In Praise of Canadian Health Care, Warts and All

I’ve been following the American health care debate, somewhat — it’s like watching a slow-motion train wreck, except less fun. The chances of any substantial legislation passing appears now to be derailed for another 20 or 30 years, or maybe forever, because it’s hard to imagine a more auspicious conjunction of the political stars. So Americans must now make themselves believe (again) they have the best health care system in the known universe, with infant mortality rates higher than Cuba, and Canadians can still retain their annoying moral superiority about our system, which frankly, has vast swaths of suckiness. Just ask any Canadian RN or physician.

And yet. Maha at Call Bells Make Me Nervous posted this:

Several shifts ago, I was assigned to an area with five rooms. In one of the rooms was a homeless man who was being treated for cellulitis and hyperglycemia. He was eventually discharged to a community care centre where home care nurses would take over. After the room was scrubbed clean, another patient was brought into the room. The second patient was a fairly well known celebrity. I thought that it was remarkable that two people with completely opposite socioeconomic backgrounds were treated in the same hospital, in the same room by the same team of doctors and nurses. The Canadian health care systems may have its problems, but it was nice to see it actually working as intended.

And also this comment on another post of mine by At Your Cervix gave me pause for reflection: her boyfriend potentially faces an expensive course of IV treatment for an MRSA infection. Maha points out that for all of the flaws in our system, there is equality of access. At Your Cervix worries about cost. Here, you would go on Home Care, with RNs visiting you daily.

I’ve worked in both systems. The bottom line is that unless you have gobs of cash and/or a gold-plated health insurance scheme, American health care will suck you dry and spit you out.

I am often severely critical of our health care system for wastefulness and stupidity. As we all should be. Money spent on exorbitant management salaries, consultant’s fees, catered lunches, duplication, inefficiencies and all the rest undermines public trust and confidence in the system, and worse, is money directly taken out of front-line patient care. It is inexcusable.

Yet I would take our system over the American without thinking about it twice. The reason: in terms of crude outcomes, like infant mortality, five-year childhood mortality, life expectancy, cost as a percentage of GDP, access to primary care and the like, the Canadian system consistently outperforms the US. And everyone is covered, without exception. We can argue about the middle and particular cases, like wait times for hip replacements or time to cancer treatment. But we also tend to forget (sometimes too conveniently) that health care in the US is rationed as well. Forty or fifty million people, depending on what statistics you hear, go without insurance, and millions more are grossly underinsured. Here you wait for elective orthopaedic surgery.

The point remains: overall, Canadians are actually pretty healthy. Despite our socialized, horrible, bureaucratized, death-panelized system.

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  1. #1 by BD on Friday 22 January 2010 - 1038

    I am American, but I lived and worked in rural Canada for three years. During that time I received good health care and never worried about losing coverage or, worse, my house. It isn’t a perfect system, but I felt secure that I’d get what I needed.

    Not so in my home country. I had a health scare last year, and it was made a million times worse as a result of regular nickel-and-dime fights with the insurance company. Then there were the games the physicians played in an effort to earn as much money for themselves as possible… no matter what was best for me. Horrible situation. Thank goodness I wasn’t dying.

  2. #2 by JennJilks on Friday 22 January 2010 - 1043

    You make good points here, ones I have made previously as my blogger friends in the US questioned our system. I saw a conspiracy early on.
    Americans are afraid of ensuring that the 47 million without insurance and jobs will take away from THEI health care insurance. They are afraid it wil bankrupt them. It is so sad.
    There are many barriers to health care in Canada. At least, in Canada, you won’t be turned away.

  3. #3 by BD on Friday 22 January 2010 - 1102

    >>Americans are afraid of ensuring that the 47 million without insurance and jobs will take away from THEIR health care insurance. They are afraid it wil bankrupt them. It is so sad.>>

    There is a distinction between no insurance and no health care, and I don’t think those who want to keep “their” insurance understand this. Those who don’t have insurance can still obtain health care. If they have no money, they’ll be chased by debt collectors. If they have no insurance, they’ll REALLY be chased by debt collectors.

    Before I had my health scare, I thought I had a good insurance policy. I’m self-employed, so I carefully researched the companies that sell to individuals in my state (only two, one of which I’d never heard of and is rated “B” for quality, not “A”). Then I purchased the lowest deductible, most comprehensive plan available from the “A” rated company. I thought I was covered! I was ignorant. I’m not talking about deductibles… I’m talking about being denied entirely for what would eventually be thousands, $50, $200 and $500 at a time. And, when I talked to the medical providers, I found out I’d be expected to pay “full price” – often 3-4x what my insurance would have paid – for whatever the insurance companies denied. Nice choices, eh? Keep in mind I was also sick and stressed-out in between fighting with insurance and care providers over money.

    If I’d never had a health problem, I’d never have known that my “good” insurance actually provides very poor protection. At the moment, I’m hoping I can find a job working for a company with good insurance (vs. remaining self-employed), though I’m also paranoid that if I did, was laid off, and again had to seek individual insurance, I then wouldn’t be able to obtain new insurance.

    Unfortunately (healthcare-wise), moving back to Canada is not a viable option. My life is here. I’m American. I hope we can work this out as a country.

    • #4 by JennJilks on Friday 22 January 2010 - 1515

      Yes, BD, That is the other issue: insurance companies that cut you off after a condition develops. We know how much physio and prevention of serious issues keeps a person employed, too.
      Those without an employee insurance company in the US are screwed.
      I fervently hope you DO work it out.
      I am happy that my tax dollars go to help those who cannot afford to pay.
      There are some that are concerned about this new American plan, but surely events like hurricanes, and how badly the poor were treated in New Orleans would inspire some compassion in those who have jobs and insurance.

  4. #5 by atyourcervix on Friday 22 January 2010 - 1205

    For the record, my boyfriend has the US govt health care plan called Medicare. He only has outpatient (doctor visits, home health, laboratory work, etc) and inpatient hospitalization coverage. It does not cover any prescriptions. In order for him to have prescription coverage, he would need to be an inpatient. As any nurse knows, it’s more financially feasible to have home health or outpatient services for something as simple as IV antibiotic therapy. However, for him, he would need to pay all out of pocket for the IV antibiotic if it’s given as an outpatient or via home health. If he was inpatient, he would need to pay over $1000 as a co-pay for hospitalization EACH TIME he is hospitalized. So, which is the worse of two evils? We’re going to break the bank either way to get his antibiotic coverage that he needs to (hopefully) get rid of his system cutaneous, highly infectious MRSA. Oh, on top of it all? He has an immune deficiency syndrome (genetic, inherited, non-curable) which makes him more prone to very prolonged healing. This isn’t going to be a quick “give him IV antibiotics and he will be all better” type of treatment.

    If he is inpatient for the proposed three weeks of IV therapy, he is going to be much more susceptible to nosocomial infections, due to his immune deficiency syndrome. Also, how can one rationalize a 3 week inpatient admission for simple IV antibiotic administration? Highly unlikely that Medicare will approve the admission.

    His ID doc wants him to go daily to the hospital for his IV antibiotic infusion. I am still not convinced that Medicare will pay for the actual antibiotic if he goes this route.

    Not to mention, he pays a 20% co-pay on all outpatient services.

    At least *some* coverage is better than none.

  5. #6 by BD on Friday 22 January 2010 - 1328

    >>I am still not convinced that Medicare will pay for the actual antibiotic if he goes this route.>>

    I agree with you… I’d be skeptical, too.

    Unfortunately, the U.S. health care system is just plain broken, and we frequently experience the worst of both public and private care. For myself, I just want to know that if I’m paying for health insurance it’s going to (predictably) protect me from financial ruin for what I think it does, so I can plan adequately for health emergencies. The “gotcha” game I played got old really fast.

    • #7 by JennJilks on Friday 22 January 2010 - 1516

      I pay for my own prescriptions, as do many others. Seniors are covered, or subsidized. But getting Primary Health Care *is* step 1.

  6. #8 by storytellerdoc on Friday 22 January 2010 - 1610

    Great insightful post. I don’t know at what point a compromise will be reached regarding healthcare…but for the children lacking care, I would like something to be figured out yesterday. They are innocent figures in all of this controversy …

  7. #9 by wilomis on Friday 22 January 2010 - 2205

    Well my plan just went up $200 per month forcing my wife and I to downgrade to a lower plan because its all we can afford…. I hope Washington gets its act together… we live in a country where no one should have to suffer. Land of the free and home of the brave.

  8. #10 by mog on Saturday 23 January 2010 - 0855

    I’m living in Canada after moving here from Britain. I see many similarities in the two systems but am shocked by some aspects of the Ontario version. Outpatient prescriptions are not covered by OHIP unless you have extra insurance, dental- not covered- outpatient physio -not covered. Canadians pride themselves on equality but it isn’t there. That celebrity will have been able to pay his meds if he didnt have top up insurance. We don’t have insurance through our work so it will cost is $300 a month extra and that is hard to find on limited incomes.

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