Regarding a single-payer system, which is mentioned frequently in your Guide to Healthcare in the 2008 Presidential Campaign (Nov. 26 issue): As a physician who worked in both Canada and the U.S., I can state that neither countrys system is optimal.
Because the Canadian system does not have a parallel private system, it is worse than that of most European countries. There is a conflict of interest that arises when the banker (the government) is also the party responsible for the allocation of resources. It will purposely or inadvertently ration care in order to conserve dollars. This means being 10 to 15 years behind in technology; having poor hospital staffing; a lack of adequate operating rooms and emergency-room facilities; prolonged waiting times; lack of anyone in the system actually being responsible for these problems; and tremendous frustration with poor access and follow-up.
There are numerous examples I could give of compromised patient care in Canada that simply would not have happened in the U.S., where market forces force hospitals, clinicians and suppliers to compete on the basis of cost and quality of care.
In the U.S., there is an overreliance on technology, which has caused an overproliferation of medical devices. Every hospital feels like it has to have an MRI or two, PET scanners, multiple CT scanners, vascular labs, catheterization labs, open-heart surgery programs, etc., when it might be better to distribute some of these services more logically so that organizations can concentrate on the service lines in which they excel. Also, there needs to be some level of guaranteed basic healthcare coverage so that everyone can get needed basic care, but this could easily be supplemented by private insurance for other services.
What is clear is that there is not enough money nor will there ever be enough money to provide every person with the best medical care. No matter what we call it, the end result will be that various aspects of medical services will be rationed to certain people. But this may start to focus resources on prevention. A few dollars spent on nutrition, smoking avoidance and cessation, and exercise would more than compensate for the toll these put on the system later. Finally, where does personal responsibility come into play with individuals in terms of their own healthcare?
It is apparent that simplistic fixes have no place in solving this problem. Expectation management of users and taxpayers needs to be balanced with fiscal responsibility.
Roger AndersenVice president, regulatory and medical affairs Ondine Biopharma Corp. Vancouver, British Columbia