Keep Bay Street at bay!
CMAJ 1998;158:167
I am disturbed by one comment in the editorial "Physician resource planning in an era of uncertainty and change" (CMAJ 1997;157[9]:1227-8 [full text / résumé]), by Dr. Bruce J. Fried. The Canadian health care system is undergoing change, and health care planners do play a vital role in the survival of our national system. However, I am concerned by Dr. Fried's comment about our choices: regulation or a market-based economic strategy. Although regulation may not be ideal, a market-based system is far less palatable.
As a Canadian physician working in the US, I face the problems of
a market-based health care system daily. Any system in which 15%
of the population is uninsured, and in which an equal number of
people have inadequate insurance, is a failure. Managed care and
health maintenance do just that: they manage the care of
healthy people. What they do not do is provide adequate
care for the chronically ill, elderly people and those with
catastrophic illness. In the free market, commercial health care
organizations do their best not to treat these "costly" patients.
Canada has a chance to learn a great deal from managed care
mistakes made in the US. Something is wrong with a country that
spends more than 14% of its gross domestic product on health
care, yet has millions of people without health insurance, a high
rate of infant and maternal mortality, and lower-than-average
life expectancy compared with other developed countries. Canada
would be best served by choosing Fried’s first option for reform:
regulation. I know, because I have served in both systems.
Readers may question why I currently practise in the US. I
recognize the problems in the Canadian system and would like to
contribute to the solutions. However, I was offered an
opportunity to train in health care management and public health
planning while practising in a large emergency room, and I am
using the opportunity to acquire the skills I need to help plan
and deliver health care effectively. At the same time I am
gaining firsthand experience in how the market economy has failed
to provide universal coverage. I will return home once my
training is complete.
In Canada we should keep Bay Street (and Wall Street) from making
a business of health care. The health and well-being of Canadians
should never be managed and traded as a commodity!
Russell D. MacDonald, MD
Associate Medical Director
Boston City Emergency Medical Services
Clinical Instructor
Department of Emergency Medicine
Boston University School of Medicine
Attending Physician
Emergency Department
Boston Medical Center
Boston, Mass.
MACDONALD@BOSTONEMS.ORG
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