Our northern neighbors are pretty proud of their universal healthcare system. Despite that pride, an editorial in Toronto’s Globe and Mail says Canadians can learn much from the United States.
Canada’s health care reforms have “largely been the purview of provincial governments trying to get their fiscal houses in order, and often places those governments directly at odds with doctors,” the paper reported. So service cuts get ordered by government bureaucrats instead of medical experts.
In places where budget-trimming has been especially severe, like Ontario, some physicians are “fleeing the province,” looking for better pay and less interference. There have also been reports of patients denied essential care.
The newspaper argues that part of the problem is Canadian doctors, unlike American physician groups, aren’t aggressive enough in telling the government what they need and what they can give up. It urges Canadian doctors to identify “tests or procedures that are commonly used, but are of no proven medical benefit.”
Talk of healthcare cuts inevitably leads to an unpleasant discussion of what Dr. Howard Brody calls “the third rail” of politics: rationing. Here, too, the U.S. provides guidance: the dreaded “R-word” sends American politicians running for the hills (remember Sen. Charles Grassley and his infamous remark about the government “pulling the plug on Grandma?”)
And yet Dr. Brody writes in The New England Journal of Medicine that, distasteful as it might be, rationing is a necessary part of medicine: “Rationing occurs simply because resources are finite and someone must decide who gets what. Rationing is therefore inevitable; if we avoid explicit rationing, we will resort to implicit and perhaps unfair rationing methods.”
The discussion might be academic, given that the Supreme Court could soon send the U.S. government back to the drawing board. The court is set to rule on the constitutionality of President Obama’s Affordable Care Act as soon as next Monday. That’s one issue Canadians don’t have to deal with.