Code Blue: Reviving Canada's Health Care System [Paperback]

Dr. David Gratzer (Author)

Book Description

Publication Date: September 1, 1999

In Code Blue: Reviving Canada’s Health Care System, David Gratzer takes a close look at Canada's health care system—from the overcrowded emergency rooms of Montreal hospitals, to the thriving practices of Canadian doctors who have decided to head south. He explores our misconceptions about the American health care system, analyzes demographic trends, and exposes the emptiness of political debate on the subject. Gratzer argues convincingly that the problems with Medicare stem from its very structure, a structure that will only continue to weaken as Canada’s population grows older. Do the commonly proposed solutions to these problems—increased funding, two-tiered services, better management, user fees—really have what it takes to correct such major flaws? Gratzer concludes they don’t, and looks at several models in other countries before writing his own prescription for Canada's.

Product Details

• Paperback: 220 pages
• Publisher: ECW Press (September 1, 1999)
• Language: English
• ISBN-10: 1550223933
• ISBN-13: 978-1550223934
• Product Dimensions: 8.9 x 6 x 0.7 inches
• Shipping Weight: 14.4 ounces
• Average Customer Review: 4.2 out of 5 stars  See all reviews (4 customer reviews)
• Amazon Best Sellers Rank: #1,596,838 in Books (See Top 100 in Books)

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Customer Reviews

Most Helpful Customer Reviews

5 of 5 people found the following review helpful:

5.0 out of 5 stars This is the roadmap, but nobody that matters seems to be reading it., February 5, 2008

By 

J. Nekrup - See all my reviews
(REAL NAME)   

This review is from: Code Blue: Reviving Canada's Health Care System (Paperback)

This is a fantastic book. Gratzer hits the nail on the head. The unfortunate truth is that the people in Canada with the power to change the system won't consider an approach like this because it would be political suicide in Canada. Gratzer shows us that health care reform in Canada does not have to be synonymous with Americanization of health care - a notion that seems to escape most Canadians.

10 of 13 people found the following review helpful:

5.0 out of 5 stars Devastating Critique of the Canadian Health Care System, April 30, 2000

By 

Greg Scandlen (Hagerstown, MD) - See all my reviews

This review is from: Code Blue: Reviving Canada's Health Care System (Paperback)

While some in the United States admire Canada's Single-Payer health care system, this book shows how misplaced their admiration is. In fact, Canada's system is under-funded, out-of-date and failing fast. They can't keep hold of their doctors -- or their patients. They fail to invest in new equipment or technology, and they barely perform any new research. Gratzer argues that Canada should move towards a system of medical savings accounts to restore accountability and patient power in Canada.

3 of 3 people found the following review helpful:

5.0 out of 5 stars A constructive critique of Canada's healthcare system, May 5, 2010

By 

Joel Barnes - See all my reviews

This review is from: Code Blue: Reviving Canada's Health Care System (Paperback)

Code Blue: Reviving Canada's Health Care System is a book that was written by Dr. David Gratzer at age 24 when still a medical student at the University of Manitoba.

In the introduction, Gratzer promises that:

"This book...breaks from typical discussion of health care, which increasingly resembles a tiger chasing its own tail. It's a book written in plain English, free of complicated technical language. And it's an invitation for those in the health care field, patients, and concerned citizens to do what nearly no politician or expert is willing to do: take an honest look at our health care system." (p. 17)

And Gratzer delivers on the promise!

The book begins with a look at the troubled state of the Canadian healthcare system. Gratzer provides anecdotal and journalistic evidence of a healthcare system beset with long waiting lists, outdated technology, lack of technology, suffering patients, inefficiently run hospitals, etc. One Canadian who practices medicine in New York is quoted as saying, "Canada has some of the best health care the 1970s can provide. But it's the turn of the millennium." (p. 47)

The problem, according to Gratzer, is that health experts deny these problems exist rather than acknowledge their presence and debate how to resolve them (p. 55). Elsewhere he surmises that the explanation for the denial among experts is that they "don't see medicare as a means to an end: solid health care for Canadians. Instead, it has become an end in itself. It is, in their view, more than a social program - it's a struggle for the soul of the country." (p. 170)

The reasons why medicare has become a sacred cow that nobody in general questions include:

1. Its inextricable association with healthcare even though medicare is not healthcare but a funding mechanism.
2. The unanimous support of the system by health economists and policy advisors.
3. The initial success of medicare (cf. pp. 80-81).

Gratzer interacts with the knee-jerk sloganeering that takes place when anyone dares question the Canadian healthcare system (e.g., "best healthcare system in the world") and takes particular aim at the caricatures of the American healthcare system, demonstrating quite easily that American healthcare is not a free market system and that increasing insurance premiums are the result of government intervention (e.g., forcing insurance companies to cover procedures the cost of which, in turn, is transferred to consumers via premium hikes), not greedy companies.

Although the American healthcare system is different from the Canadian system, both are moving in the same direction according to Gratzer as evidenced by increased management, control, and financing by government:

"The irony is that, from an economic perspective, the forces driving change in the United States are remarkably similar to those at work in Canada. American patients don't pay for the bulk of their health expenses. Neither do Canadian patients. Thus, in both countries, health care has evolved into a Sunday brunch at which consumers can feast on expensive items without concern for the cost. They have no incentive to economize." (p. 110)

Since Code Blue was written in 1999, this statement is almost prophetic given the recent developments with Obama's healthcare bill.

Gratzer goes on to identify the fundamental flaw in all healthcare, whether Canadian or American, which is the lack of direct costs borne by patients for the medical services they receive (p. 118). The lack of connection between behavior and cost leads to overconsumption by patients, overtreatment by physicians, and undesirable behaviors (e.g., spend-or-lose practices due to global budgets and block grants) from hospital administrators. In other words, medicare provides perverse incentives to just about everyone involved in the system. Says Gratzer:

"...the medicare system has corrupted the basic doctor-patient relationship. By changing the nature of this relationship - by freeing patients from concerns about costs and by distorting the need for a physician to tend to patients first and foremost - medicare created malevolent incentives for both the providers and consumers of health care. The result: inefficient and wasteful health care at a high cost." (p. 147)

The proponents of Canada's healthcare system have simply forgotten the most basic of economic facts, to wit, people respond to incentives (p. 210). And these perverse incentives that medicare offers have had disastrous results. On all five pillars of healthcare (p. 167), the Canadian healthcare system fails miserably:

1. Quality: lack of investment in technology and building renovations.
2. Timeliness: long waiting lists.
3. Cost Effectiveness: overconsumption by patients and overtreatment by physicians suggests that there's not good value for money.
4. Patient Orientation: state-doctor relationship takes priority over doctor-patient relationship.
5. Accessibility: healthcare is accessible from a cost perspective, but not in actual practice due to rationing via waiting lists.

Gratzer examines alternatives that may possibly help reform medicare (e.g., more funding, user fees, two-tiered healthcare, internal markets), but rejects them on the basis that they either deal with the supply- or demand-side problems of medicare without improving the overall system (pp. 177-187).

What is needed to make medicare work is patient choice and competition. These will provide the right incentives to curb overconsumption by patients, overtreatment by physicians, and inefficiency by hospitals. The best solution, according to Gratzer, is the medical savings account. Here's how it works:

1. Direct payment for minor health expenses, first out of a government- or employer-funded medical savings account, then out-of-pocket if and when the savings account has been depleted.
2. High deductible insurance for major (catastrophic) health expenses (cf. p. 194).

Gratzer sees this as the best way of focusing on individual choice and competition, and of introducing positive incentives to use healthcare wisely (p. 207).

***

This book is well written and not at all technical despite the complicated nature of the subject matter. It is clear that Gratzer is writing from a fiscally conservative perspective, but not so much so that he wants to jettison medicare entirely. Instead, he offers a well-reasoned, moderate approach to "reviving Canada's health care system."

Code Blue is a very constructive critique of Canada's healthcare system, but I suspect that it has not nor will be welcomed by a large audience for the same reasons - already mentioned - that neither politician nor expert dares raise a dissenting voice: an honest look at medicare is considered an attack on the soul of Canada itself.