Content-type: text/html ~ Stephen's Web ~ Bus to Canada

Stephen Downes

Knowledge, Learning, Community

Apr 21, 2000

The commercial pulled me from a sleepy Friday morning as I lay on the couch watching some news show on ABC.

"Have you heard about the seniors who come from Canada to the U.S.?" the announcer asked.

Sure, I thought dreamily. They're called SnowBirds and they travel to Florida each winter because it's cold in Canada.

"Canadian seniors coming to the United States for better treatment," the commerical continued. "The story is not just about prices - it is also about government controls."

I raised myself on one elbow and watched the remainder of the commercial message.

Canadian seniors, the ad continued, face:

  • Restricted access to newer and more innovative medicines.

  • Rationed health care services that keep government costs down.

  • Long lines for life-saving treatments.

  • Long waits for cancer treatments.

Now just a minute here...

The website - - flashed by and then the Disney News continued.

Now I can recall a few years ago, when I lived in Manitoba, stories about some seniors from Winnipeg hiring a bus to buy cheaper drugs in Minnesota.

This ocurred as the Canadian dollar fell sharply against the U.S. currency. Imports of all kinds increased in cost, including imported drugs.

But such actions are the exception. There is no groundswell of public opinion against Medicare here in Canada. Quite the opposite.

Last Sunday - five days ago, in fact, I and about six thousand Edmonton citizens took part in a rally in support of our health care system.

The protests - which have continued throughout the week at the Alberta Legislature - are against the government's proposed Bill 11, misleadingly titled "Alberta's Health Care Protection Act".

The "Bus to Canada" advertisement was sponsored by an American organization called Citizens for Better Medicare.

Like most terminology in the debate, the organization's name is misleading, for it is actually a coalition of insurance companies, pharmaceutical research companies, chambers of commerce and other industry groups.

Their philosophy, collectively, is reflected by one of their members, America's Future Foundation, "in support of free markets, moral virtue, limited government, personal responsibility, world leadership, and technological progress."

It is not surprising, then, to see their opposition to a Canadian health care program being imported into the United States. But if they think they can base their campaign on Canadian opposition to the system, they had better think again.

Even Alberta's Conservative government - which is trying to edge toward a private health care system - acknowledges that public health care is regarded as untouchable by Canadians.

Opening the debate on Bill 11, Alberta's premier Ralph Klein declared that "there is no reason; there is no motive, no rationale under the sun that could explain why my colleagues and I would set out to destroy the Alberta health care system. We all need it."

He continued, "Nothing could be clearer: a commitment to a single-tier, publicly funded system in which access is based on medical need and not personal wealth; a commitment to banning private, for-profit hospitals; a commitment to banning private hospitals - that's clear in the bill."

The opposition to Alberta's Bill 11 is rooted in the concern that Alberta's government does not go far enough in its support of public medicare.

Alberta's Friends of Medicare argues in a brief, "The title of Bill 11, Health Care Protection Act, is perverse. This Bill is deceptive and misleading. It pretends to ban private hospitals, but in reality it enshrines them in law."

Support for Canada's health care system is not limited to public advocacy groups. Poll after poll reaffirms Canadians' support for the health care system. Manitoba's Conservative government was defeated largely over its attempts to reduce health care spending.

Canada's health care system, far from driving people out of the country, attracts people into it.

Why do Canadians so enthusiatically support their Medicare programs? Why are Canadians so concerned about the Klein government's move toward an American style private health care system?

First, a private health care system is more expensive to run. Staff savings are minimal, yet private hospitals incur extra costs, such as advertising expenses, duplication of equipment and services, administrative costs created by multiple payers with many different payment plans, and the need to provide dividends to their shareholders.

Second, the evidence shows that on a per capita basis, private health care is more expensive than public health care. On a per capita basis, Americans spend almost twice what Canadians spend on health care.

Third, the evidence shows that the introduction of private care facilities has an impact on the quality of public care facilities. Private facilities tend to 'cherry-pick' the easiest and most profitable cases for treatment, leaving the public system to deal with more expensive cases.

Fourth, because a private system is based on the ability to pay, a significant number of people are unable to afford health care insurance. Canadians say with pride that every Canadian has access to health care, while Americans must live with the fact that 48 million of their citizens are uninsured.

Fifth, a private health care system destroys the relation of trust between physician and patient. A person being wheeled into the emergency room is not in a position to negiotiate a fair exchange for services; the expectation that he or she might be pressured to purchase "enhanced services" contradicts the necessary and complete trust required in such a situation.

Sixth, health care in private facilities tends to be poorer and mortality rates are higher. For example, American kidney patients remain on dialysis longer than Canadian kidney patients, because dialysis is more profitable in the long run, but with an increased mortality rate for American patients. Where profits conflict with quality care, in private institutions, profits carry the day.

For me, the advantage of Canadian health care was driven home in a personal manner while watching my father in law, who is an American citizen livin in Calfornia, struggle with his health care insurance provider. Right befor Christmas, his insurance company declared it would no longer insure people living in his county.

For days I watched him on the telephone trying to negotiate with insurance companies to obtain coverage. Because of his age, and because he lives in a rural area, he is not what insurance companies would consider profitable. Far easier to insure young, urban - and healthy - professionals.

Contrast that with my own experience. When I moved to Manitoba, I had to obtain coverage under the Manitoba system (health care is a provincial responsibility in Canada). I filled out a form, showed some identification, and was given a health care card. Done.

When I needed medical services a couple of years later, I produced my card at the hospital and was admitted immediately. For continued care I was given a list of every general practitioner in the city and told I could choose one. If specialized care was required, the GP would give me a list of specialists.

For this I pay - through my taxes - less than half what an American pays through taxes and insurance premiums.

So I wonder: why do organizations, like Citizens for Better Medicare, fight so hard against a Canadian system in the United States?

Their main point is that government "controls" health care in Canada. But what they do not point out is that the government controls rates and fee structures, not the practise of health care itself.

Look at the allegations in more detail.

Canadians, say the Citizens for Better Medicare, face "Restricted access to newer and more innovative medicines." Not true. Canadian approval of new treatments generally follows FDA approval within a few weeks, and once approved, treatments are available to all Canadians.

Canadians, say the Citizens for Better Medicare, must deal with "rationed health care services that keep government costs down." Not true. There is no system of rationing in Canada. Quite the opposite - health care is provided on a first-come first-served basis.

Canadians, say the Citizens for Better Medicare, face "long lines for life-saving treatments." From my own experience watching patients come into the emergency room at several Canadian hospitals, I can say that this is not true. Emergency patients, in fact, bypass any lines at the hospital, proceeding immediately to treatment; the people who must wait are non-emergency patients, no matter how rich they are.

Canadians, say the Citizens for Better Medicare, face "long waits for cancer treatments." This varies and is true in some instances; it really depends on the facility and the funding provided. One criticism of the Klein government is that, as part of its push toward private medicine, it has cut funding in order to create long lines.

The Citizens for Better Medicare also argues that the Canadian government opposes medical research, saying, "Canada's government controls also discourage pharmaceutical investment, resulting in little drug discovery and development."

Working across the street from a major research hospital as I do, I find this a fascinating - yet blatently untrue - statement. And Canadian news reports home-grown medical discoveries on an almost weekly basis - such as diabetes research and development, genetic research, viral research, or work in Hodgkin's disease - and that was just May-June, 1999.

It is fascinating to read the Citizens for Better Medicare's list of horror stories:

"Seniors denied drug treatments as government puts costs and budget concerns ahead of patients." - let me ask, are there any Americans, do you suppose, who are denied treatments because of costs? Obviously - about 48 million of them.

"Patient dies waiting for cardiac surgery." - a patient dies while waiting for a bed to become available. Do you suppose that, under the American system, any cardiac patients die while waiting for surgury? Or because they cannot afford surgury?

"Woman with brain tumor has biopsy delayed for over a month, dies." The delay was for six weeks, caused again because facilities were not available. Do you suppose any Americans die because they are unable to afford expensive medical tests?

What should be remarkable - but is unremarked - is that Citizens for Better Medicine's list of horror stories are all gleaned from Canadian news reports. Such incidents are sufficiently rare that, when they happen, they become news! Yet - I would contend, such events are so comon on a day-to-day basis under the American system that their occurrence no longer surprises anyone.

The Citizen's for Better Medicare's advertising campaign is a fraudulant sham filled with inaccuracies and misrepresentations.

Americans are free to select whatever health care system they wish, however inequitable and inefficient. However their depiction of Canada's system as an Orwellian nightmare does a disservice both to Americans looking for something better and to the many thousands of Canadians whose lives have been saved by public health care.

Indeed, as a Canadian, I resent the attempts by American companies and organizations to try to destroy our system.

True, the Canadian system serves as a shining example of what Americans could have, and so it is not surprising to see private health corporations in the U.S. serve their own interests by trying to dismantle and discredit it.

It's worth a lot to American health care companies and insurers to prevent a Canadian style system from emerging in the United States, and even to destroy Canadian medicare. It's worth billions, which is why they lobby so hard. But these billions do not come out of thin air - these billions come from the millions of people who pay unreasonable and even outrageous costs for health care.

But despite the organized attempts by lobby groups and even the conservative Canadian press to discredit our system, no Canadian who has experienced American-style health care even once has a desire to return to that medieval system.

Even minor amendments to Canadian health care legislation have led to riots in the streets of Edmonton. No government could survive a more persistent effort to privatize health care, and serveral governments have fallen for their attempts to do so.

It is perhaps not a coincidence that the Citizens for Better Medicine's advertisements are titled "Bus to Canada" - for that is the direction that seniors, seeking better health care, would surely be headed.

Stephen Downes Stephen Downes, Casselman, Canada

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