Snags in Canada's healthcare

Cancer Care Ontario couldn't ask for a better spokespatient than Marilyn Markou for its "Buffalo patients." That's the rubric for people the province pays to send to the US for treatments Canadian hospitals too backlogged to handle.

Canada's state-paid healthcare is often seen as fairer and more cost-effective than the American system. But Canada also needs to rely on America for medical services that it can't provide.

Ms. Markou, who spent seven weeks in Buffalo, N.Y., last summer receiving radiation treatments, has nothing but good things to say about the care she received. She even saw her summer sojourn as an opportunity to do some sightseeing. "I had never gotten to know Buffalo."

Still, she has some pretty stern criticism of Canadian Medicare, universal, government-paid medical care.

"The government has to pull its socks up.... I was sort of embarrassed that I had to go to another country because my own country couldn't look after me. That was not a good thing."

The existence of re-referral programs like Cancer Care Ontario's - and the waiting lists that produced them - are taken by many Canadians as sure signs that something is wrong with their beloved healthcare system. If this system - that to Canadians makes their country a kinder, gentler alternative to their neighbor to the south - is so great, then why does Canada have to send people to the US for treatment?

Province after province is experiencing medical inflation in the double digits. Poll after poll reports that the public identifies healthcare as the leading issue facing this country. But neither the public nor the politicians seem to have many ideas of how to fix what's broken. It's the policy debate that hasn't happened.

"There's an appallingly low level of public debate ... with a 'know-nothing quality' to it," complains historian Michael Bliss of the University of Toronto.

Indeed, a recent Internet poll asking, "Do you prefer the Canadian approach to providing health services or the American approach?" found 96 percent of the 447 respondents favoring "the Canadian public pay system." Exactly one respondent said, "I prefer the American private pay system." Three percent favored "a combination of the two." In fact, both countries have a "combination," albeit with much greater public involvement in Canada.

That "the public tends not to be knowledgeable," as Michael Rachlis, a health-policy consultant in Toronto, tactfully puts it, impedes debate. So does the tendency to see the options as either/or, public-pay Canadian medicine vs. greed-driven American medical care.

In the political arena, the genuine complexity of the challenge is compounded by fingerpointing as federal and provincial governments vie to see who can offer more in the way of tax cuts. Healthcare analyst Fred McMahon at the Consumer Policy Institute in Toronto describes the dialogue between Ottawa and the provinces: "What everybody says is, 'Money's not the answer. Real reform is needed.' Then the next sentence is, 'You're not giving enough money.' "

The most concrete reform proposal is Alberta Premier Ralph Klein's Bill 11, which would modestly expand the range of minor surgeries private clinics can provide. It's been hugely controversial; the banner headline across a recent letters page in the Toronto Star was "Klein's way is the law of the jungle in fine dress."

Federal Health Minister Allan Rock made a special trip to Calgary March 10 to give a speech raising questions about the proposal, but he hasn't offered much in the way of reforms of his own.

Huddle on healthcare

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