LYNN NEARY, host:
This is TALK OF THE NATION. I'm Lynn Neary in Washington, in today for Neal Conan.
The rhetoric on both sides of the health care debate has reached fever pitch as Democrats and Republicans duke it out over reinventing our system. While they disagree on issues such as the size and cost of the changes, both sides frequently turn to our neighbors to the north to back up their arguments. Depending on your political point of view, Canada is either a shining example, providing health care to all its citizens with little or no cost, or it's a system of socialized medicine where care is rationed and people endure long waits to get the treatment they need. As with most arguments, the truth lies somewhere in between, and today we'll look at what works and what doesn't in Canada's health care system.
Later in the hour, should there be a federal ban on using cell phones while driving? That's on the Opinion Page, but first: Canadian health care. How does it work? What are the pros and cons? We want to hear from listeners who have experience with Canada's doctors and hospitals. We'd especially like to reach out to our Canadian listeners, who hear TALK OF THE NATION on WBFO in Buffalo, New York, WGVU in Grand Rapids, Michigan, WHWC in Menominee, Wisconsin, and KNBJ in Bemidji, Minnesota. Tell us your story. Our number here in Washington is 800-989-8255, and our email address is firstname.lastname@example.org. You can join the conversation at our Web site. Go to npr.org and click on TALK OF THE NATION.
We begin with Sara Robinson, an American who lives in Vancouver, British Columbia. She's a fellow at the Campaign for America's Future, a progressive group that focuses on jobs, education, the economy and health care. She wrote a piece for their Web site called "10 Myths About Canadian Health Care Busted." She joins us from her home in Vancouver. Welcome to TALK OF THE NATION.
Ms. SARA ROBINSON (Fellow, Campaign for America's Future): Hi, Lynn, it's great to be here.
NEARY: So you've had experience with both the American and Canadian health care systems. Is that right?
Ms. ROBINSON: That's right. I'm a native Californian and American citizen. I've lived here in Vancouver for five years. I've had my family and myself in both systems and sometimes still see doctors in the United States. So I'm intimately familiar with the way both systems work.
NEARY: All right. Well, if there's one thing you could pick about the Canadian system that you'd like to see adopted here in this country, what would it be?
Ms. ROBINSON: The lack of worry. I'm impressed by the social cohesion and by the just general, more relaxed attitude, the strength of the social contract, because Canadians look out for each other and because nobody ever loses a job - they lose their jobs, but they never lose their health care because they've lost a job or because they've moved or because something has happened. They're never cut off by their insurers because they've got some condition that the insurer has decided they don't want to cover. It's there, cradle to grave, and they can count on it. And as a result, their lives are much more peaceful and sane. They're able to invest their money. It's just - it changes the whole tenor of the way life gets lived.
NEARY: But it's not perfect. I mean, what do you find...
Ms. ROBINSON: No.
NEARY: ...that's frustrating? Tell me one thing about - that's frustrating about the Canadian health care system.
Ms. ROBINSON: Interestingly, because the populations of the provinces are small, and the plans are all administered at the provincial level, as they would be in the U.S. - the proposals that are on the table now would have the plans administered at the state level - for instance, British Columbia only has about six million people, and affording new MRI machines is very hard. These are very expensive machines, and there aren't nearly as many of them per capita as you'd find in the United States. Here in B.C., MRI is the number one thing people go over the border for. So that's a frustration.
Ms. ROBINSON: Other than that, my experience in terms of wait times, in terms of the quality of service delivered, the range of services delivered, is at least as good as what I had. I had a very good PPO in California that was linked with a university system, one of the top in the country. Everything here is pretty much comparable.
NEARY: Well, let's talk about some of the myths that you discussed in your article. One of them is wait times, which I think that probably that's what we hear about more than - maybe more than anything, that, you know, you have to wait sometimes, as we've heard in a piece of tape at the beginning of our program, in an advertisement that was clearly aimed at debunking the Canadian health care system, a woman saying I would have died because of my health care system because I had to wait so long.
Ms. ROBINSON: That case is really interesting because it's been - there are certain progressive Web sites that looked into that a little more deeply and have, in fact, debunked it. It wasn't a tumor, it was a cyst, and it was life-threatening, but they were going to get her in to see specialists within three to four months, which frankly, when I was in California, in the Stanford system, seeing a specialist often took two, three, four months. There - good specialists are very busy everywhere.
Another thing that I find really interesting is since I wrote the - started writing about this 18 months ago is the Canadians I've heard from who've had the most complaints about their system, far and away, all seem to come out of Ontario. I've heard from almost none of the other provinces in terms of complaints, which tells me that there's variation in the quality, in the way resources are administered between provinces. And Ontario may be having more problems than some of the other provinces, and I expect that if the U.S. goes to some kind of universal plan, we will see similar variations between the states, as well.
NEARY: It's surprising because Ontario is, you know, the seat of the government. It's a very populated and, I would think, one of the more prosperous provinces.
Ms. ROBINSON: Yeah, I have no idea why that should be so. Part of it probably is just because there is so much of the population there.
NEARY: Something else we hear is you don't get to choose your own doctor.
Ms. ROBINSON: Not - categorically false.
(Soundbite of laughter)
Ms. ROBINSON: That's absolutely not true. You pick your own GP, and the GP that you get tends to refer you to their circle of specialists that they like, very much like American doctors do. I have changed doctors a couple times since I've been here, and it's been - we've had very good relationships. It's all been good. No problems at all.
NEARY: What about prescription drugs. It doesn't cover prescription drugs. Is that right?
Ms. ROBINSON: The B.C. plan does not. The Alberta plan, I understand, does. A lot depends on how much money the province has. There is a basic level of care that's mandated by the federal government, and that always includes doctor visits, treatments, tests and anything that happens in a hospital. In most provinces, it doesn't cover things like chiropractic care, prescriptions, medical equipment, vision care, mental health, dental. In B.C., actually, children are covered - have dental coverage until 14 because that's seen as a developmentally very good investment to make.
NEARY: And something that people here are making a strong argument about is the need for preventive care in terms of bringing down the costs of health care. Preventive care is not included, is it, or is it?
Ms. ROBINSON: One of the things that's interesting about Canadians is the minute they don't feel well for a day or two, they go see a doctor, and so this becomes preventative care because small things are seen and tended to before they could become big things. In the U.S., very often people, because their care is - they have no coverage or insufficient coverage, they'll put off small things until they become very big problems, and suddenly they're in, you know, for a $10,000 ER visit.
So preventative care is simply constant care: having a GP with whom you have a good relationship, whom you can go see at any time, who can catch things and treat them while they're still very small. That is preventative care.
NEARY: And one other thing I want to ask you, Sara, about yourself: You were uninsured in the United States, is that right?
Ms. ROBINSON: No, I was insured.
NEARY: Oh, you were insured.
Ms. ROBINSON: My husband was employed by a large tech company, and we had gold-plated insurance through one of the major carriers, and I'm uninsured in the U.S. now. If I go to see a U.S. doctor, I have to pay out of pocket.
NEARY: Would Canadian health care take care of that if you were in the U.S., or...?
Ms. ROBINSON: Canadians who go to the United States buy supplemental policies. The banks and the insurance companies all offer them. Usually, we buy them by the year. They're a few hundred bucks. It's no big deal. But also, there's also a thing where, if you have a condition that there's nobody in Canada who can treat it, and this would have been true of Shana Holmes, the woman who had the brain tumor. If there was nobody in Canada who could have treated it within the amount of time, the province would have paid to send her to the States. Canada's a small country. It has a tenth of the population that the U.S. does. So our doctors can't do everything, but the government makes up for this by being willing to export people to the United States to get boutique kind of coverage that just isn't offered within the system.
NEARY: Sara Robinson is a fellow at the Campaign for America's Future, and she spoke to us from her home in Vancouver, British Columbia. Good to have you with us, Sara.
Ms. ROBINSON: It was good to be here, Lynn.
NEARY: Joining us now is Dr. Brian Day. He is a former president of the Canadian Medical Association and president and CEO of Cambie Surgeries Corporation, a private company that developed the first private health care facility of its type in Canada. And he's with us from the studios of the CBC in Vancouver, British Columbia. Nice to have you on the program, doctor.
Dr. BRIAN DAY (Former President, Canadian Medical Association; President and Chief Executive Officer, Cambie Surgeries Corporation): Thank you.
NEARY: What would you say is the biggest problem with Canada's health care system as you see it, from your perspective?
Dr. DAY: The number one problem is, it's clearly access. I mean, let me start by saying that I have - once you access the health care system in Canada, it can be very good, can be the best in the world, and there are a lot of good doctors and nurses and other health workers in the system. The problem is access, and we have - we do have major issues with waitlists. We have issues with rising costs of health care, which, for instance, in British Columbia, is now consuming 43 percent of the total budget of the province. And we have issues related to the fact that we don't have an equal system for everyone - there's the prescription drug issues, the fact that ambulances aren't covered, the fact that two-thirds of the population in Canada buy private insurance to cover what the system doesn't cover. But I don't see the American or the Canadian system as the model that I would prefer. I think we, both countries, need to look at other areas in the world that have better outcomes at lesser costs and frankly do a better job than both of our countries.
NEARY: Which is the country you would look to? What is the best system that you see out there?
Dr. DAY: I don't think there's a best system. I think that - and Canada and the United States, we have our own personalities, but I think that there are countries that we can look at the best practices from and copy what works in those countries, countries like Switzerland and Germany and Austria, Belgium and the Netherlands, for instance, that are socialized democracies, that have an element of government care, but they're hybrid systems. They take bits of what Canada and the United States have. They do it more cheaply, more effectively and more efficiently and at a much lower cost than the United States.
So I do have concerns about the 47 million uninsured, and I think that some kind of universal plan is needed for the United States.
NEARY: All right, and I just want to acknowledge that we are getting a lot of mail, apparently, from our listeners about the ad that we played at the beginning of the program, and we will address those concerns in our letter segment tomorrow. Thanks so much for your concerns.
Do you think, just quickly before we go to a break, I'll just put this out, and we can really discuss it when we come back, but I want to talk with you a little bit more about the value that Canadians get from their health care system, but first we're going to take a short break.
NEARY: We are talking with Dr. Brian Day. He is the former president of the Canadian Medical Association, and we're talking about the Canadian health care system. If you'd like to give us a call, the number is 989-8522. Give us a call. You're listening to TALK OF THE NATION from NPR News.
(Soundbite of music)
NEARY: This is TALK OF THE NATION. I'm Lynn Neary on Washington. On Capitol Hill, the debate over health care rages, and in the battle for hearts and minds, Canada's public health care system is often used as an example by both sides. We're taking a closer look at that system today with Dr. Brian Day, former president of the Canadian Medical Association, and we want to hear your experiences with the Canadian public health care system. Give us a call at 800-989-8255. I'm sorry, I said that incorrectly a moment ago, so let me say it again. It's 800-989-8255, and our email address is email@example.com. You can join the conversation at our Web site. Go to npr.org, and click on TALK OF THE NATION.
Dr. Day, you are also president and CEO of Cambie Surgeries Corporation, and that's a private company that developed the first private health care facility of its type in Canada. I wanted to ask you about that aspect of Canadian health care, you mentioned it, which is that people do supplement the care they get from the government with private health care insurance, as well, don't they?
Dr. DAY: Yes, they do, as our national health system does not incorporate a national drug program, which I think it should. It does not cover dentistry, which I think is arguably just as important as other areas of health, and interestingly, too, there's a myth out there that we have a single-payer system. We don't. There are various groups in the country, such as the injured workers, workers' compensation patients, federal police force, armed forces, interestingly federal prisoners, who are insured separately and outside of the single-payer system. And many of those - those groups are actually entitled to seek out private health care.
But the majority of the patients we would treat at our center, for example, are injured workers, injured on the job, whom if we did not exist would be on wait lists, out of the work force and with an extreme economic cost to themselves and their employers. So we fulfill - we're actually, in many ways, part of the public system in Canada now, as is the case in many of the European countries that I mentioned.
NEARY: We're talking with Dr. Brian Day about the Canadian health care system. We're going to take a call now from Kristen(ph), and she's calling from Jacksonville, Florida. Hi, Kristen.
KRISTEN (Caller): Hello.
NEARY: Go ahead.
KRISTEN: My name's Kristen. I'm a Canadian citizen, and I've been a permanent resident in Florida since the early 1990s. My parents are both naturalized Canadians - citizens, and we support universal health care. As a family, health insurance has been very expensive for us here in the States, and growing up in Canada, we had excellent continuity of care. We were able to select a general practitioner, a pediatrician, and the experience of this woman who had to, with a brain tumor, that commercial that you played is really horrible, but that largely has not been the experience of my family with the Canadian health care system.
NEARY: And what about the health care you're getting in the United States? Is it working for you?
KRISTEN: It is. It's very expensive. Canadians are sort of - we're kind of spoiled. I think when we move to the States, it's sort of a shock, you know, when we have to pay for health insurance. My employer does pay for some of my health insurance, but they don't fully cover it. And when I had to go to the emergency room recently for an ovarian cyst, my bill was quite expensive. So that has been - it works for me. I mean, I get great - I have a general practitioner, and I certainly don't have an issue with routine care, I guess you could say.
My grandmother, who is also a naturalized Canadian citizen, she died in 2005. She had scarlet fever as a child, and she had a series of strokes. And we thought about moving her to the United States, where our family was and is, and because of her preexisting conditions, it just was too expensive for our family, and really the health care that she received in Ontario was a real blessing for my family in many ways.
NEARY: All right, Kristen, thanks so much. Thanks so much for your call.
KRISTEN: All right, bye-bye.
NEARY: Dr. Day, I'd like to ask you about that, the end-of-life care and care for people as they age. I - my understanding of the health care system in Canada is that it covers that kind of thing, which we have a hard time with that in this country.
Dr. DAY: Well, it does if you're in hospital. It doesn't if you're not in hospital. And I think that there are things that the American system needs to reform based on experience in Canada. For example, I think it's awful that if you change job, or if you get sick - if you change job, you might lose your health insurance, or if you get sick, you might have to mortgage your house. I mean, those things aren't - that's not right in a rich country like the United States or Canada.
But I said earlier, there are social - there are countries with universal health care that, unlike Canada, don't have the access issues that we have of a million Canadians waiting to get access, and we have 4.5 million Canadians who can't get a family doctor, which is a big issue for a - I mean, that's one in seven Canadians. And the trouble in Canada is if you can't get a family doctor, you also have difficulty getting access to a specialist because we have this gatekeeper system, where you see a specialist only after you've seen a family physician.
So both countries have problems. And I think that we tend to focus on the myth that there's our system, the Canadian system - the Canadian system and the American system. Let's look around the world and see how others are doing.
NEARY: All right. Thanks so much for joining us, Dr. Day.
Dr. DAY: You're welcome.
NEARY: Dr. Brian Day is a former president of the Canadian Medical Association, and he's also president and CEO of Cambie Surgeries Corporation. That's a private company that developed the first private health care facility of its type in Canada.
And joining us now is Ujjal Dosanjh. He is a member of parliament for Vancouver South, and he served as Canada's minister of health. He's also at the CBC in Vancouver. Thanks for joining us today.
Mr. UJJAL DOSANJH (Member of Parliament, Vancouver South; Former Federal Minister of Health): Good to be with you.
NEARY: And I'd like you to address what we just heard from Dr. Day. Specifically, this would be one of the areas of concern, I think, for a lot of Americans looking at Canada's health care system. Dr. Day just said many Canadians can't get a family doctor and therefore can't even get access to specialists. Why would that be, and why is that a problem with the system?
Mr. DOSANJH: Well, I think in the Western world, there is a doctor, medical shortage. The United States of America is much better at integrating international medical graduates than we are. We import doctors, as well as training them here. We lose some of them to the United States for private practice. There's absolutely no doubt about that. So we could learn something from the United States of America in terms of integrating international medical graduates into our system.
There are many, many of those people who come from other countries and aren't able to practice here. In fact, many of them find the opportunity to practice in the U.S.,. But I believe that in terms of doctors, the statistics might be different. I was just reading a poll the other day. It said one of out every 10 Canadians doesn't have a doctor. One out of seven is bad. One out of 10 is bad, but if you compare that to - I'm not now knocking the American system, but if you compare that to 47 million people without insurance who don't have the ability to go see a doctor quite often, I think that what it says is that we need to improve our system. It is not necessarily that we follow the U.S. or some other system, but we need to improve our system, improve access. There's no question in some instances, there's a long wait to see specialists. Primary care and urgent care in Canada are extremely good. Specialist care, I think there's a difficulty, and we need to attract more specialists. We need to streamline procedures. Sometimes, there are inefficient ways hospitals do things.
When I was the minister of health, I was taken to Queens Hospital in Ontario, in Toronto, where they had streamlined the knee surgery, knee replacement process, and in fact had increased, manyfold, the number of procedures they could do in a month with the same resources, once the inefficiencies had been taken out. So we need to be looking at all of those issues.
NEARY: All right. Let's take a call now. We're going to go to Julia(ph), and she is calling from Ontario. Hi, Julia.
JULIA (Caller): Hi.
NEARY: Go ahead.
JULIA: I'm a U.S. citizen who has lived as a permanent resident in Canada for 22 years. And I am a breast cancer survivor, had all my treatment in Canada - never had to wait any extraordinary or exorbitant period of time. The care that I got was completely comparable to the care that friends and peers in the United States, who are also breast cancer survivors, that they received. It was entirely comparable. I never paid a dime or a dollar for anything other than for routine prescription medication because I do not have a supplemental drug plan.
It's true that the Canadian health system needs to be better funded. We do need more specialists. But I wanted to point out that the commercial with the woman with the brain tumor is entirely misleading and biased. And everyone I know - and I know a great many cancer survivors, because I've been involved in a number of ways in that community. Everyone I know has been entirely satisfied with their care. You are pushed to the front of the line when you have a serious condition.
NEARY: Okay. Julia, thanks so much for calling and giving us that perspective.
JULIA: Thank you for taking my call.
NEARY: I appreciate it.
And, you know, again, maybe this is something else that we can address. And that is what we hear so often, what we heard in that commercial, the idea of waiting times. There is a reality to that, though, isn't there, Mr. Dosanjh, that sometimes you do have to wait quite a long time for certain procedures or certain tests?
Mr. DOSANJH: Well, for elective surgery, there are long waits. For urgent surgery, sometimes there are waits. Quite often, not. I think there are waits to see specialists, inordinately long sometimes. And I think that needs to be dealt with. There's no question. We need to do a better job.
I think that it's not about changing the fundamental nature of the system, which Canadians cherish. It is, in fact, making the improvements that need to be made with specialist care, with wait times, with prescriptions.
You know, we - when I was in government, we were talking about the possibility of a national pharmacare plan. We now have - some provinces have better pharmacare plans. Others, not so much, you know, that have the capacity to provide those kinds of prescription plans. We need to include dentistry. I think those are the kinds of issues that, perhaps, are being discussed now around the federal provincial table with the ministers of health from across the country. If they aren't, they should be.
NEARY: All right. And here is an email from Richard in Ann Arbor, Michigan. He says: Canada has a population slightly less than that of California. Extrapolating to a population 10 times as large is dangerous. Do you agree with that, Mr. Dosanjh?
Mr. DOSANJH: Absolutely. I think one of the earlier callers made the point that we have a 33-million population. And sometimes we can't provide all of the boutique and specialized care because we just don't have the resources or the capacity to be able to have every kind of procedure available in Canada. And we send patients, at government expense, to the United States of America. You're our kith and kin, or our best friends. And we take advantage of that and pay you for it. I think that may be, in the long run, in some cases, cheaper than developing native facilities in Canada because you can't really do everything with a base of 33 million population.
NEARY: We're talking with Ujjal Dosanjh. He's a former federal minister of health in Canada. If you'd like to join our discussion about the Canadian health care system, the number to call is 800-989-8255. The email address is firstname.lastname@example.org.
And you're listening to TALK OF THE NATION from NPR News.
We're going to take a call now. We're going to go Rebecca, who is calling from San Mateo, California. Hi, Rebecca.
REBECCA (Caller): Hi there. How are you?
NEARY: I'm good. Go ahead.
REBECCA: I just moved to San Mateo about two years ago. I was living in Toronto. First of all, I'm a dual citizen, grew up on the East Coast. I lived in Toronto for 10 years. And in the course of the 10 years, countless emergency visits for primary care-type things. I never had to wait more than 45 minutes any given emergency room in the downtown Toronto area. I was also hit by a drunk driver on my bicycle and had to be taken by ambulance and spent the day in the hospital, was stitched up, received MRIs, saw specialists. Everything was taken cared of.
I know that there is a population difference. And that is one of the biggest arguments that Americans have against the Canadian system. And I grew up in the States with American relatives, and we were constantly battling two sides - my Canadian mother and father, and my American family battling this health care issue for years and years. I've come to California now, and I cannot get insured because of that accident I had in Toronto because I was honest about the chiropractic care that I did receive.
A bulging disc that has been taken cared of is preventing me from getting health care that I can't afford here in California. So the only thing that I can rely on - go on. I'm sorry.
NEARY: Go ahead. I was just going to ask Mr. - because we're going to be running out of time soon, Rebecca and we wanted to get some more calls in here. I was just going to ask Mr. Dosanjh to respond to some of the remarks that you've just made. Thanks for your call, Rebecca.
Mr. DOSANJH: Well, I think the highlights the fact that Canadians, by and large, get very good care without their wallets being checked at the door of the hospital. And I believe that the other point that Rebecca raised with respect to the uninsurability because of previous injuries or conditions makes the point of the importance of having government as your ultimate insurer. In Canada, it is the government that is your ultimate insurer for primary care and urgent care and hospital treatments.
Yes, prescription medicine isn't available based on the same standard across the country. I think that's something we are working towards. It is on the table of the federal provincial ministers meetings. When I was there, it was, and we were trying to develop a plan.
NEARY: I just wanted to tell our listeners that you can head over to our blog now or at the end of the show if you'd like to see a response to some of your concerns about the ad that we played at the beginning of program. And we will continue to address those concerns in our letters segment tomorrow. And thanks for letting us know about your concerns.
I'd like to read an email. We don't have much time for this, but I'll -so I'll summarize it. It's from Tom in Juneau who says he has friends in Quebec who say that when forced to take their ill daughter to hospital, the situation is a 19th century one: people in beds in hallways and in very large rooms with perhaps two dozen patients. What - and says this is very different in a city nearby for them, at Whitehorse, which is near to them in Juneau. So there's a great variation among the provinces, is there not?
Mr. DOSANJH: Yes, there is. And there's also hallway medicine in the sense that sometimes people don't have the - hospitals don't have the facilities to treat everyone that's there. That, again, is a question of resources and not about the nature of the system, but about the resources. And I think we need to enhance those resources, streamline the processes that we have in the hospital, triage the patients and do so in a more efficient fashion.
As I said, when I was a Minister of Health, I was taken to various hospitals across the country that are continuously sharing best practices. (unintelligible)…
NEARY: Thank you so much for joining us, Mr. Dosanjh. We've run out of time. I really appreciate it.
Mr. DOSANJH: Thank you.
NEARY: Ujjal Dosanjh is the former minister of Health for Canada. Coming up: put down your cell phone, but turn up the radio. A federal ban on cell phones and driving is on TALK OF THE NATION.
I'm Lynn Neary. It's TALK OF THE NATION from NPR News.