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But the FDA in the U. She represents a dramatic new trend in Canadian health-care advocacy: finding the treatment you need in another country, and then fighting Canadian bureaucrats and often suing to get them to pick up the tab. But if Canadians are looking to the United States for the care they need, Americans, ironically, are increasingly looking north for a viable health-care model. Over the last five years, health-insurance premiums have more than doubled, leaving firms like General Motors on the brink of bankruptcy.

Health spending has surged past 16 percent of GDP. The number of uninsured Americans has risen, and even the insured seem dissatisfied. Canadians, the seductive single-payer tune goes, not only spend less on health care; their health outcomes are better, too—life expectancy is longer, infant mortality lower. Well, yes. Some are tempted. Not me. I was once a believer in socialized medicine.

I wanted to get into medical school—my mind brimmed with statistics on MCAT scores and admissions rates, not health spending. But as a Canadian, I had soaked up three things from my environment: a love of ice hockey; an ability to convert Celsius into Fahrenheit in my head; and the belief that government-run health care was truly compassionate.

What I knew about American health care was unappealing: high expenses and lots of uninsured people. My health-care prejudices crumbled not in the classroom but on the way to one.

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On a subzero Winnipeg morning in , I cut across the hospital emergency room to shave a few minutes off my frigid commute. Swinging open the door, I stepped into a nightmare: the ER overflowed with elderly people on stretchers, waiting for admission. Some, it turned out, had waited five days. The air stank with sweat and urine.

Right then, I began to reconsider everything that I thought I knew about Canadian health care. I soon discovered that the problems went well beyond overcrowded ERs. Patients had to wait for practically any diagnostic test or procedure, such as the man with persistent pain from a hernia operation whom we referred to a pain clinic—with a three-year wait list; or the woman needing a sleep study to diagnose what seemed like sleep apnea, who faced a two-year delay; or the woman with breast cancer who needed to wait four months for radiation therapy, when the standard of care was four weeks.

I decided to write about what I saw. By day, I attended classes and visited patients; at night, I worked on a book. One family friend, diagnosed with cancer, was told to wait for potentially lifesaving chemotherapy. I called to see if I could write about his plight. Worried about repercussions, he asked me to change his name. A bit later, he asked if I could change his sex in the story, and maybe his town. Finally, he asked if I could change the illness, too. The only solution, I concluded, was to move away from government command-and-control structures and toward a more market-oriented system.

Though I had a hard time finding a Canadian publisher, the book eventually came out in from a small imprint; it struck a nerve, going through five printings. Nor were the problems I identified unique to Canada—they characterized all government-run health-care systems. Consider the recent British controversy over a cancer patient who tried to get an appointment with a specialist, only to have it canceled—48 times.

More than 1 million Britons must wait for some type of care, with , in line for longer than six months. A while back, I toured a public hospital in Washington, D.

Trickle-Down Health Care: How We Could Actually Fix The US Health System

The hospital was dark and dingy, but Evans observed that it was cleaner than anything in his native England. In France, the supply of doctors is so limited that during an August heat wave—when many doctors were on vacation and hospitals were stretched beyond capacity—15, elderly citizens died. And so on.

B ut single-payer systems—confronting dirty hospitals, long waiting lists, and substandard treatment—are starting to crack. Canadian newspapers are now filled with stories of people frustrated by long delays for care:. In fact, government researchers have provided the best data on the doctor shortage, noting, for example, that more than 1.

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Katon WJ. Epidemiology and treatment of depression in patients with chronic medial illness. Dialogues Clin Neurosci. American Psychiatric Association. What is depression? Updated January Effect of interventions for major depressive disorder and significant depressive symptoms in patients with diabetes mellitus: a systematic review and meta-analysis.

Gen Hosp Psychiatry. Katon, WJ.