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What’s the Canadian medical system like, anyway?

COMMENTARY | September 16, 2007

Canada might as well be on the other side of the moon for as much as the U.S. press tells us about its health care system. Morton Mintz says he could find only one in-depth article on it, and that was published in 1992. (First in a series)

By Morton Mintz

"Sicko," the highly popular Michael Moore film, is "a revelation," Atul Gawande, the author, surgeon and Harvard Medical School professor, wrote in The New Yorker." [A] lot of us haven't met those people, or seen what happens to them afterward."

Dr. Gawande acclaimed the film, which he called an "outrage machine," despite Moore's "more than a few insufferable traits," such as being "manipulative, smug, and self-righteous."

Moreover, he said, Moore "brings to light nothing that the media haven't covered extensively for years." He was referring to coverage of the heart-breaking "ordinary tales" of, for example, insurers that "routinely deny people individual coverage, or jack up applicants' rates, if they have diabetes or are obese or produced a weird blood-test result in the sixth grade."

Gawande's diagnosis is accurate. For many viewers, however, "Sicko" is startling for a reason he slighted: its revelation of the "ordinary tales" of Canadians and others who have government-financed universal health care. This would not have been a revelation, I will argue here, had top U.S. news organizations done their job.

Consider the New York Times, which has a bureau in Toronto, and Washington Post, which had one until recently. Over the years, to be sure, these great newspapers have published hundreds of articles, op-eds, and letters about universal health-care systems, many concerning Canada's government-financed single-payer.

In July 1993, the Post published a 3,143-word article that began: "Canadians watching the Clinton administration formulate its health-reform proposals know well how expensive it is to run a national system with universal coverage: They have one, and evidence is mounting that they can't afford it." The story proceeded in this vein until the 32nd paragraph, which reported: "[M]ost Canadians, according to recent polls, are satisfied with their system and do not want to change it." It was the unelaborated news of contented Canadians that would deeply affect millions of Americans when they saw "Sicko" 14 years later.

I have a more basic criticism of coverage by major U.S. news organizations: With rare exceptions, they have not done the long-form journalism on single-payer that would present all of its pluses, minuses, and pulses. I mean comprehensive, in-depth coverage that would enable Americans to relate to Canadians—patients, physicians, other care-givers, administrators, taxpayers, the wealthy, the middle-income, the poor—much as does "Sicko."

An example Michael Moore might envy comes from Robert L. Jackson, a former long-time Washington correspondent of the Los Angeles Times and a friend of mine for more than 60 years. "Carl Fleischman, 80, our friend and neighbor in the Florida Keys," Bob told me in an email,

“came down with a disabling ailment of some mystery last year. He was covered by the Canadian medical system but Canadian authorities said they did not want him to continue staying in a Fla. hospital where he had gone on an emergency basis, or to transfer to another U.S. hospital.

“Instead, they sent a Learjet to Marathon, Fla., the nearest airport in the Keys, to fly Carl and his wife Betty back to Canada at no charge for tests and treatment there. Carl and Betty returned to the Keys on their own this year.”

In addition to searching Post and Times archives for the kind of comprehensive coverage described above, I inquired of people who would be likely to know of any because their everyday job is to seek universal health care for Americans. Only Dr. Ida Hellander, executive director of Physicians for a National Health Plan, in Chicago, could cite an example: a 5,800-word cover story in the Chicago Tribune's Sunday magazine. Storer H. Rowley, then the Trib's bureau chief in Canada and now its national editor, began the article by telling of a four-hour operation on "Ann Hill’s ailing heart" that gave her "a second chance at life in her mid-50s. On top of that," Rowley wrote,

"She never got a bill from [Dr. Wilbert Keon, often called Canada’s most famous surgeon] for his expert work – nor from the anesthesiologist, the radiologist and other members of his surgical team. There was no flurry of bills either from the hospital’s operating room, pharmacy, labs, recovery and intensive care units. And she never had to fill out sheets of complicated insurance forms or make endless phone calls to insurance company representatives.

"The care Hill received...exemplifies the best of Canada’s national health system.....[The] system has had its share of problems. A few people have died waiting for bypass surgery, it desperately needs better management and,...it is undergoing a critical cost crunch....But despite this, most Canadians are fiercely proud of the plan. Many consider health care a basic right and their system of health-care delivery a national symbol as sacred as the Mounties or the maple leaf....

"Every Canadian, rich or poor, can expect treatment reasonably comparable to Hill’s, though the patient might have to wait a year for some procedures in some places and may not always get a heart surgeon of the caliber of Dr. Keon. All Canadians have lifetime access to primary medical care that is generally of high quality, though access to high-tech services is sometimes limited. Most important, health care costs them virtually nothing out-of-pocket if they get seriously ill, except for the higher taxes they all pay."

Rowley's article ("Prescription from Canada: Would universal health care work in this country?") was published in 1992. In the ensuing 15 years a lot has changed, but neither the Times nor the Post has done what the Tribune did.

It has been as if Americans might not be really, really interested in in-depth reporting on the entirely different health-care system in the country above our northern border. Or even in the enduring love affair General Motors, Ford and other U.S.-based corporations with plants in Canada have had with single-payer, which drastically lowers their production costs (while, as I've written elsewhere, not explaining why they wouldn't want single-payer here).

[Next: Some apt comparisons between Canadian and U.S. health care statistics.]

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