Thursday, December 12, 2002
Bangor Daily News

Canadian health care not cure-all

By Michael O’D. Moore

PORTLAND — Canadians may not want America’s health care system, but that doesn’t mean their single-payer model is ideal, a Canadian health care expert told about 140 people at a health care conference here Wednesday.

Canada’s system has serious flaws and, like the U.S. health care system, doesn’t place high in comparison to other industrialized societies. Canada is ranked 30th and the United States 38th by the World Health Organization, said Brian Lee Crowley, president of the Atlantic Institute for Market Studies in Halifax, Nova Scotia.

“Both Canada and the United States are only middling programs,” Crowley said. “We both have much to learn from other places.”

Crowley said France, which has both public and private systems providing health care, offers some lessons for those looking to reform. The WHO rates France as having the best health care system in the world.

He spoke at a conference organized by the Maine Public Policy Institute, a conservative organization formed in January.

Four speakers tackled a variety of health care topics Wednesday. MPPI chairwoman Betsy P. Chapman said the idea was to lay out some new alternatives aimed at giving individuals more choice and doctors more authority. The goal is real change, not the shifting of who pays for care, she said.

Crowley, an MPPI board member, has been doing an analysis of what needs to be done to the Canadian system.

A Maine commission created by the Legislature and the governor currently is investigating the costs of moving Maine to a Canadian-style, single-payer system that would eliminate private insurance.

Crowley believes Americans believe many myths about the Canadian system.

The system as it is now organized is not sustainable, he said. He said he reads national studies that indicate Canadians want to maintain existing services without increasing taxes and without reducing care provided to the poor.

Crowley said that when the system was put in place 30 years ago, there was a spike in use of health care. Afterward, the costs did go down, but eventually the increases began tracking with the American system. So even if money is thrown at the system, health care inflation will overtake it shortly, he said.

“The Canadian health care system is a black hole into which we can seemingly pour endless amounts of money,” he said.

Crowley complains that since the government runs the whole system, it is difficult for individuals to have any clout in demanding that they be seen promptly or treated courteously.

He gave the example of a business partner who had left work for an appointment that ran four hours late. She had parked in a two-hour limit spot but had no idea when she would be seen or even if she could go out to move her car without losing her spot in line.

When she asked when she could expect to be seen after her four-hour wait a receptionist said, “You are talking as if you are some sort of customer,” Crowley recounted.

“You are totally disempowered,” he said. No one’s well-being in the Canadian health care [arena] is dependent on people being well-treated, he added.

Crowley was asked about the increase in Americans buying prescription drugs in Canada, where retail prices are lower through government regulation. He said drugs are cheaper in Canada in part because Canadians are somewhat poorer on average than Americans. He believes Canadians are getting a free ride by getting drugs whose development is funded largely by the markup in the United States.

Should the number of people crossing the border for drugs begin to draw off sales in the United States, he said, he’d expect a reaction because it would undermine new drug research.

Contrary to the assumptions of many, some services in Canada aren’t covered all the time by the system. These include drugs, dentist visits, home care and chiropractic services, he said.

Still, Crowley said he thinks the Canadian system is “superior to the U.S. system in many respects,” but he added there is a lot to learn from countries such as France, Sweden, Norway and Holland, which all rank higher in the results of health care and have some innovative ideas.