Falcon to Palin: Forget Whitehorse, Come to Vancouver!
A long time ago, Sarah Palin’s family sought medical care in Whitehorse. Last month, Danny Williams, the premier of Newfoundland and Labrador, had heart surgery in Miami. Maybe you don’t care about the medical history of politicians, but the media love stories that pit health care in the United States against that in Canada, especially if they highlight political hypocrisy.
We already know that politicians are inconsistent, as are all human beings. Danny Williams waved away criticism of his decision by saying it was his right to seek out the most skilled surgeon, although he could have had the operation in Toronto, Montreal or Ottawa. Perhaps the fact that he owns a condo in Florida also influenced his decision.
Palin’s family had fewer options. When her brother injured his foot back in the 1960s, the small Alaska town where they lived had no physicians. Despite this experience, she’s an enemy of universal health care. These anecdotes confirm that people do what they believe they have to, and they say nothing fundamental about the quality of health care today in North America.
On March 9, Kevin Falcon, the B.C. minister of health, made a proposal that’s much more significant than the location of Williams’ surgery. He proposed that British Columbia become a medical tourism destination.
Medical tourism is a euphemism for traveling abroad for better, cheaper, faster, or fancier health care. Palin’s family left the United States for want of any care. Williams left Canada for fancier care. A few ordinary Canadians go abroad to escape surgical wait lists, and lots of ordinary Americans go abroad to escape unaffordable costs. Falcon suggests that B.C. can tackle both these problems by developing health care as an industry. According to the logic, Americans will prefer to come to Vancouver for their operations; it’s much closer and cleaner than Bangkok. The revenue will subsidize the Canadian system and eventually tame the wait lists for hip replacements. At least, Falcon insisted, waiting times won’t worsen. A win-win!
The minister should consider some facts. Canada has fewer doctors per capita than most industrialized countries: 2.1 per 1,000. Most European countries have at least 3 per 1,000. The inadequate number of specialists is part of the cause for wait lists. Another problem is inadequate operating room access, whether from lack of facilities or poor organization. This problem has fuelled the establishment of private surgical clinics in Vancouver and other Canadian cities. And the small but growing commercial surgery industry in Canada is behind the push to attract foreign patients.
Brian Day is a Vancouver orthopaedic surgeon who, in a 2009 opinion piece in the Globe and Mail, declared that B.C. should become a health-care destination. Day founded the private Cambie Surgery Centre which specializes in rapid access to surgical procedures for people who can pay or who have alternative health insurance, such as workers’ compensation. For most Canadians, however, paying for quick treatment at Cambie is out of reach. But it’s not out of reach for a lot of Americans or wealthy people from elsewhere.
According to Day, U.S. health insurance companies are starting to contract with foreign hospitals where prices for operations are lower. A California health insurer offers a plan for customers who are willing to obtain treatment in Mexico. Other cut-rate U.S. health companies offer fixed reimbursement for surgical procedures that essentially force patients to self-fund a large portion of the treatment or leave home for cheaper care. Medical-tourism brokers that match patients with overseas hospitals have sprung up. This is becoming a big business. Day and his colleagues would profit mightily from an inflow of foreign patients.
Day wrote that medical tourism could become B.C.’s biggest industry. Bigger than forest products? Bigger than non-medical tourism? Wow, that is big. But wait, I have some questions. Where are all the doctors and nurses coming from? Given the relative scarcity of skilled health-care workers in Canada, how will Canadians not end up waiting longer or paying more? Given that Canada and the U.S. have similar health-care wages and infrastructure costs, how will a hip replacement cost much less in Vancouver than in Seattle?
If a surgical industry develops in Vancouver, other provinces may want to outsource operations. B.C. recently came close to making such a deal with Saskatchewan. A more far-reaching implication arises from the North American Free Trade Agreement, which has something to say about all kinds of commerce including health care. If for-profit clinics proliferate, U.S. corporations would attempt to establish their own in B.C., and U.S.-style health care would gain a foothold in Canada.
Falcon and Day’s scheme raises other questions. Should Canada enable the United States or other countries to avoid providing accessible, high-quality health care to all their citizens? Is encouraging people to leave home for a highly stressful experience like surgery a good idea? Maybe Danny Williams could comment on that. Then again, his second home is just a few hours away from that hospital in Miami.