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Is universal health care worth waiting for?
Published on July 29, 2007
Author: Henry L. Davis - NEWS MEDICAL REPORTER
© The Buffalo News Inc.
After battling brain cancer, Lindsay McCreith is ready for his next fight: He's taking on the Canadian health care system.
His case has potential repercussions on both sides of the border as pressure grows for health reform.
It started when the 66-year-old retired auto body shop owner suffered a seizure last year, and he was told he would have to wait more than four months in Canada for an MRI to rule out a malignant tumor.
Rather than wait, McCreith quickly arranged a trip to Buffalo for a scan. The MRI confirmed his worst fears -- a cancerous growth that a Buffalo neurosurgeon removed a few weeks later. "If I had been patient, I'd probably be disabled or dead today," McCreith said.
Now, McCreith is suing the Ontario government in a closely watched constitutional challenge that could reshape universal health coverage in the province by striking down the prohibition against patients buying private insurance.
On this side of the border, advocates of universal health insurance champion Canada's popular public program as a fairer system that the United States should emulate, as seen in Michael Moore film, "Sicko." Yet critics see the long waits for some services in Canada -- mainly for non-emergency surgery -- as an argument against an increased role for government in health care.
In Canada, McCreith's story reflects a debate, intensified by the long waiting times, between those who want more for-profit, private care and those who fear the rise of two-tier medicine that undermines the public system.
McCreith offers little doubt about where he stands. "We have universal health coverage," he said. "But it failed me when I needed it the most."
McCreith of Newmarket, north of Toronto, experienced seizures on Jan. 2, 2006, and was diagnosed with a benign tumor based on a CT scan. A physician at a Canadian hospital declined to order an MRI to rule out a malignancy. McCreith's family doctor agreed to request the more-definitive scan, but McCreith was told he would have to wait over four months for the appointment.
Concerned that the tumor could progress, McCreith on Feb. 2 arranged through Timely Medical Alternatives Inc., a Vancouver, B.C., company that helps patients obtain services outside of Canada's public health care system, to get an MRI in Buffalo the next day. The scan suggested the tumor was malignant, although slow-growing.
A neurologist then referred McCreith to a Canadian neurosurgeon for consideration of a biopsy, which is the only way doctors could definitively determine just how dangerous the tumor was.
This time, the Canadian health system told him the first available appointment for a biopsy was May 9. McCreith viewed his situation with more urgency, especially with the fresh memory of a good friend who died last year while waiting for heart surgery.
So in early March, he stepped outside the Canadian system again and got a biopsy at Millard Fillmore Hospital. During the procedure, the surgeon identified and immediately removed a brain tumor known as a low-grade astrocytoma.
Dr. Elad Levy, the Buffalo neurosurgeon who cared for McCreith, declined to comment specifically on the case, but said that earlier detection and treatment can increase chances of survival and quality of a patient's life.
McCreith said he has spent $45,000, including $28,000 to remove the tumor, for care in the United States that Ontario's Health Insurance Plan refuses to reimburse because he failed to seek pre-approval.
"It can take months to get pre-approval, and why should I need it anyway?" McCreith said.
In Canada, the provinces and federal government pay about 70 percent of medical costs, including most hospital and physician care. Patients and private insurance companies pay the remaining 30 percent for such expenses as prescription drugs, and dental and vision care.
Canada bans private insurance for essential health needs, but it is not a socialized system. Doctors and hospitals are private.
The Canadian system is unofficially called Medicare, the same name as the U.S. government health plan for seniors, but it's actually 10 separate provincial programs regulated by the federal government.
The social program, known for its fairness and value, remains intricately woven into the fabric of Canadian society.
In 2005, health care spending per capita in Canada was $3,326, nearly half of what the United States spends. Yet Canada fares as well as or better than the United States on comparisons such as life expectancy and infant mortality.
But like any national health system, Canada's has shortcomings that have come under attack, especially long waiting times and related shortages of physicians and high-tech devices like MRIs.
For instance, patients in Ontario wait an average of 22 weeks for cataract surgery and 34 weeks for a hip replacement, according to statistics from the Ontario Ministry of Health.
"Canada is not a medical utopia, as some would have you believe, or a disaster, as others claim," said Jack Tu, a senior scientist at the Toronto-based Institute for Clinical Evaluative Sciences and co-author of a recent study on waiting times.
"Most people get care in a reasonable amount of time. What you hear about are the horror stories," said Tu, whose study in the journal Health Affairs showed that Canada is not doing as good a job of reducing waiting times as other countries with universal coverage.
Those horror stories are turning into court cases.
In 2005, a legal challenge similar to McCreith's paved the way for private insurance in Quebec.
The lawsuit by Dr. Jacques Chaoulli and Georges Zeliotis, a Montreal man who waited a year for a hip replacement, led to a landmark but divided decision by the Supreme Court of Canada. The gist of the ruling is that there must be reasonable waiting times for patients without finances to get care elsewhere if the government insists on making patients stay within a single-payer system.
McCreith's case will test that decision in Ontario by claiming that the province's ban on private health insurance and private billing by physicians infringed on his constitutional right to life, liberty and security.
"In Canada, we have a monopoly health system, and you don't have the right to seek alternatives. That can be a huge financial and emotional burden for patients," said Avril Allen, McCreith's attorney.
A recent statement from the Canadian Constitution Foundation, which is helping to sponsor the lawsuit, said that it was intolerable that residents could buy medical insurance for their pets but not for themselves.
"The question is this: Should Canadians have to stay on waiting lists against their will?" Allen said.
Some people say the cases will undo Canada's cherished system of providing health insurance to everyone, a turn of events desired by proponents of privatization.
Others say they will force the government -- and taxpayers -- to invest more money to fill in the gaps in the health system.
"If we give up single-payer and allow private care, our health costs will go up and patients in the public system will wait even longer," said Raisa Deber, a health policy expert at the University of Toronto.
She said the United States also rations care but in a less-equitable way: There are 44 million uninsured people who lack access to specialists, and others with insurance who face mounting payments to get care.
In 2004, Canada set up a 10-year, $5.5 billion plan to establish benchmarks and reduce waiting times in such key areas as cancer care, heart procedures and diagnostic imaging. The effort, however, is seemingly at a standstill. The provinces, for instance, have not created waiting time guarantees or common ways to measure waiting times.
"The challenge in Canada is to get anything done on a national level," Tu said.
For McCreith, whose case could go to trial next month, the debate boils down to what he knows from experience.
"I was in the auto body shop business," he said. "If I gave you an appointment four months away, you would go somewhere else. Why should health care be any different?"
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Lindsay McCreith timely cancer treatment
Twice faced with delays in Canada, he quickly gets MRI scan and tumor removal in Buffalo
*Jan. 2, 2006: Seizures begin; told it would take more than four months to get an MRI in Canada
*Feb. 2, 2006: MRI in Buffalo arranged.
*Feb. 3, 2006: Gets MRI in Buffalo.
*Feb. 8, 2006: Referred to Canadian neurosurgeon for biopsy but first available appointment not until May 9.
*Feb. 13, 2006: Sees Buffalo neurosurgeon. Early March: Tumor biopsied and removed in Buffalo.
Now, with that out of the way...
