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As the New Year approached, Kim Stasiak was bracing herself for another winter of stress, strain and gridlock in one of busiest hospital emergency rooms in Ontario's Niagara Region.

"Last year was the worst winter we had," says Stasiak, a 23-year veteran of nursing who has worked as an emergency room nurse at Hotel Dieu Hospital here for the past nine years. A flood of patients poured through the doors of the emergency room with everything from headaches and chest infections to heart attacks and serious-accident injuries.

Hardly a week went by, and sometimes hardly a day, recalls Stasiak, when the hospital -- its every last bed and stretcher filled to capacity and spilling out into the hallways of the emergency ward -- wasn't forced to go on "critical-care bypass." That means that any ambulance crew hoping to rush a patient to that hospital because it was closest would have to cast its net wider.

And Stasiak's hospital wasn't alone. Last year about this time, emergency rooms in St. Catharines, Niagara Falls, Ont., and other parts of the Niagara Region were so crammed with patients that ambulances crews found themselves in a frantic scramble to find an open emergency bed anywhere.

North of the border, where universal, publicly funded health care has reigned as one of the more sacred fabrics of Canadian life for more than three decades, Stasiak's account of life as a front-line health provider has become all too familiar.

In recent years, the Canadian media have been full of stories about nurses and doctors heading for "greener pastures" in the United States, cancer patients following them because of what they perceive to be unacceptably long waiting lists for treatment at home, overcrowded emergency rooms and the closing of hospitals.

There have also been heart-wrenching descriptions of prolonged suffering, sometimes leading to death, because patients apparently were unable to get the medical help they needed. In one highly publicized case in Ontario last year, an 18-year-old asthma sufferer from a Toronto suburb died from cardiac arrest after the ambulance that picked him up was diverted from a crowded hospital emergency room three miles from his home to one more than 10 miles away.

This story and others like it have left many Canadians feeling shaken about the future of their health-care system, one that has been pointed to with envy around the world. In the United States, Massachusetts Sen. Edward M. Kennedy once described it as a possible model for a system of affordable, quality health care for every American.

But forget about plaudits from other parts of the world. These days there are voices inside Canada arguing that the country's much-celebrated health-care system has proven to be a failed experiment in socialized medicine that has simply got to go.

Under Canada's universal, publicly paid health-insurance system, everyone is guaranteed essential health services -- basic doctor care and hospital care. Canadians have a health-insurance number from birth. And contrary to what some American politicians have said, Canadians can choose their own doctor.

But a lot of dentistry and optometry is not covered by the public system. Unless you have benefits at work, you pay for it. There are medical people in some parts of the country who work in private clinics; some people who have the money prefer to pay for their medical care.

The Canadian system is about 70 percent publicly funded and 30 percent private, compared to the United States, where the percentage is about reversed. In that sense, American critics who have sometimes refered to Canada's health care system as a "socialized system" are wrong, at least to some extent. There has always been a private element to the system.

The system was first introduced in the province of Saskatchewan in 1947 and enshrined nationally in the 1960s under the Medical Care Act. Under the act, federal and provincial governments were to share in the costs of guaranteeing every citizen fully funded access to virtually all essential hospital and doctor services.

However, the system, while intended to embody generosity and compassion, especially for the poor, does not live up to "these notable intentions," insists Martin Zelder, an economist specializing in health-care issues for the Fraser Institute, a conservative public policy group based in Vancouver.

"In many ways, we are not getting value for our money" from a system that pays the full cost of doctor and hospital services, he says. Conjuring up images of patients clogging up doctors' offices and emergency wards with nothing more than a head cold, Zelder argues that moving to a system of user fees and more for-profit, privately run services may be needed to "cure" a health-care system that some view as too costly and inefficient.

On the other hand, there are voices like Murray Dobbins, a writer and researcher for the Council of Canadians, an Ottawa-based citizens group fighting to preserve the country's social programs, who sees any move to privatize Canada's health-care system as the beginning of a movement that could lead to privatization of everything from public education to municipal services.

"We are in the fight of our lives to defend Medicare," Dobbins stresses in one of the council's recent publications. "Medicare is symbolic of the public space that three generations of Canadians fought hard to create."

During a health-care forum the Council of Canadians held last fall in the Niagara Region, council spokesman Bill Heshka warned that the "creeping privatization" of Canada's health-care system inevitably will lead to "American-style, two-tier medicine . . . in which the rich buy quicker and better care, while the poorer classes line up or go without."

At the same forum, Barb Wahl, president of the 45,000-member Ontario Nurses' Association, echoed a view shared by many Canadians. If there is a crisis in health care, she said, it began in the mid 1990s, when the federal government, followed by the provinces, decided to drastically reduce health-care spending in a shortsighted attempt to cut taxes.

At the same time, provinces like Ontario introduced health care "reforms" that shifted more of the focus from caring for patients in hospitals to a system of community-based care without providing adequate funding to the community to care for these patients.

It has proven to be a "lethal combination," says Wahl, that has left doors wide open for private agencies to swoop in and fill the need. "And unfortunately," she adds, "while for-profits may be the winners, patients are the real losers (because) the for-profits are generally more concerned with the bottom line than quality patient care."

One supporter of Canada's publicly funded health care system who is not ready to describe the problems plaguing it as a crisis is Michael Rachlis, a Toronto area doctor and professor of medicine at Hamilton's McMaster University, who co-authored a best-selling book, "Strong Medicine -- How to Save Canada's Health Care System." Rachlis is convinced that Canada's health-care system remains one of the best in the world, and, with the right kind of medicine, he thinks it can be even better.

"Objectively, the Canadian system still performs way better than the American system," Rachlis said in an interview.

For starters, he said, more than 40 million people in the United States have no health coverage at all, while virtually no one falls into that category in Canada. Many American citizens find themselves facing financial ruin each year because they have little or no coverage and face major medical bills. (One of the sadder examples is that of Hollywood actor Christopher Reeve, now a quadriplegic due to a horse-riding accident, who would not be able to pay his medical bills if it weren't for the help of friends and fellow actors like Robin Williams.)

Rachlis went on to cite figures that challenge the notion put forward by organizations like the Fraser Institute that privately funded services are ultimately cheaper than those funded by the public. In Canada, for example, the cost of medical care per person adds up to about $2,000 (in U.S. dollars), compared to nearly $4,000 in the United States. Furthermore, Americans spend about twice as much as Canadians on administrative costs (including substantial sums contesting patients' insurance coverage) as opposed to spending that money on direct patient services.

That's not the kind of information those pushing for the continuance of a predominantly for-profit health-care system in the United States and for the advancement of for-profit medicine in Canada are anxious for people in either country to know, Rachlis says.

"It is only because Americans are fed a routine diet of lies about our country's health-care system that they accept the absurdity of a health-care system that costs much more than another country's and yet still fails to provide coverage to one in six citizens," he said.

That's not to say that Canada's health-care system isn't in need of reform, says Rachlis. To ensure that all Canadians continue enjoying access to quality, publicly funded health care for decades to come, a greater effort must be made to move from a more intensive and costly hospital-oriented system to one that focuses more on preventative and primary care, and on more community- and home-based services.

Interestingly enough, that is the same kind of approach President Bill Clinton advocated (and unfortunately never realized) when he was running for president in 1992 and promised every American "universal coverage" for basic health-care needs.

Rachlis says he's somewhat optimistic that Canada's publicly funded health services will prevail.

Some of that optimism stems from the decision made last year by the government of Prime Minister Jean Chretien to restore some of the billions of dollars cut from the health-care system in the 1990s. Some of it also stems from last fall's federal election, when even Stockwell Day, leader of the Canadian Alliance Party, which is perceived by many voters as the party most likely to scuttle publicly funded health care, felt desperate enough to hold up a hastily-penned sign during a televised leadership debate reading, "No 2-tier health care."

Perhaps Day realized that calls for an American-style system were not going to resonate with Canadian voters like Adriana Ruscitti of Thorold, Ont.

Ruscitti, who observed a noticeable slip in the quality of care her late father-in-law received during the health-spending cuts of the 1990s, still says she would "take our system over the American system any day. God help us, if we go to more privatization, more people will suffer and more people will lose their savings."

Apparently, many of her countrymen share her feelings. During the recent federal election, almost all public opinion polls commissioned by Canada's major newspapers, as well as those conducted by the major political parties, showed that maintaining Canada's Medicare system was the No. 1 concern among voters across the country.

Following the re-election of Chretien and his government in November, an article in the Toronto-based Globe and Mail reported that "the growth of public spending on Canada's health-care system has outpaced that of the private sector" for the first time since 1991. The newspaper declared this "a clear sign that the pouring of billions of dollars into Medicare has tipped the scales."

That sounds like good news for those who believe that every citizen, regardless of means, should have access to quality health care. But the question that remains for nurses and doctors like Stasiak and Rachlis, and for millions of Canadians who count on the system, is this: Will these dollars be spent in ways that ensure that universal health care remains viable for all, well into this century?

DOUG DRAPER is a Canadian journalist living in the Niagara Peninsula.

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