Montpelier
Article published Jun 28, 2009 (RH/TA)
Myths of the medicine line
A cross-border argument for Canadian-style health care
Randal Smathers
Myth: In Canada, government bureaucrats decide who gets treated, when and by whom.
Canadian doctors have both private and hospital practices, same as here; they get paid by the government instead of Medicaid, Medicare and dozens of private insurers. Optional services, like cosmetic or laser eye surgery, are paid privately.
Myth: All U.S. doctors are opposed to a Canadian-style health care system.
In fact, my doctor — well, actually, my physician’s assistant — suggested I write this. I have only seen “my doctor” once in four years except to nod hello, which is probably the most significant change in my health care since I married a Vermonter and left Canada in 1996. That and the billing.
Myth: Canadians hate their system.
Poll after poll places the national health care system as a primary source of Canadian pride. The founder of the system, Tommy Douglas, won a 2004 Canadian Broadcasting Corp. survey as the greatest Canadian ever. Most of them are touchy about the U.S. health industry distorting the facts about Canadian health care in order to scare voters here over “socialized medicine.”
And scare tactics abound: Remember the warnings that Canadian drugs were cheap, deadly fakes? I haven’t heard of people on either side of the border dropping dead from bad medicine, have you?
If Canadians were half as good as Americans about patriotic displays, the support for their health care system would border on the obnoxious.
Sure, Canadians complain at times about their physician or local hospital, but that happens in Vermont, too. Let’s face it, when a medical outcome is less than perfect, you either have an unhappy patient or a dead one. And the Canadian system is far superior at preventing the latter outcome. Like the other Western countries with “socialized medicine,” Canadians live longer and score better on most of the other major tracking methods for grading health care, such as infant mortality rates.
Yes, there are other factors: Americans shoot each other to death at rates far outstripping those of other Western democracies, and social programs here are more likely to let the have-nots suffer. Even so, the
American system falls short of its peers, based on results.
Myth: Canadians can’t get care without long waits.
Only partly true. Yes, in some parts of the country, particularly poor and rural ones, waits involving hospital care and surgeries can be extreme. Part of the problem is a doctor shortage made worse because America attracts Canadian doctors by throwing money at them. Somewhere between our spending and Canada’s wait times is a happy medium. As a consumer, I haven’t noticed any difference in quality of care, nor access to care. In both countries, when I needed care, I got it. I have had bad doctors in both countries and exceptional doctors in both.
Fact: There is a huge difference in billing.
After a workplace accident in Edmonton, Alberta, I walked into the emergency room of the biggest teaching hospital in the province, got a battery of tests done immediately, was treated and then released with a referral to my regular physician for follow-up care. As I was working my way through college at the time, I paid my regular $42 quarterly student’s bill. Period.
Here, our youngest son’s respiratory bug turned into pneumonia last winter, putting him into Rutland Regional Medical Center for a couple of nights. In one stay, we maxed out our company plan’s coverage, plus about $2,400 we had to pay out of pocket. And that’s after I pay $63.80 weekly for what is euphemistically referred to as a “high deductible” plan, not counting what the company pays. It’s madness.
Besides sticker shock, there’s another lesson: Our insurance plan requires us to pay with its debit card. The hospital bill cleaned out that account, and then our other doctors had to rebill us and wait an extra 10 days or two weeks to get paid … and we have a savings account and good jobs. That decentralized billing and collections process is risky and pricey. It’s also symptomatic of the redundancies built into for-profit medicine.
The for-profit system also is really good at ordering drugs and tests. Just banning pharmaceutical ads on TV would carve a huge chunk out of the budget by eliminating artificial demand for drugs. And before women blame Viagra and Cialis for the entire problem, I just saw an ad for Latisse, a prescription medicine to grow thicker eyelashes: “Ask your doctor if it’s right for you.” Trying to regrow lashes after chemotherapy is one thing; wanting to look like Latisse spokesmodel Brooke Shields is another.
Fact: Neither system is perfect.
The tests are more problematic. One area where Canadians are not faring better statistically than Americans is in breast cancer treatment, a disease particularly suited to early diagnosis with expensive machinery. That’s the great paradox of the American system: Relying on expensive testing is breaking the bank, but it’s what we’re best at. Trying to disrupt that cycle is one of the reasons the American system suddenly is emphasizing preventative care. Limiting malpractice claims also might help, as a doctor who doesn’t order every test in the book risks being sued silly.
But those are just Band-Aids for a patient whose parachute didn’t open.
Fact: The Canadian system is better.
My father died in Alberta, last spring, after a long struggle with Alzheimer’s, aggravated by diabetes, and had three years of institutional care. Yes, for those determined to find fault with Health Canada, he did have to wait weeks for an appropriate placement in a nursing home and for a couple of tests, although in the end even the Canadian system was offering more, and more intrusive, testing than made sense.
But going back 20 years, before his diabetes was diagnosed, it cost him his job. What happens to an American in his 50s with a middle-class income high enough so he’s not eligible for a government handout, who loses his job from an undiagnosed medical condition that soon after needs extensive treatment, followed by a lifetime of ongoing care?
Well, first, the medical care goes with the job, which means he’s probably diagnosed in an emergency room. That certainly would have been the case with my father, who was too stubborn to admit he needed a doctor, even when he had a job. While he had no income and he was sick with a disease that affects people as profoundly as diabetes does, there’s no way he would have “wasted” money on an office visit.
Second, in increasing numbers, an American in such a situation loses everything from a lifetime’s work and winds up bankrupt, just from trying to pay the medical bills.
A system that exacts the maximum possible payment from people when they are most in need is not a health care system, or an insurance system, it’s an industry. An industrial corporation’s first duty is to its shareholders, and as long as we put profit before patients, our system will be a failure.
Randal Smathers is editor of the Rutland Herald.