Don't Get Sick!
by: Gail Pellett,
t r u t h o u t: 27 August 2009
Don't get sick! Those were the last words my grandfather said to me as I
left Vancouver for the United States. It was 1964. Canada was in the process
of implementing a universal health care system. I hadn't noticed, because I
was young, healthy and restless.
Now, these many years later, as I witness the health care reform
"debate," my grandfather's words have returned to haunt me. He had been a
pioneer farmer in Saskatchewan on the Canadian prairies. That's where
Canada's universal health care system was conceived during the hard years of
the depression and its aftermath.
Medicare (Canada's health care plan) was largely the brainchild of a
Baptist minister turned politician, T. C. (Tommy) Douglas. He and others
founded a new party in Saskatchewan (which later became the New Democratic
Party) based on "humanity before private interests." Universal health care
was at the top of their agenda. By 1964, Saskatchewan implemented a health
care plan that treated everyone according to their needs regardless of their
ability to pay. Despite a doctor's strike that tried to kill it, the
farmers - including my grandfather - made sure that this new health care
plan survived. Then, just as now, there were those who thought it made total
sense and others who thought it was a Communist conspiracy. However, it
proved so popular in Saskatchewan that within a few years the federal
government adopted it for the entire country. Imagine the audacity of this
during a raging cold war. The year the plan went into effect was the year of
the Cuban missile crisis.
In 2004, the Canadian Broadcasting Corporation conducted a poll to
determine whom Canadians thought was the greatest Canadian of all time. It
was not Pierre Trudeau, Joni Mitchell, Dan Aykroyd, Leonard Cohen, Margaret
Atwood, Lorne Michaels, Oscar Peterson, Peter Jennings, Celine Dion, Neil
Young, Keanu Reeves, nor Wayne Gretzky. It wasn't even Keifer Sutherland or
his dad, Donald. No, it was Keifer Sutherland's grandfather, Tommy Douglas,
who is credited with making sure that Canadians would have universal,
government-funded health care. When Canadians are periodically polled and
asked what they are most proud of, in addition to peacekeeping, it is their
national health care system.
What irritates me - depresses me the most in fact - is that Americans
seem so unwilling to learn from any other country. "We would never want to
have a plan like the Canadians" is a comment I heard from an interviewee on
NPR the other day. Sadly, this speaker has never visited Canada, because if
they had they would probably witness that the average working-class or
middle-class person in Canada lives longer, works less, is a tad wealthier
and has better sex. And, of course, they have that single-payer health care
plan.
I'd like to say I'm joking, but you can check the sources of these
claims in MacLean's, Canada's weekly news magazine. In Canada there are
endless efforts to compare the happiness of Canadians vs. Americans and the
Canadians were tickled to read that they might have it better in a 2005
MacLean's feature, which began like this:
"Like the perpetual little brother, Canadians have always lived in the
shadow of our American neighbors. We (the Canadians) mock them (the
Americans) for their uncultured ways, their brash talk and their insularity,
but it's always been the thin laughter of the insecure. After all, says
University of Lethbridge sociologist Reginald Bibby, a leading tracker of
social trends, 'Americans grow up with the sincere belief that their nation
is a nation that is unique and special, literally called by something
greater to be blessed and to be a blessing to people around the globe.'
Canadians can't compete with that."
So, hubris prevents Americans from learning about Canada's health care
system - or any others for that matter - just when it could be helpful as
American citizens try to reform their own unfair and costly system dominated
by private interests. Admittedly, NPR has, in this late stage of the debate,
been reporting about some other health care systems in Europe. Finally. As a
citizen of both the US and Canada, I am perplexed by the ignorance of so
many comments I hear and read. Many interviewees don't seem to know that the
US already has huge government-funded health care programs called Medicare,
Medicaid or the Veterans Health Administration that together cover more than
80 million people! That's more than the populations covered by Canada's or
any one European country program!
Principles of Canada's Health Care Plan
But let's get back to what might be helpful for Americans to know about
Canada's program. Here are some essential facts.
1. It is a single-payer system, meaning that the government - federal
and provincial - pays the bills. But many providers - clinics, hospitals,
diagnostic services, etc. - are privately owned. They are reimbursed for
services just as doctors - who are mostly incorporated - submit for fees.
2. You get to choose your doctor.
In 2005, all the provincial government leaders reconfirmed their
commitment to The Canada Health Act's key principles: that Canadians have
the right to timely, high quality, effective and safe health services on the
basis of need, not ability to pay, and regardless of where they live or move
in Canada. They also committed to a system that is sustainable and
affordable and that will be there for future generations.
Lively Debate
There is a lively debate in Canada about how well this system is meeting
those principles. On the right, is the Fraser Institute, a think tank based
in Vancouver that regularly releases reports outlining the extensive wait
times for operations and procedures and plugs the benefits of a private
market driven system. From the left, come worries about creeping
privatization within the system. There is a tug of war between those who
wish to preserve the public system and those who want more private options.
And everyone worries about costs. The conservatives want to put less into
the system; the liberals want to put more in and get more out of it.
The outgoing president of the Canadian Medical Association (a doctors'
organization like the AMA), Dr. Robert Ouellet, was a champion for
privatization. During this month's annual meeting, he wanted to "pull out
all the stops" to push for private health care. But that effort flew in the
face of the most recent poll by Nanos Research, which found that more than
85 percent of Canadians want to strengthen their public health system rather
than expand for profit services. Dr. Anne Doig, the new CMA president, vowed
a commitment to quality care rather than privatizations. The debate will not
go away, but Americans could learn from this.
Canada's System Under Stress
Whether seen from the right, left or middle, Canada's system is under
stress for similar reasons that our health care costs have skyrocketed here.
Like most advanced industrialized countries, Canada is facing a demographic
bubble of seniors - an aging population. Senior health care costs more. A
recent New York Times article reports that treating the medical needs of
seniors with chronic diseases during the last two years of their lives
consumes a third of the US Medicare budget. Canada has lowered some of those
costs by making generic drugs available through its system. As anyone in the
US Medicare system knows, the drug program is a complicated, expensive mess.
And some Americans go without drugs because they simply cannot afford them.
Recently, US seniors have expressed concern that by extending Medicare to
the currently uninsured (40 plus million folks in the US) that somehow their
own services will be compromised. They could look at this differently. The
power that an expanded Medicare would have to negotiate better deals for
services and drugs could benefit everyone.
Other developments in health care force costs up in Canada just as in
the United States, like the overuse of advanced diagnostic tests. Canadian
health care specialists have been trying to tackle that issue. And the
discussion has begun among reformers in the US. But one area where Canada's
single-payer system really cuts costs is in the bureaucracy. While American
hospitals typically hire dozens of people to handle claims for hundreds of
insurance companies, in Canadian hospitals only a handful of people are
required to keep track of expenditures.
The Anecdotal Story - Wait Lists
We often hear anecdotal complaints about the waiting time for operations
in Canada. And that is a serious issue. I saw a TV ad on cable, as I was
cruising stations recently, that said if you fall off a horse in Canada and
break your back you will wait six months to see a specialist. This is
nonsense. And since so many of the negative stories are anecdotal, I will
tell mine. I recall my mother's experience with several hip operations. (She
lived in Vancouver.) The first was for a hip replacement. Yes, she had to be
put onto a waiting list. In the early '90s she waited some six months to get
her operation. Yes, she was uncomfortable and a bit impatient, but she also
knew she was getting a doctor with a brilliant reputation for fine work and
she would need to get in line for him. She lived in a retirement community
where demand was high. (Recent Canadian studies have shown that the waiting
times are costing the Canadian system more than finding solutions to shorten
the waits. And in 2005, Health Canada invested some $4.5 billion to reduce
waiting times during the next six years. Also in 2005, after a Supreme Court
decision allowed private clinics with private patients, Quebec province
promised it would send patients to those clinics and pay for them if they
had to wait longer than six to nine months for operations.)
But back to my mother's experience. Some eight years later, when my
mother fell and broke the part of her hip device that extended into her leg,
she was operated on within a few weeks. Since I was working out of the
country when this happened, the operation was scheduled for when I could get
to Vancouver in order to care for her. She walked with difficulty until the
operation. Then in 2005, when she became very sick and weak, she fell and
broke her other hip. She was operated on that night. Just as you would be in
the US - if you had insurance or could pay.
Canada's Reforms
Canada's system is always under scrutiny from various factions and
frequent analyses of abuses or problems are matched by eagerness to reform.
Americans could learn from Canada's reform efforts to address rising costs.
In some provinces, they are experimenting with creating more neighborhood,
24-hour clinics in heavily populated communities to take the expensive
pressure off of hospital emergency rooms. Some clinics are run by nurse
practitioners and focus on preventative care. They are also promoting
midwifery and hospital birthing centers to increase the quality of care and
reduce maternity costs.
Mouseland
Finally, resistance to health care reform is driven by a combination of
corporate and political interests. Tommy Douglas understood this well and
had a famous stump speech he used to deliver when trying to organize a new
political party on the prairies that put humanity first. Over the years,
that speech has become known as Mouseland. He told the story about mice who
every few years held elections. Sometimes, they elected the White Cats, who
would proceed to pass legislation favoring their interests including
building a mouse hole large enough to get their paw into. So, when the next
election came around, the mice voted in the Black Cats. These Cats also
passed legislation to favor themselves. They wanted to build a mouse hole
even larger so cats could get two paws in. The mice tried everything at
subsequent elections, like mixing up the Black Cats and White Cats. Finally,
they decided to elect a mouse. But that mouse was immediately arrested and
jailed as a Bolshevik. Douglas concluded that this fable illustrated why the
two party system only works for the Cats. He was stumping for a third party
that he successfully introduced to the Canadian political landscape - a
party that pushed and won universal health care. You can go to to see an
animated version of this speech introduced by Keifer Sutherland.
What Can We Americans Do?
First, we can learn as much as we can from other countries about their
health care systems. (And, perhaps, why a two-party system keeps building
bigger mouse holes.) We can speak up for humanity before private interests.
And we can let all of our representatives know our thoughts.
And Canadians?
Meanwhile, in Canada, a petition is circulating that registers Canadian
concern about the lies and attacks on their health care system funded by
corporate interests in the US. If you are a Canadian you may wish to check
out the petition at this link.
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