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Originally published July 21, 2009 at 12:00 AM | Page modified July 21, 2009 at 9:31 AM

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Myths, truths of Canada's universal coverage

Taxes are higher and wait lists are common, but private insurance endures, the nation spends far less per person, treatment is free and no one is forced into bankruptcy.

St. Petersburg (Fla.) Times

WINDSOR, Ontario — Canadian Emily Whitehead and an American friend had babies years ago, then compared notes.

The friend, who lives in Michigan, was in the hospital two or three days. Her bill: more than $3,000.

Whitehead, a diabetic, and her premature infant were hospitalized two months. The bill: $16.95, for TV and a long-distance call.

Today, Whitehead is battling cancer, but the Ontario government is paying for all her hospital stays and doctor visits.

"When you consider the cost between the U.S. and Canada, there is no comparison," said her husband, Dennis. "People who go to the hospital here don't face financial ruin."

The countries have much in common by virtue of language, culture and closely entwined economies. But there is a major difference in their approaches to health care.

Canadians pay higher sales taxes — up to twice as much as in many U.S. cities — but all 33 million are entitled to hospital and physician services at government expense. No Canadian goes bankrupt because of medical bills.

Across the border, 62 percent of the near-record number of bankruptcy filings are at least partly because of health-care costs. Some 46 million have no insurance; millions more are underinsured.

And while Americans spend more per person on health care than any other country, they aren't the world's healthiest. Canadians and residents of 28 other nations live longer.

Public-option fight

The most contentious idea in the current U.S. health-care battle is a government-funded insurance option. Critics call it socialized medicine that could drive private insurance companies out of business.

Attention, not all of it favorable, has been focused on Canada.

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"Government-run health-care systems like the one in Canada not only deny but also delay care for weeks, months and even years," Senate Minority Leader Mitch McConnell, a Kentucky Republican, said recently.

Canadians freely admit their system is not perfect, citing shortages of doctors in many places, often long waits for elective procedures such as cataract surgery, too few nursing homes so the elderly often tie up hospital beds longer than they should.

But every Canadian who needs care gets it, and the single-payer-system doctors bill one payer. The government also is inherently more efficient than the U.S. system, in which payment might come from Medicare, Medicaid or private insurance plans, none of which covers exactly the same services or pays exactly the same amounts.

Dr. Diane Normandin learned the hard way.

She moved to Clearwater, Fla., in 1994 because she thought U.S. doctors had more freedom. But she spent an inordinate amount of time trying to tell whether a patient's insurance covered visits to a particular lab or specialist.

"You had maybe five minutes with the patient but 20 minutes of paperwork and the ridiculous sorting out of where the patient could go," said Normandin, who needed six employees to handle the workload. "It was crazy."

She returned to Canada in 2003 and opened a family practice near Montreal. She now has one employee.

10 provinces, 10 plans

The 1984 Canada Health Care Act guarantees basic services for all citizens. Each province has a health-care system.

The largest is the Ontario Health Insurance Plan, or O-HIP. All Ontarians carry an identification card, about the size of a driver's license, that they present at the doctor's office or hospital.

The patient never sees a bill. The Ontario Ministry of Health pays according to fees negotiated between the ministry and the provincial medical association.

Hospitals are nonprofits that are funded mostly by the government but must raise the rest themselves. Windsor's two hospitals have spruced up rooms by charging businesses $50,000 for naming rights. Patients might be in a room with "Devonshire Mall" or "CKLW Radio" over the door.

The No. 1 myth about the Canadian system: Egalitarian is the same as socialist.

In a true socialized system such as Britain's, doctors work for the government. Most Canadian doctors work for themselves or in groups.

Nor has universal coverage driven private insurers out of business. Two-thirds of Canadians have supplemental insurance for dental work, eye care, prescription drugs and private hospital rooms.

A second pervasive myth: Canadians can't choose their doctors.

They have a choice, though it is more limited than in the U.S. Windsor, part of a metro area of 400,000, has five cardiologists; Seattle has dozens.

A major reason for Canada's shortage is that the government restricted medical-school admissions, concerned about a glut of doctors. "It underestimated population growth and aging," said Dr. Amr Morsi, a Windsor cardiologist.

Another myth: The government controls doctors.

"I can do whatever test I want," said Dr. Jeffrey Turnbull, president-elect of the Canadian Medical Association and chief of staff at the main hospital in Ottawa.

He and others acknowledge the government imposes de facto controls by not approving payment for tests considered experimental or of dubious value. Because Ontario is one of the few provinces that still doesn't pay for PET scans, used to diagnose cancer, doctors hesitate to order a scan that can cost a patient $2,400.

Sometimes you wait

One irrefutable truth is that Canadians often have to wait weeks, even months, for nonemergency care.

Early last year, Don Praill of Amherstburg, Ontario, was told it would be nine months before he could have surgery for a painful back condition. His wife, Betty, found a spinal institute in Tampa, Fla., that could operate almost immediately.

But the cost, $40,000, was prohibitive. Praill had the surgery in Canada.

"A lot of people here have gone to Detroit because things are so much faster," Betty Praill said, "but in Canada everything is free."

One reason for the long delays is a shortage of diagnostic equipment. Canada has six MRI machines for every 1 million people; the United States has 26.

And "some surgeons are just known to be great and everyone migrates toward them so the wait times are longer," said Mark Fathers, controller of Windsor Regional Hospital.

Working on the waits

The provinces have made a major push to cut waiting times, setting treatment benchmarks. At least 75 percent of Ontario cancer patients start radiation within the prescribed four weeks. They get cataract surgery within four months and hip and knee replacements within six months.

That is still far longer than Americans wait, assuming they have good insurance.

"Access to health care in the U.S. was fantastic. I was very impressed with the speed of care," said Raj Kumar Goel, a Windsor urologist who trained at the Cleveland Clinic. "But one of the challenges that was hard to swallow was seeing patients who had lost their jobs or had a change in insurance carriers not able to undergo surgery they had been booked for. In Canada, that wouldn't happen."

The long waits have sparked a robust debate over whether Canada should move more closely to a U.S.-style system in which those who have money or good insurance can have faster access to health care.

In 2005, the Canadian Supreme Court struck down a Quebec law that banned private insurance for government-covered procedures, noting some patients had died while waiting for public care. "Access to a waiting list is not access to health care," the court said.

Ways to tweak system

Turnbull and others say waits could be reduced by greater use of electronic medical records, more emphasis on preventive care and more alternatives to hospitalization for the old and chronically ill.

"What's right about our system is that we have a single-payer system that's dramatically reduced costs and provided universal coverage," said Dr. Michael Rachlis, one of Canada's top health-care experts. "Americans have ideological blinders about 4,000 miles tall and cannot see that something with the word 'government' in it could be more efficient than something without government in it."

Emily and Dennis Whitehead agree. While she undergoes cancer treatment with no worries about the cost, an uninsured friend in Alabama is recovering from major heart surgery.

"I asked my friend how he's going to pay his $110,000 hospital bill, and he has no idea," Dennis Whitehead said. "They'll probably turn it over to a collection agency and harass him for the rest of his life."

Seattle Times staff

contributed to this report.

How they compare
Canada U.S.
Pop. (in millions) 33 307
Life expectancy, female 83.9 80.7
Life expectancy, male 78.7 75.6
Infant mortality per 1,000 5.0 6.3
Medical doctors per 1,000 2.1 2.4
MRI units per million 6.2 26.5
Health spending (% of GDP) 10% 15.3%
Source: Organization for Economic Cooperation and Development

Copyright © 2009 The Seattle Times Company

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