6.12.2009

will they get fooled again? striking back at harry and louise

When I first started this blog, I was besieged by wingnuts alternately offering to help me pack and howling with derision at the wacky country called Canada.

Canada, where you can be hauled off in the middle of the night for saying bad things about the Queen.

Canada, where you can be arrested for not speaking French.

Canada, where it's always cold, and always snowing.

And above all else, Canada, where you will die while you wait for health care.

I am not exaggerating. I heard all this and more.

By now everyone knows the health care non-system in the US isn't working. It's unjust, inhumane, and wildly expensive. The quality of care is great for the wealthy, a crap-shoot for everyone else, and nonexistent for tens of millions. It's also immensely profitable for a few.

There can't be an intelligent person left in the US who thinks it's working. There can only be people who believe that if you can't afford care, that's your own problem, go die on your own; people who fear the government (except when it comes to war and the supposed fight against supposed terrorists, then the government is always right); people who are so defensive and myopic about TGNOTFOTE™ that their brains (such as they are) shut down when the subject comes up; and people who are profiting off the current non-system. Of course there's some overlap among these groups.

We Canadians know the health care system in each Canadian province is not perfect; nothing is. But as I always say, if you want to know what's wrong with the Canadian system, ask someone who uses it. Because, up until very recently, all of what you will hear and read in the US mainstream media about Canada's health care has been lies. Not some, not most: all.

There's a veritable cottage industry of single-payer-bashing in the US media. I'm not talking Fox News. I'm talking New York Times, CNN, Washington Post, AP. Everyone.

I am beyond skeptical that the US will institute universal, single-payer health insurance in my lifetime, but if it's ever going to happen, people have to see a working model. They have to know what is possible. Imagine Tommy Douglas fighting for something he couldn't even prove would work! Fighting to make a dream a reality! Now, some 50 years after Canada's first medicare system was born in Saskatchewan, USians have a bright and shining example of how the whole thing can and does work, right in their own backyard. If only they will be able and allowed to see it.

I don't know how much and what kind of publicity Jack Layton's meeting with Obama garnered. I saw the wingnut blog headlines - "socialist visits US to promote government takeover of your life!!" - but I didn't find much in the mainstream. Any CNN watchers reading this? Did you see anything?

Perhaps this column by Nicholas Kristof in the New York Times is a harbinger of change. The Times was one of the worst offenders of Canadian-health-care-bashing. Could it be that is beginning to change?
Perhaps you've seen those television commercials denouncing health care reform as a plot to create a Canadian-style totalitarian nightmare, and you feel a wee bit scared.

Back in the election campaign, some people spread rumors that Barack Obama might be a secret Muslim conspiring to impose Sharia law on us. That seems unlikely now, but what if he's a covert Canadian plotting to impose ... health care?

Rick Scott, a former hospital company chief executive, leads a group called Conservatives for Patients' Rights. He was forced to resign as C.E.O. after his company defrauded the government through overbilling and is now spending his time trying to block meaningful health care reform by terrifying us with commercials of "real-life stories of the victims of government-run health care."

So here's a far more representative "real-life story."

Diane Tucker, 59, is an American lawyer who moved to Vancouver, Canada, in 2006. Like everyone else there, she now pays the equivalent of just $49 a month for health care.

Then one day two years ago, Ms. Tucker was working on her office computer when she noticed that she was having trouble typing with her right hand.

"I realized my hand was numb, so I tried to stand up to shake it out," she remembered. "But I had trouble standing."

A colleague called 911, and an ambulance rushed her to the nearest hospital.

"An emergency room doctor met me at the door, and they took me straight upstairs to the CT scan," she recalled. A neurologist explained that she had suffered a stroke.

Ms. Tucker spent a week at the hospital. "The doctors were great, although there were also a couple of jerks," she said. "The nursing staff was wonderful."

Still, there were two patients to a room, and conditions weren't as opulent as at some American hospitals. "The food was horrible," she said.

Then again, the price was right. "They never spoke to me about money," she said. "Not when I checked in, and not when I left."

Scaremongers emphasize the waits for specialists in Canada, and there's some truth to the stories. After the stroke, Ms. Tucker needed to make a routine appointment with a neurologist and an ophthalmologist to see if she should drive again. Initially, those appointments would have meant a two- or three-month wait, although in the end she managed to arrange them more quickly.

Ms. Tucker underwent three months of rehabilitation, including physical therapy several times a week. Again there was no charge, no co-payment.

Then, last year, Ms. Tucker fainted while on a visit to San Francisco, and an ambulance rushed her to the nearest hospital. But this was in the United States, so the person meeting her at the emergency room door wasn’t a doctor.

"The first person I saw was a lady with a computer," she said, "asking me how I intended to pay the bill." Ms. Tucker did, in fact, have insurance, but she was told she would have to pay herself and seek reimbursement.

Nothing was seriously wrong, and the hospital discharged her after five hours. The bill came to $8,789.29.

Ms. Tucker has since lost her job in the recession, but she says she's stuck in Canada — because if she goes back to the United States, she will pay a fortune for private health insurance because of her history of a stroke. "I'm trying to find another job here," she said. "I want to stay here because of medical insurance."

Another advantage of the Canadian system, she says, is that it emphasizes preventive care. When a friend was diagnosed as being pre-diabetic, he was put in a free two-year program emphasizing an improved diet and lifestyle — and he emerged as no longer being prone to diabetes.

If Ms. Tucker's story surprises you, you should know that Mr. Scott's public relations initiative against health reform is led by the same firm that orchestrated the "Swift boat campaign" against Senator John Kerry in 2004. These commercials are just as false, for President Obama is not proposing government-run health care — just a public insurance element in the mix.

No doubt there are some genuine horror stories in Canada, as there are here in the United States.

But the bottom line is that America's health care system spends nearly twice as much per person as Canada's (building the wealth of hospital tycoons like Mr. Scott). Yet our infant mortality rate is 40 percent higher than Canada's, and American mothers are 57 percent more likely to die in childbirth than Canadian ones.

In 1993, the "Harry and Louise" commercials frightened Americans into abandoning health reform. Let's ensure those scare tactics don't work this time.

A few notes on the above.

Most US hospital patients do not get private rooms, either. And Canadians with supplemental (private) health insurance may have coverage for a private room.

I also think it's fair to say most USians have never seen an "opulent" hospital! I realize they're out there, but unless you are very wealthy or have amazing insurance, you're not going to get into one.

More importantly, many Americans have a mistaken impression about "wait times," so often talked about here in Canada. They believe it means how long you will wait to see a doctor on any given day, as if there is some central clinic where everyone goes and endlessly waits for care.

Doctors in Canada have their own offices and appointments are scheduled the usual way. There are also walk-in clinics where you don't need an appointment. But "wait times" refers to queues for certain procedures, such as hip or knee replacements, or to see certain specialists. There is a shortage of doctors in many fields, and in many areas.

There's a lot of discussion about how to bring wait times down. But plenty of us don't wait at all. We just make appointments and go to the doctor. We pay nothing, because we pay for our health care with our taxes. My taxes in Ontario are about the same as they were in New York.

And two, as my partner always says, there are millions of Americans who would be thrilled to be on a waiting list, and when their name comes up, get free surgery and rehab.

Instead, they're just left to deteriorate or die.

24 comments:

JakeNCC said...

The sad part is that in the commercials the rightwing and health industry will run in the states they will use real Canadians telling Americans how bad our system is. I had an American friend email me that he got a email that was going around that said Quebec only has ONE urologist for the whole province and thousands of Quebeckers are suffering because of it. And this is just the beginning, as the healthcare debate begins in the US we will be example number 1 of whats wrong with "socicalized" medicine. Whether what they say is true or not will not matter one bit.

L-girl said...

"And this is just the beginning, as the healthcare debate begins in the US we will be example number 1 of whats wrong with "socicalized" medicine. Whether what they say is true or not will not matter one bit."

The beginning? I must be slipping. The point of this post is that's what's been happening for years and years.

James said...

And two, as my partner always says, there are millions of Americans who would be thrilled to be on a waiting list, and when their name comes up, get free surgery and rehab.



No insurance = infinitely long waiting list.

But they don't include those in their averages...

(And, of course, US systems do have waiting lists for specialists and certain procedures, just like Canada. But those don't get mentioned.)

L-girl said...

To the person who wrote a comment and said "please don't publish the rest of this":

I can't publish only part of your comment. And if I publish your comment, I cannot go to any of your links, including your own blog.

If you want to communicate with me privately, please use the email address at the top of this blog.

If you want to leave a comment, please do that and I will put it through moderation.

Thank you, and thanks for the kind words about this blog.

L-girl said...

"No insurance = infinitely long waiting list."

No list, but infinite wait. Wait forever.

"(And, of course, US systems do have waiting lists for specialists and certain procedures, just like Canada. But those don't get mentioned.)"

That's true, and something you never hear about. Depending on where you live and what insurance you have, there could be long waits.

Kim_in_TO said...

It never ceases to amaze me that some Americans can cling to this belief that their system is better or preferable. In the event of a serious illness or emergency, no one in the world should have to think about bills or payment before well-being.

I spent a few hours in a walk-in clinic yesterday, having a leg injury examined. I've only had to deal with minor health issues, but every time I have to go to a hospital or clinic, I am grateful for our system, problems and all.

James said...

Depending on where you live and what insurance you have, there could be long waits.



Ten years ago, a friend of mine (who has serious mobility problems) was bitten by a spider. After five years of treatment which still left him with painful ulcerations at the site of the bite (and, at one point, facing the posibility of amputation), he asked if he could have a better doctor. The HMO told him, "With your conditions, you're lucky to have any treatment at all. Request denied."

The bite is not yet healed.

Adam said...

Something to note is that Canadian Walk-in clinics are also privately run doctors offices. The term "Clinic" in the U.S. is often associated with shabby service and less than optimal medical care compared to a private practice. In Canada that is not always the case. While on a waiting list to become patients at a chosen Health Center, both my partner and I have used services at several Canadian Walk-ins and also one of the Urgent Care centers here in Toronto. All provided more than adequate medical care. One could even say they were pleasant. My point? The term "clinic" should not necessarily be feared in Canada. While I find it ridiculous that some folk don't find a GP or Family M.D. the fact that one may not does not preclude receiving good medical care thanks to walk-ins, Urgent care centers and emergency rooms.

And the costs are all paid through one's taxes, which, Shhhh, don't tell anyone, is, for most people, about the same as in the States.

Supplemental insurance is widely available through employers and is rather inexpensive by U.S. standards because it only need cover what isn't covered by the Provincial Health Plan. Our supplemental even covers travel medical insurance to the U.S.!

JakeNCC said...

With Obama in charge the states may be closer to real reform than any time in the past and if this is the case the health insurance industry and their wingnut friends will fight back like never before and I'm afraid that what they will say about our system will be more vile and untrue than ever before. So yes I think that what Americans have seen in the past from rightwing groups re: the canadian system is just the beginning of whats to come.

deang said...

It never ceases to amaze me that some Americans can cling to this belief that their system is better or preferable.

That's partly due to the widespread US media lying about health care in Canada and elsewhere, leaving Americans effectively delusional about other systems.

L-girl said...

Jake, thanks, now I see what you meant.

Of course, selling the idea to the US public is only one step. Having someone in power willing to take on the insurance companies is the key.

The Clintons' proposed system was all about getting private insurance to more people. The HMOs loved it.

But if there's going to be public insurance that cuts the industry out of the picture - the industry that rules the country and owns Washington - that's another story. They'll finance whatever they have to attempt to scuttle it.

Cornelia said...

Of course the lack of universal free health-care in the US is a horrid grievance and very bad in terms of human rights. And the Republican propaganda against it sucks!!!

richard said...

Good post, Laura

"Another advantage of the Canadian system, she says, is that it emphasizes preventive care."

This is true-ish, but much more needs to be done in this area. Still so much of what is expensively treated in hospitals can be prevented by simple lifestyle changes. The promotion of this is also part of health care.

richard said...

Adam makes a good point, often misunderstood in the US - Canadian MDs are in private practice. They are not government functionaries. That's the way it should be. That's the way it works.

raikiri said...

I am a U.S. Citizen living in Riyadh Saudi Arabia because of my fathers job. Health Care is a bit interesting here. Saudi Citizens get free healthcare at the National Hospitals here though many because of their employers have private health insurance so they go to the private practices here. There was a new law passed by King Abdullah recently that requires all employers hiring someone who is not a Saudi Citizen to provide health insurance for them.

ErinOrtlund said...

This drives me crazy--I appreciated the links you put up a while ago on Mythbusting Canadian Healthcare.

Universal healthcare in the US doesn't have to look like it does in Canada, or the UK, or wherever. There are many models to examine--I've heard the French system is good. That said, I have been happy in Canada--I have a great family doctor, it's easy to get in to see him, and my pregnancy/childbirth care was excellent.

ErinOrtlund said...

Adam--I looked again at the benefits book that comes with DH's job. We do have travel medical insurance--it looks pretty good, covers us up to 5 million dollars. However, it also says it reimburses "reasonable and customary costs." I'm wondering if that means they will reimburse me what the procedure would have cost in Canada? But then doesn't my provincial healthcare do that anyway? I'll call them and inquire, but I'm wondering how your policy works in this regard. Or anyone else!

L-girl said...

"However, it also says it reimburses "reasonable and customary costs." I'm wondering if that means they will reimburse me what the procedure would have cost in Canada? But then doesn't my provincial healthcare do that anyway? I'll call them and inquire, but I'm wondering how your policy works in this regard. Or anyone else!"

What this generally means is that if you must travel to the US for the procedure, because of either long wait times or lack of availability, or something else, you will get a partial reimbursement. They keep the language vague because the reimbursement will vary with different times and places.

What we've found with things not covered or only partly by our provincial plan - custom orthotics, CPAP machine, eyeglasses - the private insurance picks up a certain amount, but not all.

We think it's great, but most Canadian-born Canadians we know complain about having to pay any amount for medical expenses - an interesting diffrence!

I hope that helps.

ErinOrtlund said...

Thanks L-girl! Well, I called them and they said they would try to negotiate with the American hospital/doctor, but they do pay the bill. They said it's not based on what the procedure would have cost in Canada. I guess if we ever need to use it, we'll see how true that is, but it was reassuring enough to me that I didn't get extra travel insurance.

Even when people don't have travel insurance, don't people use their provincial health cards when traveling abroad? I wonder how that's coordinated with any extra insurance people have?

L-girl said...

Sounds good, Erin.

"but it was reassuring enough to me that I didn't get extra travel insurance."

I find the whole idea of getting travel health insurance strange. (I've blogged about this before.) I figure if I have the bad luck to get sick while on a trip, that's what credit cards are for. Chances are, we won't need any medical care on any trip. To me travel insurance is the insurance industry playing on people's fears.

"Even when people don't have travel insurance, don't people use their provincial health cards when traveling abroad? I wonder how that's coordinated with any extra insurance people have?"

I'm not sure how one could use a provincial health care card abroad. It wouldn't be honoured.

I believe you submit receipts for reimbursement, and are reimbursed at the rate that your province pays. For example, this from Ontario Health.

ErinOrtlund said...

Yes, that's what I meant. Submit receipts to Saskatchewan Health.

I think differently about health insurance--maybe because I tend to fear the worst! If a catastrophe happened in the US (car accident, my child got injured, brain anyeurism, whatever), I sure want to be adequately covered and not rely on credit cards. For a catastrophe, my credit limit wouldn't be enough anyway. I wouldn't want to incur an overwhelming bill--since the IRS has all our info, I assume I'm trackable, and anyway, I pay my debts. And I wouldn't want our healthcare compromised because they knew we couldn't pay for much. Since we know we can get care in Canada, we can be sent back here for care--another thing travel insurance covers.

L-girl said...

Your way of thinking seems to be very common - it certainly is the norm in Canada! People are afraid to travel anywhere w/o travel health insurance. (For that matter, so many people seem afraid to travel, period!)

I just don't worry those kinds of things. Odds are good that the worst won't happen, and if it does, I figure we'll deal with it somehow.

Obviously it's different when you have kids, but I don't think that's the deciding factor here. :)

ErinOrtlund said...

I think the deciding factor for me is that I am kind of paranoid! ;) When I traveled to India, I worried my bus would plunge off a mountain. I fly next week and I keep reminding myself of my statistically overwhelming odds for surviving this. I worry about becoming bankrupt from medical bills. Just my nature. Fortunately I live in Canada, and now fortunately I have found out I don't need to buy a travel insurance policy every time we leave Canada.

I think you're right, whether we're naturally pessimistic or optimistic about such things, the majority of the time everything works out fine. :)

L-girl said...

Yes, I think travel health insurance is for worriers. :)

And also for Canadians, for whom the idea of paying out-of-pocket for health care is foreign and scary.