Volume 9, Number 4
December 2000

[Contents] [Next]

Kill or Cure? Or Maybe Just Waffle...

by David Gratzer, MD, University of Manitoba

Carolyn Bennett, Kill or Cure? How Canadians Can Remake Their Health Care System (Harper Collins, 2000) $24.00, 160 pp.

In her first book, MP and MD Carolyn Bennett offers a heartfelt defence of the status quo.

As this federal election has shown, health care is the issue that politicians love to discuss but seem to say so little about. If politicians are absorbed by it, they aren't the only ones. Health care is the issue that blazes on the front pages of our newspapers, burns up radio talk shows, and sizzles in union hall and coffee shop discussions from coast to coast.

Organized medicine remains steadfastly silent, as do the physicians. Few join the public discourse. There are almost 60,000 Canadian doctors; a small fraction of that number will ever bother to even write a letter to the editor.

This is what makes Dr. Carolyn Bennett such an anomaly; she isn't simply involved in the health-care debate, she is a fixture. Whether it's a Toronto town hall discussing cancer care or a CBC panel on the future of health care, Dr. Bennett is a participant. As well, she sits as a Member of Parliament for St. Paul's, an affluent Toronto neighbourhood, which made her just one of six physicians in the pre-election House of Commons. With the publication of her new book, she adds another line to her resume: author.

Intended as a sober reflection on the state of Canadian health care, Kill or Cure? is Dr. Bennett's first book. Before reading it, I viewed Dr. Bennett as overly partisan but thoughtful on this issue. By Chapter 11, the converse was true: I had respect for the person but not her analysis.

Consider the burning question of our time: what's wrong with health care? In a recent Globe and Mail article, a contributor recounts the experience of a friend who suffered an allergic reaction during a dinner party, rushed off to the local emergency room, and, post-epinephrine, returned in time for dessert. This two-decade old memory is in stark contrast to the reality of today's ERs, which periodically overcrowd. At the Toronto hospital I work at, the nursing staff advises patients to wait five to seven hours on a busy night (which seems to be most every night). What happened to prompt emergency care? Or, for that matter, timely cancer care?

Dr. Bennett's book doesn't answer these questions. Intended as a defence of the present system, the Toronto physician maintains that "Canada's health-care system has long been considered one of the best in the world." (That's actually the first sentence in the volume.) Her entire first chapter is dedicated to proving this point. The clearest evidence of medicare's effectiveness is the fact that Canadians have a long life expectancy and good infant mortality statistics. Such figures are pleasing but deceptive. They reflect more a nation's affluence and public health measures than its health care quality. (Consider that Cuba claims to have lower infant mortality than the US. Now ask yourself: if sick with appendicitis on a family vacation, would you rather be at the Mayo Clinic or in Havana's city hospital?)

Having dismissed any suggestion of a health care crisis, Dr. Bennett focuses on the real problem: waning public confidence. Not surprisingly then, she has a simple, Anthony Robbins-style outlook: "As long as Canadians continue to feel proud of their system and confident that it can continue to serve them, the system will survive and prosper."

Since she has no major cause for concern, Dr. Bennett's analysis is less than cutting. She explores both sides of the doctor-patient relationship, finding much to her satisfaction. Even the chapter titles convey the optimism: "Don't Blame the Patient" followed by "The Patient is Part of the Solution."

Much of this analysis is done through first-person accounts. Anecdotal evidence is useful but disappointingly limited. Do patients tend to overconsume health resources in a first-dollar coverage system-or, put more simply, does free health care mean misuse? Major economic studies, like the RAND Health Insurance Experiment, suggest yes. Dr. Bennett, however, argues the opposite, citing a story about a Bay Street lawyer with a bad knee and a pregnant woman looking for an obstetrician who saw eight doctors. Both stories, incidentally, reflect blatant misuse of medicare. Dr. Bennett finally concludes, "My patients rarely demanded an unnecessary test."

Not much problem with patients, not much problem with providers. Where are there problems? According to Dr. Bennett, they are only with reform ideas. She dismisses user fees, private insurance, contracting out, for-profit medicine, and medical savings accounts, all of which she does without much consideration. "I recently heard a terrible story about an American patient..." she writes at one point, justifying her position that Canadians, unlike Europeans or Latin Americans, ought not be allowed to purchase private insurance. On the topic of Bill 11, the Alberta plan that allows regional health boards to contract out minor surgeries to private clinics, Dr. Bennett supports her argument by describing her conversation with a Canadian health economist who cites an American study.

It's difficult not to respect the commitment of Dr. Bennett to her patients. She recounts, for example, the failure she felt when a patient asked basic questions about a C-section after the procedure. Dr. Bennett, if nothing else, comes across as a conscientious person.

Dr. Bennett finishes the book by summarizing the needed changes: putting patients first, investing in health information, better accountability, improving quality. All of these goals are admirable, but they have been the same goals health administrators have pushed for three decades. Few reform initiatives to date, for instance, have attempted to make the system even more unaccountable or to deliberately put patients second. Why would such ideas work now?

Dr. Bennett feels physicians should take more of a team approach. She sees clinics composed of several doctors working with other health providers, compensated by rostering, with 24-hour care. This idea isn't particularly novel, though fashionable. The evidence from Britain on capitation is, at best, mixed.

But there is truth in her outlook. Internationally, health-care reform initiatives diverge. Some countries opt for more individual control: patient funding (Sweden), medical savings accounts (Singapore, China, South Africa), defined contributions (the US). Some for more bureaucratic regulation: health planning (Cuba), managed care (the US), empowered health ministries (Canada). Dr. Bennett favours bureaucratic regulation. After three decades down that path, Canadians may finally be willing to entertain an alternative.

[Contents] [Next]

info@fraserinstitute.ca You can contact us at the above email address for any comments or information requests. Please report any dead links or technical problems.