CANADA'S SiCKO SYSTEM
I read with interest your cover story on the Michael Moore film, SiCKO (Expert Roundtable: "What does he know about our healthcare?" Vol 4, No 13, page 1). Anyone familiar with Mr Moore's work realizes that he is not a documentarian.

He presents the Canadian healthcare system as idyllic. Unfortunately, it doesn't mesh with reality. Although our system has prevented many patients with serious, chronic illnesses from going bankrupt, it also leaves ill people lying on gurneys in emergency rooms waiting for admission. It leaves people waiting for 'elective' surgery on year-long waiting lists.

Your panel of experts provided some insight into the Canadian healthcare scene. However, Dr Danielle Martin's comments are quite inaccurate. She states that "insurance companies do not interfere with our clinical practice here as physicians." Wrong! Clearly Dr Martin has not had to deal with patients following motor vehicle accidents. In fairness to Dr Martin I assume her comments are directed toward OHIP patients. However, once a patient has been injured in a car accident, their insurance provider becomes the gatekeeper of rehabilitation. Why? The answer lies in the deterioration of the rehabilitation component of our healthcare system. For example, OHIP-funded physiotherapy is all but extinct. No funding is available for new multidisciplinary pain management programs. Rehab is seen as too expensive and patients don't get better. The more a patient needs, the less they'll get.

The patient must turn to their insurance company for support. What they don't realize is that they've become a financial liability to their insurer. Therefore, the insurer will do everything in its power to reduce costs by blocking treatment. The current system is designed to give insurance companies the power necessary to dictate the treatment of their injured customers.

Mr Moore focused his attention on one aspect of the American healthcare system that must be corrected. Unfortunately, there's no Canadian equivalent to Mr Moore who could shine a public light on the manipulation of health care by automobile insurance providers in Canada.

Dr J H Ennis, MSW, MD, FRCP(C), Hamilton, ON

HEALTH LIT HOO-HA
In the article "The best of the medical net" (June 30, 2007, Vol 4, No 12) you repeat an unfortunately common misconception about health literacy -- that it's solely a problem of patients.

Health literacy is the wide range of health information skills and competencies that people develop to make informed choices. This applies to all of us. Thus, healthcare professionals can have poor health literacy. They may know much about the science and practice of healthcare but not be good at communicating it to others.

The article's approach to health literacy as a tool of compliance-gaining is also inappropriate. Health literacy is about helping people help themselves by taking an active role in their health. Sometimes that can mean seeking other opinions versus simply agreeing with whatever a healthcare provider asserts is true.

Taking the issue of health literacy seriously demonstrates that active partnerships are called for, but for some your coverage may well perpetuate a top-down and paternalistic approach.

Andrew Pleasant, Assistant Professor, Family and Community Health Sciences, Rutgers University, New Brunswick, NJ