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Tuesday, 24 October 2006

Canada: America's Conscience

College of Physicians, left
Health Care Made Simple
By Richard Carreno
Philadelphia:-- Speaking on 19 October at The College of Physicians, in a talk titled 'The History of the Canadian Health Care System: What It Got Right and What It Wrong,' Professor Jock Murray seemed hard-pressed to point out the errors of the Canadian system.
For starters, he clarified some points that, for me, at least, even makes the Canadian system even more appealing. It's portable -- Canadians can be reimbursed for charges when travelling anywhere on the globe, the system is not legally compulsory (doctors can opt out, but few do), and foreigners (ie. Americans) can use the system while visiting Canada, but might be billed for reimbursement.
Murray also clarified another point: The system is not actually a 'national' health-care system in that the system is only mandated by the federal government, but actually paid for by the provinces. Ottawa sets reimbursement fees and what's covered, the provinces dip into their individual budgets to fund the programmes. (Therefore, some provinces spend more of their gross budgets funding their individual systems).
Murray made it real simple.
The US does not have national health care because many Americans, unlike Canadians, are, for better or for worse, anti-government. Pols are still able to get away with the bugaboo of 'socialised' medicine. (Socialised public transportation, anyone? Socialised postal services?) Of course, that's the kind of demagoguery that's still appealing to many Americans who, unlike Canadians who inhabit a country forged in a vastly different crucible, don't share a sense of community. (So much for virtues of a multi-cultural, diverse society).
No industrial nation has it all right regarding national health insurance, Murray allowed. The equation boils down to the ability to provide care to 'Everyone, with Every Service, Right Now.' 'Pick two,' Murray declared. Each nation, as economics now demand, can usually afford only two aspects of the equation. Canada has picked 'Everyone and Every Service,' setting aside the imperative of 'Right Now.' The US, in turn, Murray said, has decided on 'Every Service' and 'Right Now.' Lost in the equation is 'Everyone.'
Murray noted that creation of the Canadian system was aided by the time in which it was created, in the 1960's. It was simpler time. Big insurance companies didn't have power to oppose progressive measures, as they do now in the US. Further, the Canadian Medical Association was won over.
As for pay, Murray noted that general practioners generally earn more than their American counterparts. Because of montetary incentives, so do doctors located in remote areas or those who work in specialised, needy communities. Specialists, on the other hand, make less than their American peers.
But Canadian doctors enjoy a singular benefit that American doctors would surely envy if they knew about it. No paperwork. One billing system, and the cheque (one cheque!) is in the mail each month.
The following is Dr. Murray's official biography:
OC, MD, FRCPC, FAAN, MACP, FRCP (Lond), LLD (Hon St FX), DSc (Hon Acadia) D.Litt (Hon St. Thomas)
TJ Jock Murray is former Dean of Dalhousie Medical School, Halifax, Nova Scotia, and Professor of Medicine (Neurology) and founding director of the Dalhousie Multiple Sclerosis Research Unit. He held the first Chair of Medical Humanities at Dalhousie. He has appointments in Medicine, the Division of Medical Education and Medical Humanities and has cross appointments in the Departments of History, Family Medicine and Community Health and Epidemiology.
While Dean of Medicine he was President of the Association of Canadian Medical Colleges and Chairman of the Canadian Medical Forum. He was the founder of the Dalhousie Society for the History of Medicine, past President of the Canadian Society for the History of Medicine and the President-Elect of the American Osler Society. He received the Neilson Award of the Hannah Institute for the History of Medicine for contributions to medical history.
He was President of the Canadian Neurological Society and a founder and President of the Consortium of MS Centres, which awarded him the Dr. Labe Sceinberg Award for Lifetime Contributions to multiple sclerosis research. He served two terms as Vice President of the American Academy of Neurology. He received the Dr. A. B. Baker Award for lifetime contributions to neurological education from the Academy. He was a member of the Working Group on Disability in US Presidents which presented its report to President Clinton at the White house in 1996.
He served as Chairman of the Board of Governors and later two terms as Chairman of the Board of Regents of the American College of Physicians. He was elected a Master of the College and Chairman Emeritus in 1998. He was awarded the Dr. Nicholas Davies Award and the Stengel Award from the College and the ACP Laureate Award by the Atlantic ACP Chapter.
Dr. Murray has over 225 medical publications, 9 books, 43 text book chapters, and has held 91 funded research grants. Recent books have been Medicine in Quotations (with Edward Huth) The Quotable Osler (with Mark Silverman and Charles Bryan), both to appear in second editions this year, and Multiple Sclerosis: The History of a Disease. He authored two biographies in the Dictionary of National Biography, and 12 biographies in the Dictionary of Medical Biography.
He has been the recipient of many awards, including Professor of the Year at Dalhousie. He was awarded Honorary Membership in the Canadian Radiological Society and the Canadian College of Family Practice. He was awarded the Cutter Medal by Phi Rho Sigma International, the Seymour Medal by the University of Kansas, the Canada 125 Anniversary Medal, and the Queen Elizabeth Jubilee medal. Dr. Murray was awarded 3 honorary degrees. In 2002 he received one of the first Mentor of the Year Awards of the Royal College of Physicians and Surgeons of Canada. In 2003 he was awarded the Gold Headed Cane by Dalhousie Medical School. In 2003 he was made a Paul Harris Fellow by Rotary International for contributions to the community, and received the Distinguished Service Award from Doctors NS. In 2005 he was received the Professional of Distinction by the Discovery Center. He is an Officer of the Order of Canada. The Order of Canada is the highest civilian award given by the Government of Canada.
(Richard Carreno is corresponding secretary of National Health Insurance Now, an advocacy group based in Philadelphia).