An open letter to President Obama on healthcare reform - a Canadian perspective!

The White House
1600 Pennsylvania Avenue NW
Washington, DC 20500

Dear President Obama:

As many of our Canadian readers know healthcare reform is at or near the top of your agenda.


With all due respect, if not already, you should be listening closely to former Winnipeger Michael Rachlis who authored the following article which appeared recently in the Los Angles Times.
Michael M. Rachlis MD MSc FRCPC - Health Policy Analysis

Dr. Michael Rachlis was born in Winnipeg, Manitoba in 1951 and graduated from the University of Manitoba medical school in 1975. He interned at McMaster University in Hamilton and then practiced family medicine from 1976 to 1984 at the South Riverdale Community Health Centre in Toronto. He completed specialty training in Community Medicine at McMaster University from 1984 to 1988.

Dr. Rachlis practices as a private consultant in health policy analysis. He has consulted to the federal government, all ten provincial governments, and two royal commissions. He also holds associate professor appointments (part-time) with the University of Toronto Department of Health Policy, Management, and Evaluation and the Dalla Lana School of Public Health.

Dr. Rachlis has lectured widely on health care issues. He has been invited to make presentations to committees of the Canadian House of Commons and the Canadian Senate as well as the United States House of Representatives and Senate. He is a frequent media commentator on health policy issues and the author of three national bestsellers about Canada's health care system.

HarperCollins published his third book, Prescription for Excellence: How Innovation is Saving Canada's Health Care System, in paperback in March 2005. In his free time, Dr. Rachlis enjoys running and duplicate bridge. He lives in Toronto with his wife and two children.

Furthermore, did you know, Sir, when the current President and CEO (Dr. Denis Cortese, M. D.)of your world renown Mayo Clinic retires in November of this year, he will be replaced by none other than Dr. John H. Noseworthy a Canadian neurologist who trained at Halifax, Nova Scotia's Dalhousie University and served his Internship (Internal Medicine) at the Royal Columbian Hospital in New Westminister, British Columbia? Currently Dr. Noseworthy is Medical Director for the Clinic's Department of Development.

Therefore, in conclusion we highly recommend your citizens, medical community and you pay close attention to the comments/suggestions coming from Canada, "..... one of the most impressive nations in the world."

Sincerely,

Clare L. Pieuk

We would send a copy directly to your BlackBerry but, of couse, we don't have it's co-ordinates. Rather, it will be transmitted to the White House e-mail address provided. Any reply from you or your administration will be posted.

Hope you will soon visit Canada again.

Thank You
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Opinion
A Canadian doctor diagnoses U.S. healthcare
The caricature of 'socialized medicine' is used by corporate interests to confuse Americans and maintain their bottom lines instead of patients' health.

By Michael M. Rachlis
August 3, 2009

Universal health insurance is on the American policy agenda for the fifth time since World War II. In the 1960s, the U.S. chose public coverage for only the elderly and the very poor, while Canada opted for a universal program for hospitals and physicians' services. As a policy analyst, I know there are lessons to be learned from studying the effect of different approaches in similar jurisdictions. But, as a Canadian with lots of American friends and relatives, I am saddened that Americans seem incapable of learning them.

Our countries are joined at the hip. We peacefully share a continent, a British heritage of representative government and now ownership of GM. And, until 50 years ago, we had similar health systems, healthcare costs and vital statistics.

The U.S.' and Canada's different health insurance decisions make up the world's largest health policy experiment. And the results?

On coverage, all Canadians have insurance for hospital and physician services. There are no deductibles or co-pays. Most provinces also provide coverage for programs for home care, long-term care, pharmaceuticals and durable medical equipment, although there are co-pays.
On the U.S. side, 46 million people have no insurance, millions are underinsured and healthcare bills bankrupt more than 1 million Americans every year.

Lesson No. 1: A single-payer system would eliminate most U.S. coverage problems.

On costs, Canada spends 10% of its economy on healthcare; the U.S. spends 16%. The extra 6% of GDP amounts to more than $800 billion per year. The spending gap between the two nations is almost entirely because of higher overhead. Canadians don't need thousands of actuaries to set premiums or thousands of lawyers to deny care. Even the U.S. Medicare program has 80% to 90% lower administrative costs than private Medicare Advantage policies. And providers and suppliers can't charge as much when they have to deal with a single payer.

Lessons No. 2 and 3: Single-payer systems reduce duplicative administrative costs and can negotiate lower prices.

Because most of the difference in spending is for non-patient care, Canadians actually get more of most services. We see the doctor more often and take more drugs. We even have more lung transplant surgery. We do get less heart surgery, but not so much less that we are any more likely to die of heart attacks. And we now live nearly three years longer, and our infant mortality is 20% lower.

Lesson No. 4: Single-payer plans can deliver the goods because their funding goes to services, not overhead.

The Canadian system does have its problems, and these also provide important lessons. Notwithstanding a few well-publicized and misleading cases, Canadians needing urgent care get immediate treatment. But we do wait too long for much elective care, including appointments with family doctors and specialists and selected surgical procedures. We also do a poor job managing chronic disease.

However, according to the New York-based Commonwealth Fund, both the American and the Canadian systems fare badly in these areas. In fact, an April U.S. Government Accountability Office report noted that U.S. emergency room wait times have increased, and patients who should be seen immediately are now waiting an average of 28 minutes. The GAO has also raised concerns about two-to four-month waiting times for mammograms.

On closer examination, most of these problems have little to do with public insurance or even overall resources. Despite the delays, the GAO said there is enough mammogram capacity.
These problems are largely caused by our shared politico-cultural barriers to quality of care. In 19th century North America, doctors waged a campaign against quacks and snake-oil salesmen and attained a legislative monopoly on medical practice. In return, they promised to set and enforce standards of practice. By and large, it didn't happen. And perverse incentives like fee-for-service make things even worse.

Using techniques like those championed by the Boston-based Institute for Healthcare Improvement, providers can eliminate most delays. In Hamilton, Ontario, 17 psychiatrists have linked up with 100 family doctors and 80 social workers to offer some of the world's best access to mental health services. And in Toronto, simple process improvements mean you can now get your hip assessed in one week and get a new one, if you need it, within a month.

Lesson No. 5: Canadian healthcare delivery problems have nothing to do with our single-payer system and can be fixed by re-engineering for quality.

U.S. health policy would be miles ahead if policymakers could learn these lessons. But they seem less interested in Canada's, or any other nation's, experience than ever. Why?

American democracy runs on money. Pharmaceutical and insurance companies have the fuel. Analysts see hundreds of billions of premiums wasted on overhead that could fund care for the uninsured. But industry executives and shareholders see bonuses and dividends.

Compounding the confusion is traditional American ignorance of what happens north of the border, which makes it easy to mislead people. Boilerplate anti-government rhetoric does the same. The U.S. media, legislators and even presidents have claimed that our "socialized" system doesn't let us choose our own doctors. In fact, Canadians have free choice of physicians. It's Americans these days who are restricted to "in-plan" doctors.

Unfortunately, many Americans won't get to hear the straight goods because vested interests are promoting a caricature of the Canadian experience.

Michael M. Rachlis is a physician, health policy analyst and author in Toronto.