Canada's System: A Model for US?

CANADA'S health care system, often mentioned as the ideal solution to rising American health care costs, is under strain. Hospitals are short of money, nurses are leaving for more pay in the United States, and patients have to wait months or even years to get a spot in a hospital. Health care in Canada is ``free'' - or at least there are no direct charges for people who use it. Just present your provincial health card and it is all taken care of. Private rooms are extra, but everything else is ``free.''

Doctors fees, nurses salaries, and hospital costs are all paid by provincial governments. The poorer provinces, such as Newfoundland and the Maritime provinces, get a subsidy from the federal government, in effect a transfer from richer provinces.

So Canadians don't have to worry about health costs; there are no expensive health insurance plans, no stories of families going bankrupt to pay for health care. The Canadian Medicare system is popular. A recent poll showed 88 percent of Canadians do not want any funds taken from health care spending.

But taxes are more expensive in Canada than in the US, and one of the big reasons is the $46 billion (Canadian; US$38.4 billion) national medical bill. Top tax rates in Canada are 48 percent while a high American rate would be about 32 percent.

All doctors in Canada have to bill governments for their services. They are among the highest paid people in Canada. The average Ontario doctor earns C$170,800 (US$142,800) a year before office expenses. Big city doctors in private practice would make double that amount.

Many doctors would like to see a two-tier system where they could charge private patients extra and bill the government for everybody else. Such a system exists in Britain for example, but it has been outlawed in Canada.

By one measurement Canadian health care is cheaper overall than it is in the United States. Health care costs in Canada take up 8.6 percent of gross national product, compared with 11.2 percent in the US. This has led to the idea that state medical care is cheaper. But is it?

``The [US] House and the Senate ... are both drooling over what they believe are the merits of the Canadian system,'' says Michael Walker, head of the Fraser Institute in Vancouver. ``My sense is that they have greatly oversold themselves on Canadian health care and that they should be more cautious.''

Mr. Walker says he once approved of the Canadian medicare system, but it has become too dominated by the provincial governments who administer the plan. ``Once medical care is in the public domain, it becomes a political issue.''

Transfer payments to the provinces, which help pay for health expenditures, were cut back in last week's federal budget. That means provinces will now have to take the political heat for making cuts in what Canadians see as a basic service.

The waiting room at the Yorkview Medical Centre clinic in Toronto is usually filled with parents and their children. Many are people who have grown used to visiting the doctor with even minor complaints. The doctors who see them charge so much per visit, and bill the government. The checks arrive promptly; no bad debts, no collection agencies. Good news for the doctors - but it can overload the system.

``Where the system fails is that there's no limit on the number of visits and people abuse it. They might not if they had to pay for every visit,'' says Joan Flood, a general practitioner with a family practice in a northern suburb of Toronto. ``A mother brings in three kids with sniffles. Well they don't need to see a doctor. I should be doing checkups, advising people to do things such as give up smoking and make other lifestyle changes which will improve their long-term health.''

One group of doctors says the health care system in Canada favors taking care of sick people rather than making sure people don't get sick in the first place.

``There is a lot of over-use of surgery and technology. More than half the heart surgery done in Canada is unnecessary,'' says Ulli Diemer, spokesman for a Medical Reform Group. ``Many procedures, such as [Caesarian births], may have more to do with the doctors incomes than medical need.''

``In spite of the shortcomings, I think the Canadian system works better than the American system,'' says Joan Flood. ``I think it's a moral system. People aren't refused care because they don't have the money.''