In the US, more and more people, upset by the rising cost of health care, want to turn the whole shooting match over to the government. “We want to be like Canada,” they say.I have to tell you, I lived in Canada for five years; I had surgery in Canada; I saw lots of specialists and the inside of five or six hospitals in Canada; my oldest daughter was born in Canada. America, you don’t want to be like Canada.That is not, incidentally, a slam on the people who make the Canadian health-care system go. For one thing, we were net beneficiaries, as a poor American student family living in Canada; we got a lot for not much, and I appreciated our host’s generosity. For another, we had some truly brilliant doctors, and some wonderful nurses, and the staff at BC Children’s Hospital were beyond superb; they cared deeply about their tiny patients and were past masters at making bricks without straw. The thing is, they had to be.The equipment was junk—they finally gave up on the blood-oxygen monitor on my little baby and took it off when it reported a heart rate of 24 and a blood-oxygen level of 0 (or the other way around—it’s been a few years now); while we were there, the provincial government tried to donate some of its used medical equipment, and no one would take it. The Sun quoted one veterinarian as saying the ultrasound they wanted to give him wasn’t good enough to use on his horses. Meanwhile, the doctors kept taking “reduced activity days,” or RADs (which is to say, they took scheduled one-day strikes without calling them strikes), to protest their contract. I was actually up at St. Paul’s in Vancouver for a scan one of those days; the techs were there, obviously, but no doctors. A hospital with no doctors is a very strange place.I could also tell you about the time we took our daughter to the ER (different hospital) at midnight; there were only a few patients there at the time, but it still took them three hours just to get us into a room, and another hour to see us. It was 5am before we walked out the front door. At that, we were the lucky ones—there were a couple folks still waiting to be seen who’d been waiting when we got there. Or I could tell you about friends who had other friends, or family members, die while on waiting lists for vital surgeries. Or I could tell you about doctors and nurses who got tired of it all and left for better jobs in the US. The list goes on.In case you think I only think this way because I’m an American, I’ll certainly grant you that many Canadians still loyally defend their health-care system; as I say, they have some wonderful people to defend. The fact of the matter is, though, there are many Canadians who don’t, anymore—including, among others, the (liberal) Chief Justice of the Supreme Court of Canada, Beverly McLachlin. The normal routine in Canada is, if you need a major procedure done, you get put on a waiting list. If you can afford to go south of the border and get it done in the US—or if you can get the government to pay for you to do so—you do that. If you can’t, you wait. When this system was challenged in court—a resident of Québec teamed up with his doctor to sue the province over its law forbidding private medical insurance—the Canadian Supremes threw out the law, and came very close to declaring the entire national system unconstitutional. They didn’t quite agree to do that, but they did indict the system in scathing terms; as the Wall Street Journal summed up the matter, their opinion essentially said that “Canada’s vaunted public health-care system produces intolerable inequality.”Which it did. And does, as do similar government-run systems in Britain and elsewhere. In one Ontario town, for instance, people buy lottery tickets to win appointments with the local doctor. The system doesn’t work. That’s why more Canadians are opting to sue; it’s why in Britain, seriously ill patients end up waiting in ambulances, not even admitted to the emergency room; and it’s why “the father of Quebec medicare,” Claude Castonguay, the man who started the ball rolling that produced Canada’s government-run system, now says it’s time to break it down and let the private sector take some of the load.And why not? After all, that approach is working in Sweden.
I think this is a good example of the response depending on your position. If I need major surgery, right now, I’m dead no matter what. At least in a socialized system, I’d have a chance, but it isn’t like I can afford health care in American either.
I think its definitely the case that if you can afford to go to America for major medical procedures, you’re better off, but that tells me nothing really. If you can afford to vacation in the Caribbean, its a lot nicer than driving to a park for a picnic or renting a movie from Netflix.
It just depends on what your priority is. If your priority is excellent care for the relatively affluent, then the American system is for you. If your priority is care of some kind for everyone, then America is a hole and Canada is the Promised Land.
I’d also say, for Great Britain, that a close friend of mine had his first child born there and his second child born in America, and he was a student both times. He says there’s no comparison – the pre-and-natal care quality in GB was better than in America for him in every conceiveable way.
We’ve got our own horror stories in the US as well. Kaiser Permanente has this habit of dropping people off on the sidewalk in ghetto neighborhoods with I-V tubes still sticking in their arms, still wearing hospital gowns. This has happened so much its been caught on various security cameras in LA for example, and its a logical result of a system that is privatized – if you can’t pay, you get thrown on the street, Hippocratic Oath be damned.
As I said, I think its more a matter of perspective. Particularly for me, when I can only go to free/community clinics and have no recourse if I have an emergency or serious injury, socialized medicine looks great. I mean, if I had to go to the ER, I’d…be screwed I guess. I try not to think about it, honestly.
In my experience, at least here you can get treated in a timely fashion. The financial aftermath may be truly ugly, but at least you can get treated.
I’m not saying our system isn’t screwed up; it is. I just don’t think moving to a government-run system is going to make anything better. We need to find a different way. I think Mitt Romney’s Massachusetts offers one promising approach (which is one of the main reasons I was initially supporting him for the nomination); there are others. The big thing, I think, is that we have to uncouple medical insurance from employee benefits–that WWII-era accommodation is, I think, a major cause of the cost problems we see in this country. (There are others, but I think that’s the first one we need to address.
I think there are extremes on both sides. I don’t know why it’s so hard for both governments to learn from each other’s situation and find a workable middle ground. I don’t understand why it has to be one or the other.
As a Canadian, I have had pretty good medical experiences with various surgeries and two child births. We have never had to wait more than an hour at emergency but I have heard of 4 hour waits. Twice we have had an ambulance to our house. I believe there is a small cost ($100) but our extended medical covered it. We do have extended medical insurance here that we buy to cover things that the regular medical doesn’t such as prescriptions. But it doesn’t get us into the hospital any sooner.
I did have to wait a year to get a knee surgery in my 20’s and that really sucked.
Yeah, one of the benefits Sara had with the company she worked for was extended coverage that was better than what the federal government offered its employees; it was a great deal for us, and one for which we were truly appreciative. At the same time, though, we could see the system starting to fail under its own weight; without the US to absorb some of the pressure, I’m not sure what would happen.
I think what makes addressing this so hard is that the temptation to play politics with it is irresistible. Absent that, I don’t think finding a workable third way forward would be easy–this is still a large, complex problem–but it would certainly be a lot more doable than it is now.
Waiting for hours in the emergency room is pretty common in the U.S. also. If the condition is immediately life-threatening, you should get in quickly, but people with “minor” problems like broken bones can be left sitting in the waiting room a very long time. In a relatively rural area where the ER doesn’t get a lot of business, we don’t have to wait too long, but my sister (who lives between Philadelphia and Trenton) has told me what it’s been like on the several occasions when she has had to take her husband to the ER (he has numerous medical problems, and drug interactions have caused some severe problems). I’ve read that the situation has been getting worse in recent years.
If it is going to be privatized and for-profit, then we need to actually have competition. There’s nothing keeping health care costs down, or not enough, and hospitals treat insurance the way body-shops and mechanics do – squeeze it for all the money possible. Then you have other situations, where people die of something preventable because their insurance company drops them due to small print coming into effect.
Right now, our health care system is like our defense contractors – we’re paying the equivalent of the famous $250 for an Army hammer.
I think we could have a two-tiered system – a lower tier, a safety net of minimal care that is free to everyone. Then we reserve the option of expensive services for the wealthy, because they won’t accept less, and it’ll happen anyway.
But either we need more competition, or we need the government to cap health care costs. Having neither happen is killing us.
As you say, not easy, but it almost can’t get worse in my opinion.
Actually, Doug, it’s even screwier than that. Since prices for procedures aren’t publicly available (and indeed, are pretty hard to figure out even when you get the bill), they vary widely among hospitals. Some of that is that hospitals recoup their unrecoverable costs in different ways, but still . . . one of the Denver papers managed to dig up some cost-comparison information among various hospitals in the city (I have no idea how), and the spread was completely ridiculous.
I’m not sure about for-profit vs. non-profit, but I agree, we need to foster actual, intelligible, meaningful competition; we also need a drastic overhaul of our medical-insurance system (if calling it a system isn’t giving it too much credit). Without both, we continue hosed.
Pauline–you’re right, things are getting worse in the US as well; from what I can see, our system is also breaking down. I’m no Pollyanna on the point.
Whatever. Maybe I rely too much on “God will provide” promise but I grew up with a dad who was always an independent businessman. We only went to the doctor for serious illness. My mom used the fact to later in their life together complain about how he hadn’t “provided” the way he was supposed to (she still holds a grudge that she had to pay for her own hysterectomy when needed with the moneys left her by her parents passing away). But it’s fairly a new American “MUST” in our generation to be “covered” just in case of a catastrophe. My family made it through just fine growing up. I have friends who stay in jobs they hate because of the “insurance” coverage, so then they are the living dead.
Elizabeth:
In my case, my wife has a chronic illness that causes her constant pain, and so if she isn’t going to the doctor for more medication on a regular basis, she’d be bedridden and in agony. In my case, asthma is also something that needs constant attention, even when its controlled, which luckily it is and has been for a long time.
I’d love to just go to the doctor for serious illness, but in our case, that just isn’t an option, and not having access to healthcare that won’t bankrupt us makes life “interesting”. For the most part, we get by on the generosity of previous doctors who give us samples and continue to write prescriptions…which we have filled through Canada, ironically enough.
I can’t say that God hasn’t provided to date, but I’d like for it to involve a less precarious existence.
You’ll probably think I’m awful saying such a thing but about your wife’s constant pain… if it’s fibermyalgia… I had a dear friend who had that… as a matter of fact I know quite a few housewives who suffer from this chronic pain condition… once divorced they faired much better… funny how relational misery wears on our health isn’t it?…
I even suffered from dibilitating back pain for so many years… after the divorce got stronger and now I’m able to do things I was incapable of in that marital misery… what’s that?… shouldn’t go into Christian marriage counseling?… unless, I have something more faith-filled to say?… OK.
Doug–I hear you on the asthma.
Elizabeth–I don’t know what to say to you; but I pray God blesses you.