BOOKS/Alvena Bieri

A Health Care Plan that
Won't Make You Sicker

A friend of mine is a part-time resident of Canada. He is continually praising the Canadian health system. Last summer while he was there he had a simple, minor procedure on the skin of his arm, and it cost about $50. Later he found out that the very same thing in the United States would have cost over $1,000. For a good summary of the advantages of the Canadian system of health care, he recommended I read Universal Health Care: What the United States Can Learn from the Canadian Experience, by Pat and Hugh Armstrong with Claudia Fegan, M.D. (The New Press, 1998, $24) The first two authors are at Carlton University in Ottawa and the third is a Chicago doctor.

Since the Clinton health plan failed to get approval several years ago, the number of uninsured Americans has risen from an estimated 38 million to about 45 million. I figure that's equivalent to the population of about 15 Oklahomas, and it's a lot of people even when we subtract the very wealthy and the temporarily poor, like college students and those between jobs.

To put it simply, these authors think the Canadian system is vastly superior to ours. They write that in the United States, "The mission of relieving pain and suffering has been supplanted by the dive to maximize profit ..." And the Patient's Bill of Rights is hardly a drop in the big, old bucket of pressing medical needs.

More and more patients in the United States are struggling with their health maintenance organizations to get the care they desperately need. The authors say there are even more problems. Companies complain they can't afford to insure their employees any more. And if workers go to work for another company, they can't take their insurance with them. The big insurance companies are competing for providing coverage for private firms as well as for recipients of public programs like Medicare and Medicaid for a service which ought to be public and universal.

Early in this short and clearly written book, the writers lay out the five principles of the Canadian system. None of them describes ours. Their health care is financed by general tax revenues.

It is publicly administered, saving 20 to 30 per cent on overhead as compared to the U.S. system.

It is comprehensive. Everything is covered except a few things like purely cosmetic plastic surgery.

It is universal, meaning that everyone is covered.

It is portable, from job to job, from province to province.

It is accessible. There are no barriers to its use.

How did such a system come about? The answer lies largely with one person, Tommy Douglas. As the premier of Saskatchewan in the late 1940s he started the first universal hospital insurance program there. Over the next few years other provinces followed with similar plans. In 1984 they united under the Canada Health Act to make the various plans a national program.

All this is not to say, the authors are careful to point out, that these early health care reformers had an easy time of it. At first there were doctors' strikes and protests. But the Armstrongs show clearly that now Canadians live longer than Americans on average, that Canada has a lower infant mortality rate than the United States, and that they certainly spend much less on doctors and hospitals than we do.

Finally, they suggest that we Americans have been much too well trained to think we always "get what we pay for." Some of us think that the more expensive something is, the better it must be. That isn't true in medicine, they insist. There's another argument for a better system too. Being sick in the United States is not just frightening. It can be an ordeal of paper work. Even patients lucky enough to have good health insurance and enough money to see them through the expenses not covered by insurance may not be prepared for the avalanche of bills following a major illness. They should expect a bill from the main doctor, another from any specialist consulted, one from the pathologist perhaps, one from a "diagnostic imaging" physician, a surgeon, and an anesthesiologist. If patients think they are lucky not to have much pain, they may change their minds when they start to get the bills.

This volume provides a powerfully good argument for a change in a medical system that seems to be getting more expensive and complex all the time.

Alvena Bieri is a writer in Stillwater, Okla.

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