Tuesday, October 9, 2007

A Canadian Describes His Health Care System

This is an e-mail I received. It seems in line with the comments AD posted to me, so I thought I would post it. Can't vouch for the veracity. Can say it rings true for a bureaucratic health system. Don't mean to be a Sally One-Note, and will get on to other things next.

Health Care in Canada

"This comes from a friend of a career Marine, who just happens to be a Canadian. His thoughts on the recent health care proposal might be of interest to some."
"Hey Guys; I saw on the news up here in Canada where Hillary Clinton introduced her new health care plan. Something similar to what we have in Canada. I also heard that Michael Moore was raving about the health care up here in Canada in his latest movie. As your friend and someone who lives with the Canada health care plan I thought I would give you some facts about this great medical plan that we have in Canada.
"First of all:
1) The health care plan in Canada is not free. We pay a premium every month of $96. for Shirley and I to be covered. Sounds great eh?
What they don't tell you is how much we pay in taxes to keep the health care system afloat. I am personally in the 55% tax bracket. Yes
55% of my earnings go to taxes. A large portion of that and I am not sure of the exact amount goes directly to health care - our #1 expense.
"2) I would not classify what we have as health care plan, it is more like a health diagnosis system. You can get into to see a doctor quick enough so he can tell you "yes indeed you are sick or you need an operation" but now the challenge becomes getting treated or operated on. We have waiting lists out the ying yang some as much as 2 years down the road.
"3) Rather than fix what is wrong with you the usual tactic in Canada is to prescribe drugs. Have a pain - here is a drug to take - not what is causing the pain and why. No time for checking you out because it is more important to move as many patients thru as possible each hour for Government reimbursement
"4) Many Canadians do not have a family Doctor.
"5) Don't require emergency treatment as you may wait for hours in the emergency room waiting for treatment.
"6) Shirley's dad cut his hand on a power saw a few weeks back and it required that his hand be put in a splint - to our surprise we had to pay $125 for a splint because it is not covered under health care plus we have to pay $60 for each visit for him to check it out each week.
"7) Shirley's cousin was diagnosed with a heart blockage. Put on a waiting list. Died before he could get treatment.
"8) Government allots so many operations per year. When that is done no more operations, unless you go to your local newspaper and plead your case and embarrass the government then money suddenly appears.
"9) The Government takes great pride in telling us how much more they are increasing the funding for health care but waiting lists never get shorter. Government just keeps throwing money at the problem but it never goes away. But they are good at finding new ways to tax us, but they don't call it a tax anymore it is now a user fee.
"10) My mother needs an operation for a blockage in her leg but because she is a smoker they will not do it. Despite her and my father paying into the health care system all these years. My Mom is 80 years of age. Now there is talk that maybe we should not treat fat and obese people either because they are a drain on the health care system. Let me see now, what we want in Canada is a health care system for healthy people only. That should reduce our health care costs.
"11) Forget getting a second opinion, what you see is what you get.
"12) I can spend what money I have left after taxes on booze, cigarettes, junk food and anything else that could kill me but I am not allowed by law to spend my money on getting an operation I need because that would be jumping the queue. I must wait my turn except if I am a hockey player or athlete then I can get looked at right away. Go figure Where else in the world can you spend money to kill yourself but not allowed to spend money to get healthy?
"13) Oh did I mention that immigrants are covered automatically at tax payer expense having never contributed a dollar to the system and pay no premiums?
"14) Oh yeah we now give free needles to drug users to try and keep them healthy. Wouldn't want a sickly druggie breaking into your house and stealing your things. But people with diabetes who pay into the health care system have to pay for their needles because it is not covered by the health care system.
"I send this out not looking for sympathy but as the election looms in the states you will be hearing more and more about universal health care down there and the advocates will be pointing to Canada. I just want to make sure that you hear the truth about health care up here and have some food for thought and informed questions to ask when broached with this subject.

"Step wisely and don't make the same mistakes we have.

"The saying is: "If you think Medical Costs are high now, what till you see what it costs when you get care for free."



Babs RN said...

It appears that Snopes is updating its evaluation of its veracity today: http://www.snopes.com/politics/medical/canada.asp

Jen said...

That certainly doesn't sound like the health care system that my family has benefited from in Canada.

I had triplets born at 30 weeks, and walked out of the hospital with "healthy" babies 11 weeks later not owing a cent. We also had access to a public health nurse weekly for the first six months.

When my daughter was diagnosed with cancer at 8 years of age she had her first ultrasound within half an hour of discovering the main tumour, and was transferred to a children's oncology ward in a different hospital within 3 hours. She had surgery the first day that her kidneys were strong enough, and we not only had a one month hospital stay during the initial admission, but four weeks of in-patient chemo, follow-up visits, and in-home nursing care when necessary (all covered by OHIP).

All 3 of my children are autistic, and we are not only able to access autism specialists when we need them, but most of the therapies and supports that we need are also accessed through our Ontario Health Plan.

My girls have lung damage from RSV when they were young, which leads to frequent hospitalization for pneumonia. We've rarely waited in emergency to be seen for more than about 2 hours. (And once again, we don't receive a bill for hospital or medical services for them), and their puffers, nebulizers, and medicines are paid for through their disability plan in conjunction with our private insurance ($53/month for a family of five through my ex-husband's workplace).

My mom suffered from malignant melanoma for 13 years before she passed away, and in that time we never had more than a 1-2 week wait to get her treated during a recurrence.

Oh, but my dad did have to wait about 10 months for a knee replacement.

We recently moved to a mid-sized community and were able to find a pediatrician for the children within a week. It's true that because of the doctor shortage in our area I have to go to emergency or an after-hours clinic if I need to be seen for something, but once again, at least it's covered by OHIP.

I've paid taxes all of my working life. Given that I'm now in the process of marrying an American who has a much higher tax burden that I've ever had up here (plus paying $400/month for private health insurance), I've never understood why people consider it so horrible to have your tax money going to cover your health costs. (and we're planning to live in Canada, because it would just be too scary to have to depend on the medical system in the U.S. if my fiance ever got laid off or lost his private insurance for any reason).

There's no doubt that there are a lot of things that need fixing up here (including the idea that immigrants get "free" health care the minute that they get here), doctor shortages, wait times for non-urgent conditions, lack of MRIs and even CT scans in a lot of areas, nursing shortages, the problems of servicing low population areas, the focus on cure rather than prevention, but, especially given the challenges that our family have faced, I can't imagine a better place to live. There's no doubt that in the U.S. our family would have been bankrupt from trying to pay for care in the first few months of my children's lives, or we would just not have been able to access services.

It's certainly not a paradise, but being intimately aware of how much my American fiance is paying for health care in private premiums as well as taxes, I for one am more than willing to have my tax dollars going to pay for health care.

night lightning woman said...

Thank you, Jen. You have been through much, and I honor your experiences. I'm glad the system worked for you. What I want to get going is some personal observations of what is going on. Your contribution really adds to that.
My concern is that I see so many fellow citizens who don't want to take responsibility for much of anything-they want the government to take care of it while they continue to sit on the couch. Sounds like you have been plenty busy with your family, using your government resources rather than expecting the gov'mint to take care of it.
I welcome more info on this. It seems possible to me that both your story and his could be true. But I need a lot more info to know that.

Jen said...

There's an interesting site at http://www.health.gov.on.ca/transformation/wait_times/public/wt_public_mn.html# )
which shows wait times for various surgeries in Ontario- I'm sure that they're available for other provinces as well, but this is the one that I'm familiar with. There's been a concerted effort by various governments to lower wait times over the last few years (obviously it's a hot button political issue), and although a lot of them are still much too long it is getting better.

Some of the major problems that I see up here are similar in some ways to what a lot of people seem to experience in the States. Excessive use of emergency rooms- it's not really a place you should go if you have a sore throat. We're gradually getting more after-hours clinics up here, and using Nurse Practitioners instead of Doctors for some things, which I think is a step in the right direction.

There is a huge doctor and nurse shortage throughout much of Canada, not as much because of the "brain drain" to the U.S. over the last few years, as much as because the spaces in medical schools are so limited and enough people just aren't being trained. This seems like such a no-brainer to me that I'm not sure why it's really not being addressed.

I completely agree with you that there are a lot of people who just want to "be taken care of"...while due to my upbringing and culture I think that health care is a human right, the attitudes of a lot of people do tend to piss me off to the extreme. Especially since I've had so much experience on the "disability" end of things, and it's appalling the number of people who do abuse the system.

As to the original post, I think that the Snopes article quoted by Babs debunks a lot of it. No one here is in a 55% tax bracket. Yes, you may be paying extra for your provincial health coverage, but compared to what I've seen my friends and family pay for their health insurance in the U.S. it's pretty negligible.

I have no doubt that some people are refused medical treatment because of fears that they may be non-compliant (he talks about his mother being refused surgery for a blockage because she won't quit smoking), but as far as my understanding goes that's not unusual. It's unlikely that you would get a liver transplant if you were a drinking alcoholic, for example. I've never seen a newspaper article about someone being refused treatment for a blood clot.

There definitely ARE horror stories up here...no question about it. People do fall through the cracks, and I think that in a lot of cases it's because they are not proactive or educated enough to ask the right questions- again, I think that's probably common almost everywhere. There definitely are systemic failures up here though, and although I think that the health system here is very slowly moving towards a preventative instead of a reactive model, it is happening. I know that when I go to a family doctor or pediatrician their first reaction is not to "give drugs", but to talk about lifestyle choices. And it's been a very long time since I've been in a hospital or doctor's office that hasn't had a very large sign stating that they will NOT give antibiotics unless they are necessary...the days of getting antibiotics because your throat is a bit sore or you're puking are long gone up here.

A quote from the original piece ""8) Government allots so many operations per year. When that is done no more operations, unless you go to your local newspaper and plead your case and embarrass the government then money suddenly appears."

That's just odd, and I've never heard of that happening at ALL. I can't even find anything on Google about it other than tinfoil hat theories.

Another one "11) Forget getting a second opinion, what you see is what you get." Again, that's so totally foreign to the experience of anyone that I know here- doctors are MORE than eager to have you get a second opinion, and I have never had a problem getting a referral or been made to feel badly about asking for one. While we don't quite have the malpractice insurance problems that are visible in the U.S., doctors are eager to cover their ass if asked to :-) (and I can't blame them).

There are definite differences in the way that care is provided up here, no question about it. My American fiance has no problem calling his doctor and asking for a scan if his stomach is bothering him (he had a gastric bypass a few years ago), whereas I'm sure that you'd have to jump through a few more hoops here to get one unless you were in pain or showing symptoms. His doctors tend to prescribe brand-name drugs, whereas our family is always prescribed generic first, but I'm pretty sure that has more to do with the way that drug reps and med advertising work up here rather than the medical benefits accrued by using brand name vs. generic. He is usually able to see his doctor (assuming that it's an "approved doctor" by his HMO) within a very short time, while we often do have to wait for routine things like physicals. It's also much easier for him to get a private room in a hospital- even with private insurance here, from my experience over the last 10 years I've noticed that the hospitals seem to be moving back to a 4 or 6 room ward system, or if you're lucky a semi-private, unless there are immunity or contagion issues involved (regardless of whether you have private insurance that covers it or not).

But, and I think that this is the biggest difference- I have never had to consider whether I can afford to see a doctor or not. If one of my kids has a fever and is holding their ear screaming or having problems breathing and the nebulizer doesn't seem to be helping, I just go. I can't count the number of times I've read messages on triplets' or autism mailing lists from people asking if they "REALLY" should take their child in, because money's tight that month and maybe it will just go away if they hold off for a few days.

There was an interesting article in the NYT last month talking about families dealing with cancer in the U.S., and the one thing that struck me was that "one of every four families afflicted by cancer used most or all of its savings in the battle, including one in five families with insurance". (http://www.nytimes.com/2007/09/11/opinion/11tue3.html?_r=1&th&emc=th&oref=slogin

That's scary, and not something that I ever have to worry about. There is no question that our private health insurance (again, $56/month for a family of five) supplemented her care- she received a series of injections of a drug call GCSF between chemo sessions to boost her immune system when her counts were low that would not have been covered by our provincial health plan, and they were about $250/shot if I remember correctly.

There's absolutely no question that
it's not a health care paradise up here. Lately there have been a few stories in the news about women having to go to the U.S. (usually Buffalo or Seattle) to have their multiple birth children because of lack of NICU space up here. I find that very easy to believe- I delivered in one of the top-flight hospitals up here, and my kids were almost shipped off to 3 different hospitals after birth because there was originally not enough space in the NICU for them. I have friends who are waiting 6 months for a physical, there are not enough family doctors, and non-emergency surgeries do have a wait time.
It is easy for people to take advantage of the system here- we have lots of people on "disability" who just shouldn't be, but again, I don't think that's very uncommon.

But it's still a fairly workable system, and it costs less than what the U.S. as a whole is paying per capita. I doubt that it's a doctor's paradise, to say the least- most of the doctors and nurses that I know are very overworked and underpaid compared to their counterparts in the U.S., and that has to be fixed.

I'm not positive that my experience is typical up here as we have had to deal with a few things that a lot of people don't, but we have spent a very large amount of time dealing with the medical system over the past 15 years, and I've been in a lot of oncology and pediatric wards as well as general surgery and palliative care. There are very definitely problems that need to be fixed, but I'm still pretty happy that I live up here.

Blei said...
This comment has been removed by the author.
Blei said...

Provincial Health Care covers all Canadians (which I am not one)basically free or as part of the overall taxes - if your friend was in BC I'm lead to belive that there is a basic charge for insurance. I apologize if that was incorrect in my first comment

That does not mean that those who do not earn enough to pay taxes or who are on social assistance don't get provincial health care. It means it's paid for out of the collective taxes paid for by the nation as a whole.

What I think or thought your friend was was most likely referring to is called supplementary insurance.

See, as an American I pay $400 a pay period or $800 a month out of my earnings regardless of my tax status for any health coverage and my company pays about the same $800 a month.

It's not a sliding fee. If I worked at Burger King and earned $7 an hour it would still be very close to that $800 a month for me.

So for me to get any basic health coverage in between my company, the taxes and we both (I and my company) pay $1,600 a month, plus state, local, school , federal taxes.

That is still an additional $1,600 that needs to be paid before I can go see a doctor, and if I am fired or lose my job, I still have to pay now all of the $1,600 so that I will not die in the waiting room of some ER.

Something Canadian folks get to do free or depending on the province very close to it. I doubt that those provinces that require a small monthly pay would still do so for those who cannot afford it. My point is that as a whole it's altogether more humane and inclusive .

Canadians probably consume less medicine because their not so worried about meeting such a huge financial burden just to make sure that they have adequate coverage should something traumatic happening.

Me, I also have to maintain separate policies for Cancer, Disability, and accidents because even though my medical costs may be covered, I still have nothing to live on. Something Canada is much better about.

Additional or supplemental health coverage which would be about $90 a month for the entire family, If thats what Shirleys husband is talking about, would cover non-emergency things such as... well therapy. If you need to see a therapist for a non-emergency thing, that’s on your end. Trying eastern medicine? You can get treated for back pain but if you want to try crystal, healing you will have to fund that on your own.

Psychiatry of a non-emergency nature as well, while some things like acupuncture are occasionally covered by National Health most things like that are not.

That does not mean if your bordrline suicidle or if you need to be hospitalized for mental illness you can;t be. In the states if I should be struck by a depression and need hospitalization. My insurance covers a maximum of five days. regardless of how seriously in need of help I was. Same or less for drugs or alcohol. If I were say functional drug addicted person ( or non functional) and finally as a result of having a job and wanting to better my life went for professional detox help . It would max out at 5 days.

In Canada you might have to wait a bit but you would get a 28 day program and follow up free or included. Again we are looking at a human society that is actually better looking to improve the health of it's residents

Supplemental coverage which is nothing close to the $1,600 a month a pay for just me ..not even bringing my family into the picture would also probably cover drugs, and for an entire family.

But more funny ,drugs are much cheaper in Canada, though are not covered by the provincial health plan. So if you’re taking a particularly expensive drug which in the states might in fact cost you, say $1,500 per month without health coverage. Would most likely be at the very top of the scale $300 here and that additional supplementary coverage might help cover that drug that is being prescribed completely.

As a rule of thumb though A drug that would cost about $200 a fill in the states is generally about $20 in Canada, so even if you do not have drug coverage which many Canadian citizens do not have most people can afford to buy their drugs over the counter, where as the co-pay for my medicine as a American in America is often more expensive then the cost of buying the drug as a whole over the counter in Canada .

In Canada if you cannot afford a drug there are government programs that will help you. Not sponsored by big pharmacy I might add, real government programs.

So while you do not need to have supplemental coverage. For things like Therapy, psychiatric care of a non-emergency nature, dental care... etc it might be helpful.

For basic human rights in insurance coverage your average Canadian is still heads and tails better off then your average American.

You do not need supplemental coverage in Canada and can live fine without it but even if one is forced to pay $96.00 a month for Health care in Canada it is still heads and tails more human and better then what any country that does not have drugs as a human right.

And now that I've done some research that $90 a month in BC is for those who can afford it are employed . if your not employed, too poor even if your just pregnant regardless of your financial status it's free

As an American who spends great swaths of time in Canada ( I am Jen's the previous commenter's Husband) I can tell you that as an American for my earnings I pay more in taxes then the average Canadian who earns what I earn and get nothing--N-O-T-H-I-N-G, Out of it.

I haven't even resided in my home country for near six months and I pay out the schwantz in case something should happen to me or any property of mine there (THE USA).

I do not even know people who are millionaires that pay a 55% tax rate in Canada. It's unrealistic. I earn more then 100K a year I pay that $800 a month for insurance, my company pays an additional $800 for me to be insured and my wait time in an emergency room and the services I can receive are less as a New Yorker then the average Canadian would get in an Emerg situation.

Let me also ask you,do you think a NYC Emergency room would care that it was Christmas day and my kid was sick?

In Canada, my wife’s kid woke with an ear infection on Christmas and was seen fast because someone was on duty to see kids separately then adults and to move them through as fast as possible so their holiday wouldn't get killed.

Is there any hospital in the states that cares about anything more then what my insurance is and if I can pay the co-pay today or not? Much less if my Kid is there in pain for 16 hours screaming. My tax rates depending on if my pay is regular pay or commissions can reach up to 46% and my country does not do anything but treat me like a tourist.

They are there to take my money and if I run out, they will dispose of me or make a token gesture of helping out. In Canada, you might have to wait for it. But you can realistically expect to get subsidized housing within a year. I know people who earn less then 10K a year and have houses that cost them about $100 a month that are bigger and nicer then anything I ever paid $1,500 a month for anywhere in New York.

Canada National Health care will fix you when you are sick. If you need an operation, Any and all doctor’s visits, hospital visits, Chemotherapy, Hospice all those things are basic rights for all citizens of Canada.

4) Many Canadians do not have a family Doctor.- Again I respectfully disagree. It is different from in the states where you can pick and choose. There is a doctor shortage and sometimes you do have to wait. But there are also after hours clinics for things like flu’s or fevers and general malaise.

And remember all you have to do is show your health card at the door. Last year I got my flu shot free while waiting to check out some grocery’s in Canada. They did not even bother to ask to see my health card that time; they just wanted to make sure I stayed well.

And if for some reason, I was really sick and needed say a heart doctor or an oncologist if I was a Canadian I would have one in a second flat. So while you may wait for a Primary care physicians …if you’re worried about getting some antibiotics or whatever you go to a clinic show your card and you’re seen. If it is serious, there is always the ER, also 100% free of charge.

5) Don't require emergency treatment as you may wait for hours in the emergency room waiting for treatment.-

And in the states you would not?

Shirley's cousin was diagnosed with a heart blockage. Put on a waiting list. Died before he could get treatment.-

Again, I call BS. If you go to a Canada ER actively in trouble, they will cath you on the spot. I have seen it done I have done volunteer work at hospitals in Canada. If you need a hip replacement, yes you might have to wait your turn in line. It’s not life threatening and they might have to do a few open heart surgeries to save lives and that puts things like hip replacements and non medically necessary treatments on a waitlist.

It’s not forever though. You just have to wait. And if that’s the price of free healthcare for life then I would accept it.

8) Government allots so many operations per year. When that is done no more operations, unless you go to your local newspaper and plead your case and embarrass the government then money suddenly appears.-

Your saying that there is an allotment of say gall bladder surgeries per month and if your outside that number you don;t get it? Thats hard for me to accept, I would need to see proof about that. what I do know is that Canada is having trouble keeping doctors and nurses because it's a regulated industry here and you can't just charge for what you want to. Many doctors and nurses migrate to the US where they can earn more. that does increase wait times and does hurt the system

13) Oh did I mention that immigrants are covered automatically at taxpayer expense having never contributed a dollar to the system and pay no premiums?-

Canada should be proud of the way they treat their immigrants... you know like human beings who deserve basic human rights. How many cab drivers did I have in New York City who were head of large educational department ended up driving a cab?

"Oh in Russia I used to be a civil engineer and here I’m driving a cab 6 days a week, my family is still starving and I have no health care so I’m forced to use the hospital system and clog it up for everyone when if I had free healthcare I would just see a doctor or clinic."

Look the poor will seek healthcare regardless of if they have coverage or it is free or not.

The difference is that in Canada if you are poor your only option when your kid has a fever and you don’t have money IS NOT just to take the kid to the ER and wait 16 hours for some overworked half doctor to give him an antibiotic that you may or may not afford to fill.

It’s not as if the immigrants in the states aren’t seeking health care. They are just clogging up the hospitals for every day things because they have nowhere else to go.

Immigrants get health care here and in Canada. In the states though because their poor they are more likely to take up a needed bed in an ER because they can’t afford to see a real Doctor or there is no after hours clinic that’s free

night lightning woman said...

Wow! Okay, I now believe in Canadian medical care. The thing is, the U.S. won't do it that way. Somehow, the piggies will still get to the trough, we will insist on so much documentation that care is impaired, and we still won't care if a kid is sick on Christmas. I guess I have become a real cynic. But for you Canadians, mazel tov. As flawed as this posting was, I'm glad I posted it. I have learned a lot.