8.27.2006

it works

Egalia, who writes Tennessee Guerilla Women, one of the best progressive feminist blogs out there, used to live in Canada.

A few years ago, she wrote an essay about Canada's health care system, and she's given me permission to post it here. This is killer stuff. It deserves to be widely circulated. (Let's do that!)
Take It From A Patient: Canada's System Works
by Sandy Smith Madsen

Although I was born and raised in Tennessee, I was served well by Canada's universal health-care system during the 13 years that I lived in Canada. As a legal resident, I was entitled to the same high level of health-care benefits enjoyed by all Canadian citizens. I was free to go to any doctor, anywhere, anytime.

Three of my children were born in Canada. The bill for the birth of my youngest Canadian-born daughter was $3.00. This bill covered excellent prenatal care, delivery, and a private hospital room. It included visits to my home by a nurse and by my doctor, visits that were made as follow-up care after a normal, healthy delivery. While home visits by doctors are not standard procedure, in a country that views health care as a public service, it can happen.

There are now 43.6 million Americans without health insurance and another 40 million who are under-insured. U.S. employers are cutting back on health benefits, claiming they can¹t compete as long as the U.S. is the only major industrialized nation that expects employers to provide health insurance.

And the cost of insurance premiums continues to rise. Just imagine the consequences if a disease such as SARS should strike at some of our uninsured neighbors who are in the habit of taking two aspirins and waiting it out rather than seeking expensive medical care.

Little wonder that Americans are increasingly looking to Canada's single-payer system, and looking with envy. Yet opponents of the single-payer system recite a litany of horror stories. They charge that Canadians are "suffering and dying" while waiting for medical care. They claim that the Canadian system is a "disaster," and that it is "socialized medicine." Oddly enough, I knew nothing about these dire circumstances until after I returned to the U.S.

Canada does not have "socialized medicine." The Canadian government does not decide who gets care or when they get it; doctors and patients decide. Doctors are accountable to patients, not to the government. Most doctors are self-employed; they submit claims for payment to their provincial insurance plan. They are highly paid professionals who have considerable influence in determining their fees.

Want to see a doctor in Canada? Simply show up with your health-care card. Many Americans already know this, as they have been caught helping themselves to Canadian health care by means of counterfeit health-care cards.

Canadians are never denied care, or forced to wait for care, for lack of funds or because of a pre-existing condition. Patients requiring urgent care or primary care are never put on waiting lists. While it is sometimes necessary to wait for elective surgeries, or specialist care, if the delay is such that the patient¹s health will be harmed, all expenses are paid for the patient to access care in another location.

The United States spends almost twice the amount per person as Canada spends on health care, yet Canadians enjoy a lower infant mortality rate and a higher life expectancy. Studies in both the U.S. and Canada have found that survival rates are higher in Canada for most types of cancer.

Since Canadian health care follows you from the cradle to the nursing home, the loss of a job is not the disaster it is in the U.S. Unemployed you may be, but if you are unemployed in Canada, you still have your health care. While Canadians receive quality health care in return for their tax dollars, in the U.S we pay only slightly lower taxes and soaring health insurance premiums. With the loss of a job, all our paid premiums go up in smoke. In Canada, a major health problem does not lead to financial ruin.

Doctors seldom know if they are serving the rich or the poor. Perhaps that's why I found so many doctors who were genuinely responsive to my needs, rather than to my wallet.

The way my Canadian friends tell it, there are more Canadians who believe that Elvis lives than there are Canadians who want the U.S. health-care system.
Note: many working-class and middle-class Americans pay higher taxes than Canadians. We did.

30 comments:

Lone Primate said...

Note: many working-class and middle-class Americans pay higher taxes than Canadians. We did.

Ahhh, but to be rich... to be rich in the United States... there could be no finer fate. To be righteous in the eyes of the Lord and blessed, hmm? :)

Scott M. said...

Having lived here my entire life (and having lots and lots of reasons for healthcare over the years) I have a multitude of stories to relate.

On a number of occasions I received immediate treatment upon reaching the hospital... all based on an effective (and improving all the time) triage system. Whether it was the inability to breathe due to asthma, or having severed my anterior aorta and my liver due to a toboganning accident, I was always seen immediately and, in the case of the latter, I was in surgery and under the knife within 15 minutes of my arrival.

The stories that come out every one or two years about people dying in the ER waiting room are exceptions -- I would love to see a true apples-to-apples comparison with US hospitals.

I have plenty of stories about going to other juristictions as well... being admitted in BC and Quebec on my OHIP card without any additional charges, etc. To be honest, I was surprised at this -- there are always ads from insurance companies touting how you need out-of-province insurance and how if you don't have it you'll be broke. Bah. Not true. If you leave the country, sure, but inside? Nope.

In the US health system, are there restrictions about crossing state lines and the like, preventing you from getting care at the closest hospital?

L-girl said...

In the US health system, are there restrictions about crossing state lines and the like, preventing you from getting care at the closest hospital?

That doesn't apply, because insurance is all private. The hospital will take your insurance information, and, depending on your insurance, you're either covered immediately or you need insurance co. approval (or many other scenarios). But where you live is generally not relevant.

If you don't have insurance, you have the hope the nearest hospital will treat you. There are many horror stories about refusal of treatment, but hospitals are supposed to treat emergencies regardless of ability to pay.

or having severed my anterior aorta and my liver due to a toboganning accident

OW. OWWWW.

L-girl said...

there are always ads from insurance companies touting how you need out-of-province insurance and how if you don't have it you'll be broke. Bah. Not true. If you leave the country, sure, but inside? Nope.

I've noticed that Candians frequently talk about purchasing extra health insurance for travel, and are concerned that they won't be covered for treatment outside their province, or out of the country. But in most countries, emergency treatment is available to anyone. And if it's not an emergency, I would think, either pay, or wait.

Maybe I'm crazy, but I've never purchased health insurance for travel.

L-girl said...

The stories that come out every one or two years about people dying in the ER waiting room are exceptions -- I would love to see a true apples-to-apples comparison with US hospitals.

ERs in the US are massively overcrowded, because people use them for primary care, or for the emergencies that arise because they have no access to normal primary care. There's no such thing as walk-in clinics the way there are all over Canada.

(Well, that's not entirely true. There are private facilities, the equivalent of medical care chain stores, and you can pay in cash or by credit card if you happen to live near one.)

But millions of people without health insurance use ERs for treatment, thus they are usually extremely overcrowded, scary places with very long wait times. Anyone who has been in the ER in a US city knows about this.

Scott M. said...

Maybe I'm crazy, but I've never purchased health insurance for travel.

Indeed, it may be crazy to purchase health insurance for inter-provincial travel, but it most certainly is NOT crazy for transborder travel.

Here's why.

OHIP will pay the full costs of what your treatment would have costed in Ontario. There is a set cost for everything you can imagine, and OHIP reimburses the provider based on those costs.

So if your emergency treatment required four overnight stays, and here they cost $300 for the privelege and there they cost $2000 for the same treatment, you're on the hook for $6800.

The good news within Canada is that, in general, the costs payed by the provinces are really close to each other if not dead on.

Which brings me to another question...

While any hospital in the states might accept your coverage, is there a difference in what the hospitals in one area charge for a treatment? Does this result in "shopping" for a hospital?

Scott M. said...

BTW... based on the debt of our neighbour to the South, I wouldn't be surprised if their taxes end up much higher than ours are here, along with massive service cuts.

In many ways we're always 10-30 years behind the states. In the handling of the economy however, I think our country is probably 10-30 years ahead.

L-girl said...

Indeed, it may be crazy to purchase health insurance for inter-provincial travel, but it most certainly is NOT crazy for transborder travel.

Here's why.

OHIP will pay the full costs of what your treatment would have costed in Ontario. There is a set cost for everything you can imagine, and OHIP reimburses the provider based on those costs.


I didn't know OHIP would reimburse us for anything. That's good to know.

I generally think of it as a calculated gamble. Chances are I won't need anything, so I don't bother to get the insurance. If I needed emergency medical treatment, I would just pay for it - and if I were reimbursed for any part of it, that would be great.

We also have supplemental health insurance through our employers, and that might include some travel insurance (although I'm not sure.)

While any hospital in the states might accept your coverage, is there a difference in what the hospitals in one area charge for a treatment? Does this result in "shopping" for a hospital?

Different hospitals must charge different amounts, as all costs in the US are radically
different depending on where you live. Prices in, say, a wealthy neighbourhood in NYC are vastly more than in a small city in Mississipi.

However, most people (who have the option) shop for doctors, not hospitals. The doctor is affiliated with a certain hospital, has "privileges" there, so once you choose a doctor, you use the hospital she/he uses.

Obviously this doesn't apply to emergency treatment, but when it's emergency, no one should be shopping around.

When it comes to health care in the US, everything depends on what kind of insurance coverage you have - from the quality of care you receive, to how much choice you have about what you get and where you get it, to how much hassle you'll have over getting it.

L-girl said...

In many ways we're always 10-30 years behind the states.

How so? Certainly not in quality of life, technology, or services. What are you thinking of?

Scott M. said...

I didn't know OHIP would reimburse us for anything. That's good to know.

From OHIP's website:
Services Outside Canada :

For people travelling outside Canada, the ministry pays a set rate for emergency health services. Emergency health services are those given in connection with an acute, unexpected condition, illness, disease or injury that arises outside Canada and requires immediate treatment. Ambulance services are not covered. Ontario residents are encouraged to purchase supplementary insurance when traveling outside Canada as many emergency health services provided outside the country cost much more than OHIP may pay.

As well, from that same page...

How do I submit my medical bills ?

If you have purchased supplementary insurance, check with your insurance carrier about how you should submit your bills. Otherwise, submit your itemized bill to your nearest Ministry of Health and Long-Term Care office within six months of receiving treatment. With your bill, send :

- details of your treatment
- your original receipt for payment
- your name and current Ontario address
- your Health Number.

To avoid delays, do not hold your bills and receipts until you return to Ontario. Mail them to your insurance carrier or to the ministry as soon as you receive them.

Scott M. said...

Ignore those first two links... they were relative and I didn't fix them. For the page in question, click here.

M@ said...

I may have posted this on this blog in the past, but I think it's useful for reference. My most recent experience in an ER was when I stepped on a nail. Let me summarize the experience:

5:30 - Arrive at ER, see triage nurse
6:30 - Admitted to ER bed, examined by nurse, questioned in detail about problem
6:35 - Examined by doctor, advised that I will have x-ray and tetanus shot
6:55 - Brought to X-ray clinic to ensure bone not hit and no debris remains in wound
7:05 - Back in ER bed
7:15 - Tetanus shot
7:20 - Wound dressed, painkillers administered
7:25 - Doctor returns to say x-ray shows no problems; discharged

So I was examined by a triage nurse, another nurse, and a doctor; had an x-ray and a tetanus shot; had the wound dressed by yet another nurse, and was administered painkillers; and I was out of there in [b]less than two hours[/b] and at a cost of [b]$0.00[/b].

This, by the way, was at a relatively small hospital that has suffered greatly from severe funding shortfalls, especially for capital cost improvements (like the new freakin' roof they've needed for years).

Sorry, but if that's how a health care system in crisis works, I'll take the crisis, thank you very much.

(With thanks to Cambridge General Hospital for their excellent, timely, and efficient care.)

Lisa said...

Great essay! Particularly her point that the Canadian healthcare system isn’t actually “socialist”, in the paranoid right-wing sense of the word. It is in fact privately delivered – Canadian doctors don’t work for the state, though their services are (mostly) paid for by the state.

And it’s a message that should be delivered not only to misinformed Americans, but to Canadians who take our system for granted (and I fear that there are increasing numbers of them). The system ain't perfect, and might need some rejigging - though I'll leave that up to experts - but simply privatizing the system is definitely not the way to go.

The only issue I think she missed was this:

“yet Canadians enjoy a lower infant mortality rate and a higher life expectancy.”

This is true, but it's not necessarily solely because of the health care system. These sort of stats often are as much related to the larger issues of poverty etc as they are to free access to health care. There is a direct correlation between income and life expectancy. Which brings up the much neglected point that another benefit of a publicly funded healthcare system is that (ideally) governments are (should be) encouraged to take into consideration things like the effects of poverty, pollution, prevention etc when budgeting. If the state has to pay for Canadians who get sick, wouldn’t it make sense to craft policy, based on well researched data, that acknowledges that poverty levels, quality of the air, and a myriad of other issues, are factors that directly impact the amount of money spent publicly on health care? I’ve always thought that this is one of the best arguments in favour of public health care – it forces politicians and bureaucrats, who are worried about expenditures, to see the bigger picture in terms of determinants of health.

It's a bit like the interminable studies in Canada that try to figure out why one approach to education seems to work better than another...a recent study in Alberta came to the conclusion that the actual approaches to education were beside the point when it came to student performance - the biggest determining factor seems to be the income level of the students (duh!), and that the phonics vs. whole word, classroom size, or whatever really has nothing to do with overall performance...it's all about class, (so to speak :).

Genet said...

Thanks for posting this. I am constantly shocked/amused at the myths the US media promote about our health-care system. I'm equally annoyed with Canadians that whine about having to wait for a couple of hours in the emergency room for a panic attack, for example. Not that panic attacks aren't frightening and need to be addressed, but these people seem to be oblivious to the fact that our southern neighbours would more likely ride out their attack alone at home since for many, a hospital visit is a luxury. Canadians should be eternally grateful that we can indulge our hypochondria. Health care is not a luxury- it's a human right.

My mother has a cochlear implant which cost her essentially $0. Yes, she waited a few aggrivating months, but she was looked after and her hearing loss was never going to kill her. She also saw at least 6 specialists in that time, including a speech therapist that helped her to learn lip-reading for that waiting period. My aunt in Atlanta had breast cancer and her family was forced to sell their home. My cousin in New York brought his Canadian wife back to Toronto for cancer treatment because they could not afford to have both traditional and alternative treatments and were severely limited in their treatment options.

"Horror stories" about Canadians dropping dead in the line-up of doctor's offices are almost funny, but I know that my aunt and cousin weren't laughing.

Alex said...

Wait, wait - is no one else in shock by this paragraph?

On a number of occasions I received immediate treatment upon reaching the hospital... all based on an effective (and improving all the time) triage system. Whether it was the inability to breathe due to asthma, or having severed my anterior aorta and my liver due to a toboganning accident, I was always seen immediately and, in the case of the latter, I was in surgery and under the knife within 15 minutes of my arrival.

What did that guy hit while on a tobagan?

Scott M. said...

Heh... I was 7 years old, and was toboganning down a friend's neighbour's hill. It was very icy, great fun, but no control. I slid sideways into a birdfeeder post -- hard -- and broke the toboggan and my insides.

I hurt.

The friend went and got his mother, who insisted I walk to the car -- I couldn't without two people's help. When she brought me back to my mother, she said that I should just be sent to bed with a couple of aspirins.

My mom, a nurse, noticed I was in shock and rushed me (through red lights) to the hospital. I was under the knife as quickly as possible having lost a lot of blood.

BTW, apparently I severed my anterior Vena Cava (sp?) not aorta as well as my liver.

Scott M. said...

Me: In many ways we're always 10-30 years behind the states.

Laura: How so? Certainly not in quality of life, technology, or services. What are you thinking of?


The most often quoted way is with respect to the types of crime which happen here -- swarmings, drive-by shootings, etc. tend to happen years after their "debut" in the US.

Lone Primate said...

My uncle had a really bad heart attack in his late 40s and wound up retired early as a result. He and my aunt used to spend half the year in Florida, and they were always amazed by the things they saw there. They were wintering in a trailer park where there was a sharp dichotomy in the residency... well-off migrant northern types, and not-so-well-off actual Floridians who couldn't afford houses per se. Three or four times in the years they were there they got to see trailers boarded up by the sheriff's department, and the reason was always the same. Someone got sick, it broke them, and they lost their home.

About ten years ago now, a friend of mine not quite a generation my senior had three heart blockages. While she was on the table for bypass surgery, the doctors found a fourth. They addressed it as well. The cost of the procedure was, according to her husband, over $100,000... he knew this because OHIP had begun a policy of giving patients a manifest of what their treatment cost. But aside from incidentals, this life-saving surgery cost my friends nothing. They neither had to mortgage their home, nor did they lose it. She's still alive.

Anyone who wants a US-style health care system, please... pack your bags. We don't need it here. I don't even want two-tier, because like "separate but equal", it's always the former and never the latter.

L-girl said...

Great comments, everyone. Thanks for sharing your stories. Keep 'em coming. I'm collecting them for future use.

And it's a message that should be delivered not only to misinformed Americans, but to Canadians who take our system for granted (and I fear that there are increasing numbers of them). The system ain't perfect, and might need some rejigging - though I'll leave that up to experts - but simply privatizing the system is definitely not the way to go.

Unfortunately, this message never gets to Americans (not in mass numbers, anyway) and they continue to be utterly misinformed - and so believe that there is no better way.

I seriously don't think Canadians want the system privatized. There's so much outcry and resistance to adding even certain private elements.

Lisa, thanks for your thoughts about infant mortality and life expectancy. It all works - or fails - together.

Wait, wait - is no one else in shock by this paragraph?

Yes. :) See my big OWWW. :)

L-girl said...

Scott: In many ways we're always 10-30 years behind the states.

Laura: How so? Certainly not in quality of life, technology, or services. What are you thinking of?

Scott: The most often quoted way is with respect to the types of crime which happen here -- swarmings, drive-by shootings, etc. tend to happen years after their "debut" in the US.


Oh, those ways!

Also, some clothes and hair styles lag by about 5 years, comparing NYC and Toronto, and my guess is by a lot more outside of Toronto.

But in the important stuff, Canada is generally way ahead.

Jenjenjigglepants said...

"BTW, apparently I severed my anterior Vena Cava (sp?) not aorta as well as my liver. "

I was in shock about the aorta part... although not like Scott, shock saved your life! I'm glad you clarified to the vena cava though since had it been your aorta you wouldn't have lived to see your friend's mum*. Yay my nursy spidey senses are working. More importantly, yay Scott lived to tell the tale! Thanks,

Jen

* Here's why (and I only had to look up a lil bit):
-average person pumps 80% of their circulating volume per minute
-heart pumps faster when in shock
-blood leaves heart by the aorta
Basically you would have lost most of your blood into your chest cavity within a minute. You probably lost a good bit with the vena cava too (depending on the size of the tear) but the venous system shuts down big time when in shock. I wonder if you had trouble breathing because blood loss might have restricted your lungs? Although shock also causes shallow fast respirations... J

L-girl said...

I'm no nurse (although there are a lot of health professionals in my family, so I do hear stuff), but I also wondered, wow, you can sever your aorta and live to tell the tale?

Thanks for clarifying, JJJP. :)

James said...

Me: In many ways we're always 10-30 years behind the states.

Laura: How so? Certainly not in quality of life, technology, or services. What are you thinking of?


Fads and trends tend to lag here, but not just the entertainment-and-clothing ones; business- and politics-related trends show up here after they pop up in the US too. For instance, the resurgence of US conservatism lead by Reagan showed up in Canada a little later under Mulroney. The whole neo-"small government" thing hit Ontario during Harris's term, and lots of his ideas were similar to things already done in the US. One example was the "juvenile boot camps" business (pseudomilitary boot camps for juvenile offenders to "discipline them straight"), which, IIRC, was explicitly modeled after similar ones in the US.

L-girl said...

the resurgence of US conservatism lead by Reagan

Indeed, this often appeared to be worldwide. Margaret Thatcher succeeded in ways only dreamt of.

For that matter, so did Bill Clinton. :<(

Ferdzy said...

Well, here's my story:

I realized a few years back that I was carrying (infected with) hepatitis C. I was not actually ill, so I was monitored for a few years, sent to see a specialist, etc.

About a year and a half ago I started showing some signs of elevated liver enzymes. Also, changes to the general consensus on how to treat hep C now suggested that it was good to start Interferon (Pegasys) treatment even if people aren't particularly sick.

So I took 6 months of Pegasys treatment last summer. It would have cost us over $10,000 if we had had to pay for the whole thing ourselves. We have no extra health coverage through work because we are self-employed.

The specialist told us about the Trillium program, which helps Ontario residents with drug coverage if they can't afford it themselves. We applied, and were quickly approved. Because this is a very new treatment, it isn't on the list of automatically approved drugs, so I then had to wait for the doctor to apply to treat me with Interferon, which took a bit longer. The whole process took maybe 2 months, or a little longer.

We were given a quarterly deductible based on our income tax returns. I was a bit embarrassed about this, since as landlords we can make our incomes a bit artificially low on our tax returns thanks to the miracles of depreciation. Consequently our deductable for the year was about $1500. The first quarterly deductible didn't even cover my first shot! (I had to inject myself weekly.)

If it wasn't for the Trillium program... well, fortunately we could have come up with the $10,000 somehow, but it would have hurt a lot; left us with a lot of credit card debt.

I also was perfectly happy with how quickly I was seen, and how I was treated. Given that I was never noticeably ill, my wait times were remarkably short, I thought.

L-girl said...

Thanks for sharing that, Ferdzy. I hope you're doing well now.

Ferdzy said...

Yes, thanks! :)

I got the good news just as we started our long vacation... my virus levels are now officially nondetectable. (In other words, it's a safe bet that I'm cured.) I need to have a blood test every year just to make certain, but it's looking good.

Crabbi said...

...swarmings, drive-by shootings, etc. tend to happen years after their "debut" in the US.

USA! USA! We're number one!

Thanks for this post, Laura. I especially like that Egalia stares down the socialist bugbear.

L-girl said...

Crabbi: Thanks. I agree. :)

Ferdzy: Excellent! Glad to hear it.

Anne alias Purrceyz said...

Hi Laura,

Just catching up on your blog...my first story is about my father-in-law. Although a healthy man, he had several surgeries here in Canada, including a large anureism in his stomach(the side of a baby's head). Although the surgery took a number of months wait (fortunately, the walls were thickened), the care he received was usually very good.

Unfortunately, he had a bad fall off a ladder in Texas when he and my mil were cleaning their winter trailer to sell. He broke his hip and the ambulance did not take him to the nearest hospital but the one they had been 'paid' to take him to..the care was terrible, he was not given his regular medication (he got someone else's never his own) not given an IV and given a very strong laxative and left lying in dirty sheets. He died of a heart attack the day he was to be discharged. (The staff did not prepare his wife at all, she's the one who found him dead).

My mother-in-law has been pursuing the case ever since...apparently he should have never been given that laxative; it caused the (especially without an IV) as it severely dehydrated him and caused the heart attack. Upon further investigation, she discovered that the supervising doctor was NOT licenced as a MD. (The hospital had the nerve to send multiple bills after his death to Canada which her Canadian insurance had refused to pay for services he was never given. Along, she was stonewalled and lied to...(they pressured her to cremate on the day of his death, she was shock & agreed; so an autopsy was never performed). Only on the threat of a lawsuit, was she able to view the records although some had already been 'lost' (they contradicted what she's been told

She file grievances to the state licencing commission; unfortunately due to Mr. Bush the laws protecting patients are very weak and favour the large corporate hospitals.

She firmly believes that he'd still be alive if he had broken his hip here in Canada.

Although personally I feel our health care in Canada has slipped from what it was in the 60s & 70s..(I had a family doctor who made housecalls when I was a child) it is still miles ahead of the United States.

In the Canadian health care system, my daughter was recently seen by a psychiatry clinic (for worsening anxiety and depression).here in Toronto. Although it took 5 hours waiting time to see the crisis psychiatric team (after triage through the triage nurse & regular ER doctor); the care she received was excellent (althoush she wasn't admitted, she was given an increase in medications & subsequent appointments/followup in an outpatient clinic before be returned to her family doctor's care.)

However, I worry about the shortage of family doctors in many locations (we finally we able to find one for our severely disabled son who lives in a group home north of Barrie; they are scarce in that region) & the desire to privatize our system from some Canadian rightwingers.

Anne