NOTE: This article was published well before the presidential election in November. It is still timely, however, as President-elect Obama will be working on the health-care issue during his presidency.
(by David Gratzer, IBDEditorials.com) – As this presidential campaign continues, the candidates’ comments about health care will continue to include stories of their own experiences and anecdotes of people across the country: the uninsured woman in Ohio, the diabetic in Detroit, the overworked doctor in Orlando, to name a few.
But no one will mention Claude Castonguay – perhaps not surprising because this statesman isn’t an American and hasn’t held office in over three decades.
Castonguay’s evolving view of Canadian health care, however, should weigh heavily on how the candidates think about the issue in this country.
Back in the 1960s, Castonguay chaired a Canadian government committee studying health reform and recommended that his home province of Quebec – then the largest and most affluent in the country – adopt government-administered health care, covering all citizens through tax levies.
The government followed his advice, leading to his modern-day moniker: “the father of Quebec medicare.” Even this title seems modest; Castonguay’s work triggered a domino effect across the country, until eventually his ideas were implemented from coast to coast.
Four decades later, as the chairman of a government committee reviewing Quebec health care this year, Castonguay concluded that the system is in “crisis.”
“We thought we could resolve the system’s problems by rationing services or injecting massive amounts of new money into it,” says Castonguay. But now he prescribes a radical overhaul: “We are proposing to give a greater role to the private sector so that people can exercise freedom of choice.”
Castonguay advocates contracting out services to the private sector, going so far as suggesting that public hospitals rent space during off-hours to entrepreneurial doctors. He supports co-pays for patients who want to see physicians. Castonguay, the man who championed public health insurance in Canada, now urges for the legalization of private health insurance.
In America, these ideas may not sound shocking. But in Canada, where the private sector has been shunned for decades, these are extraordinary views, especially coming from Castonguay. It’s as if John Maynard Keynes, resting on his British death bed in 1946, had declared that his faith in government interventionism was misplaced.
What would drive a man like Castonguay to reconsider his long-held beliefs? Try a health care system so overburdened that hundreds of thousands in need of medical attention wait for care, any care; a system where people in towns like Norwalk, Ontario, participate in lotteries to win appointments with the local family doctor.
Years ago, Canadians touted their health care system as the best in the world; today, Canadian health care stands in ruinous shape.
Sick with ovarian cancer, Sylvia de Vires, an Ontario woman afflicted with a 13-inch, fluid-filled tumor weighing 40 pounds, was unable to get timely care in Canada. She crossed the American border to Pontiac, Mich., where a surgeon removed the tumor, estimating she could not have lived longer than a few weeks more.
The Canadian government pays for U.S. medical care in some circumstances, but it declined to do so in de Vires’ case for a bureaucratically perfect, but inhumane, reason: She hadn’t properly filled out a form. At death’s door, de Vires should have done her paperwork better.
De Vires is far from unusual in seeking medical treatment in the U.S. Even Canadian government officials send patients across the border, increasingly looking to American medicine to deal with their overload of patients and chronic shortage of care.
Since the spring of 2006, Ontario’s government has sent at least 164 patients to New York and Michigan for neurosurgery emergencies – defined by the Globe and Mail newspaper as “broken necks, burst aneurysms and other types of bleeding in or around the brain.” Other provinces have followed Ontario’s example.
Canada isn’t the only country facing a government health care crisis. Britain’s system, once the postwar inspiration for many Western countries, is similarly plagued. Both countries trail the U.S. in five-year cancer survival rates, transplantation outcomes and other measures.
The problem is that government bureaucrats simply can’t centrally plan their way to better health care.
A typical example: The Ministry of Health declared that British patients should get ER care within four hours. The result? At some hospitals, seriously ill patients are kept in ambulances for hours so as not to run afoul of the regulation; at other hospitals, patients are admitted to inappropriate wards.
Declarations can’t solve staffing shortages and the other rationing of care that occurs in government-run systems.
Polls show Americans are desperately unhappy with their system and a government solution grows in popularity. Neither Sen. Obama nor Sen. McCain is explicitly pushing for single-payer health care, as the Canadian system is known in America.
“I happen to be a proponent of a single-payer health care program,” Obama said back in the 1990s. Last year, Obama told the New Yorker that “if you’re starting from scratch, then a single-payer system probably makes sense.”
As for the Republicans, simply criticizing Democratic health care proposals will not suffice – it’s not 1994 anymore. And, while McCain’s health care proposals hold promise of putting families in charge of their health care and perhaps even taming costs, McCain, at least so far, doesn’t seem terribly interested in discussing health care on the campaign trail.
However the candidates choose to proceed, Americans should know that one of the founding fathers of Canada’s government-run health care system has turned against his own creation. If Claude Castonguay is abandoning ship, why should Americans bother climbing on board?
Gratzer is a senior fellow at the Manhattan Institute and a physician licensed in both the U.S. and Canada, where he received his medical training. His newest book, “The Cure: How Capitalism Can Save American Health Care,” is now available in paperback.
This article was first posted at IBDeditorials.com on June 25, 2008. Reprinted here December 11, 2008 for educational purposes only.
1. What role did Claude Castonguay play in the health care system in Canada in the 1960’s?
2. What did Mr. Castonguay conclude this year about his government-run health care system?
3. What solution does Mr. Castonguay propose for Canada’s government-run health care system? (see para. 7-8)
4. Describe some of the problems with the government-run health care systems in Canada (para. 10-15) and England (para. 16-19).
5. What is the main point of Mr. Gratzer’s commentary?
6. Show a parent this article and ask whether he/she supports a government-run (universal) health care system in the U.S. and to explain why or why not.