Friday, June 10, 2005

Oy, Canada!

Sorry for the pun, but I couldn’t resist. The last few postings here have dealt with some of the shortcomings of our health care delivery and finance system, and the temptation is to look northward at “free” healthcare.
As the saying goes, though: “TANSTAAFL” (There Ain’t No Such Thing As A Free Lunch). While our system definitively needs work, our brethren to the north have some problems of their own:
The reason that this is significant is that Canada’s much-vaunted nationalized health care system has quite a few problems, not the least of which is long waits for even simple procedures, and often fatal waits for more critical ones. The problem is exacerbated by a law which made it illegal for desperately ill patients to seek care outside the system, even if they could pay for it themselves.
Sometimes, it helps to put a human face on the problem:
Baruch Tegegne, now 61, has advanced kidney disease caused by diabetes. He undergoes dialysis four times a week, and is deteriorating. He's on a waiting list for a kidney transplant, and a private donor has been found. The problem is that the Montreal hospital which would do the actual procedure is refusing to do so, on "ethical grounds." But that's a subject for another post. The point here is that another hospital, in Toronto, is apparently willing and able to do the transplant.
But in Canada, the "free healthcare" isn't portable across provinces, so the system won't pay for the procedure if it's done in Toronto. The implications of such a system here are pretty scary.
An Israeli hospital has offered to do the surgery, at a reduced rate, and fund-raising efforts are underway to make this happen. But the real tragedy here is the impersonal and unbending system that has placed someone in this position. And I’m sure that Mr Tegegne isn’t the only Canuck who faces this problem, but his story is illustrative of a system which is not, IMHO, an appropriate replacement for our own.
So, what’s the connection? Well, a clue is found in this passage from the Times article: “But in recent years patients have been forced to wait longer for diagnostic tests and elective surgery, while the wealthy and well connected either sought care in the United States or used influence to jump medical lines.
Once there’s rationing, then the system itself encourages folks to seek alternatives. As it stands, those best able to afford treatment get it, somewhere. And those least able to afford such alternatives languish or, in many cases, die in line.
Something to consider when our political class – of either stripe – propose drastic governmental solutions.
For a somewhat different perspective, I recommend Dr John Ford's take on this over at California Medicine Man.
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