Canadian Medical Association Journal 1996; 154: 1619-1625
A front page headline read, "Patient jumps queue for MRI -- private coverage offers access." The article stated that "Money and the right connections are apparently all that is necessary to jump to the top of the waiting list for an expensive and scarce medical test. . . . The wait . . . is usually nine months."[1]
On page A3 was a large display advertisement for hip and knee replacements, for which the University of Virginia Medical Center had paid handsomely. In the letters-to-the- editor section, Dr. R. Richards, president of the Ontario Orthopaedic Association, commented, "Our patients have known for some time that the time is `wrong' to have this type of surgery in Ontario . . . budget restrictions, bed shortages, hospital closings, long waiting lists . . . have contributed to the problem."[2]
The principles of the Canada Health Act lead to universal waiting lists, not to universal access. Canada's health care system is being wound down: services are being rationed, hospitals closed, jobs lost and research stalled. Illness is increased and disability prolonged. There is a brain drain, and we are exporting thousands of valuable jobs.
Health care in Canada can and should be a growth industry. It could be the single largest employer in the nation. There is the need, the demand and the necessity. We have the desire, the institutions, the people and the abilities to be a world leader in health care. Just a few years ago, foreigners come to Canada for their health care; this flow has now been reversed, to the detriment of employment and the current account.
The Canadian government cannot afford universal, comprehensive health care. Such a system is actuarially untenable and inherently unstable; it is destined to self-destruct. The government can, however, provide essential care for the poor and disaster coverage for all, and it should allow people to choose insurance coverage that they deem necessary and that fits their circumstances. An insignificant finger sprain to the scholar is a catastrophe to the violinist; a 6-month wait for arthroscopy may be quite acceptable to a pensioner but financial ruin for an entrepreneur.
We need to abandon unworkable ideologies and resurrect an enviable, vibrant and progressive world-class health care system. Freedom of choice would be a good start in a democracy.
Gabor Lantos, PEng, MBA, MD
Occupational Health Management
Services
Toronto, Ont.