Architect of Canadian health care system wants private health care

Published

Canadian Health Care We So Envy Lies In Ruins, Its Architect Admits

By DAVID GRATZER | Posted Wednesday, June 25, 2008 4:30 PM PT

As this presidential campaign continues, the candidates' comments about health care will continue to include stories of their own experiences and anecdotes of people across the country: the uninsured woman in Ohio, the diabetic in Detroit, the overworked doctor in Orlando, to name a few.

But no one will mention Claude Castonguay-perhaps not surprising because this statesman isn't an American and hasn't held office in over three decades.

Castonguay's evolving view of Canadian health care, however, should weigh heavily on how the candidates think about the issue in this country.

Back in the 1960s, Castonguay chaired a Canadian government committee studying health reform and recommended that his home province of Quebec-then the largest and most affluent in the country-adopt government-administered health care, covering all citizens through tax levies.

The government followed his advice, leading to his modern-day moniker: "the father of Quebec medicare." Even this title seems modest; Castonguay's work triggered a domino effect across the country, until eventually his ideas were implemented from coast to coast.

Four decades later, as the chairman of a government committee reviewing Quebec health care this year, Castonguay concluded that the system is in "crisis."

"We thought we could resolve the system's problems by rationing services or injecting massive amounts of new money into it," says Castonguay. But now he prescribes a radical overhaul: "We are proposing to give a greater role to the private sector so that people can exercise freedom of choice."

Castonguay advocates contracting out services to the private sector, going so far as suggesting that public hospitals rent space during off-hours to entrepreneurial doctors. He supports co-pays for patients who want to see physicians. Castonguay, the man who championed public health insurance in Canada, now urges for the legalization of private health insurance.

In America, these ideas may not sound shocking. But in Canada, where the private sector has been shunned for decades, these are extraordinary views, especially coming from Castonguay. It's as if John Maynard Keynes, resting on his British death bed in 1946, had declared that his faith in government interventionism was misplaced.

What would drive a man like Castonguay to reconsider his long-held beliefs? Try a health care system so overburdened that hundreds of thousands in need of medical attention wait for care, any care; a system where people in towns like Norwalk, Ontario, participate in lotteries to win appointments with the local family doctor.

Years ago, Canadians touted their health care system as the best in the world; today, Canadian health care stands in ruinous shape.

Sick with ovarian cancer, Sylvia de Vires, an Ontario woman afflicted with a 13-inch, fluid-filled tumor weighing 40 pounds, was unable to get timely care in Canada. She crossed the American border to Pontiac, Mich., where a surgeon removed the tumor, estimating she could not have lived longer than a few weeks more.

The Canadian government pays for U.S. medical care in some circumstances, but it declined to do so in de Vires' case for a bureaucratically perfect, but inhumane, reason: She hadn't properly filled out a form. At death's door, de Vires should have done her paperwork better.

De Vires is far from unusual in seeking medical treatment in the U.S. Even Canadian government officials send patients across the border, increasingly looking to American medicine to deal with their overload of patients and chronic shortage of care.

Since the spring of 2006, Ontario's government has sent at least 164 patients to New York and Michigan for neurosurgery emergencies-defined by the Globe and Mail newspaper as "broken necks, burst aneurysms and other types of bleeding in or around the brain." Other provinces have followed Ontario's example.

Canada isn't the only country facing a government health care crisis. Britain's system, once the postwar inspiration for many Western countries, is similarly plagued. Both countries trail the U.S. in five-year cancer survival rates, transplantation outcomes and other measures.

The problem is that government bureaucrats simply can't centrally plan their way to better health care.

A typical example: The Ministry of Health declared that British patients should get ER care within four hours. The result? At some hospitals, seriously ill patients are kept in ambulances for hours so as not to run afoul of the regulation; at other hospitals, patients are admitted to inappropriate wards.

Declarations can't solve staffing shortages and the other rationing of care that occurs in government-run systems.

Polls show Americans are desperately unhappy with their system and a government solution grows in popularity. Neither Sen. Obama nor Sen. McCain is explicitly pushing for single-payer health care, as the Canadian system is known in America.

"I happen to be a proponent of a single-payer health care program," Obama said back in the 1990s. Last year, Obama told the New Yorker that "if you're starting from scratch, then a single-payer system probably makes sense."

As for the Republicans, simply criticizing Democratic health care proposals will not suffice-it's not 1994 anymore. And, while McCain's health care proposals hold promise of putting families in charge of their health care and perhaps even taming costs, McCain, at least so far, doesn't seem terribly interested in discussing health care on the campaign trail.

However the candidates choose to proceed, Americans should know that one of the founding fathers of Canada's government-run health care system has turned against his own creation. If Claude Castonguay is abandoning ship, why should Americans bother climbing on board?

Gratzer is a senior fellow at the Manhattan Institute and a physician licensed in both the U.S. and Canada, where he received his medical training. His newest book, "The Cure: How Capitalism Can Save American Health Care," is now available in paperback.

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Specializes in Critical care, tele, Medical-Surgical.

Do you have a link to this post?

I was under the impression that to Canadians Tommy Douglas is Canada's 'Father of Medicare'.

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The article excerpt posted doesn't say he supports dismantling the Canadian system and going to a US-style, laissez-faire, private market system, just that he wants to see some private insurance and private provider services added into the mix -- which is exactly what is being discussed for the US (a private/public mix). So, Castonguay is really advocating for the proposed US reform.

Despite the Manhattan Institute being yet another right-wing orgaization cranking out the right-wing propoganda :yawn:, I agree with him -- I would be delighted to see a primarily public US healthcare system, with private insurance available for those who really feel the need to get ripped off by the for-profit insurance companies. Let's follow Castonguay's excellent advice!

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Do you have a link to this post?

I was under the impression that to Canadians Tommy Douglas is Canada's 'Father of Medicare'.

I thought so too.

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The article excerpt posted doesn't say he supports dismantling the Canadian system and going to a US-style, laissez-faire, private market system, just that he wants to see some private insurance and private provider services added into the mix -- which is exactly what is being discussed for the US (a private/public mix). So, Castonguay is really advocating for the proposed US reform.

Despite the Manhattan Institute being yet another right-wing orgaization cranking out the right-wing propoganda :yawn:, I agree with him -- I would be delighted to see a primarily public US healthcare system, with private insurance available for those who really feel the need to get ripped off by the for-profit insurance companies. Let's follow Castonguay's excellent advice!

The writer of that piece, David Grazter, has a history of distorting opinions to suit his own political agenda. Mediamatters reported on how an op-ed piece of his falsely suggested that Canadian orthopedic surgeon Dr. Brian Day, a former president of the Canadian Medical Association, was in favor of the U.S. health care system. (source)

Also, see my post here on more about Gratzer, plus a funny clip of him squirming while being questioned by Dennis Kucinich during a House HELP hearing.

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The writer of that piece, David Grazter, has a history of distorting opinions to suit his own political agenda. Mediamatters reported on how an op-ed piece of his falsely suggested that Canadian orthopedic surgeon Dr. Brian Day, a former president of the Canadian Medical Association, was in favor of the U.S. health care system. (source)

Also, see my post here on more about Gratzer, plus a funny clip of him squirming while being questioned by Dennis Kucinich during a House HELP hearing.

I'm not surprised. Just seeing that the article was posted on the Manhattan Institute website was enough to discredit it for me. :)

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I'm not surprised. Just seeing that the article was posted on the Manhattan Institute website was enough to discredit it for me. :)

If I quote NPR or MSNBC you'll eat it up, right?

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Specializes in Acute Care, Rehab, Palliative.

I was under the impression that to Canadians Tommy Douglas is Canada's 'Father of Medicare'.

He was.

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Specializes in He who hesitates is probably right....
If I quote NPR or MSNBC you'll eat it up, right?

They will :yeah:.

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Specializes in ER OR LTC Code Blue Trauma Dog.

The problem with that "news" item is that it's not giving you the big picture of the Canadian health care "crisis" they are attempting to paint in the article.

Firstly, the main issue isn't "health care" - it's access to doctors... There are simply not enough of them per capita to serve the population. The reason behind this (the article neglects to mention) is because many of them have moved to the the United States to practice. They have gone to where the money is.. IE "US Private Insurance Companies Pay Better than Canadian Tax Dollars Do!!" The US can pay doctors better because of the inflated profits of the US privately owned insured health care system when compared to public funded "not for profit" government operated health care system.

So, they are thinking that if they brought "private insurance" into the mix in Canada, then it might serve to retain doctors in Canada and private insurance companies would serve to pay doctors more money than Tax Dollars do. (similar to how it does in the US...) The system they are proposing is called "Two Tiered Health care" It means that those who have "extra money" to pay for private insurance get "faster and more access" to health care services than those who use the universal public health care system. (Something they are also proposing to do here. IE Health care for the rich and health care for the poor system....)

So the fact of the matter is not if these services are available in Canada or not. In fact, the services are already there. It's a matter of who gets access to these services first that's the problem.

It's about more money for doctors and who's willing to pay more money for faster service to see one... It's not about lack of services (other than Canadian doctors enticed to the US system or MRI equipment) otherwise available to Canadians.

They do send URGENT cases into the United States for EMERGENCY treatment when they are unable to provide immediate treatment for whatever reason. Usually it's a lack of available MRI equipment etc.. (US has 100x more MRI's than Canada does - thank you overly inflated private health care profits for making that possible...:) ) But to suggest they don't get treated in Canada is not exactly correct either. They do get treated, stabilized and then they are "triaged" into the U.S. for further or specialized treatment (MRI's ec.) when it's required and especially when all the Canadian MRI equipment is not readily accessible. (Time is usually a major factor with head injuries.. It's just faster to simply send them to a U.S. facility than to wait for an MRI to become locally available. )

Additionally, this is an organized and "planned event" They are not just "sending patients away" to the US because they can't provide Canadians with heathcare. It's just the preferred way they do this. If MRI's were cheaper I suppose they would buy those instead of sending people to existing US facilities. The fact is, it's cheaper to send people (in terms of Canadian tax dollars) to a U.S. MRI equipped facility instead. In Toronto, Ontario, emergency patients are typically flown to the MRI facility located in Buffalo, NY. It's a 15-20 minute flight...

Clearly, any lack of any health care facilities or services is not an issue that could be simply resolved by implementing "private insurance" into the Canadian Health care mix as the final solution to all these so called problems in Canada.

So yes..., there is in fact another side to this story the article isn't really telling you about. For example, the "lotteries" they are talking about don't pertain to people needing actual "REQUIRED" or "URGENT" treatment. It pertains to the idea of people making an appointment for minor issues. (head cold, ingrown toenail kind of thing etc..) Yeah, they are kinda telling people, "If you want to waste our time with this minor crap, then you will have to be part of the lottery system to be seen." THATS exactly what its about... not exactly what the article is conveying...

Private insurance plans in Canada cannot generate more Doctors to serve the public however, it may however "encourage" more to stay. Money talks.

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