Canadian Health Care System

To the Editor: I read with interest your informative article on family practice in a failing health care system in the September-October 2002 issue of the JABFP (Geyman JP. Family Practice in a Failing Health Care System: New Opportunities to Advocate for System Reform. J Am Board Fam Pract 2002;15:407–15).

I trained in family practice in Ohio and have practiced in Ohio and Ontario, Canada. I wrote to your journal a few years ago to explain what I perceived as advantages to health care system in Canada. Since then, however, our universal method has showed increasing problems and deficiencies and is under increasing attack by the Canadians.

When the single-payer system established itself in Canada in the 1960s, the timing could not have been better. It was embraced by patients and health care providers alike. At that time, available medical technologies were much less advanced, and government monies could afford the cost for nearly everyone. (With the United States providing us military defense free of charge, our publically funded health care delivery model was second to none.)

Today is a different story. Waiting lists for testing and specialty care are the norm. The Canadians are more aware of what is available to private patients in the United States, and they expect the same in Canada, which is impossible in a publically funded system.

There is still something appealing and respectable about a universal system, even as it shows its flaws. (This observation might be irrational coming from a Canadian who is hopelessly proud of the last remaining institution that defines Canada as being different from America.) I admire the physicians and subspecialists with whom I work in Canada. The pull of America is always evident, but many prefer to stay because they believe they provide sound care for their patients. “Coverage for all” might still be approachable with proper changes and the insertion of a private element. Opening the doors to more well-trained foreign physicians would also help Canada.

America needs to take a different approach. Without a previous template, a universal single-payer system cannot be built in this day and age. (For one thing, too many persons would lose their jobs.)

The United States would be better off making its private insurers and HMOs more accountable to the consumer and large employers who pay into them. They should explain large bonuses and extra costs to the consumer or suffer the consequences. Put them under intense scrutiny, like Enron and WorldCom and the rest. If government regulators can realize that the health care consumer is at a bigger disadvantage than any other consumer (ie, they are sick or have a condition), then the United States can have compassionate health care delivery with the advantage of American know how and resources. It would be a win-win situation.