For-Profit Care Not for Canada
a talk by Dr. Walley Temple
Physicians for National Health Plan newsletter,
... I've had extensive experience in different health care
systems. I've worked for seven years in the United States in a
county and a university hospital. I've lectured and operated with
surgeons in Europe, Asia and South America. I have taught, written,
done research and performed cancer surgery for 17 years in Calgary.
I've been involved both as a member and as part of the executive
of a world-wide cancer organization.
My colleagues from around the world represent countries that
total over 3 billion people and they are in awe of our health
care system. l assure you that our public health care system is
the most equitable, most compassionate, most economic and has
health outcomes that are truly awesome. It preserves the trusting
relationship that a physician needs to have with a patient. This
makes it, for me, a real privilege to work in a system where my
worry is con fined to patient care and not to financial incentives.
This is all at risk with Bill 11, even with the amendments.
Now most of the information that I share with you today is
derived from highly respected medical journals that are the source
of leading-edge research on the best scientifically proven medical
and surgical treatments, or from Statistics Canada as well as
from my own personal experience.
First I would like to look at the economics of our system.
It is a myth that health care costs are out of control. Per capita,
they only increased $50 in the seven years before the present
provincial government's cuts. In Canada overall the costs haven't
changed in 20 years and are only 8.9% of gross national product.
The cost of our health care is $2,500 per person and it provides
us with 100% coverage. In Alberta we spend less than eight other
provinces; our hospital costs per capita are the seventh lowest
and 15% less than in 1992. Where are the runaway costs?
Contrast this to the wealthiest nation in the world, the United
States, where two-thirds of the population is insured but still
pays 20% of the bill and one-third of the population is underinsured
or has no coverage at all. The government spends $2,700 per person
to support this system and each American pays an additional $1,500.
Is this the system we want to adopt?
All peer-reviewed studies show that non-profit care is less
expensive than for-profit care. The belief that for-profit minimizes
cost and maximizes care is just not true. American economists
calculate that if the money spent in the U.S. was used in the
Canadian-style health care, there would be enough to cover all
the health needs of their country. However, this is unlikely to
happen because the present profits are enormous. The most flagrant
example of this involves Richard Scott, the former CEO of the
largest health care corporation in the United States, Columbia/HCA,
who resigned in the face of a federal fraud investigation and
was given $10 million in severance pay and left with $269 million
dollars in stock. For-profit care has very little to do with care
and very much to do with profit.
Cost is not the only issue. Let's examine health outcomes.
In Canada, our infant mortality rate is 5.6 per thousand versus
7.6 per thousand in the United States. Our cancer mortality is
10% lower with 100 per 100,000 Canadians dying of cancer compared
to 110 per 100,000 Americans. We also live, on average, about
2 years longer than Americans.
All this for one-half the cost!
Now, do for-profit systems contribute to these poor results?
The answer is a resounding YES. The Journal of the American Medical
Association has estimated if the 23 million American women between
ages 50 and 70 were enrolled in for-profit care, there would be
an additional 6,000 more breast cancer deaths.
In another study, elderly patients admitted to hospital for
hip fracture, stroke or coronary heart disease, had a 25% higher
mortality in for-profit hospitals as compared to non-profit, university
Another example of second-class care is with patients needing
renal dialysis. In for-profit facilities in the U.S., the mortality
was 20% higher across the nation. This was related to shorter
dialysis times, lower staffing, deskilled staffing and decreased
use of drugs. What is more sinister is that 25% fewer patients
were on transplant lists. This is presumably to keep them on dialysis
longer. Again, in for-profit systems we see more money and worse
Of course there are some pinnacles of excellence in the U.S.
such as the Memorial Sloan-Kettering Cancer Hospital, the MD Anderson
Cancer Hospital or the Mayo Clinic.
But we are no slackers in Alberta. In our own Alberta-grown
cancer surgery division, consisting of dedicated general surgeons,
orthopedic surgeons, plastic surgeons, urologists, thoracic surgeons,
head/neck surgeons, and endocrine surgeons, we endeavor to give
Albertans the best.
For example, patients with osteocarcoma, the cancer that Terry
Fox had, are no longer routinely treated with amputation. We have
reduced the need for amputation from 100% to less than 5%.
We also have excellent results with the control of soft-tissue
tumours. The world average is 80% control while ours is 96%. The
need for colostomies for rectal cancer averages 40 - 50% around
the world, while our surgical and radiation oncology department
has reduced this to less than 5%. We also have one of the highest
breast-conservation rates for breast cancer-70%-and for those
who don't have breast-conservation, we have one of the best plastic
surgical teams who do immediate reconstruction.
Alberta has been a leader in research which has changed the
treatment of melanoma. Previous treatments involved surgery with
skin grafts entailing a one-week hospital stay. Now treatment
is an outpatient procedure. This has saved the government and
the health care system millions of dollars.
Now, these are just a few of the examples which I quote from
my own experience, but first-rate work exists in Edmonton and
in many other areas across Alberta and across Canada. We are proud
of our system, our cancer centres, our universities, our hospitals,
our doctors and our nurses and what they have done. Our health
care system is equivalent to a fine machine limited only by the
amount of gas we give it.
Why would we want to experiment with another model known to
be expensive, unreliable and a bigger gas-guzzler? Why would we
want to replicate a problematic system where there will be no
turning back and where the results will be measured in people's
Our doctors, our nurses, our health care workers have truly
broken their backs to help this province out of debt and keep
the system working. And now the government will break our hearts
with Bill 11.
The most significant problem with for-profit care is that
is destroys the sacred trust between the patient and physician.
A trust that not only provides comfort but also provides healing.
It destroys the Samaritan role of the hospital. It makes the doctors
and nurses into the instrument of the investor and it makes the
patients a commodity. A group of patients who will be greatly
hurt will be the cancer patients who need so many resources. Already
facing a frightening diagnosis, they will waste their limited
resources on any enhancement that we can sell them under the guise
of necessary treatment.
Some aspects of our humanity are not for commerce. Not blood,
not organs, not children and not medicine.
This disillusionment with private, for-profit care is attested
to by a public declaration in a national medical journal of 2000
doctors and nurses in Massachusetts who have declared that medicine
should not be for-profit or for personal fortune. Investor-owned
health care does not serve us well and physician-owned health
care facilities, as in Calgary's for-profit proposals, are rife
with conflict-of interest.
A serious question you have to ask is, why would our government
be pushing this system on us when we know the majority of Albertans
do not support a for-profit system?
There are three possible conclusions. Firstly, our politicians
are not well-informed, in which case, we can help them by giving
them information. The second conclusion is that the Conservative
MLAs are afraid to go against the cabinet position and will not
represent us in the legislature. The third conclusion is that
there are huge financial incentives affecting our politicians'
I personally would like to believe the first. Any other would
be a disgrace as it is not just greed that we are talking about
but disregard for the life of fellow human beings. I urge each
of you as a future patient to fight for your life and save our
health care system. Your doctor, your nurses and your health care
workers need your help. Thank you very much.
Editors' note: Dr Temple delivered the following speech at
a rally organized by the Canadian group Friends of Medicare on
April 16, 2000 to protest the pending passage of Bill 11 in Alberta.
Bill 11 allows the entry of for-profit out-patient surgical facilities
into the province despite overwhelming public opposition. All
figures have been converted to U.S. dollars.
Dr. Walley Temple is Chief of Surgical Oncology at the Tom
Baker Cancer Centre in Calgary and a professor of surgery at the
University of Calgary Medical School. Dr. Temple is also president
of the World Federation of Surgical Oncology Societies and editor-in-chief
of the International Journal of Surgical Oncology.