Canadians aren't aware of medicare value: U.S. cancer expert

John Cotter
Canadian Press

Tuesday, September 27, 2005

EDMONTON -- World-renowned cancer specialist Eduardo Bruera is homesick for Canada's health-care system.

Dr. Bruera left Edmonton's Cross Cancer Institute after 15 years in 1999 to become chairman of the department of palliative care at the University of Texas M.D. Anderson Cancer Center in Houston.

After working in both countries, Bruera, an oncologist, has a message for people who complain about medicare or who want to expand the use of private health insurance in Canada.

"The portability and the universality of health care in Canada are unbelievably good. I think Canadians are not aware of that," said Bruera, who was to compare care in the two countries in a speech Wednesday at the annual conference of the Canadian Hospice Palliative Care Association.

"Don't look at the United States. The public health-care system makes it possible for patients to access palliative care in Canada earlier and more effectively."

Since moving to Texas, Bruera said he can't get over the spectre of crushing debt that even upper-middle-class Americans face when a family member is dying from an advanced illness.

Even premium private health insurance in the United States rarely covers all the costs, which can lead to bereaved survivors facing an almost never ending list of medical bills, he said.

Of every $100 spent by families on medical care at the M.D Anderson Centre, only $32 is paid for by private insurance, he said.

More than 41 million Americans don't have health insurance, he said. Of those who are insured, one in three will lose all their financial assets during illness.

"To me it is an enormous impact on quality of life. The burden of dying in the U.S. of cancer is much heavier than the burden ... in Canada."

Bruera's remarks come as the federal and provincial governments work to come to grips with a Supreme Court of Canada decision in a Quebec case earlier this year which approved some uses of private health insurance.

Since the ruling, provinces such as Alberta have been actively considering expanding the use of private health insurance.

The province is expected to announce by the end of October which private insurance firm will be chosen to conduct an actuarial study of the pros and cons of such a scheme.

Premier Ralph Klein has said allowing private insurance firms to sell policies would benefit Albertans who want to shorten their waiting times for non-emergency medical procedures.

However, the province has yet to define exactly what it means by "non-emergency."

Bruera said he is "100 per cent sure" that private insurance would not improve palliative care.

"In general, services such as palliative care, that is not highly profitable or high tech, are generally not insured very well in the U.S.," he said.

"If you privatize parts of the system, the juicy parts, the ones that are more profitable, will be taken by the private insurers. The most costly and less rewarding will be left for the government services."
© Canadian Press 2005

The US at the same time spends more percapita on healthcare than any other western country, a whopping 15% of GDP and by 2010 that figure is expected to rise to 17%.
Canada's is 10% and France is 8%.
The difference is that in the US all the money goes to thehealthcare providers as in middlemen. It keeps those dollars coming in so they can bribe both the Republicans and Democrats depending on who is in power.

The US at the same time spends more percapita on healthcare than any other western country, a whopping 15% of GDP and by 2010 that figure is expected to rise to 17%.
Canada's is 10% and France is 8%.
The difference is that in the US all the money goes to thehealthcare providers as in middlemen. It keeps those dollars coming in so they can bribe both the Republicans and Democrats depending on who is in power.

..So they can convince them to not pass laws restricting health care costs so they can continue to get money. Amazing!

Canada's is 10% and France is 8%.

But why is it that France can spend less than us, but still have the #1 system in the world, with it's public-private system, while Canada with it's public system is number 20-32 depending on the report/rating.

But why is it that France can spend less than us, but still have the #1 system in the world, with it's public-private system, while Canada with it's public system is number 20-32 depending on the report/rating.It is possible that Canadians are simply sicker on the whole than the french. Perhaps we have less lung cancers but certainly more obesity related illnesses.

If everyone in the country ate a proper diet (which I don't) and got regular exercise (which I don't) then we would probably be able to cut a significant portion of our healthcare spending after a few years.

/\ Yeah seriously.
People have so many heart problems here, blood problems, ect...
go to Europe and try and find HALF of those problems.

ever heard of the book "French Women Don't Get Fat"? lol
Canadian chicks are a healthy size =) healthy.. not hearty... well most.

Once again another article that compares the US system to Canada. This is a ridiculous comparison as most reasonable Canadians would want nothing to do with a US style private healthcare. If any comparison should be made, it should be with Western Europe who have managed to succesfully integrate private healthcare with a high quality public healthcare.

Having lived on both sides of the border, I totally agree with the article.

I get irritated when I hear Canadians (typically influenced by the media, most of it fed by healthcare workers on BOTH sides of the ideological divide between "socialized medicine" versus US-style third-party payer systems -- the former group wanting to pressure the government to increase funding while the latter group wanting to introduce for-profit insurance and for-profit medical centers and doctors wanting greater pay like their US counterparts) when they whine about the deteriorating healthcare quality or bitch endlessly about the several hundred bucks they now have to pay in Ontario per year or long emergency line-ups.

Canadians have no f*cking idea how good they've got it right now. If they think it is bad here, just try going basically ANYWHERE else.

The American system is well-known a dysfunctional disaster (costs lots of money as % GDP but poor coverage, universality, etc. that directly translates to lower life expectancy and higher infant mortality rates, etc.) -- basically, if you're rich, then it is the best medicine in the entire world; if you are anyone else with less dough or your typical coverage, it can a miserable experience. Regardless of your ideological leanings, there is no way to defend that system because of its poor cost-performance ratio. But the quality of care and the cost that you get in say England or Australia (never mind what you get in say, China or Brazil) is also far inferior and costs more than what you will get in Canada.

As the article mentioned, US private insurance doesn't cover everything -- many policies limit you to $1M or so of maximum payout. Say if you are 30-something and you somehow ended up needing dialysis for the rest of your life (one of the most expensive chronic treatments ever), I hope you are rich, or you are totally screwed.

I have seen 50-something cardiologists with US$300K salaries and a $1M house go bankrupt when the wife got into a long bout of cancer.

However, that said, Canadian healthcare needs much improvement. There is quite a bit of wastage, some amount of corruption amongst doctors and administrators, archaic and inefficient management practices, and an out-of-control bureaucracy (not all of it the fault of the hospitals or the government though they definitely add to it -- it has more to do with the structure of the profession that needs some thorough re-thinking, particularly the different associations (unions) that represent and control each discipline such as surgeons verus nurses versus family doctors and the siloed organizations that arise). At the same time, many very dedicated people (nurses, administrators, interns) are being overworked, underpaid and practically abused -- more symptoms of a dysfunctional system.

We need to demand accountability. The federal government is trying to gather statistics on the effectiveness of their dollars spent -- they've been steadily improving but it is nowhere near adequate (meaning enough to drive changes of behaviour towards efficiency). The reporting and statistics currently are wholly inadequate, cannot be benchmarked and have lots of holes in them. The government (in Ontario) just gets one big lump sum amount the hospital spent -- with no detailed breakdowns on what was spent where. I remember seeing a federal report from a few years back where 9 of the 10 provinces reported back (albeit pretty lame) while Quebec had the nerve to issue a statement saying that they are only responsible to the people of Quebec and do not have to participate. This point was not to focus on Quebec -- we in Canada know how rocky that relationship was going -- but rather it goes to show the lack of federal teeth in demanding accountability for the transfer payments and the dollars spent that should have been an integral part of the Canada Health Act (and the provinces should do likewise).

Many things are overspent (overall staff numbers, certain equipment and supplies, unnecessary of expensive diagnostics like MRI) while other are underspent (information technology, wages of certain categories of staff).

As for the Emergency Room waits (I've had some experiences in those), both the patients and the hospitals are at fault.

There are many people in ERs that shouldn't be there -- they had a slight fever / cough, or rash, or other common symptoms that do not warrant ER care -- you won't die from it, it may just be uncomfortable for a few days, in fact, it might just entirely heal in less than 24 hours. So I wish that the government sets up more 24 hour drop-in clinics, really push telemedicine / Internet so that the public can get answers (many end up in ER because their family doctor's offices are closed) and use those relatively inexpensive but qualifed resources and free up the incredibly expensive ER rooms for true emergencies like heart attacks or serious car accidents or broken bones that should be set quickly to avoid permanent damage. The government steps (at least in Ontario) are lame and inadequate -- the need to get serious and throw real competent people and resources behind it.

That said, the ER operating procedures date pretty much back to some 1920s organization. The flow of information and procedures between the triage nurse, the diagnostic labs, and finally the ER doctor lack a lot to be desired -- that is why things are so slow and take hours and waste lots of resources. Another inexcusable step is to make the ambulance crew wait, in some cases for 5 hours, until the hospital has formally "accepted" the patient. This is total nonsense -- if the hospital can't determine in 10 minutes whether the patient has serious enough injuries and whether the hospital has sufficient resources to successfuly treat the patient or whether he should be shunted off somewhere else quickly, then hospital has a serious problem.

And we need to refrain from the perverse incentives such as keeping patients in recover wards longer when they aren't full so that utilization looks high and over capacity in order to induce the government to provide more budgets.

We need to keep these bureaucratic turf wars and Alice-in-Wonderland accountability under firm control of the public to make the system better.

At the same time, any Canadians who don't appreciate how lucky we are to have this sort of arrangement (foresights of some leaders + generally good social consensus + sufficient wealth of the country) to afford this -- I would unabashedly give them a taste of their own medicine and charge them as in the US where private insurance would cost $12000 per year for your average family of 4 where the median income is $33000 (as in Colorado) or having to pay $7000 for a normal child birth out of pocket ($12000 for Cesarian, $20000++ for any more complications).

Once again another article that compares the US system to Canada. This is a ridiculous comparison as most reasonable Canadians would want nothing to do with a US style private healthcare. If any comparison should be made, it should be with Western Europe who have managed to succesfully integrate private healthcare with a high quality public healthcare.

Exactly. Even Ralph Klein has clearly stated that he wants nothing to do with the US-style system (and King Ralph ALWAYS speaks the truth the first time, apologizes later). I find that those who rabidly defend the status-quo on medicare will 90% of the time start harping on the American system, with no thoughts given to the rest of the world. It's just plain stupid.

Interesting take on obesity problem:


U.S. columnist says some Canadians 'prefer to be fat'
Last Updated Wed, 28 Sep 2005 18:12:24 EDT
CBC News

An American writer thinks that government should keep out of Canadian kitchens. And if people feel like eating junk food, they have every right to crack open the chips and pop.

Jacob Sullum, a syndicated columnist and senior editor at Reason, a U.S.-based libertarian magazine spoke during a luncheon sponsored by the Montreal Economic Institute.

"People may very well choose to trade off years of their life, or the possibility of disease or injury, in exchange for the current pleasure, excitement, or stress relief they get (from food)," said Sullum.

"It's not for the government to say that's not a legitimate trade-off to make. Canadians need to question the idea that just because something implicates health that government intervention is justified."

Faced with a so-called obesity epidemic -- eight per cent of children and 23 per cent of adults were obese in 2004, according to Statistics Canada -- provincial governments are pursuing policies to limit the availability of junk food.

In July, the province's health promotion minister vowed to target obesity as aggressively as tobacco through a number of initiatives. "Fat is the new tobacco," Jim Watson said in making the announcement.

Ontario recently banned junk food from school vending machines, and British Columbia is considering doing the same. In Quebec, politicians are considering a junk food tax that would send a "healthy message" to citizens while helping fund athletic programs.

In Britain, a sweeping ban on junk food in the nation's schools-- including chocolate bars -- was announced Wednesday.

Sullum believes that while governments have every right to protect the public against health risks posed by communicable diseases and pollution, they have no authority to tell people what to eat.

"You're talking about protecting people from their own decisions," Sullum said. "What you put in your mouth and how much exercise you get, that's pretty personal."

But for Toronto-area dietitian Lynn Roblin, government-directed eating guidelines are key to a healthy society.

"Whatever government you're talking about, whether it's provincial or federal, they do have a role in promoting healthy lifestyles, definitely," Roblin said. Skyrocketing health costs are among the possible results of government inaction on healthy eating, she added.

While Sullum doesn't deny that North Americans are fatter now then they were 20 years ago, he maintains government policy aimed at restricting eating habits is not the answer.

"For some people the solution is, they prefer to be fat," he said. "That's their choice and they should be permitted to make it."

Millions of Canadians going without needed health care because of cost: report

DENNIS BUECKERT Wed Sep 28, 7:44 PM ET

OTTAWA (CP) - Millions of Canadians have been going without needed health care because of the cost, suggests a report by the Canadian Institute for Health Information.

The report says 17 per cent of Canadians questioned in a 2004 survey went without care in the previous year for financial reasons, compared with only nine per cent of those surveyed in the United Kingdom.

But the proportion of Americans who went without care was much higher at 40 per cent, according to the CIHI study, which brings together data from a variety of sources.

The study highlights the gaps in Canada's publicly funded health system, which is essentially limited to services provided by doctors or hospitals.

Not covered are most prescription drugs, dental work, vision care, home care, psychiatric services, addictions treatment or accommodation in nursing homes and other institutions.

Canadians paid about $17 billion from their own pockets for such services in 2002, an increase of almost 28 per cent from 1998, says the report.

Another $22 billion came from other non-public sources, mainly private health insurance plans.

Most of the out-of-pocket spending went to dental care ($3.4 billion), prescribed drugs ($2.9 billion) nursing homes and other institutions ($3 billion) and vision care ($2 billion).

Overall, governments cover about 70 per cent of total health spending in Canada, a smaller share than in the United Kingdom, France, Germany and Sweden.

The study notes that there has been strong pressure to shift more costs to the private sector. That trend is expected to get a boost from the recent Supreme Court of Canada ruling clearing the way for private health insurance of medically necessary services in Quebec.

Last year's federal-provincial health accord included commitments to expand medicare to cover home care and catastrophic drug costs, but so far there is little sign of progress in those areas.

"If Canada really wants to honour the principle of covering medically necessary care we need to act," said Jeremiah Hurley, an economist at McMaster University in Hamilton.

Hurley said he was struck by the wide variations from province to province in the menu of drugs and services that are covered. Even an indispensible drug like insulin is not covered in some provinces.

The average household spent $268 on prescription drugs in 2003, ranging from $200 in Ontario to $427 in Prince Edward Island, says the study.

***

It's interesting to note that government spending in healthcare in Canada percentage wise is lower than Sweden, UK, France and Germany.

Once again another article that compares the US system to Canada. This is a ridiculous comparison as most reasonable Canadians would want nothing to do with a US style private healthcare. If any comparison should be made, it should be with Western Europe who have managed to succesfully integrate private healthcare with a high quality public healthcare.

It's mainly due to the fact that his wealth of experience is shared between his time in Edmonton and Texas.

Canadians support single benchmark for health: poll

By GLORIA GALLOWAY

Thursday, October 6, 2005 Posted at 12:06 PM EDT

Globe and Mail Update

Canada's doctors say Canadians want national performance goals for medicare and a federal fund to cover travel costs for patients and their families when treatment is not locally available.

In an impassioned speech Thursday to the Empire Club of Canada in Toronto, Dr. Ruth Collins-Nakai, the new president of the Canadian Medical Association, said Canada's health care system is falling far behind that in other developed countries.

“We are no longer what we once were. We are certainly no longer what we could be, and should be,” said Dr. Collins-Nakai, an Edmonton cardiologist.

“Did you know our infant mortality rates are rising, not falling, in relative and absolute terms? We have tumbled from our top-five ranking in the 1980s -- to where we are today. In the 22 spot out of 27 OECD countries.”

A report this week by the Ontario Medical Association found Canadians have the highest pre-school obesity rate in the world, an aboriginal teenager has a greater chance of committing suicide than going to university, and nearly four million people in this country cannot find a family physician, she said.

“If you look at physician-to-patient ratios around the industrialized world, we rank way back -- a dismal number 26th out of 30 countries,” said Dr. Collins Nakai. “It is shocking. It is appalling. It is simply unacceptable.”

Canadians, she said, say health care is their No. 1 priority -- “not Gomery [sponsorship inquiry], not federal-provincial rows, not the environment, not even security” -- but politicians haven't heard the wake-up call.

Her association conducted a poll last week that suggests eight out of 10 Canadians want national performance goals to be established and a similar number want a new federal fund to cover the cost of patients and their families who have to travel to get timely access to needed health care services.

Federal, provincial and territorial leaders agreed a year ago to establish national benchmarks for health care in exchange for $41-billion in additional federal funding over 10 years. Each jurisdiction must set medically acceptable waiting times for cancer treatment, heart treatment, diagnostics imaging, joint replacement and sight restoration by Dec. 31.

But the medical community says it has been largely left out of the consultations being conducted to establish those wait times and doctors and nurses fear that each province will set wildly varying targets, creating a patchwork of care across Canada.

A report listing reasonable wait times that was released in August by the Wait Times Alliance, a group of national organizations representing specialist doctors, has been ignored by politicians and health-care professionals have been “frozen out” of a meeting of federal and provincial health ministers that will take place later this month, said Dr. Collins-Nakai.

Federal Health Minister Ujjal Dosanjh has warned that voters will punish those jurisdictions that fall short.

And some provinces are moving ahead. Ontario, for instance, announced this week that it would be putting an additional $39-million into its health-care system to fund another 42,000 procedures as part of its wait-times strategy.

But Dr. Collin-Nakai said political leaders are still not doing enough. She is urging Canadians to call or write their federal or provincial member of parliament to express their concerns.

“Canadians are getting tired of waiting for the health services they pay for. Some of them are getting sicker as they wait,” she said.

“Governments, both federal and provincial have said that they take wait times seriously. They are not taking them seriously enough.”