10 Comments

Our health

If you’ve been paying attention to the news in the U.S. you know health care is on people’s minds. Talk has been spreading almost as fast as the ranks of the uninsured/underinsured.

Michael Moore has fanned the flames of debate, spawning talk about the universal coverage offered by our fellow industrialized nations. We hear lots of stories in the U.S. about Canadians crossing our border to avoid waiting in line for certain tests or procedures. The garden-variety opponent of universal coverage brings it up constantly. ”I would never stand for a system that made me wait for a test I needed.”

That’s easy for a fictitious couple to say in a televised attack add, or for a healthy middle class couple with (what they think is) good coverage (which they’ve never really had to use). What I want to know is this: how many Canadians would trade their system for ours? How many of those folks coming to the U.S. for a procedure or test would really choose to ditch their universal system in favor of ours?

I’ve heard a few anecdotes which suggest there aren’t many.

We bemoan big government, but could it really do worse than the quagmire we’ve got now? Almost every time I’ve had to deal with my insurance providers, I’ve yearned for the relative tranquility of the lines at the DMV.

10 Comments

  1. I agree 100% with Richard’s comments. As to his mention of the negative rumours about the Canadian health-care system, they were sometimes rather humourous.

    A friend of mine who hails from New Mexico was living in Alberta when she and her husband discovered, with great joy, that they were to have a baby. Her parents back in NM were horrified that their little girl was going to deliver in some backwoods shanty, no doubt with the assistance of unqualified medical professionals. They urged her most passionately to travel Stateside for the birth.

    When they eventually paid her a visit and were shown Canadian medical facilities, they were greatly relieved and couldn’t figure out why they had heard what they had heard about our system.

  2. Thanks for the comment Richard (and everyone else). I really, really appreciate hearing a few personal, Canadian perspectives on this issue.

    I find it a little ironic that we mock the Canadian system for delays in care. I wonder if it’s really much better in parts of the U.S. With our specialized, private surgery centers, we’ve got some REALLY quick turn around times for elective procedures… and to be fair, some necessary procedures. I went to one (a specialized outpatient surgery center) to have my PIC line installed (for the chemo) that felt more like a day spa than a hospital. It was my best hospital (or hospital-like) experience… by far. On the other hand, most doctors I’ve had are booked two weeks out for appointments (which probably contributes to folks going to our ERs for their colds – in addition to it being the primary source of care for the uninsured). If I’ve got a really pressing issue, they can sometimes fit me in the next week. It’s not like I’m out in the country either, where there are only a few doctors in town. I live in the most densely populated county in Florida (it was ten years ago anyway). It’s not Manhattan… but it’s a far cry from rural Montana. And our hospital ERs are seemingly in a perpetual state of crisis. I’ve heard that nation-wide, the average wait is over three hours. I’ve heard that some public, inner city hospitals can have wait times pushing ten hours. Here in central Florida, I waited a four hours before I was seen (when I had to be admitted for complications from the chemo). Maybe that wasn’t an unreasonable amount of time to wait (in the grand scheme of things). My case wasn’t critical, but it seemed like forever. Supposedly they tried to rush me in, due to my depressed immune system (in part to get me away from everyone else in the ER waiting room). Four hours is rushing?

    When you consider that we spend WAY more per capita than any other country (I think its like 40% more than the next highest country) and everyone STILL isn’t covered, it makes me wonder if we’re spending all of that money wisely. I can’t remember all of the sources, but I’ve heard about a few studies which suggest the extra money we spend can not be wholly attributable to malpractice, preventative care, second opinions, or elective medicine.

    So we’re spending all of that money, we’re still not getting great preventative care, our urban hospitals are a disaster, not everyone is covered, and even though most in the U.S. are “covered”… medical bills are a leading cause of bankruptcy filings in the U.S.

    I usually don’t swear much, but in this case I’ll make an exception… that’s fucked up.

  3. As always, good to hear from you Steve.

    The desire to hike rates for bad habits gives me a little heartburn, but not because it smacks of “Big Brother.” It gives me pause because it disproportionally penalizes the poor. I’m not sure about the drinking and smoking, but I think it’s cheaper to eat poorly in the U.S., than to eat a healthy diet. An article in the NY Times was interesting, and on point: “You Are What You Grow.”

    The gist of the article was that farm subsidies lead to lots of calorie dense, inexpensive junk food (made with corn, high fructose corn syrup, etc).

    So… as long as it’s government policy to give people an economic incentive to eat poorly, I can’t see insurance companies penalizing people for doing so.

  4. While you are discussing health care pros and cons, how do you consider the most recent model advanced in the American Healthcare/Insurance system, where insurance rates are adjusted for those who don’t participate in a scorned habit (drinking, smoking, watching TV, enjoying McDonalds as a daily routine, etc.)

    I can understand why companies would presume that some habits can result in additional doctor visits, it seems that “Big Brother” is watching over you to make sure that you save the insurance companies a dollar or two.

    Does the Canadian system have any mechanism to punish those with those with poor habits by depoting them to the US?

  5. I’ve been meaning to chime in, too, for I have extensive experience in dealing with the Canadian medical system. I do appreciate it, and believe that it works pretty well.

    Remember when Hillary floated her infamous health plan in the 1990s, and the debate got dirty? Every US senator with half a clue described our universal health care system as inefficient and bloated, with horrendous waiting times and poor outcomes. The propaganda was unbelievable. And the funniest thing about it is that Canadians started to believe it. I heard tour guides parroting the misinformation to American tourists on several occasions.

    Our system of universal health care works better than the US system, interestingly enough. We actually score higher than the US in WHO rankings, though both countries are in the middle of the pack, well below France, Germany and Britain.

    We do have long waiting times, for elective procedures. When I tore cartilage in my knee, I had to wait months for surgery. But when a routine CAT scan discovered up a brain tumor, I was in to see the specialist, and sent for a battery of tests and an MRI within days. (It was eventually shown to be benign, whew!) When I shattered a bone in my hand, and needed immediate plastic surgery to retain the use of it, I was operated on within a week. And both of these events happened after I lost my newspaper job when I developing daily migraines… So I was poor, but I still received exemplary care.

    So when you are seriously ill in Canada, you are taken care of quickly. And you never have to worry about how much it will cost, or how you are going to pay for it. Which is a very good thing.

    But I have also seen that the Canadian system is broken, because it takes care of people after they become ill, and does little to keep healthy in the first place.

    The Canadian system is broken because it’s free, just as Colleen said, and people go to the doctor for the stupidest thing. My Mother suffered through severe asthma and osteoporosis, cancer before she passed away, and we literally spent hundreds of nights in emergency, when she couldn’t breathe, or when she twisted the wrong way and suffered multiple fractures. And the emergency room was filled with people who shouldn’t be there, suffering from minor health problems, like colds and flus and sprains.

    It’s getting worse. The system is stressed to the breaking point. An aging population, government cutbacks, hospital closures, overworked doctors (it’s hard to get physicians to practice in small towns, so some doctors have thousands of patients).

    We need to really figure out how to do a better job. I think private clinics for some procedures are something to consider. I also think that provinces like Nova Scotia should allow nurse practitioners to work with doctors in small towns; that midwives should be allowed to practice in birthing centers; and that we need to build a whole whack of extended care facilities. Our hospitals are filled with elderly people who can’t be discharged simply because they have nowhere to go. It’s heartbreaking.

    So the Canadian system is good, but it could be better. But I thank my lucky stars that I don’t have to deal with HMOs.

    And I think it’s scandalous that the world’s richest country doesn’t take care of all its citizens.

  6. Hi:

    (Hi Becs!)
    In addition to medicare, many employers also offer extra health benefits in a similar fashion to what you have at your work. The difference is that it would be cheaper since much of regular health care is already covered.

    As for cheaper drugs here in CDA, I think it has to do with generic drugs. I’m not sure how that’s handled State-side, but it seems to me, I’ve heard that it’s different from here.

    Here in NS, the government has recently instituted free prescription drugs for financially-disadvantaged people (how PC was that?) Oh, and seniors don’t pay for drugs either.

    (I hadn’t heard about the high flow toilet issue! :-) )
    C

  7. This is where I feel I should come clean, and sheepishly admit that I have it pretty good. I’m employed by the State of Florida. Part of the equation for choosing to work where I do is the benefits. The pay isn’t great – although I think it’s enough, but in my situation the health benefits are hard to beat. Florida has something for state employees called: “the spouse program.” If a husband and wife both work for the state, a family health insurance plan is free (for the employees anyway). The idea is… the state’s contribution per employee is something like 75% of the total health insurance premium (the employee paying the remaining 25% through payroll deduction).

    However, when a married couple is employed by the state (as my wife an I are), it’s the same policy for two employees, so they can pay 50% per employee, cover the whole premium, and still save a bundle. On top of that, we’re in an HMO. While it can be spectacularly frustrating at times, it’s been a good deal financially. Although we once had to go so far as to appeal a claim through the statewide oversight board… complete with a hearing in front of an administrative law judge (out of town). That was a lot of fun. I imagine there are lots of people out there who wouldn’t take it that far… but it was for my daughter, and there ain’t a lot we wouldn’t do for the kids (especially when they’re sick… and Beth has had a lot of health problems).

    Anyway, one of the reasons I can’t/won’t be leaving my job anytime soon (besides the common 1 year exclusion on pre-existing conditions on most policies, and the likelyhood that my leukemia will come back) is that my recent bout with Leukemia has cost me a grand total of $130 (so far). I haven’t gotten my bill for the hospital yet, but my co-pay for hospital admissions is $150. Still, that’s a pretty good deal. That includes prescription drugs (several), doctor’s appointments (a dozen or so), the chemotherapy, a bone marrow biopsy, and two weeks in the hospital (in isolation).

    One might wonder why I’m so outraged about a system that has treated me pretty well… and I can only say I believe that everyone should be treated as well. There’s very little moral justification for “for-profit” insurance companies to make a profit for not providing care. And let’s face it, the easiest way for an insurance company to make more money (more quickly) is to deny claims – or not provide the very thing we have them for. It’s one thing when the “thing” insured is a car or a house; it’s quite another when it’s our bodies. They’re hard to live without. I don’t think there are many industries that should be “socialized,” but a government’s most basic role is to protect it’s citizen’s (in most cases from each other). I think it’s clear many of us need to be protected from our own health insurance… not to mention all those people who don’t even have the token protection of private health insurance.

    I’m sorry… I know I’m preaching to the choir here. My fingers make a handy conduit for emotional energy, and my keyboard has borne the brunt.

  8. Well, as a Canadian living in the US (And Colleen’s BFF, by the way… hi!) I have used both systems and I can say unequivocally (sp?) I prefer the Canadian system. I would rather pay higher taxes and wait a bit longer for some things but have it all covered than have to pay 10-20% of everything and then fight with insurance cos and providers like I have done the last couple of days (examples: I live in Alaska, there is no preferred provider dermatologist in the entire state for my insurance, so I am allowed go to anyone I want and they are supposed pay preferred provider rates…supposed to being the key words..or the hopsital that sent a bill for $139 to a collections company..a bill I had PAID!!!). ANd I am not even sick, I can’t imagine what your bills must be like right now.

  9. I don’t know why I hadn’t figured out the Canadian system didn’t cover prescription drug costs. I’ve heard for years about the “cheaper” cost of drugs in Canada – and the bus loads of U.S. seniors that travel across the border to buy them. If they were 100% covered they certainly would be cheaper, but not for our folks. It only recently sunk in that they weren’t covered. I understand that there are price controls, or some kind of similar mechanism to keep the costs down though… although I don’t think price controls are the ideal way to go.

    It’s kind of cool that we’re crossing each other at the border… we’re on our way there for cheap drugs, while you all pass us on your way here for expensive procedures. By the way, how much Canadian tourism is attributable to U.S. citizens crossing the border for prescription drugs and high flow toilets?? ;-)

  10. Canadians are insanely protective of their health care system. It’s one of the things we believe make our country a good one. it is the platform that wins or loses elections.

    (For the record, our system pays for 100% of physician and hospital costs, but little for prescription drugs, emergency or dental.)

    We are proud that no Canadian will go to the poor house in their dotage because he or she became ill. Because we have a pay-per-visit system, we can change physicians whenever we want. We don’t have to choose from a prescribed list of doctors selected by a health insurance provider.

    That said, it’s not perfect.

    While basic health care is standard, there are differences in coverage across provinces. For example, optometry or physical therapy is covered in some provinces but not in others. Dental care is not covered.

    Canadians are very spoiled by never having to pay for a visit to the doctor and we go frequently for the silliest of reasons. (Why do we need to go for the sniffles? for example. Unless it has turned into something worse, a doctor can’t do anything about it anyway.)

    Doctors also use the system to pad their wallets. (Not that they earn as much as docs in the U.S. According to Wikipedia, Cdn GPs earn an average of $202,000/yr.) Family doctors, for example, they no longer renew prescriptions over the phone since medicare won’t pay for that so we have to make an appointment to go in.

    The debate over a two-tiered system has been waging here for a few years. I.E. Should we allow private clinics for those who can afford it? Would this create better care for the rich? Would this take the burden off the public system thus allowing it to improve wait-times, etc.

    Personally, I wouldn’t give it up for the world, but do think we could make it better.

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