To the Editor:
In his review of Miracle Cure by Sally Pipes, Jonathan Kay describes health care in Canada as “often second-rate” by American standards [Books in Review, January]. This may be true, but the quality of a nation’s health care cannot be judged simply by the way medical services are provided or by the length of waiting periods for treatment. The ultimate measure is the citizenry’s life expectancy and quality of life. As far as I know, no one claims that these are superior in the U.S.
I was surprised to find no mention in the review of one major factor in the huge and escalating costs of health care—namely, malpractice litigation. We are often given data about the high costs of such litigation in plaintiffs’ awards, attorney fees, and courtroom expenses; these are a reasonable burden for us to bear so that injured patients can be compensated. But the legal process involves many other costs that are inflated and unnecessary. To forestall potential lawsuits, doctors make patients undergo countless tests, procedures, and hospital stays. Patients’ trust in their doctors diminishes, and the general interest is disregarded.
Moshe Sorek, M.D.
Fountain Hills, Arizona
Jonathan Kay writes:
Dr. Sorek is correct: one cannot judge a health-care system on the basis of isolated criteria like the length of waiting lists. But the yardsticks he proposes as alternatives—life expectancy and quality of life—are so broad as to be even more problematic. The United States is a world leader not only in health spending and medical technology but also in obesity, guns, criminal violence, and other factors associated with early death. The fact that the average Canadian lives slightly longer than his American counterpart thus tells us little.
Sally Pipes would agree that frivolous malpractice suits contribute to higher health costs in the U.S. In a chapter of Miracle Cure devoted to this issue, she cites a study estimating the cost of excessive litigation at $809 per citizen. As Dr. Sorek suggests, the price is paid not only by doctors but also by patients subjected to batteries of unnecessary blood tests and radiological imaging for no other reason than to indemnify the treating physician.
Canadians are spared this costly annoyance, but not just because liability awards in Canada are rare and modest; there are also not enough diagnostic resources to serve many patients who truly need them. On this score, as with other health issues, the grass is not necessarily greener north of the border. For the many ailing Canadians who have been waiting months for their turn under an MRI machine or CT scanner, the problem of too much treatment is one they would accept in a heartbeat.