January 9, 2001
by Townsend Walker, Sr.
Most are dead now, but there was once a time when many Canadians worried about being able to get health care as many of us still worry here in the States. Among those living in Canada today who remember their bad years there are some determined to imprint on the minds of their offspring how fortunate they are to live now in a nation where health care, in theory and in practice, is institutionized by law as a legal right. One way of doing that is by leaving a written record of a nationís suffering prior to the advent of Canadian Medicare. Life before Medicare: Canadian Experience, a book published in 1995 by Helen Heeney and Susan Charters, is such a record. (I am grateful to Milton Terris, editor, Journal of Public Health Policy for calling it to our attention in the latterís book reviews, Vol. 20, No. 2) Read the simple, unadorned reflections of a grateful people:
"Many patients could not afford insurance coverage...to see a doctor or pay for the medications they needed. As a result of this, many patients were extremely ill when admitted. Sometimes it was too late to help them, and even when they improved they could not afford to continue with some of the medications they needed to sustain them."
"I recall the winter of 1932. January was very cold and stormy. The temperature would hover between thirty-five and forty-five degrees below zero. Thatís when my mother took it upon herself to nurse our neighbor who lived a mile away. So every morning she walked and nursed our neighbor with mustard plasters and hot chicken soup. This kept on for three weeks. There was no thought of going to the hospital, because there was no money."
Heeney and Charters conclude their book with numerous pleas from Canadian elders who are concerned that younger Canadians take the system for granted, and who are horrified at discussions of cutbacks and privatization:
"I hope you will tell all Canadians that the Medicare we all fought for has to continue..."
"I am foursquare behind universal medical coverage, with a single-tiered system. I think that we could possibly improve on what we have by emphasizing preventive medicine, health lifestyles, etc., and having community based centers for routine care...Then hospitals could be reserved for severe trauma and situations requiring extraordinary medical attention."
"The universal way is the fair way."
A few weeks ago I sat mesmerized watching every movement, assimilating every word, every heartbreak of Hedrick Smithís powerful documentary detailing the woes and worries of patients and doctors alike in the troubled hospital system supporting Harvard Universityís prestigious medical school. Had I only one wish it would be that everyone had seen what I saw. I had drunk in every lamenting, wrenching word spoken by Martin Solomon, consistently in "Top 10" lists of Boston doctors. Could that be, we would all be persuaded instantly that there is something frightfully defective -- something terribly morally and systemically wrong -- with the American money-driven, profitized medical delivery system. All but the most stiff-necked ideologues, money-vultures and their hangers-on would arise up in arms to institutionalize health care as a universal right and the responsibility of all. Overnight, the horror of the American health-care nightmare would be over.
For all that, however, there was one glaring defect in the sixty minutes of "Dr. Solomonís Dilemma." Not once did any of the doctors, nurses and administrators (or even the distinguished Pulitzer Prize-winning author and investigative reporter Hedrick Smith) even intimate that there are other ways of delivering health care. The tacit assumption throughout was that the solution would have to be worked out within the framework of the existing fragmented funding mechanism: job-related insurance, individually purchased insurance, Medicare, Medicaid, Veteran-related programs, the preservation of the profit-oriented insurance, hospital and pharmaceutical industries, etc. That systems so much as existed as alternatives to the American hard-core capitalist way with health care -- Canadaís single payer, or Englandís National Health Service, or any other country whose health care is universally available as an alternative and a right -- was hidden behind a wall of silence throughout the program. WHY?
Two of the most important advocates of single-payer in the U.S. practice and teach medicine at the Cambridge Hospital/Harvard Medical School and are co-founders of Physicians for a National Health Program (single-payer). Another, Arnold Relman, editor-emeritus of the U.S.ís most respected medical journal and professor emeritus of Harvard Medical School is also a long-time advocate of a single-payer system. I waited in vain for one or all three to appear and contribute to the program. Given the crisis situation at these hospitals, a crisis that is now virtually universal in the U.S., why did Hedrick Smith ignore Himmelstein, Relman and Woolhandler, of whom he must know a great deal? I do not profess to know, but I do know that Mr. Smith was funded by the multi-billion dollar Robert Wood Johnson Foundation, whose money derives from a highly privatized, out-of-control health system. I suspect the RWJF would like to keep it that way.
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