Robert Douglas: Canada is a good model for health care reform
By Robert Douglas
Tallahassee Democrat
My View
June 13, 2009
My first encounter with the U.S. health care system was in 1979. Thirty years later, it still haunts me and fuels my passion for supporting fundamental reform.
During a visit to a small hospital just outside Washington, D.C., I witnessed a scene that was utterly foreign to me as a recent immigrant from Canada. It involved a dispute between an unkempt young man in need of help and an officious clerk doing her best to deny it.
He had come into the hospital on a nonemergency basis to have stitches removed from a hand that had been injured weeks before on a nonunion construction site. The clerk told him that, until he produced proof of insurance or $60, he could not be seen by someone from the medical staff.
With his voice rising in frustration enough to prompt crying from the infant carried by his old-beyond-her-years wife who stood beside him, the man said as he started to leave: “I don’t have any insurance. I don’t have any money. The boss won’t let me back on the job until I get the stitches out. So I guess I’ll have to take them out myself.”
I left as well. But as a native Canadian who had never seen a doctor’s bill or been hassled at a hospital, I was shaken by this brutal show of how Americans treat those with no means but great needs.
With the typically understated smugness Canadians exude when they find something besides hockey where they outshine Americans, I chalked it up as another reason why my native country is a more civilized society than the one I was choosing to adopt.
But now that I’m a U.S. citizen, I’m no longer smug. And while I feel blessed to have adequate insurance myself, I’m angry that the injustice of our health care system persists.
But I’m also hopeful that fundamental reform finally has a chance here. And as the reform debate heats up, I feel obliged to share my perspective as someone who came of age Up North as Canada adopted its version of universal health care.
While progressive groups such as the Physicians for a National Health Program (PNHP) are backing legislation to create a Canadian-style system, in which government is the single payer of most health care costs, the health care establishment is cautioning against any reform that usurps its control and cuts into its profits. And now it seems that President Obama — pragmatist that he is — is listening, because he would rather achieve some incremental reform than no reform at all.
But that doesn’t mean we should take the Canadian model off the table, because it is the standard against which any progress here ultimately will be measured.
To be sure, the Canadian system of care is not perfect. And for every proponent of it you can find a detractor. But there are a few irrefutable facts. For instance:
- Per capita health care costs in Canada are about half of the comparable costs in the U.S., where 45 million remain uninsured — more than the entire 33.5 million population of Canada.
- Research suggests that medical outcomes in Canada are generally superior to those in the U.S.
- Most importantly, the specter that has haunted me for 30 years — of someone in need but without means being denied care — would not be shrugged off as routine in Canada as it too often is here.
Of course, Canadians had their share of struggles on their way to universal coverage — some of which have a familiar ring.
Socialism. Rationing. Long waits for inferior care. No choice. When reform talk here turns to the Canadian model, these are canards often used to strike fear in The Great Unwell. Much as they were in 1962, when the grandfather of actor Keifer Sutherland pioneered universal health care as premier in the sparsely populated prairie province of Saskatchewan.
The doctors in the province actually went on strike to protest changing the status quo. But Premier T.C. Douglas (no relation) would not be deterred. He successfully implemented a universal health care program in his own province and, by 1966, Canada’s federal government had adopted legislation calling for all provinces to create their own versions of a program guaranteeing that none of their citizens be denied care on the basis of their ability to pay for it.
Perhaps the biggest challenge to the Canadian system over the years has been keeping the system adequately funded. Just as Florida legislators are prone to cheat our children by underfunding education, some provincial legislators are prone to cheat the sick by underfunding health care.
But Canadians have always fought back to keep the “wonderful legacy” of universal health care that T.C. Douglas once told his grandson defines what makes Canadians special as much as their ability to endure harsh winters.
The grandson, who ironically has become an iconic American hero with his portrayal of terrorist-fighter Jack Bauer on television’s “24,” spoke passionately as a Canadian in defense of his grandfather’s legacy in 2000 at a rally in Edmonton called to protest another legislative effort to undermine universal health care.
Sutherland told a crowd of 8,000 that the universal health system his grandfather pioneered is “the envy of the rest of the world” because it shows Canadians have a way to “take responsibility for each other” by developing a platform for medical health for both the rich and poor, regardless of color or political bent. In Canada, he said, anyone can get the care he or she needs “because it is humane.”
“This is not a political issue,” he told the Canadians in a message that should resonate with Americans now. “It is an issue of humanity.”
I close my eyes and fantasize Sutherland’s Jack Bauer persona getting in the face of the clerk I saw 30 years ago denying care to the construction worker and, with his hallmark enhanced intensity, appealing to her sense of humanity.
Eyes wide open, I’m rooting for real-life champions of the reform that is in the spirit of Sutherland’s granddad.