Letters to the Editor
Canada's Health System
Psychiatric News
Volume 43 Number 20 page 25-26

The article in the May 2 issue on the practice of psychiatry in Canada was timely. According to a study by Aaron E. Carroll, M.D., and Ronald T. Ackerman, M.D., in the April Annals of Internal Medicine, the majority of U.S. physicians now favor a single-payer system, as Canada has. I left the United States several years ago and find practice in Canada preferable in several ways. I get paid promptly for all the time I work, patients are not triaged by their insurance coverage, no bureaucrats make me justify my decisions, and litigation is a less significant concern.

I just gave anecdotal reasons for preferring practice in Canada, which is what the article in Psychiatric News consisted of—anecdotes. I was disappointed that the article did not examine aspects of Canadian mental health care more deeply. For instance, while psychiatric consultations may require a wait in some places, in part because there are too few psychiatrists, Canadians have devised a creative solution. In collaborative mental health care, psychiatrists "adopt" family physicians for whom they provide in-office consultations and phone support. This extends the reach of psychiatrists and enhances the skills of family physicians.

The language of the article, with words like "dire" and" can it be saved?," exaggerated Canadian problems. All advanced countries are struggling with costs and access. Yes, in some regions, Canadian hospitals have inadequate surge capacity. The anecdote about a man who needed emergency treatment in the United States can't be disputed, but neither can Michael Moore's vignettes in the film "Sicko!" of U.S. citizens who had poor care, went bankrupt, or died because of inadequate insurance or heartless insurers. That rarely happens in Canada.

Canada spends about 10 percent of its gross domestic product on health care, slightly above average for nations in the Organisation for Economic Cooperation and Development; the United States spends 15 percent while leaving 47 million people without medical insurance. As for the Canadian psychiatrist who asked how to make national health care work, I in turn ask why the United States is the only advanced country that doesn't care enough about all its citizens to even try.

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