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As the debate over health care reform heats up in the United States, a sub-debate of increasing
significance is that of the Canadian system. Natalie Mehra, a critic of the current health care system in
Canada, is an even stronger critic of those Canadians in the US decreeing the failure of the Canadian
system, in favor of a privatized one. Mehra shares many of the same criticisms of the Canadian system
as these figures like Dr. Brian Day do, but a completely different vision for how to overcome them.

Story Transcript


JESSE FREESTON, TRNN: Hi. Welcome to The Real News Network. We’re coming to you from our Toronto studios. And I’m joined today by Natalie Mehra from the Ontario Health Coalition, a health-policy watchdog group. Welcome, Natalie.


FREESTON: We’re seeing in the debate here in the United States or—in the United States around health-care reform. And a big issue that keeps coming up is the debate over the Canadian system and whether or not it’s working for Canadians. And one voice that we’re seeing popping up now is that of Dr. Brian Day.


Conservatives for Patients’ Rights

DR. BRIAN DAY, FMR. PRESIDENT, CANADIAN MEDICAL ASSOC.: The Canadian health system is a system which focuses on the system rather than the patient. We’re calling for a patient-focused system. What we have in Canada is access to a government, state-mandated wait list. And the wait lists are long. The patients are languishing and suffering on wait lists.


FREESTON: Firstly, what do people need to know about Dr. Day? Who is he?

MEHRA: So Brian Day is the owner of the largest for-profit surgical hospital in Canada. He’s currently under investigation by the British Columbia government for illegal billing practices. So in Canada you’re not allowed to bill for medically necessary hospital or physician services, but his clinic does do that. They sell elite-program health care for $4,000 a year for patients. They sell private for-profit knee surgeries and things like that for $15,000 to $20,000. So they’re a profit-seeking private company. He’s campaigned in Canada to dismantle the public health-care system and bring in a private, for-profit health-care system, both in terms of private insurance and private, for-profit delivery, so hospitals and clinics and so on. And so now he’s being used by groups in the US to promote or to stop, I guess, major health reform from happening in the United States.

FREESTON: We also see a confusion here often, between the privatization of services and the privatization of the insurance industry. Where do you see that? So in Canada there is the debate over the privatization of services. Where does that stand? And we have seen privatization of services in some areas. And how have those private clinics stacked up?

MEHRA: What we’ve found is that there isn’t so much of a distinction between private, for-profit delivery, i.e. who owns your hospital or your nursing home or your home-care agency, and ending up paying out of pocket for your health-care services, right, so for-profit or private insurance for health care, because in our experience—. And we studied all of the for-profit clinics across Canada that exist, and they bill everywhere that they can. So they bill the patient when they can; they bill the government when they can; they bill third-party insurers when they can. They bill everywhere they can. They really do operate under the idea of maximizing their profits. And so, in Canada, a number of the clinics are breaking the law by billing patients for medically necessary health-care services, what we call “extra billing”.

FREESTON: So one of Dr. Day’s first messages in this interview is that the Canadian system is a system focused on the system, whereas what he wants to see is a system focused on the patients. What’s your response to that?

MEHRA: But I do believe that our system should be reformed in Canada to be more attuned to patient needs, to be more democratic, to listen to patients more. I think that that is a key demand of public health-care reformers in this country. Certainly in Ontario it is. And I think that there’s lots of ways to do that. I think, actually, privatizing the health-care system is the most likely way to ensure that patients have the least ability to have a say, because you don’t have any—it’s not like a government where if you don’t like what they’ve done, you throw them out, you just unelect them. When your hospital, local hospital, is owned by a for-profit company that might be owned by people who are half a world away, your chance of actually affecting what they do in that hospital is very, very slim.

FREESTON: So you share some of the same criticisms as someone like Brian Day of the Canadian system, but you have a very different solution that you propose. Could you talk a little bit about the kind of reforms that you’re advocating for?

FREESTON: Sure. The best model of health system is one in which there’s local governance. So the governance, like a city council or like a school board, is as close to the public as possible, has to be responsive to the public, is elected by them, can be thrown out by them, and therefore has to respond to people’s needs, has to listen to them. And our system is not democratic enough. We need to rebuild where they’ve been eliminated or where they’ve been eroded, the local hospital boards and local health-care boards that are more responsive to the public. I think that that would be the best kind of health reform that we could get.

FREESTON: One of Dr. Day’s other arguments is that the wait times in Canada are obscene, even, and that he even suggests that people are dying in the waiting rooms. Is that really reflective of the situation in Canada? What is the situation in Canada in terms of the delivery of health care?

MEHRA: I would say that wait times for certain procedures are completely unacceptable. And we have, like, lobbied extremely hard, along with all the other patients groups, for lowering wait times for people in emergency rooms, for example, to ensure that they get faster care. That’s not the kind of care that Dr. Brian Day is talking about. He’s talking about the kind of care that he sells in his own hospital, elective surgeries.

FREESTON: Well, he’s suggesting there are real emergency-care situations that are being neglected. He suggested people are dying in the wait rooms. What about this sort of more necessary medical care? Is this really reflective of what’s happening in Canada?

MEHRA: Well, no. I think in most emergency cases, people have good access to care.


FREESTON: Another Canadian speaking out against health-care reform in the US is David Gratzer. Gratzer works as both a practicing psychiatrist in Toronto, as well as a senior fellow at the Manhattan Institute, a neoconservative think tank in New York. He recently testified in front of the US House Subcommittee on Health, Employment, Labor, and Pensions, where he was confronted on his depiction of wait times in Canada.


Courtesy: C-SPAN

REP. DENNIS KUCINICH (D-OH): Now, Dr. Gratzer, you’ve tried to make the case for rationing in Canada worse than it is in the US. Do you know what Statistics Canada, the analog to the US Census, says the median wait time is across Canada for elective surgery?

DAVID GRATZER, PSYCHIATRIST: Why don’t you inform us, sir?

KUCINICH: It’s four weeks. And what does Statistics Canada say the median wait time for diagnostic imaging like MRIs is?

GRATZER: I can tell you the Ontario government recently looked at that for—

KUCINICH: It’s three weeks.

GRATZER: —cancers was six months.

KUCINICH: It’s three weeks. How many uninsured are there in Canada?

GRATZER: Probably relatively few.

KUCINICH: That’s right, none or very few. How many medical bankruptcies are there in Canada?

GRATZER: It depends how you define a medical bankruptcy.

KUCINICH: None or very few.


FREESTON: Another criticism is the lack of choice in the Canadian system. And while much of the time that’s directed at the idea that Canadians don’t get to choose their insurance plan, which is true, they also float this idea that Canadians don’t get to choose their doctors. We’ve seen politicians, even Barack Obama—. And we’ll run the clip.


Courtesy: KRQE

LINDA ALLISON: So many people go bankrupt using their credit cards to pay for health care. Why have they taken single-payer off the plate? And why is Senator Baucus on the Finance Committee discussing health care when he has received so much money from the pharmaceutical companies? Isn’t it a conflict of interest?

BARACK OBAMA, US PRESIDENT: So what I’ve said is let’s set up a system where if you already have health care through your employer and you’re happy with it, you don’t have to change doctors, you don’t have to change plans. Nothing changes.


FREESTON: So is there any truth to this? Do Canadians have a lack of choice when it comes to the health care that they receive under their insurance plan?

MEHRA: You can choose any doctor you want. You can even choose to go to three or four of them if you want to, and you can get a second opinion. So, yeah, no, you choose your own family doctor. You’re referred from your family doctor to specialists. They will work with you to choose a specialist. And I imagine that would be similar in any system. So, no, there’s all kinds of choice.

FREESTON: So there’s no government bureaucrat that doesn’t know you deciding who’s going to be serving you.

MEHRA: No, you’re not assigned a doctor, not in any way, shape, or form. Nowhere. It doesn’t happen. It’s just factually incorrect.

FREESTON: So, lastly, we have a prime minister in Canada who, previously to becoming prime minister, headed an advocacy group, and one of their main demands was the privatization of the health-care system, and at least the introduction of private insurance and the two-tiered system. When he became prime minister there was rumblings about this. And we saw the Canadian people sort of start to form a movement against this, and it became very clear that this was the third rail of Canadian politics, that the public system’s not to be touched, at least the public insurance system.

MEHRA: I would say not just the public insurance system, but also the public delivery system. Huge, huge, huge. I mean, the biggest protest Alberta has ever seen was over bringing in a private hospital. You know? Legislature was swamped, thousands of people came out in Alberta, which is known as probably the most conservative of the provinces. Canadians know, partly because we have so much American TV, through the soap opera stories, through, you know, the ER shows, etcetera, etcetera, that cost is a barrier in the United States that we just don’t experience here. I mean, there are problems in Canada. There are things that you have to pay for that you shouldn’t have to pay for out of pocket when you’re sick. But it’s nothing like the situation in the United States. And I think Canadians over the last 10 years, because we have had cost-cutting governments and governments that are more concerned about eliminating taxes than they are about improving services, generally, have experienced this situation in which public services are cut, and then they get new user fees introduced. And the trick of the public health-care system is that you pool your money, right? You pay your taxes, you pool your money, you’ve got a giant pool of money, and therefore you have massive bulk-buying power. And so you can control the cost of doctors and you can control the cost of drugs and so on through that buying power. When you’re left on your own and you end up paying a user fee, your physiotherapy that costs very little in the hospital per unit of service now costs considerably more when you’re left on your own to negotiate the price, because, you know, these are needed health-care services, and they’ll charge what the market can bear. So I think people having had the experience of some erosion of the public health-care system here have really learned its value. And it is, I think, the most valued public service in the country. And there is not any party who will run an election campaign on openly derailing or pulling apart the public health-care system in Canada. It wouldn’t happen. Can’t happen.

FREESTON: Back in 2006, when Canada’s newly elected conservative government tested the water for private health care, the man at the front line was Health Minister Tony Clement. Yet earlier this month, from his new position as industry minister, it was the same Clement who boasted at a business forum in Washington that in Canada not a single person who was unemployed has lost the ability to access health care, adding that, as it turns out, the bogeyman for Canadians when it comes to health care is the United States—not surprising given that every day 14,000 more Americans are losing their health coverage.


Please note that TRNN transcripts are typed from a recording of the program; The Real News Network cannot guarantee their complete accuracy.

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Natalie Mehra is the Director of the Ontario Health Coalition. The OHC is made up of more than 400 community organizations. The Coalition accompanies the communities in their engagement in the creation of policy related to healthcare, while also playing the role of watchdog on the Governments themselves. The group also plays a role in public education about the functioning of the health care system.