This is long — but it presents the truth. I hope you will take time to read it.
I am not a Canadian, but I did live in Canada as a “landed immigrant” for 21 years. My three daughters were born in Canada.
The following letter is my response to many of the false comments, interpretations, and general misinformation about the Canadian health care system (often cited as either a positive or a negative during the ongoing U.S. struggle with medical-care reform).
Although this is not my main point, I do relay that many Canadians are more-than-irritated at the mangled representations of their medicine. (And, the “cool” Canadians are not easily irritated, I might add.) Their system is so often misrepresented that the truth seems not to matter – no doubt because the truth would not be beneficial to our greedy insurance and pharmaceutical companies, among others.
II. My Personal Experience
I moved back to the United States for family business reasons and although I, a native of the United States, treasure much about this country, I also am certainly cognizant of its flaws – flaws that need to be discussed rationally and truthfully.
One of the flaws of which I have been keenly aware since my return is still the lack of adequate access to health care. Yes, I have had the comfortable employer umbrella plans that make many complacent. But, I have also been a mother with sick children and have had to make difficult decisions about, for example, groceries so that my daughters could get to a doctor. Even now, as a senior, I am on Medicare (with a supplement), which serves me quite well.
However, my younger husband — a private, small-business owner — is in that never-never land of being self-employed and too young for Medicare. His monthly premium for a $5,000 deductible is $500! It essentially does us no good. Its only possible value would be some catastrophic event, but by then, how many thousands of dollars would we have wasted on the just-in-cases? Meanwhile, no prescriptions, no doctor’s annual physicals, no lab tests are covered. This is NOT preventative medicine; it’s a waste of money.
And, before I go any further, I want to add that I have been a conservative (or an independent) for decades. I am the farthest thing from a “socialist.” Further, the people I cite below are well-educated, conservative citizens of Canada. One is the daughter, sister, and mother of doctors. The other is a doctor of anesthesiology and intensive care medicine who practices in Canada.
Although there are other countries with which we might compare our medical care, it does seem that Canada (with so many similarities to the United States) is most often cited re: their medical system. Unfortunately, too many times they have been cited incorrectly.
I present some Canadian opinions, given at my request, — and the truth
III. Several Responses from a Well-Educated Canadian Woman — the Daughter, Mother, and Sister of Canadian Doctors
As most Canadians, I feel our system, while not perfect, is nevertheless one of the great advantages of living here. And …, bureaucrats do NOT make medical decisions; doctors and patients do.
I know about that commercial the anti-reformers are running that features the Canadian woman with a brain tumour who said she had to go to the United States for treatment. Kinda have my doubts about her and think there must be a serious back story they're not mentioned. For one thing, I've never heard of the town she's supposedly from. Maybe it has a population of half a dozen, no doctor and/or no hospital. Anyway, many of us Canucks are pretty angry about our health care system being so wrongly portrayed.
I pay $162 every three months for B.C. health care: That covers all the basics. No problems. No waiting. No deductible. No refusing payment. No coverage lapses or “stops.” And, I have opted to pay another couple of hundred each month for supplemental Blue Cross, that covers dental, optometric, all prescriptions, things like ambulances, etc. (And I'm bitching about it: In Alberta, it's all free. No premiums, no sales tax, no cancelled coverage.)
The wait times get somewhat problematic for non-urgent or optional stuff, like hip replacements. But, when you need the system, it most certainly works. . . and fast. And, not just because my brother, daughter and son-in-law are all “in the system.”
Most doctors here want to be like [names her relatives]; they're on salary associated with one or more hospitals (and they're certainly high salaries, but nothing like what they tell me some of the American docs earn, especially in Texas, they tell me), but they also have some fee-for-service patients outside the hospital. Plus, they have paid holidays, lots of 'em, and a very, very good benefits and pension plan. In other words, as [one doctor] says, they can have a very nice life while delivering the best possible service to their patients.
They don't have the fear of lawsuits, either, along with the accompanying need for astronomical malpractice insurance. In fact, as an emergency and anesthesia combo specialist, [her brother] deliberately chose NOT to practice in the U.S. — said the insurance premiums for his specialty would be intolerable.
Here's the scoop: I have five doctors keeping an eye on me. I see the skin doctor for a full body exam once a month, the cancer clinic doc every six months, and my general practitioner as often as I want. Also, I have two other specialists watching my test results, and called in as “consults” whenever necessary. Can't get much better care than that! (And I'm not even counting [her relatives]!)
My advice? Lobby your senators and congressional reps for a health care plan as close to Canada's as possible. In this day and age, it's a bloody disgrace that there are 45 million Americans with no insurance, and God knows how many whose insurance coverage seems to vanish when it's needed most.
Just got the real story behind about that commercial the anti-health care reform people are running in the United States, the one I wrote about the other day.
As you'll recall, it features a young woman from Nowheresville, Ontario, who claimed to have a brain tumour and couldn't get medical attention promptly here in Canada. She said she had to go to the U.S., paid over $100,000 but was operated on immediately.
Here's what really happened: She had a congenital (i.e., she was born with it) cyst on her pituitary or adrenal gland (I can't remember which) but most definitely NOT a brain tumour. The cyst would eventually have to be removed, as on rare occasions, they can grow and eventually press on the optic nerve, but any such growth takes place over years and years.
Her reason for allowing herself to be “used” as a poster girl against Canadian-style health care? She's trying to “persuade” the Ontario health care insurance program into covering the cost of her unnecessary U.S. surgery.
But, because of the strict patient confidentiality rules under which our medical information is protected, Ontario Health cannot make any public statement about this woman and her “brain tumour.”
Not sure how the story got out — probably someone who knows her well, and is thoroughly offended off by her deliberately misleading portrayal of the Canadian system. It's amazing how upset Canadians are by this campaign, and any inference that bureaucrats — not doctors and their patients — make the medical decisions here.
I KNEW there was something not right about that woman and her situation.
As we discussed, I asked my brother [Canadian doctor] … for more comparative data re: the Canadian and American health care systems, info you could use to help convince some 'Mericans to get on board with reform.
These points might help:
1. [He] says that, in all head-to-head, system-wide comparisons — infant mortality, life expectancy, outcomes from coronary artery disease, etc. — the Canadian system always ranks higher than the American. Probably because —
2. The Canadian system provides much more uniform quality of care than the American. Private centres like the Mayo, Lehey (spelling?) or Cleveland clinics or the DeBakey (sp?) Heart Institute provide superb care, with all the high-tech bells and whistles, [brother] says, but many of the county / public hospitals are dreadful.
3. Because there is no deductible and no “co-pay” charged here, Canadians seek medical help much earlier in their illness. This means treatment begins much earlier — before the illness “gets away on us” — and the outcomes are better, simpler, and less expensive.
He says a young Canadian kid suffering an asthma attack, for example, is brought in earlier, and treated immediately in emergency by putting him / her on a ventilator and/or giving a shot of adrenalin. A couple of hours later, the child is able to go home, breathing normally.
Because 'Mericans have to pay a hefty deductible, parents are more likely to hope they get over it at home; when they do come into emergency, they are often so bad, they have to be admitted to hospital and put on IV for a few days. Thus, the outcomes are more serious, and so, of course, is the cost.
4. Interesting: that woman who claimed to have a “brain tumour,” said she couldn't get treatment in Canada so she had to go to the United States and pay a “kadzillion dollars,” is no longer appearing on television as a spokesperson for the anti-public pay health care lobby. Guess they finally got the real story, and yanked her off the air.
Does this help? I'm sure [brother] would be happy to answer any other questions you may have.
P.S. He's a conservative too!
IV. Letter I Recently Received (which I later forwarded to the Canadians, asking for their reaction):
Subject: THE 64,000.00 DOLLAR QUESTION ANSWERED!
37 Million people lived under the poverty line in 2008. According to the US Health and Human Services, the poverty threshold for a family of 5 is $25,790. Private health insurance for a family of 5 would run over $1000 per month, plus deductibles of $500 per person leaving the family with $11,290 per year to live on. Most people who have jobs that don’t pay insurance can’t afford private healthcare so I think it’s an ethical and moral obligation for a government to provide basic human health services….
With that said, I have “Gold Plated” health care for my wife and I and I wouldn’t give it up for a general healthcare plan. What most people don’t know is that Canadian and British citizens, although they have public healthcare still choose to receive private healthcare coverage from their employer because there are no restrictions on their choice of Dr. or strict limitations of benefits. In the UK birthing a child is completely free for everyone as it should be in the US but seeing a physiatrist, physical therapist, chiropractor, etc. is not. With private healthcare I can get professional help for whatever I want with no restrictions, no lines, and no worries, why would I give that up?
If it were a basic human right to own a gun, most people would get a cheap .22 and the people who are better off would have a .44, it’s the way of the world.
V. Reaction (Requested) to the Letter Above:
Frankly, it makes my blood boil.
For one thing, the only restriction on what doctor you see is the size of his / her practice. If he / she has room for another patient, no problem. If not, they'll usually refer you to someone who does have room. Even if his practice is full, a doctor will always take other members of the same family.
And, most cities also have a network of round-the-clock family medical centres, staffed in rotation by groups of general practitioners, nurses, lab staff, etc. Instead of going to the emergency at a hospital, it makes more sense to go to one of these clinics: I had one in Calgary just a few blocks from me, and that's where I went for small things, like having my infected leg dressed, (happened after a bad fall, not when I had the septicemia originating in the lymph gland), ear aches dealt with, etc. Again, just give them your health care insurance number, and that's all it takes. You never see a bill.
We do have a shortage of doctors, like practically everywhere else in the world, but …, the system works very well.
You might also tell [the letter writer] that having a baby is completely free here: all pre- and post-natal care, the delivery itself, and of course, if the newborn needs medical treatment, it's completely covered.
When [the letter writer] talks about Canadians getting add-on health benefits from their employers — or, like me, by purchasing additional Blue Cross coverage — that's for things like full dental coverage, full prescriptions, etc. And, we don't pay a deductible.
As I said, my basic BC Health Care coverage is $162 every three months.
I personally believe there should be a public-insurance option available in the United States, but I have no right to an opinion, since I'm a Canucklehead!
Must say, though, I'm appalled at some of the so-called “town hall” meetings re: health care that apparently are happening around the U.S. And, to my Canadian way of thinking, [names a radio talk-show host] should be institutionalized. The guy's nuts, certifiably nuts!
Response #6 —Resentment Expressed:
Please excuse my ranting last night about the “town brawls,” crazy [names the radio show host again], and some of those ultra right-wing politicians, paid for by the HMOs and “big medicine.”
As so many Canadians, I really resent the way these people are misrepresenting our health care system: Without any apparent conscience, they are making it appear as if some faceless civil servant with a rubber stamp decides our fate — that cancer patients are dying in the streets outside the hospital doors, waiting for a bed. And, that given a choice, most Canadians would opt for American-style health care.
My god, these people are suggesting that “living wills” are a form of euthanasia!!!!! Appalling.
As David Gergen said on CNN, these organized, highly financed rabble rousers are making a mockery of the principles upon which the United States was founded. (As you know, he's probably the most calm, dispassionate and experienced presidential advisor alive today — he was an advisor to four presidents, representing both parties. I give a whole lotta credence to what he says!)
Having dinner with my “big medicine” brother … and his wife tonight, so no doubt this will be the number-one topic of conversation. … he does a lot of work in Vancouver — although most of the time he works in the O.R. in a hospital in Victoria.
He got some of his training in Seattle and Long Beach: he has a double specialty, anaesthesiology and intensive care medicine. (In Long Beach, he said he got really proficient at sewing up knife wound victims!)
He always says the United States offers both the best — and the worst —of health care. When he was ready to set up his practice, he insisted on coming back to Canada: didn't want any part of what he called the lawsuit-happy, “politicized” health care industry in the U.S.
Interestingly enough, he says even the American Medical Association is firmly now on board with health care reform. So who are the holdouts? Seems to me it's the insurance industry and the politicians they've bought.
MSNBC had a fascinating report the other night on how much that industry has donated to the campaigns of the key senators and congressmen/women. It ran into the millions. Even more interesting, the politicians didn't dispute the report.
And, all those lobby groups?! … they're doing a disservice to the country.
VI. A Canadian Doctor Speaks Out:
Two further points of debate about health care are the "queues" for care, and the cost of bringing in universal coverage.
No health care system can exist without some form of rationing — the expectations of people and medical capabilities are limitless! In Canada, the rationing is by limiting resources, so-called secondary rationing. No politician or bureaucrat tells anyone what they can or cannot have done, but only that they have to wait their turn.
Presumably, the system triages it such that emergent and urgent things are addressed first, then elective things are considered. That is reflected in what we see in the press: anger over waiting months for a hip replacement ("I was overweight for 40 years before it began to hurt"), but very rapid care for things like cancer, trauma, and cardiac issues.
In the U.S. the rationing is primary, and provided to those who have insurance, and/or [are] able to handle the co-payment. The insurance companies vary with their willingness to pay even when one does have basic coverages, rather than deciding based upon the medical necessity or justification.
Case in point: the remarkably low rates of immunization (less than 50 percent) of American children because it is not considered "medically necessary" by some insurance providers! No intervention has been shown to have as profound an influence on the health of its people! (And we are denying this simple, proven protection to more than half the American population.)
The second point argued by opponents … is the cost of health care systems. In the USA. the administrative (non-direct care components) cost of their "non-system" is currently at least 10 percent of the total. This is largely due to determining eligibility, collecting premiums, etc. (I ignore the issue of shareholder profit). What a waste! But, it keeps a whole industry employed.
In contrast, since we in Canada have no need to determine eligibility and revenue is handled by the tax system, the overhead is under 1 percent. What we do spend goes to services, perhaps not distributed optimally, but nonetheless without being skimmed off the top!
Undoubtedly, the U.S. will pay more if the 10 percent of their population currently without adequate coverage is to be protected. However, the pundits have to factor in the enormous financial cost paid by those who are bankrupt by medical illness. Shouldn't we include these legal fees and social costs that will not be included in calculating the fiscal cost of universal coverage?
I certainly don't think our Canadian system is perfect — far from it. We need to keep the politicians' hands off it, and need to establish a boundary definition of what is "health care." We also need to stop viewing any change as undesirable, and a start down a "slippery slope." But, at least we are not wasting money on inappropriate care for the few while ignoring the legitimate needs of the unfortunate amongst us!
Food for thought!
V11. A U.S. University Professor Offers Resources:
Here are some links from npr.org that you may find useful for facts and comparisons:
A. About health care in France: http://www.npr.org/templates/story/story.php?storyId=92419273
B. A comparison of costs, systems, taxes, etc. in industrialized countries (including Canada and the UK):
I have lived recently in France, and have found their health care to be excellent, efficient, and accessible — both as someone who was inside (while I was living there) and outside (when I was researching there) the system. [As the letter writer in IV. Above], I have excellent insurance here in the States, and have few complaints personally. However, I watch my students (many of whom come from depressed areas of Michigan) without insurance, and find it horrific that — in a country that is better off than many — there are many with no access. In Canada (where I was born, and well taken care of) and in France, this would never be the case.
If you have read to this point, thank you. Whatever your viewpoint, I hope we’ll stop “shouting at each other” and THINK. We need to discuss, input sensibly, treasure the truth, and come to a satisfactory conclusion for ALL Americans’ health care.
I sincerely thank the Canadians who have taken the time to give their detailed, knowledgeable, and caring input to my original question.
My intention is to forward this to everyone in my e-mail book and to my state representatives and senators. Perhaps you’ll do the same?
P.S. Two other thoughts I’ve had since I originally compiled this:
1. We should all ACTUALLY READ (slow-going as it may be) the relevant House bill; I think many are reacting emotionally without having studied it at all.
2. Interestingly, some of the people and friends who are most opposed to health-care reform are teachers (who must have had some sort of “government” behind their health care, city or otherwise) and seniors who have government Medicare now.
Dinghy Digest ®