THE CANADIAN DEBACLE

Esther Pacione needs a family doctor. At age 56 she is afflicted with severe ataxia, a neurological condition that causes her acute pain, choking and loss of consciousness. The walls of her home are scuffed from the times she fell and hit her head.

Her regular doctor suffered a stroke a year ago, and all the local doctors she has contacted say they cannot take new patients, so now Ms. Pacione goes to a walk-in clinic whenever she has an emergency. At the clinic, she waits hours and sees a different doctor and no one there is familiar with her medical history and what drugs she has been taking.

Ms. Pacione, a retired bookkeeper, said she would like to be at the table when Prime Minister Paul Martin meets with the provincial premiers on Monday for a three-day televised meeting to find ways to alleviate the lengthening waits for basic care in Canada. "If you are not bleeding all over the place, you are put on the back burner," Ms. Pacione said, "unless of course you have money or know somebody."

The publicly financed health insurance system remains a prideful jewel for most Canadians, who see it as an expression of communal caring for the less fortunate and a striking contrast to an American health care system that leaves 45 million people uninsured. But polls indicate that public confidence in the system is eroding, although politicians remain reticent to urge increasing privatization of services.....

But medical professionals and local officials say a major reason it may not be easy to address the problem of slow access to treatment is because doctors who do preliminary diagnostic work, refer patients to specialists and monitor the care of chronically ill people are less and less available - especially in small towns and rural areas.....

Ms. Pacione's predicament is surprisingly common even in this upper-middle-class community on the north shore of Lake Ontario that seems to have everything going for it: immaculate lawns, a yacht marina, a downtown graced by vintage Victorian architecture and quaint parks and fruit markets....

Whitby officials estimate that 22,000 people here have no doctor at all, forcing them to go to emergency rooms at overcrowded local hospitals to wait in line for up to four hours simply to refill a prescription, get a doctor's note for an employer or care for their flu symptoms. "It's like winning the lottery to get in and see the doctor," Mayor Marcel Brunelle said. "This is a very wealthy country. What happened to bring the situation to this point?"....

Mayor Brunelle formed a task force in June to recruit young doctors by introducing them to real estate agents and giving them advice on how to start new practices, and the town government is considering building a municipal clinic. The town of Peterborough is offering large monetary incentives and a grab bag of perks, including memberships at the Y.M.C.A. and cable television. Other municipalities offer moving expenses and the inside track on real estate next to golf courses.

But experts say those efforts may not be enough. "If the current trends continue we can anticipate a crisis," warned Joseph D'Cruz, a University of Toronto business school professor who specializes in health care. "People will actually find it impossible to get general medical services in their towns."

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