Snags in Canada's healthcare

The provincial premiers, who will huddle on healthcare at the end of this month, have asked for a meeting with Prime Minister Jean Chrtien on the issue. Later, he has responded - like maybe November or December.

Meanwhile, some provinces continue with stopgap measures like re-referral programs for cancer care. Ontario's program, for instance, has been in place since last April and handled nearly 1,000 patients.

In the case of transborder referrals, the treatment costs nearly seven times what it would in Ontario. In Ms. Markou's case, the province paid the tab for the treatment itself (at a private hospital, she notes). It also paid for her lodging at a Buffalo hotel, gave her a meal allowance, and reimbursed her for mileage.

Similar transborder re-referral programs have been in place in both Manitoba and Quebec. Quebec officials have been reported to be discussing a deal with Vermont: easier access by Canadians to American cancer clinics in exchange for American access to lower-cost Canadian pharmaceuticals.

Analysts aren't holding their breath waiting for speedy changes. "There's an enormous inertia caused by the fact that we have had a health-policy establishment whose members are wholly committed to socialized medicine," says historian Bliss.

As a result, he suggests, there are fewer policy options being floated. There is, he adds, "a huge interest in Ottawa in saving the Canada Health Act - no readiness for root and branch reform."

Bliss, himself of the distinctly minority view that the current state medical monopoly is "unworkable and an affront to citizens of a free society," criticizes the system for overreliance on government healthcare planning. "A lot of the public still buys the idea that if you plan it better, it will work."

Mr. McMahon makes a similar point: "People get all upset when I say this - but we manage our healthcare system like the old Soviet economies.... If the last half-century has taught us anything, it's that heavily bureaucratized systems don't produce efficiency."

Describing himself as the Canadian political equivalent of a Clinton Democrat, he says he sees maintenance of the state as single payer as critical: "No civilized society should allow people to die of a treatable condition."

Incentives needed

But some sort of market incentives are needed, he says, and so he is proposing medical savings accounts. Each citizen would get a healthcare annual allowance, and anything not spent by the end of the year would be split between the state and the consumer. A special fund would be available for those who exceed their annual allotment. But the idea would be that individuals would have an incentive to help control costs.

Dr. Rachlis sees the problem as not too much government control but too little. Canadians are aghast at the idea of corporations profiting from treating sickness, if radio call-in lines are any indication. But, he says, fee-for-service medicine is alive and well in this country, as it hasn't been in the US "since the insurance companies took over." The Ontario Health Insurance Program pays 98.5 percent of all physicians' claims within 28 days, he says. "American physicians literally faint when they hear this."

He is untroubled by claims that an aging population must necessarily be a more intensively medicalized one. Older people are healthier nowadays, for one thing, he notes. And the care for people with chronic conditions can be managed with lower-cost alternatives.

"Fee schedules have always paid more for cutting and prodding than for listening and thinking," says Rachlis.

The challenge is to find ways to encourage more thoughtful and more appropriate treatment by encouraging listening and thinking.

(c) Copyright 2000. The Christian Science Publishing Society

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