Arnold Aberman, MD

When the United States embarked on its effort to provide universal health insurance, the Canadian Medicare System was cited as a possible model for American health care. Often touted as an example of low-cost, high quality medicine, the Canadian system has mirrored the problems of health care across its southern border. With rocketing health care expenditures and financing having largely been decentralized to the individual provinces, local officials have struggled to cut costs and services. A central focus of these efforts has been a move to decrease the numbers of physicians, most notably a 10% decrease in medical school class size in 1993. While some Western provinces have experimented with the privatization of health care, the Canadian system still remains the epitome of government operated fee-for-service medicine. Given the likelihood of dramatic change in the American Medicare system, Canadian academic centers offer a unique perspective on the impact of capitation, evolving relationships with government payors, and the flip side of market oriented reforms. At the helm of one of Canada's largest schools is Arnold Aberman, MD, dean of the University of Toronto Faculty of Medicine. Born in Montreal, Quebec, Aberman received his MD from McGill University, but then did his residency both in Canada and the US, followed by a pulmonary fellowship at Albert Einstein College of Medicine and the Cardiovascular Research Institute of the University of California, San Francisco. Interviewed at his office in Toronto, Aberman reflected on the trials and tribulations confronting medicine on both sides of the 48th parallel.