Canadian CareGwinn Owens, in his June 2 Opinion...


June 12, 1992

Canadian Care

Gwinn Owens, in his June 2 Opinion * Commentary article, "First-Hand Facts about Canadian Health Care," accuses critics of Canada's health care system of disseminating a "cascade of misinformation." I suggest that his article does the same.

Mr. Owens writes that Canada's health care bill as a portion of gross national product is 8 percent, compared to 12 percent in the United States. His "apples and oranges" comparison fails to note the significant difference between the two countries that account for higher health costs in the U.S.

For example, the U.S. has a more heterogeneous population and proportionally more senior citizens than Canada. The U.S. also spends more on medical research and development than Canada. When these differences are factored in, studies show that health spending in the two countries is comparable.

Mr. Owens also writes that critics of the Canadian system exaggerate when they speak of the long waits for operations that many Canadians experience. In fact, the evidence suggests that waits are common.

Researchers at the Vancouver-based Fraser Institute calculate the average wait for a coronary bypass operation in British Columbia at five months. Another recent study, cited in a Heritage Foundation report, estimates 260,000 Canadians are currently waiting for major surgery.

There is no doubt that many Canadians like their system of health care, but it is unlikely that Americans would accept the dearth of hi-tech procedures and the waiting lists that are characteristic of Canadian health care.

The U.S. system, with all of its problems, works well for most Americans. The challenge of health care reform is to make our system work for all Americans.

J. Leonard Lichtenfeld, M.D.


The writer is a trustee of the American Society of Internal Medicine.


Herbert L. Dyer's letter defending the actuarial assumptions used in determining funding for the Maryland State Retirement and Pension Systems is terribly weak on explanations.

Assumptions consisting of an approximate 7 percent annual wage increase and a 7.5 percent return on investments are truly unrealistic. Taxpayers cannot be asked to pay 7 percent wage increases in future years -- and the plan has averaged 11.4 percent earnings on investments during the past five years.

Perhaps that is why the state's pension plans are underfunded by more than $6 billion -- thus mortgaging the taxpayers of Maryland for over $200 million per year for the next 30 years to pay off the overly generous benefits that have not been funded in past years.

David C. Becker


Human Tragedy

I read with sadness about the young mother with post partum depression, which caused her to destroy her infants in a motel room. She had been treated by an HMO system and there was some question as to whether she received adequate psychiatric help.

I am concerned about financial coverage for psychiatric care, which may have played a role here.

Years ago, we psychiatrists knew a lot about theory and coulnot always treat every person, but patients seemed to have had adequate insurance coverage.

Things have changed, unfortunately. Insurance coverage has dwindled to the point that very little seems to be covered for psychiatric care. Many patients are forced to go to HMOs, and from my experience there is a paucity of care in HMOs for psychiatric problems.

There may be a social worker, counselor or perhaps a psychologist, but I have been disappointed in follow ups with patients who have become part of an HMO.

For a short period of time, I was even on the staff of an HMO but was disappointed with its control of the number of visits and the types of problems I was allowed to treat. I felt that patient care suffered.

Yet, in past years psychiatry has advanced tremendously. There is a much better understanding of mental illness. Excellent medicines and treatment approaches are now available and most patients improve.

It is true that psychiatric care will probably never be cost-efficient. Patients may need to be in treatment for longer periods of time and this cannot be justified financially in any way, except that it may help the patient.

I feel that there has to be a re-thinking of coverage for psychiatric care. Insurance will have to improve. And patients should be given the opportunity to have adequate psychiatric coverage so that incidents like this do not re-occur.

Alan H. Peck, M.D.


And Now a World

I'm sure Douglas Birch's article on the theory of the "Big Bang" (The Sun, May 31) has produced a spate of letters. Ever since the April 23 announcement that NASA's COBE satellite had generated a sufficient number of data points to supposedly validate the trembler "aftershock," I have been in shock.

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