Roanoke Times
Copyright (c) 1995, Landmark Communications, Inc.
DATE: TUESDAY, April 10, 1990 TAG: 9004100559
SECTION: EDITORIAL PAGE: A-11 EDITION: METRO
SOURCE: Bob Willis Associate Editor
DATELINE: LENGTH: Long
Hold it! You're not in the United States, you're in Canada. Your doctor consults a list and says you can get the angiogram in two or three months.
In America, you'd hit the ceiling. In Canada, this kind of delay is not unusual. The government pays for health care and rations it among the provinces. Everybody can get care. It's tax-paid. People aren't left out the way millions are in the United States. But health care in Canada may not be available right away, and when you get it, it may not be the very best.
Canadians are used to a couple months' wait for an angiogram, longer than that for a hospital bed for surgery. Worse things happen. One horror story involves a Toronto woman named Stella Lacroix who swallowed a quart of cleaning fluid in a suicide attempt. Moments later she regretted the move and rushed to the nearest waiting room. The hospital didn't have the equipment needed for an operation to stop her internal bleeding.
Her doctor, Derek Nesdoly, began checking other hospitals for an available bed. It took three hours. "She was turned away from 14 hospitals," he said. "There was no space anywhere and she just bled to death. This woman needed immediate care and we couldn't get it for her."
Hospitals in Montreal and Vancouver also have reported inability to take new patients at times. In such relatively rare instances, Canada's government falls through on its guarantee of universal access to competent health care - a system it has had since 1971. The United States has a hodgepodge system financed by public and private money that provides adequate to excellent care for most citizens. But the cost has risen inexorably, and an estimated 37 million Americans - Stella Lacroix multiplied many times - have been priced out of it, unable to afford health insurance.
To control costs and bring everyone into the health-care tent, must the United States go to a form of socialized medicine? If it does, will the quality of health care suffer as it may have in Canada?
The medical establishment in this country issues dire warnings against the Canadian model. It is joined in these warnings by a number of private groups, including the National Center for Policy Analysis, a Dallas-based research institute.
In a study released in February, the center concluded that a Canadian-style program would require that the United States raise $339 billion in added taxes, expanding the federal budget almost one-third. Ways that money could be raised, the center said ominously, would be "to increase income-tax rates by 14 percentage points, or increase the payroll tax rate by 15 percentage points, or enact a value-added tax equal to almost 10 percent of the value of all goods and services."
Big manufacturers, such as some in the automobile industry, moan about the cost of health insurance for their workers. But, adds the center, with a Canadian-type program, "[m]any U.S. employers would find that the costs of paying for national health insurance would be higher than their current health-care costs" - more than double in the auto industry.
Can those figures be right? It depends.
Canada decides first what it will spend on health care each year, a cost shared by its national and provincial governments. The latter are responsible for seeing that their spending doesn't exceed their allotment. Most Canadians seem satisfied with the arrangement; for one thing, it has held down the increase in health-care expenses, which has continued at an alarming pace in this country.
Not all Canadians have access to the high-tech medicine available here, such as magnetic resonance imaging. But their life expectancy is nearly two years longer than Americans', and their infant-mortality and heart-disease rates are better than ours. All at nearly a third less per-capita cost than we pay here.
If the United States had a similar system, it wouldn't necessarily have to increase taxes to pay for it. An alternative would be to ration care, as Canada does, by limiting the money to support it. Americans, however, would never stand for that. Whether $339 billion in new taxes would be needed is unpredictable. But our demand for health care seems insatiable; a hefty revenue increase would surely be necessary.
Demand is the key. Suppliers - physicians, hospitals, pharmaceutical companies, biotechnology ventures - throng to meet it. That's capitalism, even though the federal government's paying 40 percent of the national health-care bill.
The effort to find more and better ways to cure sick people leads to big investments in new technology and drugs. Because its people prize good health and care, the United States is on the cutting edge of research and change in the field. We pay a price for that. Nations such as Canada can watch from the sidelines, see what new developments look good and - if they decide to acquire them - get them with less grief and without absorbing the kind of investment costs we do. We shake the tree, but we don't pick up all the apples.
Because of the philosophical differences between the systems, I don't think the United States will ever adopt anything like the Canadian model. At the same time, we can't let health care continue to become less and less affordable for more and more of our people. If we won't have government hold down those costs, we must do it for ourselves.
Part of the answer, it seems to me, is changing to a system that requires individuals to assume more of the responsibility for their medical bills. We think somebody else, an insurer or our employer, is paying, so it's free. No wonder the demand and the cost keep rising.
by CNB