Pablo Picasso observed, "To copy others is necessary, but to copy oneself is pathetic." Is anyone more pathetic than Arnold Relman, the former editor of the New England Journal of Medicine, who continually writes about why America should adopt the Canadian health care system? There is. It's Arnold Relman himself, writing in Canada about why Canadians shouldn't abandon the Canadian health care system.
In this case, it's Mr. Relman in the Toronto Globe and Mail opposing the Canadian Medical Association (CMA) proposal to "allow physicians to bill patients (or private insurance plans) for services that are covered by Medicare, and allowing Medicare to purchase covered services from for-profit private facilities." The goal of the CMA plan is to allow people a chance to get medical care when they need, not when the government sees fit to provide it.
Canada has pumped billions of dollars into its system to reduce waiting times for specialty services, cancer care, first-time health visits and emergency rooms. But according to Health Canada and the independent Frasier Institute the waiting times and shortages have gotten worse. In a recent incident, a child with a brain tumor headed to the states to get a MRI because he would have had to wait four months in Canada. His family paid cash because Health Canada refused to cover the cost.
Mr. Relman's response? He urges Canadians to "avoid exploitation by those who would like to make profits from publicly funded health care. Canadians should not follow Americans down the path to greater privatization." The kid should die for the greater glory of socialized medicine rather than pay cash and line the pockets of profit hungry docs in America.
Groucho Marx once observed, "Who do you believe? Me or your eyes?" Our eyes tell us that here and abroad government run and financed health care stinks. Price controls cause shortages of doctors in the UK that in turn are filled by waiving immigration regulations that allow neurologists with bomb-making skills into the National Health Service (NHS). In the United States, restrictive formularies and cookbook approaches to care have undermined mental health treatment for soldiers returning from Iraq. Medicaid reimbursement levels have increased waiting times and caused millions of children to seek care in emergency rooms. Meanwhile SCHIP — 10 years after its enactment — has failed to enroll 3-out-of-5 Medicaid eligible children in private health care plans and access to care has barely increased.
Incredibly, Mr. Relman claims that's just a sign free market health care does not work and does not care about people. Enlighten us Arnie, how are the two connected? "Physicians in our commercialized, profit-driven system tend to gravitate toward the highly paid specialties, so we now face a major shortage of primary-care doctors." Well, we know how flush the NHS is with well-trained terrorists — I mean family doctors. What about Canada? It turns out the College of Family Physicians of Canada found that 17 percent of Canadians didn't have a family doctor because of a primary care physician shortage. Two million of the Canadians that Mr. Relman wishes to deny free choice of care to have attempted to find a family physician in the past year, but have failed.
In the U.S., we have a market-based response to the problem. A rapid expansion of retail health clinics in the United States is taking place in what the Department of Health and Human Services has designated as medically underserved areas. Take MinuteClinics, a division of the drugstore chain CVS, which offers walk-in health care centers for common medical problems such as strep throat, sunburn, mono, flu, ear infections and sinus infections, and offer vaccinations, checkups, etc. People can pay cash or use their regular insurance. Most visits are 15 minutes or less with no appointment needed. In many cases, MinuteClinics are often affiliated with local hospital or physician practices, and will refer customers to a primary care doctor if they don't have one. Additionally, the center generates an electronic medical record that customers and doctors can access through the phone, fax or Internet.
There are 200 MinuteClinics across America. Most are in federally designed medically underserved areas providing immediate care, referrals and electronic medical records for about $50 per person. Other private companies are involved in this trend as well and have been joined by the American Academy of Family Physicians in an effort to improve access to health care for millions Americans.
Meanwhile, as the marketplace makes medical care more accessible in America Mr. Relman is telling Canadians, "One thing is certain. If medical care and health insurance are allowed to become private businesses... patients with little or no resources do not get the care they need."
What did Santayana say about fanaticism? It consists of redoubling your efforts when you have forgotten your aim. Fighting against medical choices that are available elsewhere in the world is a sure sign that ideological zeal has transcended compassion or the Hippocratic oath. Mr. Relman, once a great scholar, should be pitied, not scorned.
Robert Goldberg is vice president of the Center for Medicine in the Public Interest.