Bush vs. the facts

...THE FACTS HEALTH CARE THAT WORKS resident George Bush, in his attempt to deal with the issue of health care, felt it necessary last month to engage in the common—in the United States—right-wing practice of Canada-bashing...

...This in turn is related to Canadian court practices and, to some extent, to the fact that Canada has a universal health system...

...are advised to purchase extra coverage from private-sector insurers, since the coverage provided in Canada is not usually enough to pay bills incurred in the U.S...

...Saskatchewan, New Brunswick, and Newfoundland finance the system out of general revenue...

...Nova Scotia, a poor and underdeveloped region of Canada, gets good value for its money...

...On the whole the system is effective...

...Unionized workers bargain for benefit packages just as they do in the U.S., except that basic medical and hospital services are provided through provincial programs...

...Commonweal 27 March 1992: 7...

...Quebec has already set up a number of community health centers and has implemented a deterrent to discourage the use of hospital emergency services in areas where community centers exist...

...in the U.S...

...In several provinces, drugs are also included for those over sixty-five...

...for certain mental-health services, and for a private room in a hospital...

...Patients can choose their doctors and—the insurance being universal—can be admitted to any hospital...

...in Nova Scotia ran to $863 million (Canadian dollars, about $745 million U.S...

...He announced that in Canada there is a six-month wait for bypass surgery and declared Canada's health-care system to be bureaucratic, inefficient, and undesirable...

...reports administrative costs of 2 percent...

...Their recommendations point in the direction of some serious restructuring of medical services...

...It seems clear from here that the whole debate in the U.S...

...Last year, the cost of M.S.I...

...In Alberta and British Columbia, premiums are paid by individuals or families...

...In Nova Scotia, children under sixteen receive dental care...

...Premiums for an individual in British Columbia come to $64 per month...

...Such charges are not new, although even conservatives seldom make them in Canada where support for the country's healthcare system stands at 86 percent...

...And however one may appeal to economies of scale to justify bigger and bigger business, the fact remains that there are also diseconomies of scale...

...In Nova Scotia, a 10 percent provincial sales tax is paid into Medical Services Insurance (M.S.I...

...He lived in Nova Scotia and underwent the bypass operation in Toronto—sixteen-hundred miles away—four days later...

...Canadians get private-sector coverage for dental care, for prescription drugs, for the extra cost of basic services incurred (for example, when visiting the U.S...

...the provincial insurance agency...

...It was successful...

...In years past, a case of pneumonia meant days or weeks in a hospital...

...It is more expensive than Great Britain's national health service, but considerably less expensive than health care in the U.S...

...dollars—was $1,991 in Canada...

...is much larger...

...And then the U.S...

...As everywhere else, costs of health care have escalated in recent years...

...Doctors engage in private practice and are paid on a fee-for-service basis, much as in the United States...

...The remaining 6 percent went to public health and community-based health care...

...And in every province coverage is universal...

...The Canadian system began in an era (early 1970s) when hospital care was assumed to hold a central place in treatment...

...The number of medical doctors in Canada has increased more than the increase in population, and it appears that costs have increased with the number of physicians...

...It boasts the lowest infant mortality rate in the world...

...The population of Ontario— Canada's most populous province—is less than that of greater New York City...

...The Canadian program—or, better, programs—cover both medical and hospital services...

...The United States currently has a number of circumstances that do not apply in Canada...

...it was $2,566...

...In Ontario and Quebec, premiums are paid through payroll taxes...

...In every province the federal government shares the costs of health care, although the present Conservative government has been reducing such assistance...

...The cost of malpractice insurance, for example, is almost nominal in Canada...

...This writer had a colleague who was suddenly in need of such surgery a few years ago...

...The ministers recommended a 10 percent cut in admissions to medical schools—a recommendation that was sharply contested by some professionals—and that serious attention be paid to the idea of moving away from 6: 27 March 1992 Commonweal fee-for-service as a basis for paying medical professionals...

...But while structural problems remain and there is clearly room for reform, Canadians looking south are immediately struck by the fact that in the United States 35 million people—more than the entire population of Canada—are not covered by medical insurance...

...Some of these problems are "historical...

...Agreements between provinces cover those who are traveling within Canada, although Canadians who are traveling to the U.S...

...What is much more important to most Canadians is that ordinary, essential, and routine things such as prenatal care, childbirth, and postnatal care are effectively and efficiently provided to everyone who needs them...

...This is probably a case of small is beautiful: the whole population of Nova Scotia is less than 1 million...

...Bush's example of a patient in Canada waiting for up to six months for bypass surgery...

...there are over fifteen hundred insurers and administrative costs are considerably higher...

...According to the New York Times, 1990 per capita health-care spending—in U.S...

...And for the rest, the private sector flourishes, much as in the United States...

...of which 61 percent went to hospitals, 21 percent to physicians, 6 percent to pharmacy expenses, 4 percent to capital expenditures, and 2 percent for administration...

...The basic funding varies from one province to another...

...Today, with antibiotics and visiting nurse services, pneumonia can be treated at home...

...This picture, most Canadians would say, is far more typical than delays for urgent treatment...

...Reform will not happen overnight, and some problems are extraneous to the health-care system as such...

...Today, critics question whether it should...

...Some claim that Ontario, for instance, could maintain its present quality of care with half the number of hospital beds, simply by applying appropriate technologies to various situations...

...In February Canada's health ministers met to discuss the problems they face...

...Canadian physicians are also increasingly looking to preventive medicine rather than responding to crises...

...These things are no doubt relative, but small is sometimes not only beautiful but more efficient...

...over health care has to be refocused and that President Bush's approach is clearly inadequate...

...The 2 percent figure does not include internal hospital administration, or the administrative costs of individual medical practices, although these are simpler for medical practitioners who have only one insurer with whom to deal...

...In fact, Canada funds health care through universal insurance, organized on a province-by-province basis, although federal support has ensured uniform minimal standards...

...JORDAN BISHOP Jordan Bishop, a frequent contributor to Commonweal, lives in Ottawa...

...Some doctors, for example, have been known to send aged poor people—too poor to pay their heating bills—to the hospital when they are faced with colds or other viral infections that could become lifethreatening...

...In such instances, hospitals are called on to make up for the inadequacies of the welfare system, at a cost which is astronomically higher...

...Federal cost-sharing is contingent on the universality of access...

...Since there is but one insurer in each province, cost control has proven relatively effective...

...It is commonly portrayed by its critics as "socialized medicine" and is assumed to be a bureaucracy run wild...

...And what of Mr...

...Nova Scotia's M.S.I...

...Canadians do not claim that their system, or systems, are an answer to all problems...

...In contrast, in the U.S...

...What characterizes many of the attacks on Canada's health-care system must be attributed either to ignorance or to deliberate misinformation...

...Other ideas that were discussed were to make greater use of other professionals such as trained midwives...

...There was also considerable discussion of moving toward a system in which hospitals have a different role...