John Geddes

John Geddes writes on politics and policy, with occasional reporting and comment on arts and culture.

Categories: Capital Read, John Geddes

Canadian health care survives Danny Williams' surgery

by John Geddes on Tuesday, February 23, 2010 10:24am - 118 Comments

[UPDATED BELOW WITH SURGEONS' COMMENTS]

I haven’t heard anybody say that Danny Williams shouldn’t have been allowed to travel to the U.S. for heart surgery. As the Newfoundland premier has declared in interviews published yesterday and today, it’s his heart, his health.

But accepting the personal nature of the choice hardly ends the conversation. Williams’ decision to check into Mount Sinai Medical Center in Miami to be operated on by a veteran surgeon has been seized upon by critics of public health insurance as proof of the Canadian system’s inherent weakness.

Since I support the single-payer model, I admit I was worried about how details of Williams’ condition and treatment, when he finally talked about them, might reflect on Canadian cardiac care. If it turned out he had needed some esoteric procedure not available in Canada, I figured the critics would have a field day.

But the reality appears to be the opposite of what I feared. Williams needed an operation on his mitral valve. His office admits the procedure was, in fact, available in Canada. It’s more than that, though: Canadian cardiac surgeons happen to be renowned for their expertise in valve repair.

It was two Canadian physicians who wrote the how-to paper on valve surgery published only late last year in the New England Journal of Medicine. There are famous surgeons like Toronto’s Dr. Tirone David, who’s been called a “virtuoso” valve man. Minimally invasive procedures, the style of surgery Williams chose, are offered in Canada in places like the University of Ottawa Heart Institute.

None of this is to suggest that Williams might not have had good reason to go to Miami. He might have heard impressive things about the surgeon who worked on him there. He might have preferred to be close to his Florida condo for recuperation. He might have liked the sound of the amenities and privacy offered by a pricey U.S. hospital.

But those sorts of factors don’t tell us anything about the capacity of the Canadian health care system to provide high-quality care. I’ve heard no credible claim that Williams would have faced a long wait, if any wait at all, for surgery in Canada. And now we know that his category of heart problem, far from being one Canadian surgeons can’t handle, is one of their fortes.

I’m reminded of another politician’s medical history and how it briefly made news decades ago.

When Paul Tsongas, the former Massachusetts senator, was running for president in 1992, he lashed out at the Canadian health model. Tsongas had suffered from lymphoma, and he said, rather dramatically, that the bone marrow transplant that saved his life was an example of how the American system spurred innovation that would never happen under creativity-stifling Canadian-style health care.

It was a gripping personalized take on the issue. The only problem was that the key research breakthroughs that led to bone marrow transplants were made in Toronto, and Canadians, at the time Tsongas was speaking, were receiving the procedure more often than Americans.

Case studies that initially cloud the broader issues can ultimately be quite illuminating.

UPDATES:

Getting into the details of why Danny Williams made the choice to go to Miami is delicate. Health is a personal matter, and anyway, the real issues here are about policy, not the particulars.

Still, Williams told Canadian Press that doctors in Canada suggested conventional surgery, while his U.S. surgeon did the operation through a incision under his arm that didn’t require opening up the bones in his chest.

This might create the impression that minimally invasive surgery wasn’t offered in Canada because of some limitation in the techniques available here. I put the question to the University of Ottawa Heart Institute. Quite properly, the institute stresses that its doctors can’t comment on Williams’ case.

But Dr. Thierry Mesana, chief of the institute’s cardiac surgery division, and a leading international authority on mitral valves, responded by email on the general question of how minimally invasive surgery is viewed by the experts.

“Minimally invasive mitral valve repair consists of doing an MV repair surgically through a 5 cm small side chest incision instead of a 10 cm incision in the middle of the chest. A recent survey published at the Society of Thoracic Surgeons meeting (Jan 2010) expressed some word of caution and showed it is not recommended for complex mitral valve repair and also that the rate of complication (strokes in particular) is higher.

“There are a few advantages in terms of length of hospital stay or transfusion or post-operative arrythmias. The only real benefit is cosmetic. Many world renowned experts do not advocate it, in fact. It is done in Canada, but again, with caution. I propose it only for cosmetic reasons in a young woman who dislikes the idea of having a scar visible in summer. This procedure is well publicized in the U.S. in some centres.”

ANOTHER UPATE:

I mention above the well-known Toronto heart surgeon Dr. Tirone David. From India, where David is teaching just now, he responded by email to questions I asked through his office. Here’s what he said:

“I don’t know the reasons Mr. Williams opted to have his operation in Florida. It is certainly not because minimally invasive mitral valve repair is not available in Canada. Canadian heart surgeons routinely do minimally invasive mitral valve repair including techniques involvng endoscopic and robotic approaches.

“There is absolutely no evidence that robotic mitral valve repair is superior to other minimally invasive approaches, such as a limited sternotomy or lateral thoracomy, with or without the aid of endoscopes. Moreover, when it comes to heart valve surgery, there are very few places in the world that can match the outomes we have provided at Toronto General Hospital.

“Having said all that, Mr. Williams certainly had the right to go anywhere he wanted for surgery.”

Tags: cardiac care, Danny Williams, health care, New England Journal of Medicine, Paul Tsongas

More by John Geddes

Joe Johnson

I'm an American by birth, Canadian by choice. I've lived with both systems and can say with no doubt that the 18,000 Americans who die every year from lack of health care would probably choose the Canadian style health care if they weren't dead. The US system is superior to Canada's ONLY if you ask the millionaires like Danny boy. For the rest of us – the reality is Canada got it right yet again.

Chico

I've never seen a death certificate with the cause of death "lack of Health Care" listed. If only millionaires get health care in America, then that's news to me. Besides, you seem to take the simplistic approach that the choice is either one system or the other. It's not. There must be good things about the U.S. or why did Mr. Williams just come here? They had to send my father-in-law by ambulance five hours from PEI to get a heart test — that's one way. President Obama has specifically said he doesn't want the Canadian model, but wants to reform the US system. So, it's a false choice — and if you think there aren't thousands who die of lack of health care or from poor health care in Canada, well, I can just make up a figure for that, too, Joe.

To imply everyone gets the best care possible in Canada and nobody dies is simply a falsehood. We know from the survival rates of various diseases such as breast and colon cancer. For example, Mr. Williams was told to come back in six months. Had he been in the U.S., he'd have been brought back sooner perhaps — and you'd complain about the evil profit motive. Mr. Williams also "said he spoke with and provided his medical information to a leading cardiac surgeon in New Jersey who is also from Newfoundland and Labrador." (CP)

If the Canadian system were better for doctors, there wouldn't be a brain drain driving them to the States — then everyone could have top-notch heart procedures, and not only the "millionaires" like premiers who can afford it.

Is there no place to believe that and want the best for everyone in Canada?
tenac

Joe how many of the 18,000 did you know? I am no millionaire, but pay $530 a month for my family of five. My health care insurance hasnt gone up or done more than $100 per month in 15 years. Yes, I have to shop it, but it is worth it. Unlike my Canadian friends, I can "fire" my health insurance company next month and get another. You cannot fire the govt.

http://intensedebate.com/people/SisyphusThis SisyphusThis

You're a lucky man ….

http://californiawatch.org/watchblog/anthem-blue-…

http://www.cafepress.com/alteredstates Glenn

How is this an example of "Canada got it right again?" This guy had a choice and he ran to the US as fast as he could get here. Funny how he chose our "grossly inefficient" and "frankenstein-like" medical establishment over his own country's medical system, yet Joe thinks Canada got it right. If Canada was so great, he would have stayed where he was and got treated by the great Canadian healthcare system. I don't know what "lack of healthcare" as a cause of death means – was that on the death certificate?
http://intensedebate.com/people/s_c_f s_c_f

There are no 18000 annual deaths from lack of health care.

Pierre

Joe, you are delusional if you think Americans don't wait in pain waiting to get something done. Millions of Americans go without care because they CAN'T AFFORD it. Guess how long their wait times are?? FOREVER!! Although are system is not perfect, and still needs improvement, the fact is over 90% would NEVER give it up for the U.S. style of healthcare. You are drinking the far right wing, Rush Limbaugh, American Kool-Aide. Careful you don't choke on it.

George Bush Reeks

50 million Americans have ZERO health care b/c their government has failed them. Show me a Canadian who thinks they would be better off in the USA and I'll show you a rich person or an idiot.

Chico

And you show me where it's 50% and also where it says in the Constitution that the U.S. government is responsible for providing health care. They're not. Do you take any responsibility for your wants and needs, or do you expect your neighbors to pay for everything. Oh, that's right. I'm asking socialists who've gladly let America pay for their defense for the last 100 years.

Also, Kool-Aid doesn't have an E. Talk about an idiot.

And as for the 90%, funny your premier just left the Canadian system for the U.S., isn't it?

Again, relatives in Canada. I've seen it. You hear about these big cases and you hear people who may not have health care, but you never do hear about the Canadian horror stories — and if you dare mention examples, somehow you listen to the most-popular radio talk show in the history of the world.

Wow, what a dig!

Henry Rifles

This just shows the just nature of the Canadian system. If the Americans had such things as ques for health care the rich would jump to the front every time. I'm glad Danny could not push his way to the front of the line in Canada.

http://www.cafepress.com/alteredstates Glenn

Well, I'm glad we don't have queues. You think queues are an example of a "just" system? It sounds like a symptom of an overextended system on the brink of collapse. Canada can only have socialized medicine because the US doesn't and is here to pick up the slack. You're welcome!

Inthedistance

Should that ever change and we can't go to the US for medical, we'll just have to go to Cuba.

Our queues are full of people in discomfort that isn't going to kill them…knee surgeries have a long wait list, critical, life-saving surgeries do not. Doctors keep patients stable with medication. Diagnostic testing machines seem to be concentrated in areas with a large population, so for the people who are scattered across the country living in remote areas, it's not just a long trip but a long wait to get an appointment. My tiny community did fundraising for a year and bought our 20+ bed hospital a CAT scanner. Now we don't have to fly so many people out of here on the provincial tab, just to investigate symptoms urgently that can be treated locally. There are many different contributing factors to the diagnostic queues.

http://intensedebate.com/people/PacificGatePost PacificGatePost

It is a gross misrepresentation to claim that the Canadian system is working. The Williams case is one of hundreds of thousands of examples of very serious cracks in the foundation. People wait for a year to get operated on, . . . for ONE. Lack of facilities across the country, . . . for TWO.

AND it's getting worse, . . . http://pacificgatepost.com/2008/05/canadas-breaki…

It's a simple matter of enough money, taxes, feeding the system, and millions who pay nothing are depending on the system, . . . even when they don't live in Canada.
Micheal

Where Mr Williams decides to have surgery is his own business, and does not reflect one way or another on the Canadian public health care system. He is free to choose, and should be encouraged by the Canadian public to go wherever he wants. The USA has a vastly larger health care industry, with many options for the consumer, both public and private. Canada does not offer private care options, and it would be difficult for Mr Williams to access the public system in a timely fashion without being accused of "skipping the line". Public hospitals on both sides of the border are excellent; however there is no fair comparison for private hospitals offering heart surgery, because Canada doesn't have any.
Frank

I don't understand the comments about a waiting list for routine surgery. In the costly, inept, frankenstien model in the US, there is a wating list for some transplants due to the lack of suitable donors. But why a waiting list for the routine. Once my mom had to wait for 4 hours to have heart surgery, but that was because the rooms were already occupied by other surgery patients. Once they cleard through, in went mom. The hospital staff was very apologetic, explaining that it was an unusually busy day. We could have transfered to a hospital in a nearby state without the approval of the governor.
Chico

"I’ve heard no credible claim that Williams would have faced a long wait, if any wait at all, for surgery in Canada."

Really? Is Mr. Williams himself credible enough? He said, quote: "I would've been criticized if I had stayed in Canada and had been perceived as jumping a line or a wait list." So if he'd stayed in Canada, he would have been said to cut the line. That means there's a line, doesn't it? Why else would he supposedly fear this unfair (in his mind) criticism?

Obviously he should have shown how great the Canadian system is by staying home. If this was the reverse situation, you'd be hearing all about how U.S. health care sucks and Canada is great. In fact, Canada has the same system the Americans have: Those who can pay for it, get the care they want. Those who don't, get to wait in line and use publicly provided options.

I know that you're not open minded enough to objectively look at it, but, that's clearly the case. Everyone wants the best care they can get, but all a socialized single-payer (is that some dude chained to a chair and you use his credit card?) can do is give everyone universally mediocre care.

He claims, further, the procedure was NOT available in Canada. CP: "His doctors in Canada presented him with two options – a full or partial sternotomy, both of which would've required breaking bones, he said."

JMG

What publicly provided options are these in the US?

Williams is lying when he claims that the procedure is not available in Canada. It's false and directly contradicted by the surgeons quoted in the article. Williams' failure to seek a second opinion within the country was his choice alone. The wait for this kind of surgery might be on the order of 2-3 weeks, at the most and least urgent. Williams evidently had time to spend several weeks hemming and hawing to consider his "options".

And as a point of information, it is not possible to perform any kind of heart surgery (short of angioplasty) without "breaking bones", except that in the case of a sternotomy, this involves cutting slowly through the bone with a cautery device. As near I can tell, Williams' reason for opting for something else had more to do with vanity than the effectiveness of the procedure.

Mrselaineous

Of course you can get to the heart without breaking bones! It's right in the article — "minimally invasive" means they performed the procedure with a scope, possibly robotically. Also, you don't cut through the sternum with a cautery device, but with a sternal saw. Welcome to the 21st century!

Rick Frado

Congratulations Canada- your wealthy elites can get the best healthcare-too bad you cannot. What is pathetic is that he did not even trust the private clinics that service elite clients in his country. Where does he go??? To the screwwed up US
Sparky

The comment about the great outcomes Canada has in MV surgery had me thinking. If we eliminate all those who might have bad outcomes by making them wait a month or two so the risky ones drop out of the queue (by dying of course) we could very reasonably boast of a very good outcome. Why don't we do that for all procedures? Wait, we do! Those in the USA who want next day or next hour surgery are all those not willing to queue up and see if they can get surgery rather than drop out and save the tax payer all that money. Selfish people who could just die quietly and save their neighbors all that money… Goes back to the concept of the "rights of Man" (meaning the rights of the State) verses the "rights of men: (meaning the rights of the individual).

Sparky

The term rights of man come from the French Revolution where they killed all who opposed the revolution and it's leaders. The rights of men comes from the American Revolution, where those that disagreed strongly enough resettled in Canada, but were not guillotined. The Canadian scheme is the average for everyone. If you want the best of care in the USA, you had better start by studying in school, get a real job, work hard, and then, and only then can you enjoy the best of life. Socialized societies put a real crimp on motivation.

Pierre

SOme of you people are either dense, or you don't read articles properly or fully.
The procedure Williams had IS OFFERED in Canada. According to cardiology experts across the country, there are virtually no wait times for heart surgeries as well. Therefore, no que jumping. Williams could have gone to Ottawa, Toronto or London, just in the province of Ontario. There are other centres in Canada that provide this more non-invasive procedure. The lone surgeon he saw offered him the more evasive surgery. He could have done to ANY other centre in the country, if not available in his province. He claims in his interview that the non-invasive procedure was not available, which we now know NOT to be true. This tells me he didn't even check to see where else he could have gone in Canada, and simply opted to open is HUGE wallet and have it done in Florida where he owns a condo. Let's see, recover in Ontario in the middle of winter, or Florida. Hmmmmmm By the way, they told him in December he needed immediate surgery, yet still waited nearly 2 months to have it done privately.
Some of you people are cherry picking this story and painting with an extremely broad brush.
http://intensedebate.com/people/Gaunilon Gaunilon

There seem to be differing opinions on the experience in the Canadian vs. US health system by those claiming to have experienced both.

For the record, I've lived for years at a time in both countries…and there is a lot to be said for both systems. On balance, my experience was better within the US system.

Clearly my experience isn't representative of everyone – but just as clearly, those saying Canada's is superior for all but "millionaires" (I'm not even a thousandaire) are making pretty wild generalizations.
Chris from Manhattan

You canadians are nuts — there's more MRI machines in NYC then there is in all of Canada – and to actually try to argue that minimally invasive heart surgery is somehow more dangerous then breaking the sternum " the old fashioned way" is similarly ludicrous.

Live in denial all you want, but the bottom line is that nobody who can afford not to is going to canada for healthcare.

Joel

You do realize that the state of New York alone has the equivilant of Canada's population right? So that's not exactly surprising. …

http://www.thepatientfactor.com The Patient Factor

Finally someone is asking questions! Our current health care system is failing both patients and providers. It is time to ask questions, seek answers, contribute ideas and drive change. Join the conversation at http://thepatientfactor.com/canadian-health-care-…
Canadianandproudofit

A stable patient went for a cardiac angiogram and the results of the test were so severe it caused the doctors to issue a "do not dicharge" order. The stable patient remained under observation for 6 days in hospital until a surgery slot opened. He was given 3 cancelled surgery dates because there were other more critical patients who weren't stable who were given this patient's dates. That's the kind of line-jumping we have in Canada, based on actual, not perceived need. The patient, who was ripe for complications, has completely recovered and now lives with a clean, normal sized heart with a normal heartbeat and a hugely extended life expectancy.____Awww, Danny didn't want a small scar on a cracked sternum? It's less painful than if you accidentally broke an arm and the scar is hardly noticeable less that 6 months later. I don't want to see Danny Williams without a shirt on, so his secret would be safe! ____A word of caution – when you shop and pay for surgery, you usually get what you ask for, even it's not always in your best interest.

Mr. Williams has no credible opinion on the subject of healthcare and should keep his private life at home where it belongs.
http://intensedebate.com/people/s_c_f s_c_f

I'll believe the guy with the heard problem getting on the jet plane, not the Maclean's writer commenting from his armchair.

Geddes skirts all the controversial issues to write a puff piece that satisfied his ideological blinders. Here, instead of investigating and reporting the news, we have a writer trying to deny the news, and ignoring all the real questions people want answers to.

Like, for instance,
-why does he continue to insist the premier of a Canadian province is a complete idiot? The premier already claimed there were medical reasons for the decision
-why are only those with fortunes like Williams allowed to make these decisions? If we had private care in Canada then the rest of us would have the same choices as Williams.
-why do politicians routinely praise the Canadian system and routinely choose to avoid it?
-why does Geddes rely on anecdotes from true believers in socialized medicine? Does he have the guts to talk to someone with an opposing position? Obviously not.

What a puff piece.

JMG

No choice? Are you not paying attention? This exact (endoscopic) procedure is available in multiple centres in Canada, with minimally invasive surgeries involving partial sternotomies available most everywhere. Williams chose to go to Florida so he could hang out at his Sarasota condo. He also didn't seem to like the option originally offered by his own doctors, so he called up an acquaintance in the US to refer him somewhere south of the border.

FYI: foreign surgeons can't just fly into another country and take up a hospital's OR time. Which "true believers" are you talking about anyhow? The cardiac surgeons quoted? I suppose you know more about heart surgery options than them?
Joel

Routinely avoid it? When was the last time you heard of another high profiled politician leaving Canada for medical care?

http://intensedebate.com/people/s_c_f s_c_f

Off the top of my head: Chretien. Stronach.

http://twitter.com/mooseandskwerl @mooseandskwerl

From the Globe & Mail: "The impression Mr. Williams left, that the technique he sought in Miami is not available in Canada, is reinforced by his statement that he will consider applying for reimbursement for his medical costs in Florida."

The hypocritical Mr Millions is considering stiffing the Canadian taxpayer with the bill for this. Typical trough feeder for you — I guess that's how you get to be a millionaire: make other people pay your way.
OnTheJob

The Canada-USA immigration rate is twenty nine times higher than the USA-Canada immigration rate, with only 8,000 Americans coming to Canada every year, 7,999 of whom apparently consisting of poor bastards who met some Canadian chick online. Almost nobody from America moves to Canada, which negate's our friend Joe's narrative thoroughly.

Joel

Exactly the problem. Those greedy people seeking bigger fortunes will go where the money flows. For the rest of us, we're nice and comfortable living here and accepting to help anyone who would like it.

As a leader, you have a choice. If you don't like it, then you can either fix it, or run away to somewhere else. What do you choose?

Fred – Brandon MB

Now it turns out that the procedure Danny Williams had is chosen most often for cosmetic reasons. It only leaves a small scar under the armpit instead of a large chest scar. The drawback is a significantly greater risk of stroke.

I'm not surprised Mr Williams would choose vanity over health.
Seen from all sides

We spend 5 months a year in PEI and the remainder in the USA. We see both health care systems up close and personal and, as a result, feel qualified to judge both systems.

In PEI, far too many people do not and can not get a family doctor. I required an ultrasound this past summer which the doctor deemed "urgent" and an "emergency". I was then scheduled for one in two months!!

There is a hospital in the local town as well as a clinic with 8 doctors. NEITHER the hospital nor clinic has an ultrasound machine!

There are 3 ultrasound machines in this same town…………… all 3 at the veterinary clinics. Something is very wrong with this picture.

Please, call your American friends and tell it like it is.

Have them tell Obama to keep his hands off our world class health care system!

Pierre

Where do you live in the States??? Is it the least populated State in the union?? Cripe, I know more people then what live in that province. Why not compare where you live to say Halifax, Ottawa, Calgary, Kingston, etc.

I had a swollen spleen, went to the hospital, had an ultrasound right away. And that was in a small town in Ontario with population of 12,000. You can't paint a picture of entire nation based on your experience in little P.E.I.

You do realize that more Americans don't have a family doctor then Canadians right???