Canada's health care myths

A couple of posts ago, I ended a piece on the Canadian prescription drug market thus: "It will be interesting to see whether any of the major parties adopts a commitment to pharmacare as part of its platform for this year's election. There would seem to be a lot of votes in it."  I think I need to walk that back -- quite a long way back.

The fact is, a national prescription drug plan for Canada may be the right thing to do, and opinion polls may show it has widespread popular support, but that doesn't mean it will be a big vote-getter in this year's Federal election.  Who's going to vote for it?

• Seniors?  They traditionally turn out at the polls in higher numbers than other age cohorts, so their support is crucial. But most seniors already enjoy prescription drug coverage. Some may vote for a national program as a matter of principle but for most, to the extent that it's a pocketbook issue at all, it's a negative one, because taxes will have to go up to cover the additional costs to the public sector (estimated  at $ 1 billion) if a national scheme is adopted. 

• The middle classes?  A high proportion of permanently-employed Canadians, especially those in the public sector, have a health insurance plan, often financed on a co-pay basis with their employer. Those plans include prescription drug benefits.  The insurance companies that underwrite the plans are expected to save big-time if a national pharmacare plan goes into effect, but unless you believe that those reduced costs will be passed onto planholders (and if you do believe that, can I ask if you've met any insurance people lately?), there's no obvious advantage to the middle classes in a national drug plan. In fact, to the extent that a national public plan might well cover a much smaller formulary than private plans do, many people with private insurance might actually feel they would be worse off with a public plan.

• The less well-off?  They would certainly benefit the most from a public drug plan. Many of them can't afford prescription drugs at present, and the tax burden of setting up a public plan would mostly fall on the better-off. But the poor tend not to be politically engaged, so it's hard to imagine them turning out in greater-than-usual numbers to support such a plan.

Not many sure votes for any party that supports pharmacare, then.  But in reconsidering my initial take on this issue, I've been forced to focus on the sad but usually ignored truths about Canada's healthcare system in general: it's not very comprehensive, it's not entirely in the public sector any more, and it's not very good.  

The absence of a prescription drug plan is by no means the only hole in Canada's public health system. To take just one example,  there's no publicly-funded dental care of any kind. Anecdotally, dentists and their fellow-travellers (denturists, endodontists, orthodontists and so on) seem to outnumber family doctors by at least two-to-one in our neck of the woods, which gives you some idea of where the big money is to be made.

As for the system no longer being primarily in the public sector, this is evident in a number of ways:

• Almost all ancillary services (X-rays, bloodwork and such) have been contracted out to private labs. This may be cost-effective, but it places a burden on those seeking treatment, who now have to trek from place to place to get work done.

• The growing role of insurance companies in the system is evidence of the mounting inadequacy of the public system.  The very fact that these insurance providers are around seems to provide cover for governments' continual, stealthy reduction in services provided at public expense. 

• Some of the more prestigious specialized hospitals (Princess Margaret Cancer Centre and Sick Children's Hospital, both in Toronto are prominent examples) rely on annual multi-million dollar lotteries to raise funds.  In a properly-funded system this would hardly be necessary. 

Taking all of these things together,  it's clear that what a Federal health minister once referred to as "our magnificent medicare" is, nowadays, nothing of the sort. So what's it like to live under such a system?  Well, maybe I can be allowed to illustrate by reference to the recent experiences of my wife.  

A few years ago, back in the UK, she was diagnosed as needing a hip replacement.  From diagnosis to operation the interval was six weeks. All meetings with the surgeon, pre-op sessions, the operation itself and post-op treatments including physiotherapy took place at our local hospital

Last fall, here in Canada, she was diagnosed as needing a knee replacement. The diagnosis was based on X-rays (taken at a private clinic) and an MRI (at a nearby hospital). Meetings with the surgeon took place in his office, in a medical arts building separate from the hospital. He referred her to an internist in the same medical arts building.  He sent her for further X-rays (same location as the first set) and for heart stress tests (at a separate private clinic in another location). A date for the procedure has finally been set, fully six months after the initial diagnosis -- if she's lucky: the surgeon has already warned us that he had to cancel some planned surgeries at short notice last year because the local hospital ran out of funds!

You could get sick worrying about these things, but that probably wouldn't be wise.