Medical Progress Today

Rethinking Socialized Medicine In Canada

David Gratzer
Investor's Business Daily
July 22, 2010

As Washington prepares to implement the White House's health care reforms, no one is talking much about Regina, Saskatchewan, these days. Maybe that's not surprising: With so much work falling on state governments, the news cycle focuses on Albany, Indianapolis and Sacramento, not some small city in the middle of the Canadian prairie.

But while Americans may not know Regina, Canadians know it well. Regina (ridge-EYE'-nuh) is the birthplace of Canada's socialized health care system. It was there that Saskatchewan Premier Tommy Douglas first proposed a government-run health care system back in the 1950s. And it was there that, in 1962, the government bill passed in the province's Legislative Assembly.

That was then. Today, Regina's health care model is becoming more market-friendly. The dramatic changes occurring there—the very first city in North America to experience government-run health care—and throughout Canada are worth contemplating as the U.S. prepares an unprecedented expansion of the federal government into private health care.

For example, Regina's health board (charged with providing health service to the city's population) recently started entertaining the idea of contracting out CT scans to the private sector. And with good reason: Regina has just three CT scanners, and they are running at full capacity, seven days a week. The reach-out to the private sector, then, is about practicality, not ideology—patients are simply waiting too long.

Regina isn't the only place in Canada where health care officials are contemplating private reforms.

In British Columbia, the government is moving hospitals to a pay-for-service model that would lead providers to compete with one another directly. In Quebec, the premier has openly endorsed the idea of co-pays for basic services, which no politician previously supported. And governments across the country are hiring private clinics to provide basic surgeries.

By one estimate, 50,000 patients a year in British Columbia are served in some type of private facility.

Why the appetite for change in a country that has long been held as a model of health care efficiency and equity? The system is beset by problems. According to the Canadian Medical Association, roughly 4 million to 5 million people don't have a family physician.

Patients wait for practically any problem, sometimes with disastrous results. A Montreal woman died recently after waiting four days in a hospital ER, the last of a string of Quebec deaths that led the head of that province's College of Physicians to hope openly for a "miracle."

Even according to government statistics, Canadians wait too long for everything from surgeries like knee replacements (seven provinces fail to meet the benchmark wait times) to MRI scans. In other words, by the governments' own standards and data, Canadians wait too long for care, even after massive increases in spending.

In the past few decades, in order to bend the curve of health costs, provincial governments have trimmed back on the supply of care: reducing the number of medical-school graduates, removing hospital beds, and failing to invest in new diagnostics and pharmaceuticals.

It's the reason that Regina is so lacking in CT scanners (a 1970s technology). Indeed, Canada sees half as many CT scans performed per capita as the United States.

That isn't, of course, the story Americans often hear about Canada's system. But the statistics are striking: American patients are more likely to survive cancer, for example (66.3% over five years for American men, but 58% for Canadian men). American outcomes are also better for heart attacks and transplants.

And data from the Joint Canada/U.S. Survey of Health show that Americans have greater access to preventive screening tests; that they have higher treatment rates for chronic illnesses; and that the poor in Canada's public system seem to be less healthy relative to the non-poor than their American counterparts.

Canada isn't the model for White House reforms. But also it's true that many in Washington quietly admire its system and systems like it.

Howard Dean, the former Democratic National Committee chairman, favors a Canadian-style single-payer system. Dr. Donald Berwick, a Harvard physician and nominee for director of the Centers for Medicare and Medicaid Services, has stated that he "loves" Britain's National Health Service. "I've said that the Canadian model works for Canada," President Obama said last August.

As policymakers in Washington, D.C., and state capitals contemplate the most sweeping health care changes in 40 years, it's worth remembering that our neighbors to the north know that all isn't well with government-run care.

Indeed, Regina's woes—ever-rising health costs and the resulting challenges of fiscal balance, coupled with the problems of managing programs dictated by a distant federal government—should be very relevant in Albany, Indianapolis and Sacramento.