Thursday, September 3, 2009

My View of Health Care – Part 1

Okay, first off, if you think I should pay more taxes because I earn more money, you can probably stop reading now. My goal here is not to change your opinion, but if you are a socialist at heart, what I have to say likely won't resonate with you, but read on if you must. Also, these are just my 'at-the-moment' opinions and do not reflect my family's opinions, nor my employer’s (in fact it may piss him off). The kids are in bed, my wife is entertaining friends and I have run out of celebrity sex tapes to jack-it to. This post is a result of all of the above.

I've lived in a socialized health care system in Canada (for 28 years) and I've lived in a privatized health care system in the US (for 12 years). I can speak from experience. I've tried to educate myself on 'The Obama' plan (no I can't cite chapter and verse) and looked at it from left-leaning opinions as well as what free-market libertarians think. Of course I have biases because I am human.

*** rant-on ***

Okay, you republicans/conservatives/neo-cons, you had your chance. You had control of Congress for more than enough time to effect change. You did nothing but advance your own political agendas. Now that health care is up for public debate, you muddy the waters with propaganda and stupid shit like 'Death Panels'. You get to sit in the corner and shut up. Your opinion doesn't count. Let the grown ups have a sensible conversation about this.

*** rant-off ***

The Canadian System

Depending on which side of the aisle you sit, the Canadian system is either a super successful model for the world or 3 steps from Communism (maybe 2 steps). As with most things, I think the answer lies somewhere in between.

Basically, everyone who pays income taxes throws their tax money into a big pile in the middle of the country. The federal government sets aside some of that ‘general fund’ for health care. Every province gets some of the money to manage their own provincial health care system. How much they get depends on population, voodoo and who's giving whom a reach around on Parliament Hill. This is the 'single payer system'. There is a single entity that pays for your health care, the government. They also legislate how much the doctors can charge for services and what is covered (say what? that doesn't sound right? that sounds like a conflict of interest doesn't it?).

As a Canadian (or resident, legal or otherwise), when you get sick, you go to your doctor. And by *your* doctor, I mean you have 1. Your GP is your primary care physician. You basically have to see him for everything. If you need further specialized care, he'll refer you to a specialist (not unlike a HMO). As the system exists right now, many people do not have a GP (sorry I don't have a quote on the national numbers but it is pretty common). There is a dearth of GPs and a waiting list to find one. You can always go to a clinic or the emergency room so just because you don't have a GP doesn't mean you won't get treated. You will never see an 'explanation of benefits' form or a bill. From a sore throat to cancer, you won't pay a cent. The doctor bills the government at an agreed upon price and the government pays him for his services. No one dies because they can’t afford health care, and no one goes broke because they get sick. It is a reasonable system, but it does have plenty of warts, some serious.

First off, it is pretty expensive. The average Canadian pays 45% if his income back in income taxes (I read this somewhere and know it is pretty close). I don't know how much of that goes to pay for health care, but I'm pretty sure it is a large chunk of it (a basic problem with the 'general fund' approach). In some provinces, it isn’t enough, so they started charging a 1% health premium (it wasn't a *tax* because the elected party promised no new taxes...douchebags!).

Secondly, all that money still doesn't cover it. Not everything is covered. Prescriptions are not covered at all. Your employer may choose to cover you for prescriptions, but that's between you, them, and a private plan. Dental care is not covered. I think teeth are an import part of your overall health but that seems to have slipped through the cracks (just ask the front row of a Rita McNeil concert). More and more treatments are being cut back as costs rise. The government doesn't dictate your treatment to your doctor, but they do dictate what (and how much) they'll pay for. You do the math.

Thirdly, the system is not competitive. Prices are fixed (likely artificially low). If the system worked, we would be graduating or importing doctors by the truckload. Great government health care for all! The fact is there is an extreme shortage of doctors, especially in the rural communities. Governments are closing hospitals everyday. Seriously. An aging population that is going to require more and more health services and we are cutting them back? There are fund raisers every year just to help the Children's Hospital get a few more bucks to help the kids. What the fuck? This is a model for the world?

Fourthly, did I mention the lack of doctors and money in the system? That leads to delays. We've all heard the 'it takes 6 months to get an MRI' quote. I'm not sure if that is accurate, but they definitely aren't next-day like they are in the US. When you wake up paralyzed on your right side, you want that MRI next-day, not next-month. With all the available doctors treating sore throats and cancers, that doesn't leave a lot of room for 'elective' surgery. No I'm not talking about boob jobs and liposuction, I'm talking about 'elective' hips replacements, 'elective' back surgery, and 'elective' knee replacement. The government has deemed those as 'elective'. So you, who just slipped a disc in your back and are bed ridden popping Oxycontin all day just to numb the pain, back of the line for you bub. We'll try to get you to see a specialist in 4 months, then maybe schedule surgery 6 months after that. I shit you not. That *is* the system. But you'll never receive a bill.

Fifthly (is that a word?), with all that hard to get healthcare, it should make for a great market place for entrepreneurs to fill in the gaps. Doctors could open their own clinics, maybe even charge a few bucks extra so you can get prompt service. WRONG! That would be illegal. If you have done well for yourself and have a few extra bucks in your pocket and want to get a mammogram tomorrow, it is off the US for you. You can't buy your own health care in Canada, that wouldn’t be very socialist now would it?

Sixthly (now I know that’s not a word), I’m going to stop railing on the Canadian health care system. It really isn’t all that bad, and it really isn’t all that good. I speak from experience and familial experience. I’ll share some personal stories.

  • I lived in Canada until I was 28 and was pretty healthy the whole time. Aside from a few visits to get ‘the clap’ cleared up and UPIs (unidentified party injuries), I think I stepped in the doctor’s office maybe twice from age 14 to 28. As a child, we saw the doctor when we were sick. I even had a house call once. Never heard Dad complain about the rising cost of health care. Perfect. Life is good.
  • My daughter was born in 1996 at an Ottawa Hospital. At the time, I had a good job with the RCMP. My employer provided supplemental insurance carried a ‘room upgrade’ for the recovery room. We were privileged to move from a 4-person ward to a 2 –person ward. Living large! During Linda’s recovery, the family of 6 we shared a room with decided to have a fucking candle-light prayer/séance on the floor of the ward to welcome their new offspring. Not quite the way I had envisioned my daughter's first day. No, it wasn’t a life-threatening event, but it was life-changing. I never looked at socialized medicine the same way again.
  • I have a relative who had thyroid cancer. Caught it, cured it, great service.
  • I have a relative who pays into the system and has seen a doctor maybe 3 times in 20 years. The system likes him.
  • I have a relative who had severe back problems. I think it took him 18 months to get it operated on, and he went home with an Oxycontin addiction for his troubles.
  • I have a relative who endured 6 months of back pain before seeing a specialist. He rode the morphine dragon for most of it.
  • I have a relative who had throat cancer. She had surgery, chemo and radiation and is cured. The throat cancer was a direct result of 40 years of smoking. I love her with all my heart, but I wonder if she should bear some of the financial responsibility for her actions. All (tax paying) Canadians had to pay for her treatment and she paid none. I don’t think that is right, but I’m glad we still have her nonetheless.
  • I have a relative who died from cancer. Diagnosed at stage 4. He was basically told there is nothing we can do for you, please go home and arrange your affairs. It turns out there was a 5-10% chance that an experimental treatment could have cured him. He was never given the option because the Canadian health care system can’t bear the burden/cost of something with a low chance of a ‘return on investment’. Tell that to the family he left behind.

Seventhly, I just don’t think the Canadian health care system can be sustained for a long time. I don’t have diagrams, charts or projections, but logic says we have an aging population, more people taking out of the system, less putting into it, and a non-competitive government environment that stifles innovation and change.

Believe me, I understand what it is to be Canadian (and still am), and the great ideals that entails. The system has great benefits and serious flaws. When trying to figure out what to do with the US health care system, we can’t look to Michael Moore for the truth, nor can we look to Bill O’Reilly. We need to look at real people and how health care affects their life. We all pay for it one way or another; we should demand that it be the best.

Okay, so I didn’t propose any solutions. That wasn’t my intent…yet. My next post will detail this poutine-eating, beaver-tail loving Canadian’s experience with Big Medicine.

Now I have to go work on my other blog post – ‘BJs Prevent Breast Cancer’.

See you soon.

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