The health debate beyond the Danny Williams story

Why Canada should be looking for ways to adapt, not revolutionize, health care

The story of Newfoundland Premier Danny Williams’ trip to Florida for heart surgery hasn’t exactly elevated the argument about health care. To try to shift to a more useful debate, I suppose it would seem even-handed of me to insert here a diplomatic comment about how both advocates and opponents of universal insurance went overboard. But I think the mistakes mostly came from the right, in the form of hasty claims that Williams’ decision somehow proved the Canadian system is fatally flawed.

As more facts emerged, that gleeful assertion just didn’t hold up. All evidence suggests that excellent heart surgery of  exactly the sort Williams needed was readily available in Canada. The other factors that might have legitimately influenced his choice—the amenities of a U.S. hospital where the rich can pay out-of-pocket, the skills of a particular surgeon recommended to Williams by his own doctor, the proximity of a Miami hospital to the premier’s Florida condo—don’t matter much.

Still, even though I was relieved to see that this entertaining case didn’t serve as a vivid lesson about some failing of a Canadian model that I broadly support, I’m left uneasy about how the argument has gone.  Rather than forcing us really examine the Canada-U.S. contrast, the Williams story has been a grand diversion. At first, it put wind in the sails of conservative opponents of public care; in the end, it buoyed up liberal supporters of universal insurance like me.

There’s much more to be learned by making international comparisons. A good staring point, I think, is the research conducted by the Commonwealth Fund, a private U.S. foundation that backs study into health issues. Broadening beyond the stark Canada-U.S. contrast to include other countries is a good idea. But since the Danny Williams story highlighted only the North American fault line, let’s start with a few points on the two-country comparison.

The Canadian system’s clearest advantage, not surprisingly,  is that it doesn’t leave anybody without insurance. That’s reflected in how often Americans don’t seek care because they’re worried about cost. Here’s a Commonwealth Fund stat that jumps out: in a 2005 survey, 34 per cent of “sicker” American adults reported instances when they had a medical problem but did not visit a doctor, compared to only 7 per cent of Canadians.

On the other hand, our Canadian insistence on equal access has led to sluggishness. A 2009 survey by the fund found that 47 per cent of Canadian primary care physicians reported their patients having difficulty getting specialized diagnostic tests, compared to just 24 per cent in the U.S. In that 2005 study, 36 per cent of sicker adults in Canada reported having to wait six days or longer for a necessary medical appointment, compared to just 23 per cent of Americans. Worse, 57 per cent of Canadians who needed to see a specialist had to wait more than four weeks, compared to 23 per cent of Americans.

(It’s worth noting, though, that these waits were reported before progress on shrinking Canadian waits began in earnest, following the 2004 deal that saw Ottawa inject $5.5 billion over ten years into shortening queues.)

The numbers often back up some of what we might assume about the differences between public and private systems: more fairness in the public, faster service in the private. Widen your view to take in other countries with mostly public systems, however, and that neat picture becomes more complex.

For instance, only 37 per cent of Canada’s primary care physicians use electronic patient records, compared with 46 per cent of U.S. doctors. That U.S. edge must reflect business-style thinking among U.S. docs, right?  Maybe not: in European countries with mainly public systems, the rate of electronic patient record-keeping is far higher still—72 per cent in Germany and 96 per cent in Britain.

Other Commonwealth Fund stats challenge assumptions, widely held even in Canada, about the advantages of free-market motivations in the U.S. system. Consider this: just 30 per cent of U.S. primary care doctors report that’s there’s any financial incentive in their practice for improving the quality of care to their patients; in Canada, it’s 41 per cent.

No statistic taken alone is definitive. But together they point us in the direction of nuance. Canada should be looking for ways to adapt, not revolutionize, health care. If the path from primary physician to specialist is shorter in the U.S., learn from that. If, as I’ve been told recently by Canadian doctors, Britain has done better at cutting wait times within a public system, learn from that. If Europe is broadly better at computerized records, there’s our classroom.

None of these potential lessons, I’m afraid, has zing to match of the saga of a millionaire politician jetting south for surgery. Personal stories are fun to tell. Policy requires charts and graphs.