Canadian Healthcare Author Writes a new Ending

Investors Business Daily:

Canadian Health Care We So Envy Lies In Ruins, Its Architect Admits

By DAVID GRATZER | Posted Wednesday, June 25, 2008 4:30 PM PT

As this presidential campaign continues, the candidates’ comments about health care will continue to include stories of their own experiences and anecdotes of people across the country: the uninsured woman in Ohio, the diabetic in Detroit, the overworked doctor in Orlando, to name a few.

But no one will mention Claude Castonguay — perhaps not surprising because this statesman isn’t an American and hasn’t held office in over three decades.

Castonguay’s evolving view of Canadian health care, however, should weigh heavily on how the candidates think about the issue in this country.

Back in the 1960s, Castonguay chaired a Canadian government committee studying health reform and recommended that his home province of Quebec — then the largest and most affluent in the country — adopt government-administered health care, covering all citizens through tax levies.

The government followed his advice, leading to his modern-day moniker: “the father of Quebec medicare.” Even this title seems modest; Castonguay’s work triggered a domino effect across the country, until eventually his ideas were implemented from coast to coast.

Four decades later, as the chairman of a government committee reviewing Quebec health care this year, Castonguay concluded that the system is in “crisis.”

“We thought we could resolve the system’s problems by rationing services or injecting massive amounts of new money into it,” says Castonguay. But now he prescribes a radical overhaul: “We are proposing to give a greater role to the private sector so that people can exercise freedom of choice.”

Castonguay advocates contracting out services to the private sector, going so far as suggesting that public hospitals rent space during off-hours to entrepreneurial doctors. He supports co-pays for patients who want to see physicians. Castonguay, the man who championed public health insurance in Canada, now urges for the legalization of private health insurance.

In America, these ideas may not sound shocking. But in Canada, where the private sector has been shunned for decades, these are extraordinary views, especially coming from Castonguay. It’s as if John Maynard Keynes, resting on his British death bed in 1946, had declared that his faith in government interventionism was misplaced.

What would drive a man like Castonguay to reconsider his long-held beliefs? Try a health care system so overburdened that hundreds of thousands in need of medical attention wait for care, any care; a system where people in towns like Norwalk, Ontario, participate in lotteries to win appointments with the local family doctor.

Years ago, Canadians touted their health care system as the best in the world; today, Canadian health care stands in ruinous shape.

This had to be hard for him, and I respect any man who can see his life’s’ work not working as intended, and trying to change it, though this seems a weak start.

It reminds me of the 80’s Soviet Union farms.  5 year plans and Communist Agriculture consistently resulted in inadequate crops and food shortages.  In desperation farmers were allowed a small plot of land to grow food, the sale of which they got to keep the proceeds from.  Guess what sector of their farm economy was most productive?  This is now proposed for medicine in Canada.

I’m sorry for Canadians, and at the same time unsurprised.  Now, can we learn from others?


  1. And yet, the public resistance to change in the healthcare system here is staggering. Yes, there are problems with it, but I don’t think for a minute that Canada wants US-style healthcare.

  2. Mr. Gratzer overstates the case; “Canadian health care stands in ruinous shape”. I’ll be the first to acknowledge the rationing care, lack of primary care providers and long wait times are the cross our citizens must carry. Mr. Castoguay is not advocating the de-socailization of Canadian Health care, more acknowledging that public dollars and public control are not enough. Personnally I agree with his stance on co-payments and some privitization.

    But what is the alternative? The PCP ratio in Mass. is no different than Ontario. ER wait times are similiar. The only difference is that services are rationed by wait times not the ability to pay (or who you know – in Canada politicians and doctors rarely wait for care) but the cost to the American citizen is tremendous. Mr. Castonguay’s change is not so radical as Mr. Gratzer is reporting.

  3. I know I’m nitpicking but there is no town in Ontario called “Norwalk”. Hard to have faith in an article who can’t get the details correct.

  4. Even if the town name is wrong (and you never know there are tons of little hamlets not named on google) the sentiment is unfortunately true. When a new FD moves to a small town the way they accept patients is an issue. If the FD worked for the governement they could mandate who to accept. Because each FD is their own enterprise (who receives 99% of their dollars from public insurance) they are free to accept or decline whomever they choose as long as it doesn’t violate human rights charters. The lottery is true.

  5. My parents live in Canada and they love the healthcare there. Of course, they’ve never actually been sick.

    I had an ACL repair in Canada in my late teens and will never forget how horrible the care was – inadequate pain management, no adherence to evidence based protocols, no follow up with physical therapy… took me 12 months to recover. Of course, this is anecdotal and the same could have happened in the US I suppose. But I’ve never seen it – and I’m a rehab doc.

  6. Privatization and the addition of “user fees” is the new Mantra in Quebec. This is not only true with health care but with all government services. For example, since 2001 an entry fee ($3.50) is required to walk in our provincial parks. This may be a barrier for exercising outdoors but maybe we can avoid being in ruinous shape!

  7. I know I’m nitpicking but there is no town in Ontario called “Norwalk”. Hard to have faith in an article who can’t get the details correct.