Thursday, July 23, 2009

U.S. Health Care Reform

O.K. So there is quite the talk south of the Canadian border regarding Health Care Reform. Leaning toward Socialism like I do, I fully support the idealistic dream that would start with the creation of universal ~comprehensive~ health care with a single payer system. Many false apologies to those of you who believe that there is a place for the many private health insurers in the U.S. I do not. As long as there is a profit motive cost reduction will not occur. No citizen of the U.S. should be without health care. None. Not the poor, or the unemployed, or the families of the unemployed. No one.

On the other side of the pond, England's NHS covers all residents and visitors also receive several (free) services. Why do I mention England? Simply because the U.S. GDP in 2008 was over 14 Trillion. The GDP of England? Not even two and a half Trillion (give or take a buck or pound). With a population of roughly 61 million, the NHS covers all its residents and provides several health care services to visitors (tourists) for free. Not so the U.S. system. No free coverage for visitors and upwards of 45 million of its own residents without coverage. Of the remainder, how many are underinsured?

Now let's look across our northern border. Canada's population? Approximately 34 million. Canada's GDP? 1.5 trillion. The Provincial Health care plans that make up the Canadian system cover all citizens, permanent residents and temporary foreign workers (certain conditions apply).

Let's compare the U.S. and Canada for a moment. 303 and 34 million people respectively with nominal GDPs at over 14 Trillion and approximately 1.5 Trillion (U.S bucks). And yet, all Canadians are covered AND health statistics and outcomes for Canadians as a population are better than those of the U.S. ...Oh, yeah, Canadians are paying per capita roughly half of what the U.S. is paying; $3173. vs. $6096. Eric and I can attest to the U.S. figure (your milage may vary). As part of a spread sheet comparison of health plans offered by his previous employer, we determined our yearly monetary health care spending. Premiums, deductibles, co-pays, costs for lab tests and prescriptions (did I leave anything out?) amounted to roughly the U.S. average. All rather baseline stuff. Nothing exceptional. I have had employer provided health care like most in the U.S. I have also been an independent contractor and had to provide and purchase my own individual health care policy. I have been lucky to be covered under my partner's employer provided health care plan. In the states I had to concern myself with pre-existing condition exclusions, health care coverage gaps, and each time I changed insurance providers I had to learn the new rules; what was covered, excluded, the limits, etc. I even had the indignity of having to pay taxes on my health care benefits as if they were income. For that, thank you to the U.S. Federal Government.

Much of what is told the U.S. population about the Canadian system is myth. The debunking of such misinformation can be found in articles on my "links" resources page under health care. As with much of life, they are all a little bit true. And the deeper one investigates the more, dare I say it, understandable these myths become and the less frightening they are.

I write this post in response to a current T.V. ad that is being aired in the U.S. One where a Canadian woman speaks rather poorly of her home country's health care system. She is pissing a lot of people off up here. For you see, Canadian medical tourism to the U.S. is one of those myths. Does it happen? Sure - which makes it a little bit true. But it is rare-which is one of the reasons she, the one in the T.V. ad, has no other Canadian company in her criticism. Out of 34 million people she is the exception, not the rule-and that is being generous. She was covered under the Canadian system and would have received treatment. No one - no doctor or bureaucrat denied her treatment because that never would have happened. The system here doesn't allow it. She *chose* not to wait and to pay out-of-pocket for treatment. There are quite a few folks up here asking for more details regarding her situation. People do, indeed, wait for treatment up here but only if the situation is not critical. Medical concerns requiring immediate attention are moved to the front of the queue. She may be one that fell through the cracks of an imperfect system. If that is the case I don't begrudge her opinion. If that is the case, should she be the example given of the Canadian health care system? I think not. The jury is still out.

Watching the health care circus south of the border makes my head spin for several reasons. Firstly, that in the U.S. the population still sees the current health care system as superior despite the fact that the numbers and outcomes do not support that conclusion. That society and businesses will greatly benefit if a universal single payer system is adopted in the U.S. but that it will not happen because of one lone exception that is being paid to shout out on U.S. television. That health care bankruptcies will continue to occur, that people will continue to worry over health care and have to compare and forecast the cost and benefits of company health care plans hoping to make the correct decision. How many more insurance forms and questionnaires will have to be sweated over and completed...?

Good questions all because, you see, I had to fill out no forms or compare plans living here in Canada. I have the same coverage as the CEO next door to me and the homeless person on the street corner. I have a private doctor and I pay less for my drug prescription (same name brand drug) than I would in the states without a drug plan (yes there are, and I have a, supplemental health plan(s) that include drugs). During the time I've lived here I have received more than adequate health care from both primary and a urgent care doctors and so have several of my Canadian and U.S. expat friends-among them situations including health maintenance, emergency care, cancer, and several on-going physical and mental treatments. I have confidence in the system here and I like that all I need do is hand my "Health" card over to be treated. I am not asked to fill out a form, I am not asked to update my insurance, I am not asked about payment. There are no deductibles or co-pays. No doctor will ever deny me treatment-and the provincial gov't assumes that if we decide I need a procedure it will be paid for. I could go on...

Canadians like to bitch about it, but as mentioned in one of the articles on my "links" page, they wouldn't give it up for anything. And the rules here are the same for everyone. Health care details are the same for everyone-doctors, patients, institutions and governments. This makes it really easy to bitch about specific health care treatment and delivery problems with pin-point accuracy. Those concerns affect us all so everyone has an interest. And that interest becomes loudly apparent. For Canadians, the issue isn't health care coverage but how to maximize its delivery and control costs. How many different insurance companies, plans, rules are there to navigate and manage in the U.S.? And one can play the U.S. health care game by the rules and still be denied a pay out for a treatment. Health care insurers in the U.S. clearly have an incentive to find ways to limit how much they pay for treatment. Not so much in regard to protect their subscribers, but to maximize shareholder returns on investment.

Point is, Universal Single payer health care is not all that scary folks. The benefits definitely outweigh the risks. Once U.S. moxie is part of the Universal Single Payer Health Care formula, what is there to fear?


James Redekop said...

The Shona Holmes ads are lying, as well. She did not have a brain tumour (implication: malignant cancer). She had a benign cyst which, at worst, might have threatened her vision if left untreated for years. Rather than wait six months for treatment, she ponied up $100,000 to have it treated at the Mayo Clinic -- which is great, if one has $100,000 to spare. However, had she not had the money, she would have been treated before the year was out.

Adam said...

Thank you for the additional information. There was clearly something not kosher about her story. She testified in front of the U.S. congress regarding her "situation." I wonder if all those facts were presented. I doubt it.

James Redekop said...

Here are some details on the facts behind Holmes's story.

Anonymous said...

There are some issues with the Canadian Health Care system, but it's overall pretty good. I do believe anecdotal facts are totally used to support private companies.

I heard a lot of French complaining about the system, which I personally find weird considering both systems are very similar, albeit a few differences (eye exams covered in France but not Canada BUT a long waiting list for these exams in France).

I think Americans just don't realize that the current system is not great because (and forgive me for saying that, I'm not anti-American!) they don't travel enough to realize that universal health care DOES work in most countries. I can't believe how many Americans I met having really weird misconceptions about universal health care... and once they understood its strength and weaknesses, they were like "ahhhhh".

The USA is a great country in many ways. Just not health care... or least, just not in providing fair health care to all its citizens.