Canada's Burning!(strain on medical resources caused by 1999-2000 North American influenza epidemic)

• Author: MARMOR, THEODORE

Media myths about universal health coverage

LAST WINTER'S FLU EPIDEMIC OVERWHELMED emergency rooms across North America. Patients trapped in uncomfortable conditions were forced to wait for long periods of time before finally getting treatment. It was an ugly situation and the American press dutifully reported the winding lines, the cold drafts, and the screaming drug addicts adjacent to the people suffering from the flu. But their reporting of the situation in Canada and the situation in the United States was dramatically different.

The three major reports on Canada, by The Washington Post, The New York Times, and ABC News, used the overcrowding problem as evidence that Canada's universal health insurance program was critically flawed. The problems of Canadian emergency rooms, in short, indicted Canada's medicare. The two major reports on the problem in the United States, by USA Today and Time magazine, did not, however, turn overcrowding in American ERs into an indictment of America's non-universal health insurance system.

This contrast in press coverage cannot be attributed to obviously better conditions in American emergency rooms. Emergency rooms in both the United States and Canada have come under increasing stress over the last decade and, although there's no rigorous data on ER overcrowding, the data we do have suggest conditions are as bad, if not worse, in the United States. What the disparity does reflect is a tendency among American reporters to state or imply that Canada's increasingly intense debate about its universal health insurance program is evidence that its program is in "crisis" and that universal, government-financed health insurance programs are bound to fail.

Breaking the News

The USA Today and Time articles presented vivid evidence that in parts of the United States the condition of the ER is already putting Americans at risk. Time reported that patients entering the Thunderbird Samaritan Medical Center near Phoenix last December waited "for up to six hours to see a doctor." In Los Angeles, "for nearly 10 days in December," according to USA Today, "60 of the [city's] 81 ERs were so full that hospital administrators asked to send ambulances elsewhere." The USA Today story quoted a Boston paramedic saying: "When we get to a hospital, we either have to wait with the patient on a stretcher or we are told on the radio, `No, you can't come to this hospital.'" The articles explicitly attributed some of the overcrowding directly to the flu epidemic.

The journalistic portrait of Canadian ERs was similarly and deservedly dire. But the conclusion drawn wasn't simply that some Canadian ERs could be overwhelmed by events like the flu epidemic. The three reports on Canadian ERs either ignored the flu or dismissed it as an excuse used by Canadian public officials trying to minimize "the crisis." The problem was really our northern neighbor's universal health insurance program.

Steven Pearlstein of The Washington Post quoted unnamed "experts" to the effect that Canada's system is doomed. "Most academic experts," wrote Pearlstein, "say that while more money might alleviate the shortage of advanced machinery, hospital beds, and medical school slots, it will only be a matter of time before the demand for medical services once again overtakes the willingness of voters to pay for it." Pearlstein then quoted a Canadian "professor of health administration" who claimed "the big problem" is that "Canada has un-managed care," implying that Canada could avoid the apocalypse predicted by Pearlstein if it would import the techniques of managed care from the United States.

What Pearlstein did not say is that Canada is spending far less of its national income on health care than the United States is, that polls indicate Canadian voters want to spend more money on health care, and that in all countries with national health-insurance programs, doctors and other health-care professionals justify their demands for medical care with claims of critical shortages--a tactic known as "orchestrated outrage." Under these circumstances it is easy to find an "expert" who claims to foresee catastrophe; pending disaster is a great way to justify increased funding.

James Brooke, covering the flu outbreak for The New York Times, asserted that "few Canadians would recommend their system as a model for export," citing a tangential...