Recently, Toronto doctor Danielle Martin achieved YouTube fame by appearing in front of a United States senate hearing where she was asked to defend Canada’s single payer healthcare system to a largely partisan audience. The video shows a composed Dr. Martin outlining the benefits of Canada’s universal healthcare structure and contrasting it with the American one, while noting the strong public support in Canada for access to care that shouldn’t depend on one’s ability to pay. With close to 1 million views and further attention garnered from the media, it’s hard to deny the sense of pride and maybe even superiority Dr. Martin evokes when referring to our system, especially with the debate over Obamacare raging to the south of us.
But where does this sense of pride come from and is it even justified?
The history of Universal Healthcare in Canada
Historically, we weren’t always the staunch supporters of medicare that we are today. With its first appearance in Saskatchewan on July 1, 1962, both the North American medical establishment and entire insurance industry were determined to stop medicare in its tracks. Spearheaded by the local College of Physicians and Surgeons and further supported by the CMA, AMA and economic and media elite, the battle over medicare lasted decades before it became accepted on a national level.1
Yet even today, despite overwhelming public support that sees 80-90% approval ratings and Tommy Douglas voted as “The Greatest Canadian” over the likes of Terry Fox and Wayne Gretsky in a 2004 CBC poll, there still exists a strong movement to see a 2 payer system here in Canada; and in some respects we already have one. In order to access certain health services such as Physical Therapy, Occupational Therapy and Psychotherapy, private health insurance is required in addition to the provincial medicare coverage. If you don’t have it, you either have to pay out of pocket or not get it at all. While not a foreign concept to many other publicly funded systems, this added obstacle to accessing certain services undermines the concept of a truly universal healthcare system and can indirectly lead to higher system costs.
Perhaps the greatest example of this is the exclusion of certain medically necessary drugs from the Canada Health Act, with the result being that uninsured individuals have to absorb the price of acquiring some of their medications. A recent study by Law and colleagues found that approximately 1 in 10 Canadians do not fill a prescription or take medication as prescribed because of concerns regarding costs. A patient with congestive heart failure, for example, might face out-of-pocket expenses varying between $74 and $1,332 a month for their prescriptions, which could result in non-adherence to their treatment plans and increased morbidity, mortality and need for in-hospital care.
So could it be that our pride is a little misplaced, and that our system is closer to the American one than we care to acknowledge? Just recently I was involved in the case of a 2-month old infant who suffered a cardiac arrest while at home just outside of North Bay, Ontario. Following the initial resuscitation efforts by paramedics, she was transported to the nearest hospital 30 minutes away where she required several hours of care. Given the severity of her condition, she then required transfer to the pediatric referral centre in Ottawa, and this involved a 9 hour journey by ground and air transport for the patient, parents and accompanying medical personnel. She was then admitted to the Pediatric Intensive Care Unit for a 1-week duration where she underwent a battery of tests and evaluations by various medical specialists. Once deemed stable, air transport of the infant and her parents back to North Bay was provided.
Good, but not perfect
Now, what is the importance of this story? Not once did anybody ask the parents if they had the appropriate coverage for all this care. Not once did they ever have to think about anything other than the heath of their daughter. Not once did the medical teams have to stop and consider the cost of their care and limit their investigations based on how much the family was able to pay.
So yes our system has high costs and we continue to struggle with certain issues, but as the discussion towards introducing a 2 payer system ensues, it’s important not to forget the stories that remind us why universal healthcare coverage is so important. For my money, I’m with Dr. Martin. Our system is a good one; it may not be perfect, but it’s definitely better than the alternative.
- Brown, Lorne; Taylor, Doug. The Birth of Medicare – From Saskatchewan’s breakthrough to Canada-wide coverage. July 3rd, 2012. <http://canadiandimension.com/articles/4795/>