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    Thursday, September 23, 2004

    Tales from the North Country: A Canadian reader, and frequent contributor of ideas to this site, on healthcare in Canada:

    Canada has an enviable record of providing universal, quality health
    care at a reasonable price for the last half a century. But, as in
    every other country, our health care system is facing several strains:

    Soaring health care costs, driven by astronomical salaries paid to senior medical practitioners by competing private health-care providers in the US

    Disproportionally high usage of the health care system by Canada's
    exploding immigrant population

    Ageing population needing more health services

    The answer of US-worshipping Canadian neocons is two-tier health care. Why, cries John Tory, the new leader of the hapless Ontario Conservative party, shouldn't Canadians have "choice" in their health care services? This is classic conservative re-framing of public debate. "Choice" in health care means choice for those who can afford it, which means doctors who want to make obscene amounts of money
    (including many of the best ones) would work for the higher-paying private-tier system and the rest of us would be stuck with long waits and second-class service, just like we face in every other private sector of the economy.

    Fortunately, and to the chagrin of the Canadian neocons, the vast majority of Canadian's aren't buying this Orwellian deceit. Recent polls say support for a public, single-class health care system is as high as ever.

    So what's a civilized country to do to deal with the three great challenges of 21st century health care bulleted above? I recently listened to a talk show featuring the federal Minister of Health, discussing how these problems should be solved. Caller after caller said the same two things:

    Much of the work done by doctors should be transferred to
    paraprofessionals and to self-diagnosis and self-treatment. Much more
    information, expert systems and self-service equipment needs to be
    provided to enable this. [I spoke to two doctors who said they would
    love to do this, since the majority of the work they do does not
    require a licensed professional to do it competently -- but that the
    lawyers wouldn't let them do it.]

    There needs to be a massive shift in the health care system from
    treatment to preventative care.

    When the moderator asked the Minister whether he had learned anything from these recurring messages, he 'summarized' the discussion by saying that better measurement systems were needed to ensure hospitals wereoperating as efficiently as possible, and that the government was looking into ways to do public-private partnerships without allowing competition or giving up control over pricing and access. The interviewer was incredulous: Had the Minister not heard the two messages that the public had been bombarding him with for the past hour? Of course these things would be considered, he replied, but the first priority was to find ways to increase access without increasing cost. His deafness to these two obvious solutions to the malaise of the system was astonishing.

    What one listener of this talk show said about neoncons' true motivation for wanting two-tier health care was also telling: "The reason rich politicians want a two class system is that they're embarrassed to have to wait in line for health services the same as 'ordinary' Canadians, when their US business colleagues can jump the queue so easily and have their company write off the extra cost as a business expense. They're also embarrassed that, to jump the queue,they have to fly to the US and pay out of their own pocket". So in fact there is a choice for the very rich to jump the queue: Pay for treatment in the private US system.

    Is Canada's health care system the best in the world? Far from it. Health care in Canada's cities is much better than in rural areas. The bureaucracy in much of the system (notably the blood collection system and the 'walk-in' clinics) is suffocating, and needlessly so. And because of its zeal to protect jobs in the system, Canada, which ranks first in the world in per-capita patents of medical technology, ranks forty-first in the world in the use of modern medical technology in its hospitals (MRI equipment is as scarce as gold, for example).

    But it's still an excellent system, and one that a two-class health care system won't improve, at least for 95% of the population. If only the politicians and bureaucrats only had the intelligence and vision to listen to the Wisdom of Crowds and make the two changes (more paraprofessional/self-care, and more prevention instead of treatment) that the public is already starting to make themselves, our system would be the best in the world.

    Oh -- a word about prescription drug costs: You may have heard that
    many Americans come up to Canada to buy prescription drugs much cheaper than they can buy them in the US. Now, US municipal and state governments are fighting for the right to buy their drugs from Canada, too (and Kerry wants them to have this right). The funny thing is, the companies selling them are essentially all the same companies, since the Canadian pharmaceutical industry is dominated by the same handful of global corporations as the US industry. Why do these companies charge more in the US than the rest of the world for the same drugs? Not, as the neocons and the pharma industry are telling Americans, because Canadian drugs are inferior (perhaps, it is implied, dangerously so) -- they are the identical drugs. They sell them for higher prices in the US because they can. Drug companies charge as much as the market will bear, and in the bloated US health care system where if you have enough money you can buy anything, the market will bear a lot. In the rest of the world money available for drugs is much less, so to sell their products pharma companies lower prices by 30, 50, even 70%, and still make a good margin. This is a case where globalization threatens to backfire on some of the corporations that most benefit from it. Couldn't happen to a nice bunch of guys.

    Actually, I thought the prices were so much lower in other countries because their governments force lower prices. They'd rather take the lower prices than do without the market, but, because our government doesn't set prices for drugs, we in the U.S. have to pay the higher cost. If drug importation becomes the norm, you can bet the prices in Canada will go up to meet the prices in the U.S.

    The safety issue isn't because the drugs come from Canada. It's because many people send for them from big warehousing operations whose integrity is unknown. There have been cases of counterfeit drugs being passed on this way. Of course, that can happen with the big mail-order warehouses in the U.S., too, I suppose.

    I wouldn't put so much hope on "self-treatment" and preventive care to reduce costs. Preventive care costs a lot of money, and it doesn't guarantee that more money won't be spent further down the line. Providing colonoscopies for everyone over a certain age will cut down on the number of colon cancers in the future, but those same people will live to have other diseases that can't be entirely prevented- arthritis, emphysema, heart disease, other cancers. And self-treatment? Well, if you treat yourself for the wrong diagnosis, you're going to be a lot sicker than you were to begin with. (I thought Canadians are already allowed to self treat. Aren't antibioitics available without a prescription up there?)

    posted by Sydney on 9/23/2004 01:32:00 PM 0 comments


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