England’s and Canada’s Health Care

This widely forwarded e-mail, targeted to senior citizens and claiming that health care legislation could constitute "senior death warrants," is riddled with false claims.

The anonymous e-mail claims that "[i]n England anyone over 59 cannot receive heart repairs or stents or bypass because it is not covered as being too expensive and not needed." That’s false.

We called the United Kingdom’s Department of Health and a spokesman told us: "It is not true that anyone aged over 59 years cannot receive heart repairs, stents or bypass surgery on the basis of their age."

He also said that medical procedures in the U.K. are not routinely denied for older people. The National Health Service, the U.K.’s public health care service, has a constitution which prohibits discrimination on the basis of age and other factors. "The NHS Constitution states that the NHS provides a ‘comprehensive service, available to all irrespective of gender, race, disability, age, sexual orientation, religion or belief,’ " the spokesman said.

We also contacted a nonprofit group, England’s Age Concern and Help the Aged, which works to stop age discrimination in various facets of life, including employment and health care. Age Concern’s press office had never heard of any kind of prohibition on heart surgery for those 60 and older.

The group’s handbook on health care says that a national organization was created 10 years ago to improve health care for older people. One of the standards for the organization is “rooting out age discrimination.”

Age Concern does receive complaints from older citizens, and its Web site says that ageism in health care does occur. It says, for example, that a doctor could refuse to refer an older patient to a consultant, medical professionals may make inappropriate comments about the patient, or a patient "might even be pushed into a care home you don’t want or be refused specific social services because of your age." The site then tells older people what they can do if they feel they’ve been mistreated.

The site mentions one age limit – those over the age of 70 won’t get regular invitations every three years to breast cancer screenings. But those older folks get a screening if they request one.

Canadian Choppers

The e-mail also falsely claims that it took eight hours to drive actress Natasha Richardson to a hospital in Canada in March after she fell and hit her head while skiing. "If Canada had our healthcare she might be alive today," the e-mail speculates, saying that the U.S. has fast-moving medical helicopters and implying that Canada doesn’t.

That’s not true; in fact, the province of Ontario has an air ambulance system that the Toronto Star called "the envy of North America" and "the largest and most sophisticated of its kind on the continent." However, it is true that the province of Quebec, where Richardson was skiing, is the only province in the country that doesn’t have an air ambulance system, according to the Star. And her death raised questions about whether a helicopter could have made a difference in the tragedy.

Mont Tremblant Ski Resort, where Richardson was taking a lesson on a beginner’s slope on March 16, is about 25 miles from Centre Hospitalier Laurentien in Ste-Agathe, where Richardson was first taken. Ambulance records obtained by the New York Times show that the ambulance arrived nine minutes after a call was made for it, and it took 38 minutes to get to Centre Hospitalier Laurentien. Richardson was later moved to Montreal’s Sacre-Coeur Hospital, which has a trauma center and a team of neurosurgeons that the smaller Ste-Agathe hospital lacks.

The ambulance that took her to Ste-Agathe was the second to arrive for her; the first was turned away when the actress said she was fine. As the Times, and many others, reported, the first ambulance arrived at 1 p.m. but was turned away. At 3 p.m., when Richardson said she wasn’t feeling well, the second ambulance was summoned. Paramedics attended to her and then made the 38-minute trip to the hospital in Ste-Agathe, arriving at 4:20 p.m.

At about 6 p.m., she was transported to the Montreal hospital. The time line of events has prompted many questions as to whether Richardson could have been successfully treated had the ambulance taken her straight to the Montreal hospital rather than Ste-Agathe, or if she had gone to the hospital in the first ambulance, or if she had been transported sooner from the Ste-Agathe hospital to the facility in Montreal. Or if a helicopter could have taken her from Ste-Agathe to Montreal, a drive of about 45 minutes, or if a helicopter could have been called by the resort.

The Toronto Star reported that “Quebec is the only province that doesn’t have a network of helicopter air ambulances in place,” a situation the Quebec government had been studying. The Star said that the head of the trauma center at Montreal’s McGill University Health Centre had voiced concerns about this at a conference before Richardson’s death. Dr. Tarek Razek warned that skiers needed to wear helmets, saying "I cannot get you to my centre fast enough to have those reductions in mortality. I just can’t.” Razek told conference participants that Quebec was "the only region that I’ve ever been able to find in the Western world" without an air ambulance system.

In a letter to Canada’s National Post, Razek said that Canada’s health care system wasn’t at fault, putting the blame squarely on Quebec.

Razek, letter to National Post, published April 11: Our failure to ensure public safety to a minimum standard is indeed shameful, but it is not a failure of Canadian health care, as this service exists in most of Canada. Rather, it is a failure of Quebec health care.

Another Canadian newspaper, Montreal’s Gazette, quoted the director of Quebec’s pre-hospital care as saying that the lack of helicopters was a matter of cost. Daniel LeFrançois told the Gazette that it was a case of "the biggest gain for the biggest need," saying "[i]t costs $6,000 for one hour of flight." LeFrançois noted that Quebec’s accident death rate was slightly lower than Canada’s average.

So would Richardson have had a better chance of survival had she been skiing in a different Canadian province, or in the United States? We can’t possibly say. It’s worth noting that not every state in the U.S. has medical evacuation helicopters – Vermont and Rhode Island, small states to be sure, do not, according to the Atlas & Database of Air Medical Services, which is funded by the Federal Highway Administration. As shown on this map, some areas of the country have many more air medical services than others: In North Dakota and Wyoming, for instance, it could take well over 30 minutes for an evacuation helicopter to get the scene of an accident, depending on the location.

What Obama Wants

After making false and disparaging claims about health care in those two countries, the e-mail says that "Obama wants to have our healthcare like Canada’s and England’s." Actually, the president has said repeatedly that he doesn’t want a single-payer system like England and Canada have, one in which everyone has insurance through the government. We’ve written about this several times, as conservative groups, former Massachusetts Gov. Mitt Romney and then-presidential candidate John McCain have all made similar claims and implications.

Obama has said that the United States should build on the system it has now. His stance has irritated some single payer advocates and prompted several questions about why he’s against such a system.

On July 1 at a town hall meeting in Annandale, Va., Obama was asked again why the U.S. shouldn’t have a single payer system. The president responded:

Obama, July 1: … the way our health care system evolved in the United States, it evolved based on employers providing health insurance to their employees through private insurers. And so that’s still the way that the vast majority of you get your insurance. And for us to transition completely from an employer-based system of private insurance to a single-payer system could be hugely disruptive. And my attitude has been that we should be able to find a way to create a uniquely American solution to this problem that controls costs but preserves the innovation that is introduced in part with a free market system. …

But I recognize that there are lot of people who are passionate – they look at France or some of these other systems and they say, well, why can’t we just do that? Well, the answer is, is that this is one-sixth of our economy, and we’re not suddenly just going to completely upend the system. We want to build on what works about the system and fix what’s broken about the system. And that’s what I think Congress is committed to doing, and I’m committed to working with them to make it happen.