Saturday, July 4, 2009
universal health-care: a canadian's experience
As a Canadian enjoying the benefits of universal health-care, I watch with interest, and on occasion with incredulity, the struggle to get across-the-board, single-payer (government) health coverage for all Americans. Over the past few months I have heard many erroneous assumptions being stated as fact over the Americain airways about what government provided health care would mean for the average American - often using Canada as an example of the horrors of universal health care coverage. Let me tell you a little (with a few personal examples) of what universal health-care has been like for myself and my family:
:::Overall, our family of five has had excellent medical care through the years. We have never received a bill or had to write a check for any health care consultations or procedures. I am basically healthy, but do make the average amount of visits to doctors for health concerns. I have had broken bones, hospitalizations for pneumonia, day-surgeries and visits to emergency rooms. Fairly average wellness/illness profile - but having enough experience with our medical system to give an informed evaluation.
:::I have a general practitioner, but have moved away from her area and have since visited local clinics when I needed immediate attention. I can, however, still see her whenever I choose and do so for yearly check-ups, non-emergency problems, prescription renewals, etc. If I became dissatisfied with her services, I can look for another doctor. Yes, other doctors' rosters may be full, so I can keep looking until I find a physician I like. In the meantime, there are medical clinics in all regions with very qualified physicians where one can go free of charge for any and all health concerns. At one clinic that I frequent, I ask when the physician I like is on duty and try to make my appointments at those times in order to have continuity of care. The times I have not been able to see him, I have received respectful and appropriate care from on-duty physicians.
:::In a recent instance of sudden pain, chills and high fever (turned out to be pneumonia), the ambulance medics gave me the choice - I could go to one of three different hospitals in the region. The government does not "preordain" what hospital you must go to . . . it was my choice.
:::My GP recently saw patch of skin on my forehead that gave her concern. She gave me a referral form to see a dermatologist . . . I CHOSE the dermatologist that I wanted to see. If, after a consultation, I had found that I did not like him/her, I COULD HAVE CHOSEN ANOTHER. That is in direct contradiction to what I hear some of your politicians say e.g. " . . . you will not be able to choose your own doctor." In fact, this may be one of the abuses of our system. Because you simply have to present your medical health card, some people over-use the system. You do not have to pay out of pocket if you seek a second opinion, or want to shop around for a different doctor than the one you have. Universal health care has not meant that we have lost any of our freedoms!
:::Back to my example of seeing the dermatologist: A biopsy is taken - one week later lab results are in indicating a basal cell carcinoma. Two weeks later I have an appointment with a surgeon. I see him, discuss my situation with him (interviewing him as much as he is assessing me), like him, decide to proceed, and surgery is booked for 1 month from that visit. I do not have to discuss payment with the doctor or the accounts office of the hospital. Nor do I have to fill out lengthy insurance forms to get the care I need. I have a sense of control and a sense of being well attended to. For all the "problems" our health care system does have - I am usually satisfied with the scheduling, the waits for appointments and surgery, etc. However, in the past few years lengthier waits are one of the compromises we all must make to enjoy universal health-care.
:::A pediatrician we loved moved away to another region. Under our health-care plan, we were not "assigned" another, or required to see one in our region. For general care, we took our 3 children the extra 30 miles to see our pediatrician. In emergencies, we had a choice of taking them to local medical clinics or to the emergency room of a hospital of OUR choosing. We never had to hesitate about taking a sick child to the doctor because medical bills were adding up. We have never been informed by the government as to which doctor we should see - the services and physicians are there and we choose where we go, who we see, and how often. We have never received a bill or had to pay out of pocket.
:::Yes, our taxes are higher here to pay for the guarantee of health care. But we aren't paying any high insurance premiums for health care coverage, so paying more taxes seems reasonable to me. When politicians tell you your taxes will go up, they almost invariably omit to remind you that you will not be paying any insurance premiums for general medical care. The extra paid in taxes is MUCH LESS than the cost of monthly insurance premiums. As long as insurance companies are involved in providing health care there is a profit motive. In Canada the hospitals and medical clinics are not "for profit" institutions. Health care costs will never be as low as they could be if insurance companies remain a part of your health care plan - that's why I preferred Hillary Clilnton's plan to President Obama's.
:::One of my adult children was recently diagnosed with a serious, rare form of cancerous tumor. Dozens of tests and scans were required before surgery could take place (no charges). There was NOT a huge wait for most of the tests. One scan that did have a long waiting list, was done and paid for privately to speed up the results and surgery. That scan was the only out-of-pocket money paid during months of treatment (my daughter had insurance that covered the test through her place of employment, so was re-imbursed what she paid out of pocket). Major thoracic surgery took place within 6 weeks of diagnosis and 10 days of hospital recovery was required. Other operating room procedures took place during the 10 day hospital stay. She was seen by a variety of specialists during the hospital stay. The "tab" was not running - there was NO BILL for any of the services, or procedures, or bed, or room, or meals, or medications while in hospital, or, or, or. There were no worries during several months of recuperation at home about how to pay an exorbitant medical bill, or if financial ruin would be one of the costs of contracting a serious illness. There were NO debates with insurance companies about what procedures were covered or what were not - because insurance companies are NOT involved. Care was prompt, professional, caring and even had the occasional personal touch - the surgeon sometimes called back personally when calls were put in to his office with questions or concerns.
:::The hospital was crowded and private or semi-private rooms were reserved for terminal cases. My daughter could not get the private room she wanted and while we were not happy at first with her having to share a room with 3 other patients, it was not as bad as we anticipated. In fact the 4 patients became quite friendly with each other and were an important source of company and support to each other (e.g. ringing for nurses when another was in distress or need). The families of the patients also became friendly and supportive of each other. Yes, the nurses are overworked and under-paid, but you would never know by judging the quality of care provided. Yes, there are lapses, irritations, set-backs, disappointments but all tolerable in the grand scheme of things, especially when you remember you will not owe hundreds of thousands of dollars for the care.
:::My daughter discovered in research on the internet that right here in our city there is a specialist (not the surgeon) in this rare form of cancer - and she asked for a referral . A referral was given and my daughter is now being seen by this specialist as well (no out of pocket cost just because SHE elected to consult this doctor). She wanted to see him, made her wishes known - and now is seeing him and her 2 other doctors for this situation. There are no extra charges for seeing more doctors, or for perhaps more frequent consultations than the norm. Whatever needs to be done is done. The government does not intervene and say "too many doctors are following your case". Really, there are no "secret government agents" keeping track of how you use the system - as one recent American ad depicted.
:::My daughter has done an incredible amount of research about her condition and says what she reads about the medical care of folks in the United States, with the same condition, is far from encouraging. On top of some reported misdiagnoses and inadequate care, they have huge financial bills and/or the insurance company fighting with them about what procedures are covered and what are not . . . Her care was not compromised in the least because we have universal health care.
:::WE HAVE CHOICES AND OPTIONS! We are not assigned a doctor by the government. We have no sense whatsoever that the government is involved in our personal medical choices. There is no limit put on our use of the system. No one's tax rate is raised because they in particular use the system more than another. You get your medical card and you relax knowing that you will be taken care of in whatever medical situation arises.
::: Some examples of things not covered in the Canadian health-care coverage are: prescriptions once out of the hospital, alternative treatments (chiro, osteo, massage, etc.), podiatrists, elective plastic surgery, ambulances, etc. - but many people are offered extra health coverage insurance for these things through their place of employment. Or you can go straight to an insurance company to get extra coverage for these things if you choose.
:::I am saddened to hear stories of Americans who have a catastrophic illness and on top of that are slammed with bills that could drive the person and/or family into bankruptcy. Or they have insurance but it is not enough to cover all, or the type of care required. I cannot imagine the trauma of losing all the comforts of home while fighting for your life, and have to worry about basic survival (beyond your illness) because of medical bills. That seems beyond traumatic, and almost abusive to me! With universal coverage we can put all of our energies into healing.I heard of one woman with terminal breast cancer who was in mental anguish and inner conflict about feeling she needed to continue treatments to stay alive as long as possible for her children, but knew that because of these efforts, she would be leaving a legacy of tremendous medical debt for them. Universal health care spares us that kind of double-bind anguish.
:::No, our health care coverage in Canada is not perfect. There can be waits for certain tests or procedures. Doctors and hospitals complain about lack of money. Small towns may not offer the same medical options as larger cities. The waiting time in emergency rooms can be long. With the ageing baby boomer generation, health care dollars are going to be stretched. Hospitals are crowded. Some doctors move to other countries to make more money. (I like to think that those who stay are really in it to serve, not to make money, but who knows . . . Oh, and the ones who move to the States spend half their time having to fill out lengthy insurance forms, rather than spending all their time practicing medicine.) I would take our system and its imperfections over any for-profit system. So many Americains live with the fear that a serious accident or illness could put them into financial ruin - trying to recoup financially for the rest of their life -(and most of us can expect more than one medical crisis in a lifetime).
:::Some of the stories you hear about the state of medical care in Canada may be true, but many baffle me as they have not been my experience and must come from people with links to vested interests in the insurance industry. Lobbyists for the insurance industry are fighting Obama's health care initiatives with a campaign of fear and inaccuracies to ensure they do not lose their customers nor their profits. Insurance plays an important role in society and insurance companies involved in medical health care will have to make big adjustments if you enact universal coverage. However, there are many other areas that require insurance and those companies can "retool and repackage" themselves. Let's not worry about the insurance companies! Let's make sure all Americains have equal rights when it comes to medical care. Ask yourself if your representatives in government are protecting a capitalist, for- profit agenda or a humane, equal rights one. Profits can always be recovered, a shattered life cannot always be recovered.
:::Universal health care is not frought with all the dangers and limitations some advertisements or politicians would have you believe. It has its flaws, but it has served our family well and I wish the same level of medical care and financial ease, for you and your family. Your comments are invited, will be read and valued.