Canadian DUers: Brazilian Columnist uses movie to bash Canada healthcare.

He wrote the following in a Brazilian newspaper. It reeks of right-wing propaganda. I hereby offer the relevant pieces for your analysis. Forgive the sloppy translation - some medical terms may look strange.

For us Brazilians, the excellent movie "The Barbarian Invasions" has a facet that, although fundamentally important, is being left aside in discussions about the movie. It's the Canadian healthcare system. Many have written about the more philosophical aspect of the movie: the end of utopias, the right to dignity in death, the crisis of socialist thought, the clash of values between "to consume" and "to know" and the demonstration of the truth of Fukuyama's thesis about the end of History, although the movie's title suggests a leaning towards Huntington's thesis about clash of civilizations. But understanding the Canadian healthcare system is fundamental to get to the core of what the moviemaker thinks.

In the movie, the public hospital is a mess: patients are divided between those with access to an overcrowded infirmary and those who must stay in stretchers in the aisles (just like Brazilian hospitals). Simple medical exams, like magnetic ressonance, are not available. The doctors pay little attention to the patients: they confuse names and even the diseases that afflict them (and talk to them while eating apples). The main character, a terminal cancer patient, says stoically: "I defended the nationalization of healthcare, now I can't complain." Everything is so shocking that the few Brazilian journalists who covered the subject credited this dismal portrait to moviemaker Denys Arcand's ideology, or refused to admit the thing was real, branding it a caricature.

I sent e-mails to Canadian journalists, asking whether Arcand committed excesses or the situation was at least close to what the movie shows. Those who answered said real life is very well represented, things are really like that. (...)

What system is that? In Canada, medical consultations are free, as well as hospital stays, surgery, exams, medication during stay, and medication of continuous use for people over 65. The model began being built in 1950 and was fine-tuned in the 60's and 70's until becoming what it is today. Central government is responsible for 40% of the budget; the rest is financed by provinces through a tax on salaries (paid by employers) and general taxes paid by citizens. To avoid the public system being deflated by a private parallell system, a state monopoly was established: no insurer may offer plans to cover basic health services. The system is universal and mandatory.

One of the studies I researched says this: "Rudimentary economy principles state that, if a commodity is offered at zero price, demand grows exponentially, and what you see is shortage." That's exactly what yopu have in Canada. In the absence of private insurance, a private hospital network can't prosper to compensate state deficiency: hospital services are too expensive and few can pay. Consequently, government spending grows year after year to the limit of the unbearable, which prompts continuous attempts at slashing costs. Since the main expense in a health system is the payroll, salaries are depleted and insatisfaction grows, and with it inefficiency. There's a shortage of doctors in distant regions, and of beds in urban areas.

(...) The country is in the ten worst in a list of 30 OECD (Organisation for Economic Co-operation and Development) member countries in respect to availability of hi-tech equipment, like magnetic ressonance and tomography (although it's the 5th in healthcare spending); in Ontario, in 1999 and 2000, demand for specialized treatment overtook availability by 1200 cancer patients, who had to travel to the USA; there is a chronic lack of doctors, who prefer to emigrate to the USA where pay is better; in 1997, breast cancer patients had to wait in average 67 days after surgery to start the necessary chemotherapy (81% waited more then recommended).

In the movie, therefore, the hospital is as eloquent a character as protagonist Rémy. And, like him, victim of a fatal disease. Socialization of basic services - although a generous idea - always leads to inefficiency, stagnation and blocks development of technology. It's pure Fukuyama.(...)

have a beef with Canada?

Who the hell is this guy?

Really big Brazilian media conglomerate.

He portrayed a health care system I am unfamiliar with. In the last 10 years my grama,my dad, and an uncle all died. They were given the best of care. Not once did a I see a patient laying in bed in the hallway. He is a bitter man with a bitter agenda.

Keep it coming, Canucks. Testimonials, I want TESTIMONIALS! Debunking right-wing propaganda is indeed a transnational endeavour.

I am a Canadian in fairly poor health. In the last ten years I've had two heart attacks and two minor strokes. Each of these times I was hospitalized for two or more weeks. I never waited in line for anything. Every service, test, procedure etc. that my Doctor thought I required was ready within hours. MRI's, X-Rays, Ultrasounds, everything. The only bill I ever got was for $45 for an ambulance, and that my employer paid.

The stories of huge waiting lists and poor medical services exist almost entirely in the imagination of the A.M.A. and the American health care industry.

I can almost see right-wing heads exploding in the Brazilian list where this appeared. Thank you guys, keep the testimonials coming!

But I have never heard of a Canadian who wants to change their system for ours.

that perhaps explain why he would do his best to portray Canada in a bad light?

But of course other people, with different interests, took the ball and ran with it.

The Brazilian columnist goes on to say Brazil's (sadly dismal) public healthcare system is on par with Canada's. I am a Brazilian and will defend my country in a discussion, but you may guess how much of a stretch is THAT.

I haven't seen Arcand's film, but definitely oughta and will at some point.

Quebec has had more than its share of difficulties in some aspects of health care. The self-styled progressive PQ government in recent years has in actuality been about as right-wing as some other provincial governments, and the health care system has suffered. Orthopaedic surgery (the fabled "2 years for a hip replacement") is one of them, and it's the one that the critics love to jump on. Amazingly enough, pregnant women keep getting prenatal and maternity care, all sorts of people keep going to doctors and hospitals and getting treatment and surgery, and people aren't really dying in the streets.

What USAmericans have to realize is that while we have the trappings of a lefty system up here -- like universal public health care -- we have for some years having right-wingers running the system. Ontario's Conservative government committed atrocities against the health care system, for instance. (And yet even after everything they had done, my dad's 6 weeks in a regional hospital near Toronto last winter before he died -- melanoma that had metastacized to bones and organs before he was symptomatic -- included constant care from three specialists, radiation therapy, various diagnostic tests including an MRI, and orthopaedic surgery, on a terminal patient, all with absolutely zero waiting time.)

The right wing is ideologically opposed to public health care -- look at all those insurance premiums just begging to be collected -- but cannot directly attack it in Canada, because they'd be voted out on their ears. So they got elected on platforms of tax cuts, just like in the US, and of course took the money from places like public schools and public health to pay for tax cuts for the rich.

Judging the performance of a public health care system on a decade of right-wing management of it doesn't make sense.

A public health care system *can* be run efficiently etc. -- if only because of all the profit dollars that are available to operate the system. Of course there will be some form of rationing, which will involve waiting times to some degree. Canadians happen to overwhelmingly prefer rationing according to need rather than according to ability to pay. But what you are seeing in Canada today is in no way attributable to the theory or practice of universal public health care -- it is attributable to deliberate right-wing mismanagement of universal public health care.

As we speak, a challenge to Canada's health care system (actually to Quebec's, but the principles will be generalizable) is waiting to be heard by the Supreme Court of Canada. The appellants allege that the prohibition on purchasing private insurance is a violation of their constitutional rights to life and security of the person -- that they are prohibited from taking out insurance so that if they need care that is better than the system provides, they can get it. The challenge was rejected by the trial court and appeal court in Quebec.

I've been reading the judgments and the parties' arguments (at the moment they exist only in French), and the issues are interesting. Obviously, I believe that the system we have, if it is a limitation on the exercise of those constitutional rights, is a justifiable limitation. Permitting private insurance/private medical care is the beginning of the end in terms of the kind of health care that is available to people who do not have the necessary dollars -- witness what happened to the UK's NHS when people were allowed (nay, encouraged) to "go private". Maintaining a single, universal, exclusive system is the only way to ensure that everyone has equal access to necessary medical services. Funding and managing it properly is the only way to ensure that everyone has access to those services within a reasonable time when they need them.

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I know there are more Canadians here. I've seen no maple leaf flags yet.

And then Paul Martin, the finance minister at the time and future Prime Minister, balanced the budget partly by decreasing health funding to the provinces...

The system is still struggling to catch up.

record on human rights (particular the rights of children) :hi:

It was an uber-media-executive who wrote this trash piece, not your average legitimate reporter. Brazilians greatly respect the achievements of socially-minded countries like Canada and most of Western Europe. This is an attempt at reversing this (correct) perception.

And yes, Brazil is largely a mess (compared to developed countries). Lack of money (which begets lack of education, jobs, basic services etc) does these things. I am convinced things could be much worse.

Sticking around for the November Debacle next year, but hoping to be settled by sometime in 2005.

My relatives in Canada have nothing but praise for the system, and nothing but scorn for Mike Harris.

and I'm counting on our new Liberal government here in Ontario to put things in health care back the way they were before Harris started his meddling!

I was in a car accident while visiting in Alberta, was not injured badly enough for an ambulance, went to the hospital, was looked after immediately, x-rays, etc. On returning to my home province, was immediately able to receive care at my hospital, and all followups were great, no problems.

All this was done without me having to put out one extra penny. I pay 56.00 a month and it covers everything.

In terms of state of the art equipment, we do not have enough, that is true. Does that mean that universal health care doesn't work, NO!

Our Brazilian friend can think "Texas". ;)

BC does have direct premium payment by individuals (sliding scale, max is still pretty nominal). Ontario funds out of general tax revenue and (Harris Tory invention, not sure whether it's still going) a small payroll tax.

I meant to mention that of course my dad's six weeks in hospitals, with the internist and orthopaedic surgeon and oncologist making daily visits, and all the tests etc., cost not a penny to us. Other than the parking, which can be damned expensive at those hospitals!

My co-vivant was diagnosed with type II diabetes 3 years ago, and as a patient at an Ontario community health clinic he gets nutritionist and foot-care services in addition to regular complete health check-ups and any specialist examinations (e.g. ophthamologist) needed. I go to a different community health centre, the one in the next neighbourhood over where I used to live. They are an alternative to private medical practices, and we go to them by choice. They're provincially funded with salaried staff and run by community boards, and provide a wide range of social services as well, and do special outreach to immigrant communities, the developmentally disabled, and so on. Unfortunately, no new ones have been opened in years and there are not nearly enough of them in the province.

Since neither of us works for a major employer and so don't have supplemental insurance coverage (which we could buy privately), we do pay for dental and prescriptions. My mum is over 65, so her prescriptions are free. Except for Harris's invention, the $2 per prescription co-payment, which maxes out at $100 a year I think and which many (mainly independent) drug stores waive.

By the way, my experience when I needed medical attention in Cuba was the same as yours in Alberta. ;) Unfortunately, when my mum needed medical attention in the UK 10 years ago, we went to a public hospital, with the two-tier (public/private) system in full swing, and that experience was not nearly as good.

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is to compare the real public health indicators, such as life
expectancy and mortality at all ages, rates for common deseases and
conditions etc. By those indicators Canadian healthcare is
consistently in the top 3 in the World, while costing only half
of US spending per capita. If Canada has fewer expensive MRI systems
per capita and longer waiting lists than the US, one has to question
not Canadian frugality, but instead the utility of spending all
that money on expensive equipment without any improvement in the
actual health outcome for the public. Healthcare is a scarce resource
which has to be rationed based on public need and its distribution
must be optimized based on the actual measurable results. It's
not to say that Canadian system is perfectly optimal, but it is sure
as hell is more efficient than the US system. About twicw as
efficient really.