re eight myths about national health insurance pt ii in article apr news columbia edu gld cunixb cc columbia edu gary l dare writes v pxgt ubvmsb cc buffalo edu daniel b case writes also in the april globe and mail there was a letter from the director of trauma services at st michael s hospital in toronto responding to an article on a study comparing heart surgery in california and canada in which some canadian doctor worried that that study which was in the nejm i think noted that the frequency of heart surgery on patients over seventy increase with income in california i guess richer people have more heart disease in california whereas the frequency of surgery on patients over seventy in canada was relatively uniform across income distribution heart surgery was more frequent in california but mortality and outcomes were essentially the same american analysts would seize on the results as proof that canada rationed vital services the doctor i can t recall his name said that canada is rationing vital services as any physician can plainly see he said that a system in which people are refused treatment because they can t afford it is no different from a system in which people are refused treatment because the government can t afford it as a result of deliberate underfunding of the health insurance plan in fairness he did say that both the us and canadian systems are in the same situation the ndp cleaning up a tory spending mess and just when i thought i understood canadian politics there was one about a group of doctors in calgary who have opened canada s first us style mri clinic as an alternative to the provincially owned one it s about time i ve ragged on my own doctor friends as to why they don t invest in their own private practices in the end it s their money but they choose to spend it on america s cup pipedreams and that s none of my business as for provincially owned for sure it s against the law in canada for governments to be directly involved in the provision of health care except in the military or native reser vations what that term actually means is that the facility gets by on public grants to meet shortfall from lack of use no kidding medical practice itself is much more conservative up north my own best friend did two clerkships at the mayo clinic in rochester mn and is no stranger to high tech medicine but his boat comes first there were some people expressing concern that it was the first wedge of two tiered health care and that it might violate the canada health act no it s probably socialist whiners who are offended that we have private practices and always have they can all take cash anyways so why not have a particular facility the canadian big government mentality often imagines government where it does not even exist the only potential problem i see with the private mri facilty in calgary is the self referral problem to the facility for the doctors who have a financial interest in it which is basically unethical but in canada because of our small population there is likely only to be a few private facilities involving only a small number of doctors and thus i don t think the self referral problem which is an epidemic in the us could ever get out of hand here look nobody stopped the clinic when they planned on the mri nobody stopped them when they bought it nobody seems to be stopping them from using it either much ado about nothing thank goodness that hockey playoffs have started it is an experiment that will be certainly be watched carefully while it seemed currently unjustified there was one anecdote told by the head of the partnership to demonstrate the mri he showed an image of an injured knee which happened to belong to the manager of the bank who approved the loan he said that without it the guy might have had to wait a month or more at the provincial mri then another length of time for treatment after which the muscles would have atrophied and rehabilitation would have been that much harder if that isn t the first whiff of two tiers i don t know what is i m certain there is exaggeration somewhere because the gao study of canada cited often on usenet did not find access to mri to be a problem i ll bet the doctor is relying on people having listened to american trash talk on cable so that he can puff his chest a bit there are already a few treatment regimens for knee injuries without relying on mri unfortunately i ve had a few and i m not a banker what likely happened is the sponsors of the private mri which include doctors anticipated that alberta would need more mri s and instead of waiting for the health planners to realize they needed another one or two saw a business opportunity where they would have a secure business from the public insurance side of things and they could supplement people and businesses who want to pay cash gerald
