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Tuesday, July 13, 2004 - Page updated at 12:00 A.M.

Guest columnist
The truth about Canada's ailing health-care system

By Robert J. Cihak
Special to The Times

Dr. Robert J. Cihak
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All the major candidates in Canada's recent national election acknowledged that the country's health-care system is failing Canadians. The common prescription, however, was just to spread more taxpayer money on it — the usual nostrum of socialism. In the end, no major candidate had the political courage to tell the truth about the ailing Canadian system.

Indeed, on the other side of the border, Americans such as Rep. Jim McDermott, D-Seattle, fantasize about importing the Canadian health-care dream to the U.S. so that every citizen has comparable "equal access" to medical care.

But more and more Canadians are awakening — not from a dream, but from a nightmare. The results are coming in. After years of government control, the medical system is badly injured and bleeding citizens' hard-earned tax dollars.

A study recently released by the Fraser Institute in Vancouver, B.C., compared industrialized countries in the Organization for Economic Cooperation and Development (OECD) that strive to provide universal health-care access. Among those countries, Canada spends most on its system while ranking among the lowest in such indicators as access to physicians, quality of medical equipment and key health outcomes.

One of the major reasons for this discrepancy is that, unlike other countries in the study that outperformed Canada — such as Sweden, Japan, Australia and France — Canada outlaws most private health care. If the government says it provides a medical service, it's illegal for a Canadian citizen to pay for and get the service privately.

At the same time, to try to keep spending down, the government chips away at the number and variety of covered services. According to another Fraser Institute survey, this means that on average a patient must wait in line 17.7 weeks for hospital treatment.

In 1999, Dr. Richard F. Davies described how delays affected Ontario heart patients scheduled for coronary artery bypass graft (CABG) surgery. In a single year, just for this one operation, 71 Ontario patients died before surgery, "121 were removed from the list permanently because they had become medically unfit for surgery" and 44 left the province to have their CABG surgery elsewhere, often in the U.S.

In other words, 192 people either died or were too sick to have surgery before they worked their way to the front of the waiting line. Yet, the Ontario population of about 12 million is only 4 percent of the population of the United States.

In an article in the journal Health Affairs, Robert Blendon describes an international survey of hospital administrators in Australia, New Zealand, Great Britain, the U.S. and Canada. When asked for the average waiting time for biopsy of a possible breast cancer in a 50-year-old woman, 21 percent of administrators of Canadian hospitals said more than three weeks; only 1 percent of American hospital administrators gave the same answer.

Fifty percent of the Canadian hospital administrators said the average waiting time for a 65-year-old man who requires a routine hip replacement was more than six months; in contrast, not one American hospital administrator reported waiting periods that long. Eighty-six percent of American hospital administrators said the average waiting time was shorter than three weeks; only 3 percent of Canadian hospital administrators said their patients have this brief a wait.

Canadian physicians' frustration with their inability to provide quality and timely care is resulting in a brain drain. A doctor shortage looms as the nation falls 500 doctors a year short of the 2,500 new physicians it needs, according to Sally C. Pipes, president of the San Francisco-based Pacific Research Institute.

Another casualty of the lengthy waiting periods is Canada's much-vaunted equal access to medical treatment. Even though medical emergencies allow some people to jump ahead in the waiting line — making others wait longer — a survey published in the Annals of Internal Medicine medical journal found that more than 90 percent of heart specialists had "been involved in the care of a patient who received preferential access" to cardiac care because of non-medical reasons including the patient's social standing or personal connections with the treating physician.

The Canadian system works fine for minor problems, but danger lies ahead as baby boomers age and more serious illnesses afflict them. Call it "Canadazation," the myth of high-quality, "free" care. Its real costs in human suffering are ones that U.S. proponents don't want you to know about.

Dr. Robert J. Cihak, of Kirkland, is a senior fellow and board member of the Discovery Institute and a past president of the Association of American Physicians and Surgeons.

Copyright © 2004 The Seattle Times Company

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