- The Washington Times - Thursday, June 11, 2009

TORONTO | For a Canadian facing emergency surgery in the United States, a ride on a privately chartered Lear jet back to Canada is a whole lot cheaper than having the operation in a U.S. hospital.

Canada’s universal health care system will pay for urgent medical care outside the country, but at Canadian rates of about $360 a day for a hospital stay.

That compares with daily rates of up to $5,000 to $6,000 a day in Florida, where tens of thousands of well-to-do Canadian retirees spend each winter.

Before stepping across the border, “the first thing a Canadian thinks about is supplemental health insurance,” said Michael MacKenzie, a spokesman for the Canadian Snowbird Association, which represents about 80,000 migratory citizens from the land of ice and snow.

No wonder President Obama’s plan to expand American health coverage to the uninsured has become such a hot topic north of the border.

If Mr. Obama succeeds, the U.S. could draw even more Canadian doctors and nurses to the U.S., exacerbating a shortage of medical professionals, said Dr. Brian Day, a Canadian health care critic and former head of the Canadian Medical Association.

If Mr. Obama fails, perhaps Canada could open its system to “medical tourism” from the U.S., Dr. Day said.

About 500,000 Americans annually travel to other counties such as India, Thailand and the Philippines for high-quality but much cheaper medical care, he said. Few of them go to Canada, where the notion of funding public hospitals with money from U.S. patients has been politically unacceptable.

The Canadian system insures everyone, and all Canadians have access to basic and critical health care without ever seeing a doctor or hospital bill.

Nevertheless, the demands on the system have led to waiting lists for treatments such as MRI scans, cataract and artery bypass surgeries and hip replacements.

That’s one reason why 70 percent of Canadians have some form of supplemental health insurance, whether or not they plan to visit the United States.

The Canadian system needs fixing, said Dr. Robert Ouellet, president of the Canadian Medical Association.

“We have improved waiting times from years to months in most areas, but people still wait too long even in emergency rooms,” he said.

Dr. Ouellet suggests that the U.S. look elsewhere for models of universal health care.

Both the U.S. and Canadian governments, he said, would do well to examine systems such as one in the Netherlands, which provides universal and broader-based health care through a small number of regulated, private health insurers and government funding at a slightly lower cost than in Canada.

Dr. Catherine Kurozu, a Canadian doctor who has been practicing obstetrics and gynecology in the U.S. and Guam for 13 years, said, “In Canada, there’s an egalitarian attitude I admire. Medical treatment in America depends almost entirely on what insurance company you have and what state you live in.

“In Massachusetts, you get four days in hospital after a C-section birth; in California it’s one day and out the door,” she said.

For Canadian Raymond McEwan, American hospitals are among the best in the world but are focused on making as much money as they can per patient, while in Canada the goal is good medical care for everyone.

In December, he was wintering in Port Richie, Fla., when he checked into a hospital with stomach cramps and pain.

“I’d worked in an auto repair shop for years so I knew all about insurance,” said Mr. McEwan, 68, who had a supplemental policy from a private company.

Over the next several hours, Mr. McEwan said, doctors and nurses came and went, he was given blood tests and an ultrasound and was moved from room to room. He said he was “terrified” that the hospital hadn’t contacted his insurance company: Would he be stuck with an American hospital bill?

Once diagnosed with an infected gallbladder, the hospital was all set to operate and possibly add some repairs to Mr. McEwan’s colon. Before that happened, the hospital apparently got around to notifying his private Canadian insurance company, which put an end to everything.

“A few hours later, I was strapped in a stretcher and my wife and I were on a Lear jet being flown back to Canada,” he said. There, the doctors confirmed the gallbladder infection, deadened the pain and successfully performed Mr. McEwan’s surgery four weeks later.

To save money, Mr. McEwan’s insurance company paid $20,000 for the private flight home and his brief stay in an American hospital.

Mr. MacKenzie of the Snowbird Association said it is not uncommon for U.S. hospital bills to top $100,000, especially when surgery is involved.

Once Mr. McEwan was back in Canada, his insurance company was relieved of responsibility because there are no hospital bills.

“In Canada, the first thing I was asked coming off the plane was, ‘Are you in pain?’ ” he said. In the American hospital, he said, he waited an hour in the emergency room and then five hours more in various rooms without ever being asked whether he needed pain relief.

“It seemed like everyone in the American hospital was working on commission and trying to get me to sign for this and that treatment,” he said. “In Canada, it’s not about making money.”