Dr. David Gratzer (Canadian trained MD)
I learned my most important lesson in medical school not in the classroom, but on the way to it. I grew up in Winnipeg, which is in the middle of Canada. It's a city roughly the size of Indianapolis. On a cold winter day in Winnipeg, it can drop to 40 below. Needless to say, Winnipeggers are a hardy bunch, and all parking lots are outside.
So I parked my car that February morning and walked to the classroom. I wanted to take a short*cut because it was blisteringly cold outside, and I decided to cut across the emergency department as I had done before. I swung open the doors and walked in, and I discovered the emergency room overcrowding crisis that was plaguing so many Canadian hospitals in the mid-1990s. I stood there, and I remember the smell: the smell of sweat, the smell of urine, the smell of fear that hung in the air. Elderly people had been waiting four, sometimes even five days to get a bed. And I remember step*ping into that emergency room and thinking to myself, something is desperately amiss.
When I grew up in Canada, I was interested in getting into medical school. If you had stopped me on the street when I was 16 or 17 and asked me about the Medical College Admission Test, I could have given you a variety of very satisfying, unique statistics on admission and so on. I didn't give a lot of thought to health policy. When managed care was debated in the United States, I remember vaguely thinking there was something good about the idea: After all, government should be involved in health care. I had never even been to Washington, D.C.
But when I stepped into that emergency room, it got me thinking. Again, I was a Canadian. There are three things I absorbed from that environment: One was a fondness for ice hockey, the second was an ability to convert Fahrenheit to Celsius in my head, and the third thing was a belief that if the government did it when it came to health care, it must be compassionate.
Eventually, I began to think about these things. In Canada at the time, there were really two schools of thought with regard to health reform. There were the people who thought we should spend more--I like to call them the spendthrifts--and the people who thought we should just hire more administrators and make the system work better--I like to call them the magicians. I started to think about these things, and I became a spendthrift, and then I became a magician, and then I became agnostic, and eventually I became an atheist on health policy in Canada because I realized there was something going on which was much more fundamental: that there was a problem with a government-run system.
Maybe it was just the experiences I had, seeing a patient who had a minor hernia repair and a neu*rofiber was caught and needed to be referred to a pain clinic; unfortunately, there was a two-year wait list. A gentleman with the classic symptoms of sleep apnea needed to go to a sleep disorders clinic and get a test: three-year wait list. My father, who could barely walk--classic symptoms of spinal stenosis--was told he needed an MRI and told he should wait eight or nine months.
These were the things I came into contact with, and I rethought my beliefs. I started to write arti*cles on this and the problems in Canadian health care, but there's only so much you can say in 700 words, so I started to write a longer piece. I told my parents, and they were very supportive about the idea, but I'm not sure they thought I would get my book published.
I initially approached 12 publishers and got 13 letters of rejection. One publisher lost my sample chapters. They rejected the proposal. Then they found the sample chapter, and it was just as bad as they thought it would be, so they sent me another letter of rejection. Eventually, I got the book pub*lished, and it went on to win the Donner Book Prize, which is a prestigious award in Canada.
What I discovered was how many Canadians were realizing that there was a problem in the system. Maybe our politicians weren't willing to talk about it, but they themselves could appreciate that something was not right in Canada. Eventually, people spoke out about this. Canadian politicians are a very cau*tious lot and continue to not really speak at great length about these things, but the mood had sud*denly shifted.
Today, things are very different than they were even a short time ago. A private clinic opens up at a rate of about one a week in Canada. One of the foremost critics of Canadian health care is a doctor who was just elected president of the Canadian Medical Association. Even the Supreme Court of Canada recognizes something is desperately amiss; just last year, they ruled in a case that access to waiting lists is not access to health care, and this undermines some fundamental constitutional rights that Canadians had, and they struck down key laws in the province of Quebec.
Canadians are beginning to rethink their system. You find the same thing across Europe. Yet here's the irony: If Canadians are willing to rethink things and embrace, at least to some extent, some capital*ism when it comes to health care, I find increasing*ly that Americans are not. If Canadians are willing to rethink these issues, Americans are also rethink*ing and heading down the same lines that Canada once did. That's a terrible mistake and part of my motivation for writing this book.
The Cure: How Capitalism Can Save American Health Care
Dr. Gratzer is the author of Code Blue: Reviving Canada's Health Care System. He's also a frequent contributor to the Canadian publication the National Post. He's written for The Wall Street Jour*nal, the Weekly Standard, the Los Angeles Times, National Review, and Time Canada. He is, of course, a member of the medical profession and also a senior specialist in health policy. He's a peer reviewer for professional journals, including the Journal of Health Politics, Policy and Law, the Canadian Medical Association Journal,and the American Journal of Medicine.
