Dr. Paul Smith has seen the health care delivery system from the points of view of a physician, a patient and a scholar. He also knows how health care works on both sides of the U.S.-Canadian border, and he is tired of hearing the Canadian side being maligned by voices in the U.S.
That's especially true in regards to prescription drugs, which the U.S. pharmaceutical industry tries to pass off as unsafe if they come from north of the border. In fact, Dr. Smith says, they are every bit as safe as drugs purchased in the United States. "Their Food and Drug Administration is more stringent than the U.S.'s," he says.
Dr. Smith, 63, is taking the RX Express to publicize that message. He also hopes that, by drawing attention to safety in Canada as well as the Canadian system's advantages, he will help bring about reform in this country.
Dr. Smith also is a patient, who takes medication following his stroke in 1996. He spends roughly $1,000 a month on prescription drugs. The stroke "changed my life 180 degrees." He takes many medications, including blood thinners. He has a pacemaker.
Originally from Montreal, Dr. Smith was an associate professor of medicine at McGill University. He moved to California with his wife, Ginette, in 1983 and worked as an obstetrician-gynecologist in Long Beach, with a focus on high-risk pregnancies.
Dr. Smith has become intensely involved in promoting changes in the health care delivery system, in part by exposing myths about Canada's health care. "Effective lobbying by Big Pharma" has given Americans the wrong idea, he says, and prevented reforms from seeping down from Canada into our health care system.
Dr. Smith toured Manitoba and British Columbia last month for the AARP, exploring the health system by looking at pharmacies and interviewing members of the Manitoba provincial government.
He realizes he has his work cut out for him, because there is a mountain of misperception here.
The considerable misinformation about Canada's health system can reside in something as small as a single word like "re-importation." The average citizen hearing that phrase thinks that a particular drug is made in the U.S., sent to Canada, where something indefinable but sinister happens to weaken its effect, and then is "re-imported" to the U.S. In fact, Dr. Smith says, most prescription drugs are made and bottled in the same place - it might be someplace like Germany - and shipped to other countries - say the U.S. or Canada. "Re-importation' is a misnomer," he says.
But the misunderstanding among U.S. citizens goes beyond language. Here, the media and many governmental and business leaders sharply criticize the Canadian health care system in general, and regular folks join in the attack. But in Canada, "citizens rarely talk about the system in evil terms. One hears complaints of long waits and slow technological innovations. But the system works; they take for granted that they will receive adequate care."
"If you go to Canada, they never talk about doing away with their health care system," Dr. Smith says. "They'll talk about the weather. Here, it's the opposite. Wait five minutes, and the subject of health care will come up."
Although the general citizenry may be talking about health care's shortcomings, not enough decision-makers are, even though trends are alarming. Just one example of what is wrong: Social Security is pegged to the cost of living; drug prices are increasing at a multiple of the inflation rate. Drug price increases are not at all related to the cost of living.
In addition, Dr. Smith says, there is great waste and misallocation of funds. Pharmaceutical companies spend more on advertising than they do on medical research, for example.
"I'm afraid that the drug companies are not very good citizens at this point in time," Dr. Smith says. "This is the richest country in the world, but you wouldn't know it by seeing the millions of people with little or inadequate or no health insurance coverage. The World Health Organization ranks U.S. health care 17th out of 131 countries."