Report from Montreal

During my visit to Montreal and Quebec City this week I had a chance to hear what Canadians are saying about their single payer health care system. As in any socialized system,there are shortages, waiting lists, and illicit payments. A few examples:

• The lead article in today's Montreal Gazette is about a crackdown on privately owned MRI clinics that charge patients fees for services that are covered by national health insurance. The problem --from the Canadian perspective-- is that patients who can pay fees are "queue jumping" --getting MRIs sooner and therefore getting follow-up care more quickly. (The clinics are apparently allowed to charge fees for non-covered services.)
• A well-to-do acquaintance was able to get his knee surgery done right away rather than waiting for months by "giving the doctor an envelope." Standard practice, he tells me
• A relative who had successful chemo tried to give his oncologist a cash gift as a thank you. The doctor refused it, though he did accept a gift of wine and my relative donated the rest of the money to the hospital
• Some patients come to US border towns, such as Plattsburgh, NY for faster access. (I don't have the facts but I'd be willing to bet that giving "giving the doctor an envelope" in Canada is a better deal financially than paying US retail rates.)

There are some positive aspects of the Canadian system, especially universal access to care. And if they had the US per capita budget to work with, they could probably run their universal system with unconstrained access.----I usually steer clear of politics on this blog, but I have to mention the radio interview I heard yesterday with the newly nominated US ambassador to Canada. He is an embarrassment. When asked if he'd visited Canada he said yes. When asked where he'd visited, he struggled to come up with something and then said "the Falls area and some place above Indiana." He didn't even try to answer the interviewer's Canada trivia questions: "Where does maple syrup come from?" and, "Can you hum a few bars of O Canada?" I'm glad he wasn't asked if he knew the name of the capital city where he'll be posted or what an ambassador does.In case you're wondering, his main qualification for the job is being a fundraiser for the President. Someone better tell him to pack some envelopes in case he gets sick while he's up here.