Fact or fiction? The Canadian Medicare "crisis" as viewed from the U.S.

• Author: Marmor, Theodore R.
• Position: Part I

There are at present two conflicting images of Canada's Medicare available to observant adults in the United States. One is the conventional media portrait of crisis--from both U.S. and Canadian sources--an image of a program in deep trouble, overcome by problems of access, cost, and quality. The other image is far more favorable: Canadian Medicare as an structurally sound program of universal health insurance that largely satisfies those who use it, but, like all programs, requires managerial adjustment and attention to the fearfulness of Medicare's future that has marked the last decade. This was the conclusion of the report of the Canadian Institute for Health Information (CIHI) in 2000. Both portraits cannot be accurate, just as being green and white all over is logically impossible. What is the American interpreter to make of this dispute?

1. THE EMERGENCY ROOM STORY: A Similar Tale with Two Meanings

   One place to begin is the crowded state of the North American emergency room (ER), a familiar story in both Canada and the United States over the past decade. When the winter's flu season of 2000 aggravated overcrowding in North American ERs, the U.S. (and Canadian) media took special notice. That winter The Washington Post, The New York Times, and ABC News did stories on the quality of emergency rooms in Canada. (This paralleled Canadian media treatment and in fact amplified those stories). During the same period, USA Today and Time published substantial reports on U.S. emergency rooms. But there was a distinct difference in the stories told. The three reports on Canada used the overcrowding problem to suggest Medicare is critically flawed. The two extended reports on American overcrowding did not, by contrast, indict America's overall health insurance arrangements.

   The similarity of the North American stories was, however, quite striking. USA Today reported that "for nearly 10 days in December of 1999, "60 of 81 [Los Angeles] hospitals were so full that hospital administrators asked to send ambulances elsewhere." The same newspaper cited a California woman who died in an ambulance awaiting hospital admission. The journalistic portrait of Canadian ERs cited similar experiences. In Toronto, overcrowding was so serious that the New York Times reported "23 of the city's hospitals [had] to turn away ambulances." ABC News cited an asthma patient who died in an ambulance that had been diverted from the nearest hospital.

   The important point is not the parallel reports but the different interpretations placed on them. The stories about U.S. conditions attributed the problem in part to the flu, while the reports about Canadian ERs either ignored the flu or dismissed it as an attempt by Canadian public officials to put a happy face on a Medicare in crisis.

   Steven Pearlstein of The Washington Post asserted that "most experts" agree that Canada's Medicare is doomed, that "while money might...