Here is an old article that I wrote for Minnesota’s Metro Doctors back in 2005. It still seems relevant today especially in light of “Obamacare”.
As a Canadian physician working in the United States, I have an interesting perspective on health care in the two countries. I love Canada. It has beautiful geography and wide open spaces. Its people are generally friendly and kind. But when I realized that the government was interfering in the type, quality and amount of medical care that I could deliver as a radiologist, it became too much to bear and I moved to the United States three years ago.
Despite having some problems with rising costs and an increasing number of uninsured, U.S. health care remains the best in the world and is vastly superior to that which is delivered with government-provided universal health insurance in Canada. This is demonstrated with a chilling personal example when my brother and I developed similar clinical symptoms.
In December 2001, I developed an unusual stuffy sensation in my left ear. Trained as a neuroradiologist, I was aware that such a symptom could indicate the presence of a mass in my nasopharynx. Denying the symptoms, they persisted for a few months and I finally conceded that I needed medical attention. Once I had made the decision to do so, I made an appointment to see an Ear, Nose and Throat specialist. The appointment was booked and I immediately had an appointment. He performed a thorough exam including direct visual inspection of my nasopharynx. No mass was visualized. Also, a MRI was performed. The test was completely normal. I was relieved. The stuffy sensation was merely a nuisance but it would not kill me.
My brother in Canada has not been so fortunate. Unbeknownst to me, in March 2004, he developed a stuffy sensation in one ear. It became worse after an airline flight. Not medically trained, he was not aware of the potential significance of such a symptom. Apparently, neither was his doctor. Despite repeated visits to his doctor, nothing was done until November, 2004 at which time he finally was assessed by an Ear, Nose and Throat specialist. A small tube was placed through the eardrum to relieve the stuffy sensation but no physical exam was performed and the cause was not addressed.
Early in December 2004, my mother mentioned my brother’s need for an ear tube for a persistent stuffy sensation. With no other information, cancer of the nasopharnyx immediately leapt to my mind.
My brother began to lose weight and his neck lymph nodes became massively swollen. Now complaining of severe head and neck pain, this former workhorse lawyer could barely get off the couch. This man who rarely complained of anything was labeled with differing diagnoses such sinusitis, stress and chronic fatigue syndrome.
My brother’s wife phoned me in despair with details of his deterioration. I stated that malignancy had to be ruled out. The family doctor was consulted again. Although the local veterinary college has a MRI for animals, with the government controlling human health care resources, there is no MRI for people in his city of 80,000. An “urgent” MRI was arranged – for several weeks later in the nearest community with this equipment.
Time passed without diagnosis. The pain became unbearable. He was so sick, his wife feared he was dying. Despite having three small children, on Christmas morning, he was taken to the hospital in Waterloo, Canada which is the nearest city with an MRI. This one public MRI serves about 600,000 people. The Minneapolis-St. Paul suburb of Edina has eight with a population of 55,000. The Waterloo MRI operates 8 a.m. to 5 p.m. during the week. It is normally unavailable on weekends and holidays. There is no one on-call for emergencies after hours. After applying a great deal of pressure, begrudgingly a MRI was performed the day after Christmas. It was incorrectly interpreted as “sinusitis”.
This diagnosis didn’t make sense. With weight loss, enlarged lymph nodes and now an inability to work his tongue and a drooping eyelid, I feared the worst despite the benign diagnosis. I flew to see him. I reviewed the MRI; an area in which I have had extensive training. He had a tumor the size of a baseball between his nose and his skull base. The mass was eroding his skull and coating multiple cranial nerves. I became the prophet of doom and had to tell my own brother that he has advanced nasopharyngeal cancer. He has a stage IV cancer; the worst of four possible stages. His chance of long-term survival has been reduced considerably. The treatment he now requires is so aggressive that serious morbidity is guaranteed. The extent of radiotherapy required will abolish his sense of taste and annihilate salivatory function. It may cause some hearing loss and carries a 25% chance of blindness. He must also undergo chemotherapy simultaneously with risk of serious immunosuppression. If his illness had been recognized earlier, a smaller radiotherapy field could have been employed and chemotherapy may have not been necessary.
The fact that my brother has universal health care coverage has not helped him much. I have seen the uninsured in America receive better care than the insured in Canada. Although there is a marginal cost savings to the Canadian system, Canadians receive little for their money. Although “free”, it is paid for by the people in the form of tax dollars. With such a system, individuals completely lose control of how their own money is spent.
On average, the U.S. spends about 4500 dollars per capita on health care per year. Canada spends about 4000 dollars (Cdn) per capita. So where is the big savings? In fact, some Canadian provinces and territories spent vastly more. The territory of Nunavut spends 8851 dollars per capita. Such figures also neglect to mention that there is very little health care research and development in Canada. With prescription drug costs in Canada tightly regulated by government, and profit motive squelched, R and D for drugs in Canada is almost zero. Furthermore, my brother’s productivity may be terminated with an attendant loss to the economy of tens of thousands of dollars annually. The advocates of universal health insurance never account for these cost factors.
In Canada, without competition, and with the government maintaining an iron-grip on the availability of resources, service is painstakingly slow and of poor quality. With doctor shortages engineered by the government to save costs, the field is vulnerable to incompetence. With dire physician manpower shortages, anyone with a pulse will be gainfully employed.
Without the accountability of the free market, costs are inflated and dollars are not spent efficiently. But of course, this is the same in the United States where 85% of the populace is insured such that someone else other than the patient is footing the majority of the bill. Without direct individual consumer pressure to keep costs down, costs in the U.S. are massively inflated above their objective market value.
It was an act of Congress, not the free market that mandated that billings be directed primarily to the insurance carrier rather than the patient. This distortion of the free market and the fact that conservatively 43% of American health care costs are already paid by the government proves that the U.S. system suffers from the same disease as that of Canada; too much government interference. It is preposterous to believe that government covering 100% of health care costs would magically solve the woes of U.S. health care.
It is free market capitalism that feeds us, clothes us and provides us with entertainment. It produces the highest standard of living that the world has ever seen. Perhaps we should try something new and give it a try in health care.
Advocates of government health care in both countries claim that resources can be “rationalized” and redundant services eliminated. Availability of resources doesn’t seem very rational in Canada despite assiduous attempts by bureaucrats to make it so. They have been working at it for decades in Canada and they just can’t make it work. Canadians don’t get it; centralized government planning of the economy simply does not work. The impoverishment produced in the U.S.S.R., Cuba, China and North Korea should have proven this once and for all.
There is an assumption in Canada that although resources are limited, those most in need will get the attention they need. Having worked in Canada for years, I saw little evidence of this. Often people did not get into the health care system until catastrophically ill; perhaps with no chance of redemption. As a radiologist reading CAT scans and MRI scans, I was sickened by the wait people had to endure (up to 13 months for a MRI scan and seven months for a CAT scan). The faulty argument is that the most urgent cases should be scanned first but they forget that if I knew the results of a patient’s test, they would not need the test. Now working in America, I sleep better at night working in a system where tests are liberally ordered and performed.
The Canadian health care system is a disgrace and yet there are those in America that want the same system. As the saying goes, be careful what you wish for. You just might get it.
Lee Kurisko MD FRCPC is a diagnostic radiologist from Canada working in Minnesota and is Chief Medical Officer of Medibid. Medibid is an online portal for buying and selling medical goods and services without the intrusion of third parties. He is also author of “Health Reform – The End of the American Revolution?”