March 19, 1999

I suggest that Dr. Saul Isaac Harrison try to live, work, and be treated in Canada before extolling the virtues of a single-payer health care system (Psychiatric News, January 15). After having spent four years in British Columbia, I have seen how destructive the single-payer system is for both physicians and patients.

To protest health ministry clawbacks of their reimbursements, physicians last year took 24 "reduced activity days" (that is, strike days), and 52 are planned this year. Only recently were Canadian physicians moving to British Columbia from outside the province allowed to bill for their services. The British Columbia Supreme Court made this judgment, and the province's health ministry is appealing it. A provincewide nurses' strike seriously curtailed services for weeks, and paramedics are now on strike.

British Columbia hospital wards are being closed, and plans are under way to send heart surgery patients to Alberta, because waiting lists in British Columbia are dangerously long. Prescriptions are not covered under the British Columbia health plan. Patients who wish to see a psychiatrist are told there is a nine-to-12-month waiting list. Most psychiatrists' practices are closed.

Neither do people necessarily "pay less" for health care in Canada than in the U.S. While it is true that monthly contributions to the system are low, British Columbia goods and services are taxed at over 14 percent. I also paid 53 percent in Canadian income tax on money made working in the U.S. and living in Canada.

I spent thousands of dollars in an unsuccessful attempt to get even a temporary restricted license to practice medicine in British Columbia. After four years I finally was told I needed to take a year Canadian residency and all my examinations again (that is, the equivalent to the National Boards Parts I-III and specialty board certification). In the meantime Canadian physicians flock to the U.S. because of better pay and infrastructure. Washington State, for example, requires only the Canadian equivalent of the National Boards to get a full permanent license.

Those in British Columbia who live near the U.S. border, and who can afford to, seek more responsive, higher-quality treatment in the U.S. Patients on welfare in Washington State get far superior care to those in the single-payer system in British Columbia.

Cutbacks to health care and callous treatment of physicians and patients are commonplace where no alternatives, competition, or accountability exist. While our health care system has its own set of problems, I believe a single-payer system, at least the Canadian model, should be resisted with all possible zeal.

Rick J. Strassman, M.D.
Port Townsend, Wash.