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http://www.baltimoresun.com/news/opinion/bal-op.chapman20jun20,1,831465.story?
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Don't believe hype about Canadian health care model


By Steve Chapman

June 20, 2005

CHICAGO - To critics of the American health care system, Shangri-La is not a
fantasy but a shimmering reality, though it goes by another name: Canada.

Recently, the Canadian Supreme Court, ruling on a challenge to the health care
system in the province of Quebec, sent a clear message south: Don't believe the
hype.

The health care program, said the court, has such serious flaws that it is
violating constitutional rights and must be fundamentally changed. And the
flaws are part of the basic structure of Canada's health care policy.

The dirty secret of the system is that universal access is no guarantee of
treatment. Sick Canadians spend months and even years on waiting lists for
surgery and other procedures.

In 1993, the average wait to see a specialist after getting a doctor's referral
was nine weeks. Since then, according to the Fraser Institute of Vancouver, it
has increased to 18 weeks.

The typical patient needing orthopedic surgery has time to get pregnant and
deliver a baby before being called. The Supreme Court cited the testimony of
one orthopedic surgeon that 95 percent of patients in Canada waited over a year
for knee replacements - with many of them in limbo for two years. In some
cases, the delay lasts longer than the person enduring it. Or as the Supreme
Court put it: "Patients die as a result of waiting lists for public health
care."

Not only does the government subject its citizens to painful and even fatal
delays in the public system, it bars them from seeking alternatives in the
private market. You see, it's illegal for private insurers to pay for services
covered by the public system.

That policy is what forced the Supreme Court to order changes. "The prohibition
on obtaining private health insurance," it declared, "is not constitutional
where the public system fails to deliver reasonable services."

The program has created a gap between supply and demand that is wider than
Hudson Bay. Its failings, however, go beyond that. The single-payer approach,
for example, is often held up as the only way to simultaneously control costs
and deliver quality care. In fact, Canada has somehow managed to do neither.

After adjusting for the age of the population, the Fraser Institute compared 27
countries in the Organization for Economic Cooperation and Development that
guarantee universal access to health care. By some mysterious alchemy, Canada
has proportionately fewer physicians than most of these nations but spends more
on health care than any except Iceland.

It would be a dubious feat to control costs only by depriving people of
treatment. But to forcibly deprive people of treatment while letting costs
surge is no achievement at all.

Admirers of our good neighbor to the north say the United States pours money
into all sorts of fancy equipment but doesn't get better results by such
measures as life expectancy. But life expectancy is affected by multiple
factors, including education, crime rates and diet - with health care playing
only a modest role. In those areas where modern medicine can make a big
difference, the United States does very well.

Take breast cancer. In Britain, which is famous for its socialized system,
close to half of all victims die of the disease, according to a recent Cato
Institute study by John Goodman, head of the National Center for Policy
Analysis. In Germany and France, almost one-third do. In Canada, the figure is
28 percent - and here, it's 25 percent. Our mortality rate for prostate cancer
is 67 percent lower than Britain's and 24 percent lower than Canada's.

The usual story we hear is that the health care system next-door provides
first-rate care to all, at low cost. The realities - dangerous delays, bloated
expenditures and mediocre results - are not so appealing. American liberals may
not welcome evidence that the single-payer model works far better in theory
than in practice. But for that, they can blame Canada.

Steve Chapman is a columnist for the Chicago Tribune, a Tribune Publishing
newspaper. His column appears Mondays and Wednesdays in The Sun.

Copyright + 2005, The Baltimore Sun

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