CMA takes debate about health

HEALTH CARE * LES SOINS

CMA takes debate about health care south of the border

Milan Korcok

"With a few exceptions, those who need emergency or urgent care receive it, very few people fail to get the care they need because it is not available or because they cannot afford it, quality of care remains high despite waiting lists, and the clinical autonomy of physicians has been

W ith 33 million Americans having no health care insurance and most of the ones who have it digging ever deeper into their pockets to pay ever-increasing bills, some legislators and consumer advocates see salvation in adopting, or at least learning from, the Canadian system. But, at a recent student council convention sponsored by the University of Miami School of Medicine, Dr. Colin McMillan, chairman of the CMA's Political Action Committee, told students that as effective as medicare has been in guaranteeing Canadians reasonable access to quality care, it faces serious problems caused by "an inability or unwillingness of provincial governments to pay the costs involved". Speaking at a panel weighing the "indications and contraindications for a nationalized health care system", McMillan, past president of the Prince Edward Island Medical Society, sounded a clearly positive note about the Canadian system.

Canadian patients who have to seek surgery in the US are "hardly an advertisement for reasonable access

Milan Korcok is a freelance writer living in Fort Lauderdale, Florida.

Dr. Colin McMillan

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maintained." And in comparison to health care in the United States, said McMillan, "life expectancy is 2 years longer in Canada, infant mortality is lower, and yet we spend less than 9% of [gross national product] on health care per year, whereas the US spends 11.4%". But there are conflicts with provincial governments over costs, he explained. Provincial governments often exert inflexible budgetary controls on hospitals, so hospital boards often resort to bed closures to balance budgets, patients are discharged earlier, and more surgery is performed on an outpatient basis. "In my specialty of cardiovascular medicine many of our tertiary hospitals have only 70% of the CCU [cardiac care unit] beds they need, so occupancy is 95%. And 40% of patients who need CCU

care wait more than 2 hours in Emergency until beds are available. Many patients wait 8 weeks for cardiac catheterization or 5 weeks for angioplasty. And the wait for elective coronary artery bypass surgery can be up to 16 weeks." He noted also that in Ontario "many patients have opted for heart surgery in Detroit or Buffalo. In British Columbia the government is currently negotiating for 200-plus Canadians to have surgery in Seattle every year". He said such examples are "hardly an advertisement for reasonable access". McMillan said no one knows what the future holds for the Canadian system, but remained "cautiously optimistic that it will be maintained, even enhanced, if for no other reason than that the public will demand it". Admitting that there were "some things about the medical system which can be fixed as far as accessibility is concerned", Dr. Rufus Broadaway, an American Medical Association (AMA) trustee and senior vice-president of medical affairs at Cedars Medical Center in Miami, called US health care "basically decent, [and] good". And though he refrained from any specific reference, good or bad, about adopting a Canadianstyle system in the US, he did say change should not be forged at the expense of basic freedoms: "The freedom of the patient to select his or her physician, to be part of the decisions in [his or her] medical care, and the freedom of the physician to treat [that] patient as he thinks the patient needs to be treated." Projecting the AMA's platform for improving health care in the US, Broadaway urged a revamping of the Medicare system, which insures the elderly and disabled, to make it more fiscally sound. "Medicare is now providing less than adequate

insurance for its citizens", he said. Broadaway also called for improved Medicaid benefits, which cover the indigent, and for making those benefits uniform across the country. (Medicaid funding is largely a state responsibility.) And he called for expansion of employer-paid health insurance, which he termed "the basic method of providing health care for our citizens". Douglas Peters, senior vicepresident for public affairs at the Blue Cross and Blue Shield Association, said the US would not adopt a single national health care system. Proposals advocating one have been debated since the 1970s, but he said no action has been taken to translate them into legislation. "Our values, our culture, our

politics, our social and economic systems, are not consistent with the concept of a monolithic buyer." Americans, he said, do not accept the concept of "one set of rules for everyone and one set of options for everyone". He added that the health care system of the future will continue to be "a blend of public and private financing, voluntary and public regulation". In a summation, McMillan told the medical students that the debate about multifaceted versus monolithic funding, and private versus public funding, will be around for a long time. He urged them to become involved in the dialogue, but warned that such debate is essentially a political public-policy process, not a medical one. "And the rules are different", he concluded.u

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CMA takes debate about health care south of the border.

CMA takes debate about health HEALTH CARE * LES SOINS CMA takes debate about health care south of the border Milan Korcok "With a few exceptions,...
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