Medicare attack dogs barking up wrong tree

Posted on February 4, 2010 in Health – Opinion
February 04, 2010.   Michael Rachlis

On Tuesday morning Newfoundland and Labrador’s deputy premier Kathy Dunderdale announced that Premier Danny Williams would be receiving heart surgery in the U.S. later this week. There was no information on the exact diagnosis of the premier’s health problem or what type of surgery was planned.

Within minutes, right-wing groups in Canada and the U.S. claimed that the premier’s trip was proof positive of medicare’s inadequacies.

The Americans for Prosperity Foundation has poured millions into beating back President Barack Obama’s mild health-care reforms. They concluded that Williams’s trip highlighted the shortcomings of Canada’s single-payer system.

The Vancouver-based Fraser Institute went even further.

Spokesperson Nadeem Esmail said Williams’s exit showed that Canadian health care was not up to standard. Esmail plugged the institute’s recent survey alleging that thousands of other Canadians go to the United States every year for health care they can’t get in Canada.

But did Premier Williams really need to leave Canada for care? Do lots of Canadians go to the U.S.? And what does this debate say about medicare?

Dunderdale did say that the procedure was not available in Newfoundland and Labrador. Although we don’t know Williams’s exact condition, Canadian doctors have been unanimous that it is highly unlikely he had to leave Canada for his procedure.

University Health Network director of cardiovascular surgery Chris Feindel claimed that he is aware of only one non-experimental cardiac procedure available in the U.S. but not Canada: the repair of complex aortic aneurysms.

Ontario usually sends one or two such patients a year to Baylor College of Medicine in Houston. On the other hand, Feindel notes that several U.S. patients a year come to the University Health Network for the valve surgery for which Toronto is world famous.

Ottawa Heart Institute president Robert Roberts was previously Baylor’s chief of cardiology and he said that Canadian heart care was as good as the best centres in the U.S. And data from the Ontario Cardiac Care Registry confirms that Ontario’s patient outcomes are as good as, or better, than anywhere in the world.

Conservative senator and heart surgeon Wilbert Keon went even further, saying he was convinced Williams could have had his procedure in this country. The former director of the Ottawa Heart Institute added that Williams will have to admit that fact when he recovers.

The Fraser Institute would have us believe that many Canadians go to the U.S. for health care. But the facts show few Canadian patients go south, especially for elective care.

A 2002 study by American and Canadian academics found that one out of 500 Canadian hospitalizations occurred in the U.S. and 80 per cent of these were for pregnancy-related conditions. In other words, women precipitously going into labour while travelling.

Another 10 per cent were for other emergency conditions, meaning that about one in every 5,000 Canadian hospitalizations were for patients deliberating seeking elective care, presumably like Williams.

What does this debate say about Canadian health care?

First, Williams’s case reveals medicare’s cross-border attack dogs are ever vigilant for potential bad news. They will broadcast it far and wide before we know any facts.

There’s billions of dollars at stake for Canada’s growing private health-care providers. And, there’s hundreds of billions at risk if our American friends ever decide to join the rest of the civilized world and enact public health insurance.

Second, when the facts are revealed, Canadian hospital care is as good as anywhere in the world. Of course it has problems. Like other countries, we need to pay more attention to quality and safety.

But Canadians facing heart surgery shouldn’t feel that they are getting anything less than world-class care.

Finally, we do need to adopt one American political value – transparency about our politicians’ health care.

I wish Williams a successful surgery and a swift recovery. And we don’t need to know the details of his case. But, when a provincial premier leaves the country for health care, Canadians deserve to know why.

Michael Rachlis is a health policy analyst and an associate professor at the University of Toronto.

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