As the United States attempts to overhaul health care and improve access for more of its citizens a US Senate committee recently met in Washington and invited several international experts to share perspectives on their own health care systems. Toronto physician Dr. Danielle Martin very nicely represented the Canadian perspective. It was an articulate presentation of Canadian health care. The smug Senator sitting opposite her clearly had some pre-conceived ideas about the Canadian health care system and had already formulated in his mind what he wanted to hear. Overestimated stories of Canadians going to the US for health care were offered as a rebuttal. The full exchange can be viewed. It is the aftermath of this interview, widely shared over the Internet, that I found most striking. There was much fist pumping and flag waving about how a Canadian doctor took on a mighty US Senator in an entertaining smack down. It was a patriotic reaction that would not have been out of place a month earlier in Sochi. Certainly Dr. Martin did not pretend to say our system is perfect and acknowledged improvement is needed. Unfortunately that message was lost in the noise.
The day before, on this very site, a very different picture of the Canadian health care was presented. The story of a young Alberta man was highlighted. Greg Price died from complications of testicular cancer after a very delayed diagnosis. A review of Price’s clinical course exposes a number of inefficiencies and gaps in our health care system. I was struck by how a thoughtful examination of why our system needs fundamental improvements to make care better for patients was drowned out within 36 hours by the public reaction to the spectacle from Washington.
Our publicly funded health care system is in my mind something that should be cherished. A system that is accessible to all of its citizens strikes me as a fundamental human right, especially in an affluent country such as ours. Canadians have a lot to be proud of. Our patients do not have to worry about whether they will become financially burdened by expensive medical care and providers and hospitals are not burdened with large accounting departments. Given the need to be careful with resources, physicians I think can better provide medical advice according to best evidence. Marketing forces influence clinical care much less in Canada. Our operating rooms are always full. Walt White’s “Breaking Bad” character may have made different choices had he lived in Canada. Finally, our physicians and health care providers are highly respected around the world as thought leaders and have always led many medical advances, from the discovery of insulin to advances in transplantation surgery and cancer care.
However I think complacency puts Canadian health care at risk in 2014. We cannot simply be content to define ourselves as not-American without a clear attempt to understand where we can improve. There are many things we can learn from other countries. The contrast between Martin’s testimony and Prices’ experiences highlights this. Ontario hospitals have generally operated with close to a 0% budget increase over the last four years. This is despite the rising cost of technology and labour as negotiated by collective bargaining. A recent report by the Fraser Institute attempted to quantify the financial costs that patients absorb waiting for care. Of course, spending more money on our system is not the simple answer. We need to find ways to make it more efficient, innovate constantly and encourage partnerships across institutions.
Testicular cancer is a highly curable disease if managed quickly. A number of specific recommendations Health Quality Council of Alberta were made in the wake of Greg’s experience. In my own experience as a urologist my clinic is always booked and OR time filled. Despite that there is a regular stream of patients like Greg that enter my care. The task of moving them through quickly and expertly must always be front of mind. Certain aspects of healthcare cannot be commodified. There is a significant responsibility placed on health care providers to be proper stewards of our system
Certainly as we move forward we should justifiably be proud of the health care system we have created but must understand that the delivery of modern health care is a complex challenge that will require broad consultation between physicians, health care providers, administrators and government with a vision that looks beyond the rhetoric and four year election cycles. As Greg’s case highlights we need to take individual ownership as physicians to advocate for our patients. Celebrate what we have but strive to make things better.