Moral Low Ground

World

Interview with Canadian Medical Association President Dr. Louis Hugo Francescutti

(University of Alberta)

(University of Alberta)

What does the president of the Canadian Medical Association think about the United States’ rejection of ‘socialized medicine?’

I recently interviewed CMA President Dr. Louis Hugo Francescutti, along with health ministers and health leaders from around the world, and found nearly all of them were perplexed by America’s continuing disdain for all things ‘socialist,’ even among those who rely upon government-run health care systems like Medicare.

“Americans are worried about socialized medicine, but what do you think Social Security and Medicaid are,” asked Francescutti, a native of Montréal who began his career as an emergency medical technician in the Canadian Arctic. “I always find it so funny when Americans say, ‘We don’t want socialized medicine,’ but as soon as they turn 65, they’re asking, ‘Where’s my Medicare?’

I asked Dr. Francescutti, who completed his residency in preventive medicine at Johns Hopkins University in Baltimore, USA before joining the Royal Alexandra Hospital in Edmonton, Alberta as an emergency and preventive medicine physician, to clear up some misconceptions about Canadian health care perpetuated by US special interest groups keen on preserving a for-profit health care system that delivers some of the worst results, even while spending far more per capita than any other most-developed nation.

Moral Low Ground: Do you believe health care is a human right?

Dr. Francescutti: I believe everyone should have the opportunity to good health. Health care is part of that equation. I don’t think people should be denied access to care based on the size of their wallet. It’s just not the right thing to do. For folks that think, ‘These people just need to pull up their socks,’ well, those are usually the people who are fairly well-to-do. And those people need to better understand the consequences of poverty and its impact on health. It’s totally unfair that people who can’t afford health care should be denied health care.

MLG: We here in the States are bombarded with horror stories about Canadian health care. ‘Death panels.’ Rationed care. Dangerously long waits to see doctors. Meanwhile, the US ranks 51st in global life expectancy, it’s health care is ranked 37th by the World Health Organization, and one in six Americans still lacks health coverage. What do you make of all this?

LHF: Any patient at any time can switch physicians. There are no ‘death panels.’ I don’t know where that came from. I think it’s a Tea Party slander. Do we have slightly longer waits than Americans? Yes we do. But when you take a look at the indicators, we’re faring better than you in just about every category, and you’re spending twice as much money as we’re spending.

What people should do at the end of the day is not exaggerate. If you’re an American, come up here, and if you’re involved in a terrible crash, we’ll take care of you. Nobody gets turned away here.

MLG: What about abuse? Americans often hear stories about how people in countries with robust public health care systems abuse those systems, or that expanding access to health care somehow breeds laziness. Is this true?

LHF: There’s no abuse. [US] critics claim there’s so much abuse because everyone just goes running to the doctor every time they have a problem. That’s just not the case. Working in emergency, I’d say less than a handful of patients a day don’t have to be there.

MLG: What’s the best aspect of Canadian health care?

LHF: Nobody goes bankrupt if they have a heart attack. God forbid you have a heart attack in the United States and you don’t have coverage. Here, it’s a kinder, gentler way of taking care of the health needs of our population.

MLG: The worst aspect?

LHF: If there is a worst one, perhaps it’s the fact that the wait times may be a little longer in some cases. But that’s definitely not the case with acute illness. If you have a heart attack today, you would get [care] immediately… If you need a hip replacement, it may take a little longer… You’d still get it, but at the end of the day, you would have to pay for it.

MLG: In the US, the notion of a Canadian-style health care system is anathema to conservative politicians and pundits. In Canada, even Conservatives support your public health care system, and to suggest dismantling it would probably mean political suicide. What does universal health care mean to Canadians, and would you ever dream of returning to for-profit health care in Canada?

LHF: Our health care is ingrained in us like maple syrup or hockey. It’s part of being Canadian. It’s in our fabric. It’s in our DNA. No one would dare touch it. People are questioning, ‘Can we make it more efficient?’ Yes, there’s no doubt about that. ‘Can we improve our outcomes?’ Yes, we’re working very hard on doing that as well. But going for-profit? I don’t think that’s a good idea. All we have to do is look south of the border and see that it’ll cost us a heck of a lot more money and we’ll get even worse results, so why would we want to emulate what our neighbors to the south are doing?

MLG: What’s your message to people in the United States who oppose government-run, or government-funded health care?

LHF: You have to understand what health is. The health care system may contribute 25 percent of your health. The things that make you healthy have nothing to do with the health care system. You’ve already experimented with Medicare and Medicaid, which have worked for certain populations. Now what you have to do is experiment and make sure you have cost control measures and accountability measures built in. Intermountain and Kaiser Permanente are excellent examples of how you can do it. If you take those as examples and roll those out across the country, your patients and your population would see better care at less cost with better outcomes.

Help people live healthier. If you’re a single mom or a senior on a fixed income and the only thing you can afford is junk food, you’ll eat junk food

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4 Comments

  1. PrimeFebruary 12, 2014 at 9:36 amReply

    “Americans say, ‘We don’t want socialized medicine,’ but as soon as they turn 65, they’re asking, ‘Where’s my Medicare?’”

    Perhaps Americans should be given the opportunity to opt-out from having to pay into these systems, so they can save or invest in a way they prefer? Maybe they aren’t hypocritically embracing socialism; maybe they just want back what was taken from them.

    “the US ranks 51st in global life expectancy”

    If you normalize for non-health-related fatal injuries, the US ranks first. Americans have a higher propensity for getting killed in ways that no insurance plan or ER visit will prevent.
    Then there’s also the facts that Americans knowingly engage in unhealthy eating habits, and that US statistics for infant mortality includes extremely premature births that many other countries classify as stillbirths. Also on the subject of infant mortality… Low birth weight is strongly correlated with infant mortality. The US has both higher infant mortality and more low-weight births than Canada. But, if Canada had the same distribution of low weight births as the US, the Canadian infant mortality rate would be significantly higher than that of the US. If the US had the same distribution of low-weight births as Canada, it would have the same infant mortality rate. The US health care system seems to do a better job than Canada at keeping low birth weight babies alive. Low weight births in the US are primarily due to the high rate of teen motherhood, which is largely a result of cultural factors, not health care.

    ” it’s health care is ranked 37th by the World Health Organization”

    This is question-begging. The WHO rankings include ratings for how socialized a health care system is.
    Also, this ranking is 14 years old.

    “If you’re an American, come up here, and if you’re involved in a terrible crash, we’ll take care of you. Nobody gets turned away here.”

    US hospitals won’t turn away crash victims, either.

    “Nobody goes bankrupt if they have a heart attack. God forbid you have a heart attack in the United States and you don’t have coverage. Here, it’s a kinder, gentler way of taking care of the health needs of our population.”

    By “kindler, gentler,” maybe he means “less effective?” The US has a better 5-year survival rate than Canada does for heart attack patients. This is almost entirely due to the fact that revascularization treatment is more widely available in the US than it is in Canada.
    Speaking of 5-year survival rates… the US also has the best cancer survival rates in the world. Heck, with prostate cancer, no other country even comes close.

    “Our health care is ingrained in us like maple syrup or hockey. It’s part of being Canadian. It’s in our fabric. It’s in our DNA. No one would dare touch it.”

    Are Canadians dogmatic about their health care system?

    “Now what you have to do is experiment and make sure you have cost control measures and accountability measures built in.”

    What about having the US ditch its extremely regulated and quasi-socialist system it has now, and replacing it with a genuine free market? Regulation drives cost increases.

    • Brett WilkinsFebruary 12, 2014 at 10:17 amReplyAuthor

      Incisive rebuttal. Let me ask you: why do you think that the US, alone in the developed world (and, increasingly, even in the developing world), is without some form of universal health care program? Do you think Americans know better than people in other advanced nations, all of whom live longer, healthier lives and spend much less per capita on health care? What role does corporate greed, and the ceaseless efforts of special interests to poison our minds against public health care, play? Why is it that people in countries with government-funded, or government-run health systems report much higher levels of satisfaction than Americans? Also, just wondering if you’re a physician or health care professional/expert. I ask because of the thoroughness of your rebuttal.

  2. PrimeFebruary 12, 2014 at 2:31 pmReply

    “is without some form of universal health care program?”

    I think Americans are more gullible on some subjects than they are with others. For example… Americans are generally rather gullible when it comes to excuses for war. But they tend to be much more resistant to infringements on, say, freedoms of expression and religion. Americans would probably be upset if the production of food and clothing were likewise targeted for socialization.

    “all of whom live longer,”

    As I pointed out above, it’s mostly that they don’t get killed as early. Getting shot to death in the streets during a gang turf war, for instance, doesn’t really have anything to do with the health care system. Certainly that is an area for improvement. It’s just not a health care issue.

    “healthier lives”

    Americans eat too much and exercise too little, and they know it, too. I don’t see how increasing subsidies to treat the effects of this is going to help. Maybe when being overweight is looked upon the same way being a smoker is, that will change.

    “and spend much less per capita on health care?”

    And their outcomes often aren’t better. That’s not to say that Americans couldn’t be paying less. Americans’ health care costs are going up, thanks to an assortment of regulations in the health care and health insurance industries.

    “What role does corporate greed…”

    Plurium interrogationum.
    What is “public” health care, and how does it differ from just regular ol’ health care?
    Do you feel your mind is among those that have been poisoned?
    Why are prices going down, or at least not rising, in many other sectors of the economy? Are those other corporations not as greedy?

    “just wondering if you’re a physician or health care professional”

    No, but I am a health care consumer.

    It isn’t my intention to defend the status quo, but to challenge the assumption that further socialization is a solution. There is not a free market in health care in America, despite it often being labeled as such. There are myriad regulations restricting supply while increasing demand, and no one should be surprised that prices are going up.

    • Brett WilkinsFebruary 12, 2014 at 3:09 pmReplyAuthor

      Thanks for the intelligent, respectful rebuttal, Prime. You make some convincing arguments, although the rest of the developed world’s consensus on health care will eventually become mainstream thinking here in the US, or at least I hope it does.

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