TORONTO — A letter from Moncton Hospital to a New Brunswick heart patient in need of an electrocardiogram said the appointment would be in three months. It added: "If the person named on this computer-generated letter is deceased, please accept our sincere apologies."
The patient wasn't dead, according to the doctor who showed the letter to the Associated Press on condition of anonymity. But there are many Canadians who claim that the long wait for the test and the frigid formality of the letter are indicative of a health system badly in need of emergency care.
Americans who flock to Canada for cheap flu shots often come away impressed at the free and first-class medical care available to Canadians, rich or poor. But tell that to hospital administrators constantly having to cut staff for lack of funds, or to the mother whose teenager was advised that she would have to wait up to three years for surgery to repair a torn knee ligament.
"It's like somebody's telling you that you can buy this car, and you've paid for the car, but you can't have it right now," Jane Pelton said. Rather than leave daughter Emily in pain and a knee brace, the Ottawa family opted to pay $3,300 U.S. for arthroscopic surgery at a private clinic in Vancouver, with no help from the government. "Every day we're paying for healthcare, yet when we go to access it, it's just not there," Pelton said.
The average Canadian family pays about 48% of its income in taxes yearly, partly to fund the healthcare system. Rates vary from province to province, but Ontario, the most populous, spends roughly 40% of every tax dollar on healthcare, the Canadian Taxpayers Federation says.
The system is going broke, says the federation, which campaigns for tax reform and private enterprise in healthcare. It calculates that at present rates, Ontario will spend 85% of its budget on healthcare by 2035. "We can't afford a state monopoly on healthcare anymore," said Tasha Kheiriddin, federation director in Ontario. "We have to examine private alternatives as well."
The federal government and virtually every province acknowledge that there's a crisis: a lack of physicians and nurses, state-of-the-art equipment and funding. In Ontario, more than 10,000 nurses and hospital workers face layoffs over the next two years unless the provincial government boosts funding, says the Ontario Hospital Assn.
In 1984, Parliament passed the Canada Health Act, which affirmed the federal government's commitment to provide mostly free healthcare to all, including 200,000 immigrants arriving each year.
Despite the financial burden, Canadians value their system as a marker of egalitarianism and independent identity that sets them apart from the United States, where some 45 million people lack health insurance.
Raisa Deber, University of Toronto professor of health policy, believes that Canada's system is one of the world's fairest.
"Canadians are very proud of the fact that if they need care, they will get care," she said. Of the United States, "I don't understand how they got to this worship of markets, to the extent that they're perfectly happy that some people don't get the healthcare that they need."
Canada does not have fully nationalized healthcare; its doctors are in private practice and send their bills to the government for reimbursement.
"That doctor doesn't have to worry about how you're going to pay the bill," Deber said. "He knows that his bill will be paid, so there's absolutely nothing to stop any doctor from treating anyone."
Deber acknowledges problems in the system but believes that most Canadians get the care they need. She said the federal government should attach more strings to its lump-sum allocations to the provinces so that tax dollars are better spent on preventive care and improvements in working conditions for healthcare professionals.
In Alberta, a conservative province where pressure for private clinics and insurance is strong, a nonprofit organization called Friends of Medicare has sprung to the system's defense. It points up the inequities in U.S. healthcare and calls Canada's "the most moral and the most cost-effective healthcare system there is in the world." "Is your sick grandchild more deserving of help than your neighbor's grandchild?" it asks.
Yes, said Dr. Brian Day, if that grandchild needs urgent care and can't get it at a government-funded hospital. Day, an English-born arthroscopic surgeon, founded Cambie Surgery Center in Vancouver. British Columbia is one province where private surgeries are making inroads.
Day, ex-president of the Arthroscopy Assn. of North America, says he got so frustrated at the delays to book surgeries at public hospitals in Vancouver that he built a private clinic. He testified in June before the Supreme Court in a landmark appeal against a Quebec ruling upholding limits on private care and insurance.