriate you, or to let you die so that he can have medical coverage for his sniffling child while you die for lack of money needed to get the surgery millionaires like Williams can afford.

    As far as I'm concerned, Williams is personally responsible for the murder of every Newfoundlander who, from this point forth, dies as a result of having been taxed so much for socialized health care that he lacks the after-tax dollars needed to buy services of the kind Williams purchased in Florida.

    Put THAT on your chart.


    Paul McKeever, B.Sc.(Hons), M.A., LL.B.
    Leader, Freedom Party of Ontario

    • "Williams is personally responsible for the murder of every Newfoundlander who, from this point forth, dies as a result of having been taxed so much for socialized health care that he lacks the after-tax dollars needed to buy services of the kind Williams purchased in Florida."

      I see you are making good use of your B.S. degree.

    • I would have to agree with this. Danny Williams, being in the position he is in should be acting to change the laws to give Newfoundlanders the "choice" that he claims he should have. In other words, he should be working to open up competition for insurance in that province.

    • You know, anytime somone feels the need to post their credentials in order to validate their piont, it usually means that they're probably not somone who feels confident enough in their own logic to let it stand by itself.

      Anyhow, since you decided to bring in deaht logic, here's one for you. If somone chooses to jump off a bridge and kill himself, and you have the ability to stop him by forcing him off, should you?

      Point is, in this world, too many people think greed is the way to go until they're old and it's too late. What happens when a person become un-insurable? They fall into the governement plan? So the plan they have paied nothing into, is supposed to pay for their most expensive care?

  7. You say, "…liberal supporters of universal insurance like me." This isn't insurance at all. Insurance involves risk. The entire "risk" is shouldered by the taxpayer. Much of the revenue goes into "general revenues", therefore, Canadian Health Care, paid by the taxpayer, is really a tax, not a premium. Since, less than 50% of the population pays tax, the rest are recipients of the money paid by the rest. In other words, responsiblel, working taxpayers are SLAVES to the majority of the population who are universal receivers. Our system stinks in favour of the sloths and useless. That includes govermnent employees at all levels, who make 5 to 20% more than their employers in the private sector. Until we realize that private enterprise is the engine and the employer of over 50% of Canadians, we are doomed to socialistic ideals.

    • Up above, I mentioned the mindless sloganeering that stifles healthy and fruitful discussion like "no two tier healthcare" and "health card not a credit card" in defence of the current system.

      Well, KingH has presented the mindless sloganeering that stifles healthy and fruitful discussion from those who would throw out the very idea of a universal system.

      Thanks for filling in the gap, King.

  8. Who can blame Danny.
    My sister was first diagnosed with a suspicious growth on her ovary in May of 2009. Yesterday, Feb 23, 2010 she finally rec'd biopsy results.

    • That is ridiculous and frankly a bit unbelievable. I just had a growth detected on my Thyroid and had the biopsy results in a couple of days and half the thyroid removed (even though the lump was benign) within a month. There must be more to your 8-9 month saga.

      • Both of you are correct.

  9. Maybe not: in European countries with mainly public systems, the rate of electronic patient record-keeping is far higher still—72 per cent in Germany and 96 per cent in Britain.

    How much of that is due to having a national system in either Britain and/or Germany as opposed to 10-13 different systems in Canada (provinces and territories)? It seems to me the provinces all want to reinvent the wheel when it comes to building their own proprietary e-Health systems, often to disasterous results (Ontario of late).

    • Well, considering that even within each provinces it is not getting done, I'd say probably not a lot.

      • Canada, in general, is a laggard in using technology to increase productivity, not only in gov't, but also industry.

        SAP, which seems to be making inroads here in industry (I'm not an IT guy so I'm not sure if it is applicable) interestingly is headquartered in Germany – a country known generally for its engineering and innovation skills.

    • "How much of that is due to having a national system in either Britain and/or Germany as opposed to 10-13 different systems in Canada (provinces and territories)?"

      I don't think it would be any better if it was only Feds in charge. Bureaucratic incompetence rarely rates a mention in msm these days.

      "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

      • How does individual provinces faililng demonstrate that the federal governement would fail? I agree, one country, one health care systeme. All canadians shoudl have equal access from sea, to sea, to sea.

  10. My experience of the Canadian health system has been positive on the whole. I don't begrudge paying taxes for it because I have gotten good value so far. I'm all for incremental improvements, however, one of which is greater use of private contracting out to take the load off the public system. And please, some way of streaming minor medical cases away from the public emergency waiting rooms! It's not necessary to compromise single payer to do this and I think it should be tried before going to a formal two-tier system.

    The alarmists on the left who see for-profit health provision as a slippery slope and the red meat eaters on the right who want nothing less than full on Darwinism are equally undermining to an effective public health system.

    • The problem with private contracting is that it does nothing to fix the staffing levels. I knew a sonographer from Alberta who claimed that working in a Hospital was something you did if you felt like giving back into the community, because the clinics paied much more. With a shorrtage of sonographers, how are the hospitals supposed to compete with the private clincis who deal with the rich and, in turn, give a little extra to their employees? Sure those who can afford the clinic can now get finished faster, but what of those who don't? They wait longer. In fact, this exact scenario is probably why alberta now needs a "Health drive". Outsourcing their medical care so that everyone can have access to these private clinics.

      • Doesn't usually work that way. Some (not referring to just sonographers) like the security of the public system. Others like the flexibility of the private clinics. Many work both because they can't get enough hours. And quite frankly, the public system is often not that pleasant a place to work for some people. Lack of choice for patients is just as bad for everyone as lack of choice for professionals.

  11. I have been disheartened by the articles in the media discussing Mr. Williams surgery and the public comments that have been posted. I strongly believe that he would have received criticism if he had stayed in Canada also, most likely something about receiving preferential treatment.

    This article is one of the fairest, logical assessments I have read. Well done Mr. Geddes.

  12. As I have residency in Guatemala, I would get all the tests done down here first as I could wait in Canada for months to get them and I could be dead by then. I get the tests done and they are ready the next day and they remain my property not the doctors.

    • Are you speaking from personal experience here or are you repeating urban myths you have heard? No one I know has had to wait near that long for anything life threatening.

      • I have heard of some cases of hip surgery and the like being seriously delayed, but only in the news and not personal experience or anyone I know.

        Life threatening stuff? Never. And the exhaustive studies show slower than the US and slower than European universal health care systems – so we have a problem – but nothing as bad as detractors claim.

      • My wife waited three months for a CT scan in Ottawa that showed she had terminal cancer. She might not have died if she had been able to receive treatment more quickly. Do I have a problem with Canada's health care? You bet I do.

  13. I was far more interested in the comment that essentially what Danny went to the US for was a 'cosmetic' version of the necessary surgery. IE, that the surgery he received would not leave an unsightly scar on his chest.

    If this more expensive surgery was essentially cosmetic, I think it would bother me that taxpayers up here would have to pay for something done for cosmetic reasons.

    Frankly, if he wants cosmetic surgery and is willing to pay for it out of his own pocket, I'm all for it.

    • Right on.

    • You've never had your chest opened have you? Recovery is long and painful. Yes, there's a scar.

      If you ever need to have heart surgery and "minimally invasive" is an option…For God's Sake Take IT!

      • In another macleans article, a cadiologist mentioned that minimally invasive was not the surgery of choice for the premier because of it's increased risks of stroke. So how is a doctor that is willing to take on these increase risk doing a better job then the one sa ying that the recovery time is painfull, but worth it?

        • well he's in the US–he's inherently "better" you know. *rollseyes*

          and he may be "willing" to pay out of pocket but he's also going to try and get reimbursed by his provincial health care plan first. Or did you miss that part?

  14. "A shortage of pediatricians is hurting Canadian children, especially those with chronic, long-term health problems, says a report released Tuesday." Canwest, Dec 2009

    "Five million Canadians are currently without a family doctor-and things are only getting worse" Macleans, June 2008

    Thank god we all have insurance. As has already been pointed out, insurance does not equal service when there are few doctors. At least in America, when you pay for insurance you actually get service.

    I think you are battling strawmen, Geddes. In Canada, the arguments coming 'from the right' are questioning our system where a significant number of Canadians don't even have a doctor while people with money fly off to receive better care whenever it suits them.

    And your argument completely ignores the fact that US is basically only country where new drugs, treatments, equipment and the like are created anymore because The State is dire at R/D. If every country has The State in charge of health care, few new treatments, drugs will be created.

    • Three comments:

      1. The US is not in anyway whatsoever "basically only [sic] country where new drugs, treatments, equipment and the like are created". In fact, the very subject of Geddes' post is about showing exactly that. The technology in question here was originated by Canadians and they are the experts.

      2. Drug policy is a whole different issue and is not currently part of the "Canadian healthcare system", but is governed by a whole different regulatory regime. The same point as #1 applies to drugs – they are being developed all over the world – but there are very complex differences between universal health care regulation and drug regulation.

      3. The shortage of doctors may or may not have anything to do with our system. Certainly, some countries with universal coverage have a much higher doctor to patient ratio than Canada and even the US. Where the tie-in to state health care certainly is is in the decision – driven by budgetary concerns – across the country in the 1990s to cut university funding and specifically to restrict the number of doctors and nurses graduating.

      • The shortage of doctors may or may not have anything to do with our system

        What a laugh. Of couse it's the system! We've always had immense demand of qualified students to get into medical school. We have no shortage of dentists and veterinarians. In fact, we have no shortages of pretty well any profession you can think of EXCEPT MEDICAL SERVICES, THE ONLY INDUSTRY MANAGED EXCLUSIVELY BY THE GOVERNMENT! Of course it's the system! That's one of the telltale and inevitable indicators of a socialized economy: shortages and rationing!

        • As noted above, I meant the healthcare system and that I'm not sure how much of the doctor shortage can be simplistically and entirely blamed on the healthcare system.

          For example, Bob Rae's decision (like in other provinces) to drastically cut educational grants and the number doctors graduating to save money on the budget, points the finger at the healthcare system but also a bunch of other things.

          I'm not sure which statement demonstrates that you are living in your own ideological fantasy world more: that you think that medical services is the only profession in which we have shortages or that you think medical services is an industry exclusively managed by the government. In either case, it shows you have no idea what you are talking about. Is it winter in your world as well?

          Unfortunately for those who prefer a rigid loyalty to empty slogans (either in defending our system or trying to demolish it), reality is far more detailed and nuanced and complex. Unfortunately for Canadians, those two groups inhale all of the oxygen in any debate on this.

      • Are you a politician or want to be one, tedbetts? You certainly talk like one with your boilerplate liberal shibboleths.

        I would like one example, just one, where The State was better at innovation than proper markets. Canadian heart surgeons does not disprove my claim that State is not remotely known for innovation – drugs, treatments, equipment – no matter the "very complex differences".

        "The shortage of doctors may or may not have anything to do with our system."

        hahahahahahaha. What else accounts for our lack of doctors other than the system?

        • Do you see someone you assume is on the left in all aspects (I don't consider myself to be frankly) and just bang out a contrarian response?

          I didn't say the state does a better job. I didn't say the state does anything. You said that basically only the US is innovating which is demonstrably very false. Geddes example disproves your claim that basically only the US is innovating.

          As for the system being or not being responsible for doctor shortages, I should clarify I meant the healthcare as a system of regulation. Clearly, I think the government has a big impact on doctor shortages because I gave a specific example of of government interference directly resulting in doctor shortages.

          Does the universal healthcare system result in fewer doctors? In France and the patient to doctor ratio is better than in the US. They have a hybrid system with universal state funded healthcare.

          • "Geddes example disproves your claim that basically only the US is innovating."

            Yours and Geddes example really doesn't prove anything, tedbetts.

            Here's a link to studies that show why America, and its markets, is so important to medical care. If you have anything other than your beliefs, like stats or facts or anything at all, that prove Canada is just as good as America in medical innovation I would love to see it.

            "In three of the four general categories of innovation examined in this paper — basic science, diagnostics, and therapeutics — the United States has contributed more than any other country, and in some cases, more than all other countries combined."


          • I love how you keep changing what you are saying and making up what I am saying.

            You said quite clearly that basically the US is the only place any innovation is happening. That is demonstrably false. We've given evidence here.

            Now you are making the statement that the US is a important. Well duh.

            You also seem to think that somewhere I have said that Canadian medical innovation is "just as good as America" or is "better than the US". Can you point out where I said Canada is as good as or better than the US at innovation? Please? I only refuted your claim that only the US is developing new technologies which is clearly false.

          • As for your quotation, again, where did I say the US has not contributed more? I believe they have contributed way more than others in fact.

            One part of that fact that I'm sure is uncomfortable for anti-government types to admit is that the US government contributes way way more towards science and innovation than any other country. In fact, some time ago I read that the US government owns more patents than any other entity or organization in the entire world by a long shot. So it is a little much to say America is great only because it has free markets.

            With such general wealth, such higher government spending on R&D, such economies of scale (bigger companies, bigger patient/customer base, more researchers feeding off each other), it's no wonder they are producing more technologies than others.

        • Nasa

          Without money to be made on the moon, why woudl they go?

          And I even picked an American institution, just for you :)

  15. As we now understand Williams decision had absolutely nothing to do with Canada's system. It is clear he could have received the exact same procedure at several Canadian hospitals. As a private citizen he exercised his right to spend his own money on his own heart. His business not mine. As a now fully exposed political hypocrite the voters can decide whether or not they can continue to trust in anything he says.

  16. The maddening thing about all the shallow US-Canada healthcare comparisons is that Americans pretend they have a private system, when the largest payor is government, and Canadians pretend we have a public system, when we have all kinds of privately run practices, private insurance, user fees, and uninsured services.

    If we could just stop rearguing the Medicare debate from the 60's and look at how to improve the mixed system we have (for instance, despite having single payor for primary, acute and community health services, we do an abysmal job of connecting the dots between them for patients. Portable electronic health records would help, but so would a customer service focus and some kind of case coordination or navigation assistance.

    • well said toby.

    • You hit the nail on the head! Good point! Well said! Thank you!

  17. "Still, even though I was relieved to see that this entertaining case didn't serve as a vivid lesson about some failing of a Canadian model that I broadly support, I'm left uneasy about how the argument has gone. "

    Geddes thinks there was a debate?? To me the "debate" went something like this:

    Righties: Hey look! A Canadian premier is going to the US for surgery. Guess the US system can't be that bad after all, eh?
    Lefties: Shut up! His heart his choice! Shut up shut up shut up! You people are so nosy and judgmental!
    Righties: Why can he get premium care by going to the US, but it's illegal for us to do the same in Canada?
    Lefties: It's not premium care!! It's no better than Canada's! In fact, our heart surgery is more advanced!
    Righties: If ours is so advanced, why'd he pay extra to go to the US? What's there that we can't set up here?
    Lefties: His surgeon recommended that he go to Florida, ok? Why are you trying to come between a man and his doctor??
    Righties: We don't give a flying leap where he goes, but we sorta kinda think it's the same as two-tier health care.
    Lefties: He has a condo down there, ok?
    Righties: Oh ok…he wanted to combine heart surgery with a nice vacation to the cottage.(?) Fun for the whole family!
    Lefties: You know, the tone of this debate has been over-the-top, mostly on your side of course. Let's just agree that our system is better but not quite as perfect as the other socialized systems out there.
    Coyne: I'm glad Williams came out of the closet on this.

    Look, if you really want a debate then answer the following:
    How is what Williams is doing any different from two-tier health care? If it's essentially the same, why can't we put two-tier within Canada instead?

    • Very funny. Sounds about right to me.

    • Exactly!

      The story of Newfoundland Premier Danny Williams' trip to Florida for heart surgery hasn't exactly elevated the argument about health care. To try to shift to a more useful debate

      What debate? There is no debate from Geddes at all! He's saying everything's peachy and putting just about every possible discussion item off limits, such as your question and many others.

    • I like your Coyne reference.

      • Thanks. I almost died laughing during that discussion. It was pure comedy gold until someone went and ruined it by spelling everything out.

  18. Geddes continues to battle his favourite straw men. As others have pointed out, medical insurance and medical services are not the same thing. We're all insured, but none of us can get timely care unless we're in the middle of a heart attack or we have a potentially fatal condition.

    Geddes should try asking some of the real questions, like:
    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. If he cannot accept Williams' answer, then perhaps he could pursue that issue with WIlliams and his doctors.

    -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. Williams says "it's my choice", yet there is no choice for those of us who must remain in Canada.

  19. Since when is a wait of six days to see a family physician (if you can find one), or four weeks for a specialist (a fantasy) acceptable? And seeing the specialist is only the beginning. The author neglected to mention that the push to reduce wait times only began after advocates for choice started exposing the failings of the Government monopoly. He does make one valid point in that limiting this issue to a Canada – US comparison is short sighted.

    Many of the clinics in Canada were started out of frustration by our world class specialists who, for example, were getting one day of surgery a week, had two year waiting lists, and were fielding dozens of calls each day from patients whose lives, careers and future health were being seriously damaged by the delays.

    I don't know about Williams' personal politics, but let's look at the case itself. Suppose there is a serious health issue that deeply affects you. The first option is quick access to a personally recommended, acknowledged expert in a superior procedure at an excellent facility. The second option is to begin a research project to see if the same or similar procedure that might be as good might possibly be available to you somewhere in Canada in maybe a few days or several weeks if your case is not bumped because of a lack of beds.

    The choices are clear and the actions very predictable. Even the most self righteous choose the first if they have the means, and start calling in every favour from every acquaintance if they do not.

    Whatever Williams' politics are, he made the right choice. It's up to the voters of Newfoundland to decide if they believe in him – two separate issues.

    • It depends what the effect of a wait time is, esp. for a specialist. If there's no discomfort or danger in waiting four weeks, it's not a problem. If it entails severe risks, it's of grave concern.

      One of the many reasons its hard to draw conclusions from large-scale generalizations.

  20. It is also a myth that no one really explores to say that patients haven't suffered because of delays in the US. I have read a number of cases where insurance companies needed to approve extended coverage after patients had reached their cap and that approval can take a long time.

    So some wait times vs. being capped and delayed in getting extensions of coverage (if the approval is even granted)? I know which I would prefer.

    But again, we do ourselves and our healthcare great damage to limit the comparison to the US.

  21. The system is hte shortages. All your anecdotes are meaningless. We should not have a system where Bob Rae's whims decide if I can have an MRI when I break my leg.

    Our system has shortages of pretty well everything:
    -hospital beds
    -hospital rooms
    -medical diagnostic machines like MRIs and CT scanners
    -ER doctors
    -everything! There is almost no medical service that is freely available within a timely fashion.

    • Yes yes, but at least everyone has the same shortage. Have you any idea what a travesty it is that some people are able to buy a root canal when they need it, while others… are still able to get a root canal when they need it… no wait…

      • Yes, I know, the travesty, it's horrifying :-)

        • Well I'd put food a little higher than medical care. We should universalize grocery stores! That way the many citizens with no access to food would be able to get some, and grocery stores would be stopped from the heinous practice of raising prices on such an important necessity.

          • You've reminded me of another one of those crazy things that people have invented: food banks.

            Now, I don't begrudge those who wish to give to charity. I don't begrudge the idea of free food for the hungry. And I think soup kitchens are a great thing. But food banks are the dumbest thing on earth. Charitable people actually go to the grocery store and buy things, then they transport those things to a large building where they proceed to set up an exact replica of…. drum roll… a grocery store, except that it requires significant man hours of volunteers to stack all the food again on shelves and then hand it out to the hungry!

            Consider how much easier and more efficient it is if people actually provided coupons, food stamps or cash to people to get their food from the…….. grocery store!! What's the point of moving it all into the food bank?!!

          • Yes, I like the food stamps approach.

            I like the older approach even better, in which monasteries/convents provided food (and medical care, and search-and-rescue, and orphan care, etc.) to anyone who came to the door in need of help. People donate to the monastery, the staff work for free, and the care is superb because they view each person in need as a God-given opportunity to do some good.

            It doesn't get more efficient and motivated than that, and the result is a one-stop shop for every basic human need for those who can't afford to buy it. At the same time, no one is forced to give to it, so everyone in society has an opportunity to be charitable to others, and everyone in need has someone to be grateful to.

          • Back to your idea…. I think Venezuela is going down that road, they've got the price controls and the food shortages now and they are close to the next step of nationalizing all the grocery stores, so that down the road they can replicate the famines that have been common to China, North Korea and the USSR.

          • Chavez is exactly the guy I'd expect to try that.

    • Can you get uranium? Weapons grade, preferably. I know somone who migh be interested.

      Seriously though, some things are just that important thatyou want to regulate it. Do you really want your dentist deciding one day that they can do complete maxillo facial surgeries… i mean, a face is close enough to teeth right?

      Our shortage is mostly du to the fact that we have a massive baby boomer generation that are now starting to fully required all these services. Additionally, that same generation allowed some of our politicians to cut medical school funding. Next, we would also need much more spots for residencies.

  22. Reading a lot of these comments is depressing. The point of the blog post is to say that the system here isn't perfect, can and should be improved, and that we should not only look at the US but everywhere else where they've had success as well, no?

    What's there to argue with here?

    • While your point is essentially correct, the tone of the article tends to minimize the reality. While we have some good things here, the system requires more than a few minor tweaks. For example, at first glance 57% waiting more than 4 weeks to see a specialist, while high, doesn't seem so bad. What's 4 weeks after all, and quite true for some health issues. But it's a completely irrelevant number. You could say that perhaps 85% wait more than 2 weeks. That's not so bad either. What is being completely hidden with these statistics is that a large number of people with debilitating health issues wait years for attention because they are not immediately life threatening.

  23. A leaky valve.Thats an every day operation.He didn't want a scar, poor boo boo. What a megalomaniac

  24. My soul mate received all her treatments for colon cancer stage 4 on Canadian Medicare. The operation itself involved 16 doctors at Mount Sinai in Toronto. A private flight back to her city and followup care at her home. She is a survivor after 3 years, cancer free. I received a double bypass after 7 months of consultation with cardiac specialists. Education, training, and followups are still the norm for the two of us and our medication is covered in Ontario. The system works.

  25. Canadian healthcare its free &we know what you get for free,I am 70& its taken 5 yrs of xrays &other crap to get to see a specialist,7 mo. from now I get to have a knee replacement.Family doc says older folks have to wait,Government hopes I die before spending all that money for nothing,Guess I should not complane it is FREEE

  26. I'm a boomer who had Stage IV cancer – 12-18 mos. to live. I was operated on within a week or 2 then had chemo as soon as I was fit. Received exceptional care. Had to have 2nd round of chemo a couple of years ago. Can't count the no. of CT scans I've had over the years. Couple of weeks ago had a PET/CT scan and was told I'll be around for a while yet. I was diagnosed 7 years ago.

    Sure, for non-life threatening situations we often have to wait longer for surgeries, but at least we know we won't go bankrupct.

    Agree, we should look at our countries that provide various forms of universal health care and learn from them. My husbands family lives in France. They provide excellent health care, with a small co-pay. Doubt France still does it (fuzzy memory) but citizens used to be able to have a free 'complete' check up every 2 years using latest technology. It was a preventative measure.

    IMO, the US system stinks.

  27. This seems like a partisan attempt to let Danny off the hook and move the debate in a new direction.

    I'm still steamed at Williams for a short-sighted selfish decision from someone elected to act in the public's best interests. But with Danny Williams it's always everyone else be damned, I'll do it my way.

  28. What is missing from this "argument" is the basic understanding that the procedure is available because of the US health care system. Those that do is in Canada were likely trained by US doctors (maybe even this one). Premier Williams wanted the best care possible and when to the US and this doctor by choice. All facts.

    What if the US system did not exist? What if it were socialized and no private payment existed? What would a non-citizen do? Even worse..forgive me my Atlas Shrugged moment…What if Dr. Lamelas had decided that the bureaucracy, paper work and law suits were just not worth trying to advance the science? Where would we all be? That is the risk in the socialization of the US system, the death of advancement and research. I am sure the 8000 surgeries Dr Lamelas performs make him a tidy sum of money… how dare he make money off advancing the entire practice of medicine…Damn him…

    Exerpt from the Mt Sinai Web Site:
    Great advances have been made in minimally invasive valve surgery, and Dr. Joseph Lamelas, chief of cardiac surgery at Mount Sinai, is on the leading edge. Board-certified in cardiac and thoracic surgery, as well as surgical critical care, Dr. Lamelas he pioneered an advanced one-man surgical technique for minimally invasive valve procedures. He teaches this method to surgeons across the United States and around the world.

    Dr. Lamelas consistently has had one of the lowest morbidities and mortalities in Florida and the United States. He has completed almost 8,000 cardiac surgeries and more than 800 minimally invasive procedures, making him South Florida's most experienced surgeon in his area of expertise.

  29. All of my adult life, I have been covered by the oldest American single-payer health care program, the one provided members of the Armed Services.

    When I read about Canadian experiences with their health care system, it reminds me of the experiences I had as a professional soldier. Good care was available. There was usually a wait involved. (I went for years without a personal doctor, and then when I had one s/he wasn't always available when I was under the weather.) Naturally, we bitched and moaned about the wait, but we didn't complain about the price.

    I've purchased private health care insurance for the last 20 years even though I didn't need it. I have better health care than President Obama has. With my BlueCross BlueShield health care card and my military retiree ID, I am welcome instantly in any hospital, clinic or practice in the United States, because there is never a doubt that the doctors and staffs will be paid their full fee. The combination of private insurance and CHAMPUS/Tricare (the military system) covers every expense I've ever encountered, and I've encountered some doozies.

  30. Of course the system is broken, we have known that for a long time, the issue is still the sour taste that Williams has left the Canadian public with.
    You Newfies should get your head out of Danny's butt! You keep defending him like he never did anything wrong, wake up!
    This now shows what kind of leader he really is, a bad one!
    His arrogance makes me sick. He's probably saying "screw them all, the Canadian public is so stupid that they will forget in no time flat" like he was heard saying in the past. Way to go Danny boy, one more person who lost respect in you.

  31. 11 days… my father still waiting for his routine (but essential!) heart procedure. Not allowed to leave his ward, otherwise he gets bumped to a lower priority queue.

    So, Danny, how many days were you willing to languish in the hospital before your name came up?

    Oh wait. I forgot. You're too important for the Queue.


    I support our Health Care system… but I also think it's sick and needs improvement. I have no objections to the idea of a baseline health care available to all, with a second tier for those who can pay. We can debate the inequitites forever. The fact remains, however, that those inequities already exist (just for people more rich than upper middle class).

  32. With this comment is John Geddes confessing that he is a Liberal. “in the end, it buoyed up liberal supporters of universal insurance like me.”

    Just asking John. Just asking.

    • Since you ask, I've never belonged to a party, but do consider myself liberal. Of the meanings offered in my Canadian Oxford Dictionary, the most germane is 6 (a): “favouring a relaxing of social traditions and a significant role for the state in matters of economics and social justice.” Nobody likes to be too neatly defined, though. In my case, while I do favour a “significant role for the state in matters of economics and social justice,” I tend to cleave to “social traditions,” rather than seeking to see them relaxed.

  33. There are of course many Canadians alive today thanks to the Canadian medical system. Speaking from experience, the Canadian medical system kept many of those same canadians alive thanks to the treatments, technologies and procedures developed under the US Free Market system.

    The Canadian generic drug industry exists because of the US free-market drug industry. If there were no US free-market drug industry, then there would be little or nothing for the Canadian generic drug industry to copy.

    Canada has always had a two tier health system, the second tier is called "the US".

    • Steve, ugh, no. More money is spent on drug advertising in the US. then in R and D. The reason you have so many discoveries is because you have the most profitable market. That does not mean that drug research would not continue if the market became less profitable. In fact, the increase pressure would probably have a bettering effect. You wouldn't have pointless rebranding and waste money on silly reasearch like how to change this drug just enough to maintain patents. Isreal, in fact, has actually been doing a fan

      Additionaly, how much fuding is being spent to do comparative research in mutliple labs for multiple compnanies? Because no one wants to share any discoveries, just in case they loose their patents, then research is actually slowed down since it must first be replicated before continued.

      There was an interesting video up on yourtube. It was a buisnessmans perspective on the managment of cancer reserach. Old CEO of intel. You should check it out. Free market can be a very inefficient beast.

  34. Any Canadian that has ever been treated in the Canadian medical system has benefitted from at least one and probably many, treatments, technologies and procedures developed thanks to the US free-market medical system.

  35. A public systeme is not a free systeme. It's a cost shifting systeme. You pay taxes your entire life so that when you get that 100 thousand dollar bill for that 6 month icu stay and transplant, you don't have to worry about paying it off.

    If you had multiple choices, then corperations would maximize their profits by limiting access to their premium plan to only the healthiest of the bunch and, as soon as they become un-profitable, would ditch them.

    Now, the public systeme that did not receive a dime frome this person, would have to pick up the slack.

    You could say that if the person still payes their taxes, and then buys a suruplus plan on top of that, then no harm no foul. However, how long before people start saying hey!, why am I paying for someone elses health care?

  36. I can't believe this is still an issue. Who cares if he went to the States for medical treatment? It's his body and his right and if he can afford to do it then good for him! Considering the mistakes being made by our doctors and hospitals that are currently in the media I don't blame him one bit! Just give it a rest already …

  37. You know, the entrance pecentage of applicable students in med schools is less then 10 percent. Meaning 90% of applicants can't get a spot. On the other hand you have the CMA continuing to stimulate even more demand for those spots by creating these we need more doctors campaign. Yet, i've yet to see them actually work with governement to create more spots.

    The problem is deeper then governement. You know, when you're the only cardiac surgeon around, you may get some very interesting pay offers. When there's twenty, a little less.

    Not long ago, sick kids wanted to shut down a section at cheo because they said they where not busy enough… doctors trying to shut down other doctors… it's not just governement

  38. I know we Americans and Canadians like to compare/contrast/criticize our respective health care systems, but in todays The TimesOnline there is a story about the Mid Staffordshire NHS Foundation Trust, a hospital, at which there may have been up to 400 unnecessary patient deaths to do staff neglect of patients. Read it. Our respective health care problems in North America are trivial compared to the suffering revealed in that report.

  39. The current system as it is currently structured is not fixable. That is clear since despite billions more health care dollars over the past few years, wait times in only a few areas are measured and these have not improved substantially despite this massive funding and what was supposed to be a "fix for a generation".

    The system is seriously flawed because it requires no individual/personal responsibility.

  40. This is a classic case of a man who preaches one thing and does another. This is what we get for politicians these days, idiots without a backbone, unable to stand beside what they preach and spout to the people. Shame on the man and he knows it.

  41. I just wish that hospitals would send patients a copy of the bill paid by their provincial insurance provider. Nothing like a 10 thousand dollar bill to sober someone up.

  42. The sad thing about all of this is that this story should have been reported as fact and fact alone, with no spin. When one is told by his doctors that he has to have immediate surgery or he could die and one has the ability to get it anywhere because finances don't have to be considered, the last thing on his or her mind would be the politics of the situation, no matter who he or she is. He checked with a leading cardiologist in Canada and was not offered the minimally invasive surgery. Time being of the essence, he consulted another leading cardiologist and the Mt. Sinai option was recommended.

    I guess there are many hearts in the journalism profession and many more in the public in general that no cardiologist can fix.

  43. I think you are missing the point here: as premier Williams has consistently stood behind the Canadian healthcare system as it CURRENTLY exists.

    No no no–this is EXACTLY the problem!!!!!! He does NOTHING to IMPROVE the current system and then when he finds it doesn't meet his "standards"? He bails and goes to the US??? I am NOT OKAY WITH THAT. And neither should you be. Our system IS inadequate in SO many ways and we all know it. That is not to say the US system is any better. I would not be able to access ANY health care in the US so their system means nothing to me. I want BETTER access to care AT HOME. So should you. But when people like this, people in a position to do something about that bail on you when things don't go their way? How is anything ever going to get better?

    Answer: It isn't.

    Wake up people!

  44. Folks this is all about choice. Some believe we shouldn't have choice because we are all in the same boat so just wait until big brother tells you it's your turn. Hope you stay health enough during your imposed wait for the good of all….equal access can kill you.

    Danny wasn't politically sound here but it was his choice. He new of Canadian excellence in his particular need….he made a free choice. The government is telling us they know best so wait and don't consider starting up a private clinic that would ease our tax dollars in health care infrastructure but also make more facilities available to the public.

    Equal access at all costs….until its their health we're talking about. All of our political leaders go to the states when they have a health concern….what the hell does that message tell us?

    Take care of your self at all costs…. we only get one kick at this life.

  45. One: Danny Williams, like everyone, is capable of chosing how and when they get medical treatment. Two: His surgery, south of the border, or in any other country for that matter, positively impacts our wait times. Three: our health care system saves more than $1,000 per bed per day, plus the cost & time of the surgical staff. Four: someone on that list gets medical care sooner. Good on ya' Danny Williams. You get care, we save money, someone else gets treatment earlier. Are there any questions?

  46. Let's face it, Canada has a socialist health care system and it's working pretty well. Don't knock it, as you can't have it both ways.

    As for Danny Williams, he has a right to go to where ever he wants for an operation, just as you do if you can afford it. Actually it's no one else's business and has nothing to do with selfishness.

    His doctor advised him and he has a condo near my.
    I sometimes think reactions are based on emotion and jealosy, in most everything!

  47. Having had cancer I got good care but the problem is getting in to see a specialist. There is usually a six week wait and that is after you have seen your general doctor. Then another 6 week wait to see a surgeon. In my case we had to have another opinion so waited another 6 weeks. After you are in the system appointments are fast . Also went to a private clinic in Montreal and paid for an endoscopy as I was moving and it would take too long to go through the process of finding a doctor in another province and then wait for a specialist. In the province of Manitoba getting an appointment with a specialist can be a year or more wait depending on the situation such as knee surgery. The first appointment is just the referral and then you usually have to wait for a date for surgery. This is a common problem and have had friends go to private clinics for back surgery etc so they did not have to wait. Danny Williams has a right to do as he wishes, politician or not . It's his life and maybe waiting is not always the best thing.