Canadian Brand Socialism: Failing the Sick and Poor
Once a proud supporter of Canada's social safety net, Heather Cook now wouldn't mind seeing a little more free-market competition in her country. Maybe then she wouldn't have to wait over a year to take her son to the doctor's office.
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Canadians are proud of their social safety net. Growing up in the True North, Strong and Free, I was never afraid of not being able to afford to go to the doctor and I knew that there were programs out there that magically took care of the sick and poor. Though I’ve never had to take social assistance, family members of mine have.
But it wasn’t until I started paying taxes that I started to hold the system to higher expectations. And it wasn’t until I started getting some real world experience that I realized that in some ways the system is very broken.
If US health care is broken due to its inaccessibility, Canadian health care is broken because it’s too accessible. Imagine that US health care has ten doors with different admission costs. The line up for the ‘free’ door is long, but there’s still a steady stream at the other end where the entry is so expensive that there’s a sign overhead reading “if you have to ask - you can’t afford it”.
In Canada, there’s one door. And, lucky you, there’s no admission. Well, unless you count the provincial health care fees you have to pay if you make more than the accepted poverty level. And those pesky taxes.
Health care costs make up, on average, 40 percent of a province’s budget. About 73 percent of all health care is paid for by public funding (taxes), while the rest is paid for with supplementary insurance packages (paid for by the individual) and employer-based programs, or direct from the consumer’s pocket.
But that one door? It has a heck of a lineup.
Across Canada the words “wait times” are buzz words. They show up in campaign promises, opposition criticism and anywhere you find sick people. Provinces have developed “wait time registries.”
What’s the median time for an MRI in Alberta? Almost 9 weeks. And for about 360 of the 18,839 people served in a 90 day period, their wait was up to a year. Granted, if you arrive in the ER in desperate and dire need of an MRI, you are rushed to the front of the line. The rest just wait. Not knowing, wondering, waiting.
In Ontario, if you learn you have cancer one of the first things you’ll do is develop a treatment plan. If this includes radiation, the median wait time before you can actually have that radiation is over a month. As of August 2007, if you were diagnosed with breast cancer in Ontario this year, you had about a 50 percent chance of waiting longer than two weeks to even see your specialist for the first time.
I am the mother of a child with asthma. When my son had difficulty breathing randomly through the winter, I sought treatment. First I made an appointment with my doctor (2 week waiting time) so I could obtain a referral to a specialist. (In Canada you cannot just go to a specialist, you must get a referral from the gatekeepers: family doctors. Oh, and about 5 million Canadians don’t have one of those.) It took about six weeks for the specialist to get back to me with how long I’d have to wait for my son’s appointment: 12 months. Did I mention that periodically he couldn’t breathe?
Earlier this month, a friend’s wife was told that she had pre-cancer cells detected during her yearly Pap Smear. Her doctor advised her that cervical cancer would be the next step and was concerned that the same test one year earlier had not yielded one single pre-cancer cell, intimating that this had come along suddenly and therefore could quickly become cancer. He referred her to a specialist for further testing. Her appointment is February 2008.
Socialist Canadian health care is wonderful if you are an emergency case. If you can wait, trust me, you will.
Even the Canadian Medical Association is staging a revolt. Dr. Brian Day states on his site:
Our system was built to meet the needs of the underprivileged. It is now failing both them and everyone else, because it has not adapted to the times. The greatest deficiencies are in the poorest regions of our nation, especially aboriginal communities. Our health system has been ranked 30th by the World Health Organization. If a hockey team were one of the most expensive in the league, but ranked 30th, would we not hold the owners and managers responsible? You all know the answer.
Due to the Canada Health Act, Canadians are prevented from paying for any medical procedure if it is provided free of charge to others. They are also prevented from buying any sort of private medical insurance. Fortunately, Dr. Day wants to change that.
Let’s be clear: Canadians should have the right to private medical insurance when timely access is not available in the public system … Doctors must reject our government assigned role as a gatekeeper without a key to the gate. The Canada Health Act must be updated for this century.
The issue of child care is handled very differently, depending on which province you are in. Some have subsidized or publicly funded facilities, others strictly private, and some a mix.
Since 1970, both Liberals and Conservatives have been tossing about the idea of a “national child care program” or “national day care strategy.” But in 1997 Quebec began its own provincial day care program at the bargain basement price of $5 per day. A decade later, it’s $7 per day. However, only one in five Quebec kids has access to these spaces because the demand exceeds the supply. Yet the province still keeps the cost low. It was this program that became the touchstone for the Liberal government’s 2004 plan to create a quarter million more child care spaces in Canada. When the government fell shortly thereafter, Conservative Prime Minister Stephen Harper scrapped that plan for another called “Choices In Childcare” or the “Universal Child Care Benefit,” which gave parents a taxable $100 for every child under six. The rationale was that this would benefit every parent no matter what choices they made for childcare: family, day home, day care, babysitter…
But exactly how does Canada measure up when it comes to taking care of our children? Surely a socialist country like ours would place high priority on raising children. It takes a village, right?
The Organization for Economic Co-operation and Development (OECD) ranked 14 countries on their early education child care. Canada ranked last. Only 0.2 percent of our GDP is earmarked for early childhood development. That’s not much of a village.
So who is benefiting from lower, subsidized day care spaces in Quebec? You’d think that it would be designed to help lower income families. According to a report issued by the Montreal Economic Institute, that’s not so.
Let us take the example of a household with one child in daycare and family income of $28,000. We can measure the financial gain or loss if the family is paying $7 a day as compared to $26 a day for an unsubsidized space. At the provincial level, daycare fees of $26 a day are eligible for a 75% refundable tax credit, or $19.50. This results in a net cost of $6.50, which works out to less than the current $7 subsidized rate. Tax consequences at the federal level results in the household losing even more. The amount paid for daycare affects net family income and thus also affect the Canada Child Tax Benefit, the GST credit and income tax. According to calculations by a tax specialist, a household with $25,000 in income, consisting of a single parent with two children (one of whom is in day care), would lose the equivalent of $1350 a year by using a $7-a-day childcare services as opposed to a $26-a-day childcare. For a household formed by a couple, the loss would be $1264. In contrast, a couple with family income of $60,000 would come out $935 ahead using the $7-a-day childcare rather than a $26-a-day childcare and a couple with $90,000 in income would come out $2,330 ahead. The policy thus provides the greatest benefit to upper-income families, who as it turns out make greater use of subsidized daycare services.
To add fuel to this fire, national childcare advocates are pushing for the government to further restrict private daycare options in Canada, after an Australian company - 123 Busy Beavers - began buying up Canadian day care centers. The company’s only crime seems to be that it’s the largest such company in the world.
It seems to me that a little free-market competition might help to keep the costs reasonable and the options open for Canadian parents.
It’s clear that the Canadian brand of socialism is no longer effective. Canadians are clinging to the safety nets of “free health care” and “subsidized programs” without thinking things through. They don’t stop to ask themselves “what would happen if the tax money currently earmarked for health care and subsidies stayed in my pocket?”
If Canadian socialism can’t take care of the children and the sick, what exactly is it here for?
Heather Cook lives in Calgary, Alberta with her husband, a former U.S. Army officer, and two children. She can be found online at heather-cook.com.
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28 Comments
1. David Thomson:There is no such thing as a viable health system unless its users directly feel the financial costs. At this moment, the typical individual residing in the West subconsciously, if not even consciously, believes the government or the insurance company is picking up most of the tab. Thus, they are tempted to be wasteful. Human beings are innately selfish. Ignoring this harsh fact of life will inevitably lead to a tragedy. The at least metaphorically reality of Original Sin remains alive and well on planet Earth.
Nov 23, 2007 - 10:22 am 2. Matthew:No offence to Miss Cook, but having worked and been treated by Canadian (Ontario) healthcare, she’s missing the biggest part of the puzzle. Our doctors are running a supply-side cartel and are not graduating enough MD’s to fill the roles required given the demographic shift where baby boomers as they age require increasing care. Until that’s solved single-payer universal system or out-of-pocket system is moot. The other thing Heather fails to mention is the relative costs of each system. At present our system to cover everyone regardless of its warts, costs about 50% of what the United States pays on a per capita basis and in the USA, not everyone is covered ($3,165 vs $6,102). In addition, your private insurance costs are growing at upwards of 8%-9% per year, while our tax-funded system is growing at only about 4% per year. Compound that over a decade and the difference is going to be striking. But frankly that shouldn’t be the end comparison. Canada’s system does not equate to “the only way a universal system can get set-up”. Based on what I’ve read there are several European as well as the NZ and Aussie systems that appear better, although it must be remembered they are operating without the cartel-create doctor shortage we have. See attached patient-interviewed study for some interesting reading for those who are willing to look at numbers rather than make this decision based on ideology: http://www.commonwealthfund.org/usr_doc/1027_Davis_mirror_mirror_international_update_final.pdf One last thing, for those that do see Universal Coverage as some sort of political sin, why is it that no one complains about Medicare and in particular the Bush Pharma Plan? Both are 100% socialist systems that are cctually far more inclusive than what we have here (no province here includes prescriptions), so why shouldn’t they be banned in the United States as well? I’ll check in to answer any follow-up questions anyone has later….Cheers all. And a belated Happy Thanksgiving to you all too.
Nov 23, 2007 - 12:32 pm 3. mishu:why is it that no one complains about Medicare and in particular the Bush Pharma Plan?
You haven’t heard complaints only means that you haven’t been paying attention.
At present our system to cover everyone regardless of its warts, costs about 50% of what the United States pays on a per capita basis and in the USA,
If that’s true, why are Canadian income tax rates roughly double that of the U.S. income tax rates. Why are sales tax rates almost double as well? If socialized medicine costs less, why aren’t savings passed on to tax payers?
Nov 23, 2007 - 12:50 pm 4. Heather Cook:Matthew,
You are correct. I did not miss these points, it just was not the focus of the article. I could go on for 3000 words on the Canadian health care system but I can really only focus on one aspect at a time. Your points are very valid.
Oh, except I’m a Mrs.
:0)
Heather
Nov 23, 2007 - 12:55 pm 5. David Thomson:“In addition, your private insurance costs are growing at upwards of 8%-9% per year, while our tax-funded system is growing at only about 4% per year.”
Canada’s costs may be going up only 4% annually—but that’s not saying much. Truly ill Canadians are often forced to go the United States for emergency care. The country is grossly unable to take care of its own people. America is its safety valve.
Nov 23, 2007 - 1:42 pm 6. Heather Cook:David Thomson,
You are so right. My last article for PJM was on that very topic - Canadians going to the US for treatment.
Moms from Alberta and Ontario giving birth in Montana, Politicians having follow up surgeries in California…
MRIs, Knee surgeries and hip replacements are the most common medical procedures that Canadians have done in the US. There’s even a segment of the “medical tourism” industry that caters to Canadians travelling to the US for procedures.
Nov 23, 2007 - 2:08 pm 7. Robert:This article is rather timely considering I am here in Canada this week visiting my youngest sister. I live on Long Island along with the rest of my family but my Sister married a Canadian back in 1992 and has lived here ever since. She brings up the topic of health care all the time. For her, she would never move back to the United States because of the high cost and inaccessibility of health care. Granted she has had problems find a primary care physician but she likes the fact that in an emergency the last thing you have to worry about is being covered.
I myself will be losing my current job by the end of the year and the biggest fear is the loss of medical insurance. My own physician now charges $200 for a simple office visit (no tests or anything other than just saying “hi”). My current Health Savings Account plan cuts that to about $65 which I have to pay but without any insurance that would be the full $200. Now the insurance companies have only one primary responsibility; to increase profits and return value to the shareholders. As such, I see private medical insurance going nowhere but higher in cost. Some kind of quasi-public/private system is going to have to be developed for the United States or everyone is going to wind up being covered by default by the taxpayer.
Nov 23, 2007 - 3:57 pm 8. jacksmith:My heart goes out to Dennis Quaid and his family. And to Kanye West and his family. These are two unfortunate examples of why it is so important to end the Cancer of private for profit health care delivery in America. HR 676 Single Payer Universal Health Care (Medicare For All) is The Way to go. Like all other developed countries did years ago. See sickocure.org
You see, It’s not just about the 47 million Americans that have no insurance. Or the 89 million who went without insurance part of the time from 2006-2007. It’s about everyone. Private for profit health care delivery is not only highly immoral, and unethical. It is just down right dangerous, and bad medicine. That injures, and kills millions of Americans needlessly. Disgracefully. Shamefully.
These injuries, and deaths should not have happened. We only heard about them because it happened to celebrities. But these tragedies are happening to thousands of Americans every day in this country. But you don’t hear about it. These thousands of needless deaths, and injuries of your loved ones are covered up. Under so-called patient confidentiality. Which is just health care industry speak for “don’t tell anybody we injured, or killed another one”.
See, no one is immune from the Cancer of private for profit health care delivery. Mr. Quaid’s children were being cared for at a very renowned hospital. And I am sure Mr. Quaid probably has excellent insurance. And can afford the finest medical care available. But as it turned out. None of that mattered. Hospitals have always been potentially very dangerous places. But under the pressures of greed, and a rush to profit. All US hospitals have become extremely dangerous, deadly places. Like they were in the 18th century. When hospitals were primarily the place you went to DIE!
I don’t know exactly how this tragedy to Mr. Quaid’s babies happened. But I imagine it was the same scenario that plays out thousands of times every day across America. Driven by greed, and the profit motive hospitals cut corners as much as they can get away with. This means staff that is over worked. And under staffed. It means hiring the least experienced, and cheapest hospital staff you can get. And pushing out the more experienced safer higher paid staff.
They say the pharmacist stocked the wrong meds. And that the hospitals were warned about this problem months ago. After many other perfectly healthy new born babies were killed by this mistake. I wonder how many thousands of perfectly healthy babies were killed this way across America. And how many thousands are still being killed this way across America.
It should not have mattered what concentration of heparin the pharmacist stocked the medicine cabinets with. Because every one who administers drugs is supposed to have been taught to follow the (7 R’s).
a. Right drug,
b. Right patient,
c. Right dose,
d. Right time,
e. Right route,
f. Right reason,
g. Right documentation,
This is just basic practice. A experienced person will check additional things. Before giving a patient a potentially deadly drug.
In anticipation of coming changes in our health care system. Thousands of patients are being killed at a fevered pitch. And millions injured, and poisoned with unnecessary medications, medical procedures, and surgery’s. In an orgy of greed, and profiteering a head of proposed changes to our current disgraceful health care system.
HR. 676 Single Payer Universal National Health Care For All (Medicare For All) can fix this disgrace. Until then, I advise you to be careful of taking any recommended medical care at this time without doing your home work. And getting a good independent 2nd, or 3rd opinion. Especially if you have so-called good insurance coverage.
And If you have to receive medical care in, or out of a hospital. Try to have a knowledgeable family member or friend to keep an eye on what they are doing to you.
Good Luck…
Nov 23, 2007 - 4:13 pm 9. Raymond Barry:Unfortunately everyone misunderstands the real purpose of so-called universal health care. It has very little to do with health care. Its real use is to make it possible for middle class people to afford high mortgage and SUV payments. In effect, it is a subsidy for the auto industry and the real estate agents.
Nov 23, 2007 - 4:16 pm 10. pixologic:Canadian universal health care is not profit driven, that’s why even amatuers and people who don’t know what they are doing can become doctors in Canada.
Nov 24, 2007 - 2:22 am 11. SlimJim:Heather’s point was an analysis of Canada versus the US. We can easily go over NZ or AUS or even France, the UK and Cuba and China and find a wide variety of programs. The one core to these all is that the medical industry is an arm of government. Thus it reflects the needs of government, not the individual.
Nov 24, 2007 - 6:28 am 12. mishu:There are those in the US who believe medical care should be managed by the same people who put $ billions in pork ears into every budget bill passed and WILL NOT create a balanced budget. At the same time, it is not written within our constitution that Americans should be taken care of from cradle to grave. The theory of life in this country, for as long as I have known it, has been that I should be given every opportunity to succeed or… fail, depending on my self, not government. Over time, the US population has been given political Kool Aid to permit government to manage sectors of the commercial economy. The latest example IS Mr. Bush’s drug plan.
At the same time, much of the higher costs incurred in medicine in the US can be directly attributed to government interference and restriction. Who does not believe that someone can come up with a better medical plan if they believe they can make money at it? Who, also doesn’t understand that the reason we do not have enough vaccines for standard treatments of the common flu is because government has fixed the cost on this commodity? How much of Robert’s $200 fee goes to government mandates and liability insurance?
With the aging baby boom population, why have the number of medical school graduates declined over the past 25 years? Could it be because college students who are now looking at medicine hear the stories of those now practicing in the general fields and how, between government restrictions and trial lawyers, there is very little ability any more to make a significant income for one’s self and family? Of course, there is no shortage of cosmetic surgeons because that industry is still an elective surgery, for which the people pay.
Every country, save one, has a tradition of government management of their nation. Their people expect government to “fix” problems. It’s a situation where the Canadian people will need to vote in another government who will address this situation. Then change might come. The US is the one nation where government is meant to be “of the people, by the people, for the people.” That way, our people can grow to help each other and our neighbors to the north, when they need it.
Umm jacksmith? if hospitals kill people, they won’t be profitable. Killing people is just not good customer relations. People will choose to go elsewhere for treatment. HR. 676 will take that choice away from treatment.
Nov 24, 2007 - 8:44 am 13. Fred Beloit:So Robert is up in Canada visiting relatives (fly or drive $$$ ?). That’s nice. While he is there, he is paying an eight to ten percent currency premium when he buys some good or service. He choses the warmth of family and is willing to pay a price to enjoy it. Why should health care “insurance” be any different? Why should I have to pay part of his $200 health care visit so he can go to Canada when I am already willingly paying for my own health care? He wants me to in effect help pay for his trip. That is what this is all about.
Nov 24, 2007 - 8:52 am 14. Daryl from Canada:As a Canadian, I can tell you that our health care system is a very important item in our daily life.
Unfortunately today we have a situation wherein people do not have an appreciation of what the system costs and it is abused.
My GP when asked told me she believed that 2/3 of the people in her office didn’t need to be there. This is what happens when there are no user fees associated with usage of the health care system. I believe a combination of a nomimal ($20 or so) charge to go to a GP with some private delivery of health services would make our system far more effective.
I also agree with the post regarding creating more doctoral seats at the universities. You are completely right that this would reduce the inflation we see with the cost of doctors. We also need many more nurses as their inflation is worse currently than the doctors. We have nurses making well into the six figures in Canada, which I don’t believe we need to be doing.
Pixologic: your comment doesn’t make sense. Because of the low number of people who get into our Med Schools, the people who get into Med Schools in Canada are the brightest people on campus. They are not “amateurish” in the least and I would put the quality of Canadian trained doctors against any out there.
Nov 24, 2007 - 11:40 am 15. Matthew:First, to Heather, my apologies for my mistake re: Mrs vs Ms. No offence was intended.
To Mishu re: costs - I assume you didn’t open the attached file I provided. I breaks down a comparison of nations with costs and outcomes. RE: Tax Rates - Don’t forget that your current tax rates are based on running deficits that average in excess of $1,000.00 per citizen while Canada’s current tax rates are based on running surpluses of about $400.00 per citizen. In short, our nation on its own balance sheet is generating a net difference of about $1,400 per citizen per annum of net wealth which in our case turns into debt servicing savings, and yours turning into new debt servicing costs. If we chose to run the deficits you’re willing to, actually our tax rates would be very similiar. I should add that if you haven’t actually read your own budget (I have and compared it to both Canada as well as Australia’s budget documents, in addition to the IMF database which tracks national financial stats), you would be aware that your manditory spending including Medicare, Medicaid and Social Security has just surpassed the $1.2 trillion per year level (out of a total budget of $2.1 trillion). In comparison, your defence budget is only $400 billion. And the CBO going forward is predicting your numbers get downright ugly to the point that a number of your Republican Presidential Candidates have said outright that in their current form your entitlement programs will bankrupt your country (Fred Thompson is one, I’m blanking on the other I’ve heard describe it in interviews). Bottom Line: I find it interesting that you’re willing to bag on the Canadian system (as well as Australias, NZ’s, France’s, Germany’s, etc.) which are all sustainable based on our current tax rates without recognizing the fact your model is fundamentally unsustainable without increasing yours, or cutting your benefit model dramatically.
To pixologic,
Your comment re: not being profit-driven and employing amateurs demonstrate beyond any reasonable doubt you don’t have a clue about which you speak.
To Darryl from Canada,
Totally agree. I’m in favour of user fees for services to eliminate that type of abuse. Part of that problem also comes down to the “for profit” model of doctors offices. For those Americans who don’t know, doctors offices are for all intents and purposes private businesses trying to maximize revenue and minimize expenses. The services they provide are then billed back to the various provincial insurance programs on a “fee for service” basis. Although this should maximize efficiency and generate the maximum number of visits possible, what ends up happending is that doctors tend to create a repeating book of business where in particular retired seniors are scheduled for repeat visits every 2-weeks or so, thus guaranteeing them a base level of revenue. Obviously on the downside because the schedules are always “stacked” it provides many fewer slots available for people who actually are sick and need immediate assistance. Add user fees, and this repeat senior citizen repeat business very quickly thins out. I should add newer doctors look at themselves far more a professionals instead of healers and because of that behave like lawyers trying to maximize their billing hours rather than healers who strive to heal those who need help. In short, it is the prioritization on a for-profit model that in cases creates this problem, as opposed to providing the solution. The other component which often draws comparison is the time to get a non-emergency quality-of-life surgery like a knee or hip replacement. Again, this is a huge entitlement issue. When you’re talking about $10,000 per surgery plus, the out of pocket cost of taxpayers providing several of these surgeries in a lifetime to retirees who want to continue to play golf, tennis, etc. is incredibly expensive. For this reason, user fees should be absolutely required with minimum patient contributions being 10% and maxxing out at 35% based on a means test, again with the objective of reducing unnecessary surgeries and the huge cost impact they make.
My final note is (and I’d like Heather to respond to this) if provinces dramatically ramped up med school enrollement and instituted the user fees described in order to thin out the unnecessary service abuse primarily by seniors, I think the measured outcome of the Canadian healthcare system would improve a minimum of 30% with no substantial increase in taxpayer costs (and again I state this having worked in the for-profit medical industry in Ontario for a number of years and with family, having no less than 4 friends in the healthcare industry and with family who sit on Hospital Advisory Boards).
P.S. Some of you may find the following interesting. My father as a semi-retired professional now sits on the local hospital oversight board. About a year ago they instituted a new patient satisfaction program. The program is based on EVERY patient who receives treatment now receives a follow-up call from a member of the treatement team (this includes doctors, nurses and admittance staff). The primary impetus of their questions is “If we could change one thing to improve your overall experience, what would it be?” The teams then meeting weekly to review those responses and adjust accordingly. Given the general disdain Canadian healthcare is viewed with south of the border due to what I see is intentional misrepresentation, I hope knowledge of such a program starts changing views from the current black&white to accept there are many shades of grey when discussing this topic.
Cheers all. I’ll be back later to reply to any questions anyone has.
Nov 24, 2007 - 1:06 pm 16. Winston:Let Hillary be the next POTUS and USA will become another Canada very soon. It’ll be very sad
Nov 24, 2007 - 2:52 pm 17. Heather Cook:Matthew,
No offense taken. :0)
First, you may be interested in a movie called Dead Meat by On The Fence Films:
http://www.onthefencefilms.com/video/deadmeat/
As to the provinces increasing enrollment in med schools and instituting user fees:
1. Med School Enrollment. That would be great, first we need to increase the number of spots available before we can increase enrollment. There are only 16 med schools in Canada and the spots are highly contested (as they should be, you don’t want just anyone there!) and far more people are turned away than get in.
Then, you have many graduates heading to the States where they can make a heck of a lot more money. This is why (Daryl from Canada) the salary of a nurse is increasing dramatically, because we need them to stay here.
From a recent Edmonton Journal article:
“Nursing is another health field that can’t seem to grow fast enough. Although institutions around Alberta have been opening more spots, enrolment is still well behind what’s needed to combat a provincewide nursing shortage.But the demand from students appears to be there. Ruth Hunter-Moffatt, dean of health and human service careers at NorQuest College, said the practical nursing program has a wait list of 200 students, while the pharmacy technician and health-care aide programs are also red hot.”
(http://www.canada.com/edmontonjournal/news/story.html?id=1a6c91ab-f521-4a20-b4b3-ff68c0b52df8)
2. User Fees. I could not agree more. I have no issue paying a user fee to go to the doctor. But I do know people who would see even $10 as a barrier. Especially here in Calgary where sometimes up to 75% of your income can be spent on housing. (Personally I’m at about 60%)
But user fees are not designed to be burdonsome, they would hopefully weed out the people who abuse the system. Unfortunately the Canada Health Act prohibits this. Unless you live in Quebec, they’ve managed to circumnavigate the Health Act in many ways that the rest of us aren’t entitled to. (Private health clinics etc..)
I must say, I have gotten great individual service at MOST of my hosptial visits. It’s not the fault of health care personnel that they system is stressed. The exceptions have been with maternity care, which is why I was able to pay out of pocket ($3000) for a midwife. Because this service is not paid for in Alberta, I am able to pay for it myself. So I wasn’t one of the Calgary women giving birth in the hallways of the hospital in August 2006 due to bed shortages.
Nov 24, 2007 - 3:04 pm 18. Richard Cook:Heather
What I see is the biggest problem for both systme’s is:
Canada - that model seems to provide basic medical services well but if you have something seriously wrong then you will wait for treatment and then possibly with not the most up to date treatment methods.
American - The biggest problem seems to be that insurance is not portable but tied to your employment. If you lose your job your insurance goes.
There does not seem to be any method of getting joe and josephine
Nov 24, 2007 - 7:32 pm 19. Fred Beloit:to take good care of themselves possibly lowering overall healthcare costs in both countries. Would you care to comment?
“Daryl from Canada :
As a Canadian, I can tell you that our health care system is a very important item in our daily life.”
I am so sorry to hear that Canadians are so sickly. In my visits to and trips through your fine country, I never noticed how many of you were ill or injured. You always seemed an especially robust group to me. May I wish you good fortune in solving this almost unbearable problem.
Nov 25, 2007 - 7:59 am 20. Jabbar Fazeli, MD:Better Healthcare for the un-insured. Why forgo simple solutions now in favor of comprehensive reform later?
As a physician and as someone who was once un-insured, I see both sides of the healthcare coverage issue. You would think that being a physician I should have always had health insurance, but in fact I did not have insurance coverage for two years; I could not afford the high premiums and pay for my new private practice at the same time. I also had an eye opening experience when I helped an un-insured niece through a life threatening illness for which I am still paying in excess of $330,000 in medical bills. The cute little thing is worth every penny but her medical bills total would have been no more than a measly $100,000 had she been insured.
It is undeniable that having millions of uninsured Americans is morally unacceptable and financially unsustainable for many Americans. It is regrettable, however, that we are constantly trying to address this problem by waiting for drastic solutions to materialize. We neglect the many smaller scale, less costly, options available to us now. Many of these interventions cost very little when compared to the holy grail of healthcare reform, the “universal healthcare”. Most importantly, we probably could implement many of these simple measures right away and with minimal controversy. Below is an outline of some of these quick and small scale fixes that in my humble opinion deserve more attention and consideration.
Families spend thousands of dollars on medical bills and health insurance premiums but are often unable to tax deduct these expenses. It would be worth considering removing some of the many restrictions that preclude the tax deduction of health related expenses, knowing that it would deprive the government of highly addictive tax dollars.
Hospitals and doctors, like me, have a peculiar billing system. The first ground rule is that they are not allowed to charge insured patients anything beyond what their insurance dictates by contract. This is in contrast to dentists who can bill patients for whatever the insurance doesn’t cover or underpay; something that makes dental insurance obsolete in my opinion, but that’s another story. You would think that all medical bills sent to the insurance companies would therefore be for the exact amount allowed, but they rarely are. These bills often contain charges that are more (much more in case of Hospitals) than the allowable amount for the medical service rendered. A Hospital that is billing $2,750 for a service that only pays $750 (per the insurer) is only going to get paid $750. The difference between the charges on the bill and the actual money paid is called an adjustment. So why bill higher if they’re only getting a pre-set amount, you may ask. There are many reasons for this billing practice, one of them is that the insurers periodically adjust the allowable payment rates based on actual unadjusted bills, and so Hospitals and physicians try to bill the actual desired amount rather than the allowable amount. For the insured person this is a harmless exercise except for the confusion when he or she reads a copy of the bill. Most patients eventually realize that they are not paying anything beyond what their insurance allows, and so there is no harm done.
In the case of uninsured patients this harmless billing discrepancy turns into sanctioned over-billing across the board. By law, hospitals and physicians must bill every patient equally for the same services. Therefore they must send uninsured patients the same unadjusted high bill they usually send the insurance companies. There is no adjustment to follow however, as there is no contract in place to mandate such adjustment. Ironically, the law designed to ensure equal billing is mandating inequality in billing for the uninsured. Simply put, in our previous example, the uninsured patient gets the $2,750 bill and has to pay the total amount. In comparison, the insured patient would get the $2,750 bill but the payment is only $750, as determined by the insurance company. Ironically most Americans, including politicians, are unaware of the shocking fact that there is no law on the books to protect the uninsured from this systematic over-billing. In the United States of America un-insured patients are charged much more than their insured counterparts and there is no law against it–shouldn’t this be a headline?
The only time an adjustment is offered is when the uninsured patient requests it, and if the Hospital feels generous enough to grant it. Physician bills are much smaller compared to hospital bills but the same legal principles apply. Each doctor’s office has a policy on how to deal with bill adjustments and ride-off for the un-insured and many make provisions for such patients, but they are not obligated by law to do so. Clinics with sliding scale payments and some government sponsored partnership programs with hospitals have no such issues of over-billing.
It would be great if presidential candidates or other politicians and activists were to show interest in tackling this simple issue of equal and fair billing for the uninsured. It would be quite reasonable to pass a law that requires hospitals and doctors not to charge the un-insured anything beyond what they expect from their best paying insurance. That would mean that the hospitals and physicians would still get to bill at the most generous rate available, and the un-insured will be spared the unfair over-billing.
Last but not least, there is the matter of the sky rocketing health insurance premiums. I find myself dealing with high premiums for my own employees, just like any other business. I can’t help but find it wasteful to pay the hefty premiums when most of my employees never end up needing a physician or hospital care. For my personal insurance I have a $5000 deductible insurance that has a premium of under $300 per month. That’s a total of ~$8600 per year, assuming I use up all the money set aside for the deductible. The ~$5000 I am allowed to deposit in my health saving account is totally tax deductible and I use it for my dental care, medial bills, and medication purchases, etc. Any remaining money in the health saving account carries over to the following year and it even earns interest. After depositing $5000 the first year I can either supplement it with smaller amounts the following years or deposit the maximum ~$5000 allowed each year, creating a cushion for future years. This money never goes to waste and can even be inherited.
I considered the same insurance option for my employees but I realized that there is a constant problem and that is that most people who can not afford the high health insurance premiums can not afford to set aside $5000 for their health saving account to cover the high deductible. Without having this money set aside in reserve in the health saving account they risk having to pay for unexpected medical expenses of up to the maximum $5000 deductible out of pocket. Most employers want to help but can not afford to step in and contribute the full $5000 per employee towards their individual health saving account as that can add up to a large sum of money. This becomes a major barrier for use of this seemingly reasonable healthcare insurance option. If small businesses or businesses in general, were allowed to have a business health saving account to cover employees in lieu of individual health saving accounts then the amount of money that has to be set aside by the employer can be set to be much less and still have a large sum of money on aggregate to be used toward employee high deductibles, and still enjoy the lower premiums offered by the high deductible insurance. Businesses can accumulate money, tax free, in the business heath saving account overtime to be used for various healthcare expenses. This is yet another option that should be considered by politicians and advocates even by those who believe in working towards universal coverage.
Being a geriatrician, I deal with the US versions of government sponsored healthcare as most of my patients are insured by Medicare, Medicaid, and the VA. These programs provide universal coverage for select groups, the elderly, the poor, and the veterans. I also had first hand experience with national universal healthcare when I practiced Medicine in Eastern Europe at one point in my life.
Nov 25, 2007 - 9:08 am 21. Heather Cook:The grass is greener on the other side, as they say, but for those involved in the healthcare industry it is no secret that countries with national universal healthcare are moving towards fee for service models to supplement their universal systems. Private healthcare in these countries is readily available and is accessed by the wealthy unsatisfied with the long waits and the inevitable rationing of healthcare resources. Rationing healthcare resources often seem very reasonable to planners and proponents of universal healthcare until these individuals are themselves the ones waiting an extra couple of months for chemotherapy or are denied expensive life saving measures. The wealthy have no such worries as they will always have the option of paying for their healthcare or traveling to wherever the needed medical care is available. They are also more likely to use their influence to improve their access to any universal healthcare system, resulting in even longer waits for the rest of the population. I also worry that expenditures on the elderly will likely be considered a second tier priority, as spending healthcare dollars on children and younger adults will most likely be considered more cost effective. Ultimately, Americans who choose universal healthcare should ask themselves if they believe that Medicaid, Medicare and the VA is the way to go for all Americans. Hopefully any major overhaul of healthcare in the USA will be a result of deliberate analysis and debate, and not just because it’s better than nothing. In the meantime, I think it’s reasonable for all sides of this debate to press forward with what little we can do for the uninsured now, even if it is done piecemeal.
Richard Cook;
“There does not seem to be any method of getting joe and josephine
to take good care of themselves possibly lowering overall healthcare costs in both countries. Would you care to comment?”
It can be difficult to legislate any sort of healthy living. Which will cost more: a man who smokes all his life and doesn’t get sick until he’s in his 70’s and dies six months later (like my grandfather) or a marathon runner who has two knee replacements by the age of 40 and then goes on to require the normal amount of health care that any senior does.
There is a lot to being sick or healthy that is genetic. Not that that removes any responsibility, it just means that people with genetic marks against them are more likely to be less healthy.
First you’d have to determine which level of government should be responsible for helping us get healthier. The provinces control health care spending, but the Canada Health Act is federal legislation. Then you have regions in each province that actually deliver the health care.
But really, getting Joe and Joesephine Canuck to take better care of themselves starts with Joe and Josephine valuing health and having them realize without a shadow of a doubt that it is NOT and should not be up to the government to take care of them regardless of their health situation.
Digression: There was a senior in Calgary who recently hit his head and went into a coma. Doctors issued a DNR (do not resuscitate) and the family disagreed, eventually getting a court order to block the DNR and allow her to get a second opinion. (Don’t forget, Canadians have to go through their current doctor to get to a specialist… if their current doctor won’t refer them, they are stuck. Obviously this man’s doctor had written him off.) The man has now recovered to the extent that he can write his name, speak and recognize family. The Calgary Health Region is still fighting the court decision because they don’t want to set a “dangerous precident”.
Sorry… back to your question…
There are very few things Canada has attempted to put into place:
Tax benefits for the parents of kids enrolled in sports. Called the “Children’s Fitness Tax Credit” of a credit up to $500 a child (http://www.cra-arc.gc.ca/fitness/)
Focusing on vaccinations, getting every child they can vaccinated before Kindergarten.
Re-doing Canada’s Food Guide to “better reflect evolving eating patterns and food markets, an increasingly ethnic population and new scientific findings”. (http://www.hc-sc.gc.ca/fn-an/nutrition/fiche-nutri-data/rationale-raison_d_etre_e.html)
Uh… that’s all I can think of. This past week someoen from the Calgary Health Region basically stated “we need you all to take care of yourselves… because we can’t do it.”
It is easiest for me to speak about Alberta, where the government pays $3695 per person per year on health care and where the wait times are the longest. Our overall unemployment is the lowest in the country and the health care staffing crisis is critical.
In Calgary, 20% of us have no family doctor (my husband included, since my older doctor doesn’t take men) and the city apparently needs 300 more physicians to remain out of a crisis situation. (http://www.missoulian.com/articles/2007/11/25/news/local/news05.txt)
My family is probably very typical. Busy. Two kids. Husband and Wife both working. Child care costs are high. I have a gym membership that I don’t use because I can’t find the time. With a promotion at work I find myself busier than ever and it’s tough to tear myself away for an hour to work out. And getting up in the morning? Puh-leeze… when the baby still wakes up a couple times each night I like all the sleep I can get. Then I’m sitting and writing until 11 pm or so.
What’s the solution? How can the government encourage me to be healthier? Oh, wait, gee… maybe it’s not up to the government to help me. Maybe Canadians just have to let go of that notion that the government CAN and WILL help them.
Richard: I do know Americans who are self-employed (writers) who have their own insurance. So it’s not that insurance is not portable, it’s that the insurance that is portable is wildly expensive. From my understanding.
Right now it would SEEM that the system provides basic care well, but I would have to disagree. When your doctor comes in and only talks to you for three minutes because she’s too busy … and you can’t switch doctors or get access to a specialist without having your doctor’s OK, then the system doesn’t work very well at all.
Nov 25, 2007 - 9:32 am 22. Matthew:To Heather,
Alright where were we?
1) Med School Enrollment increase - Looks like a point of agreement. Again, my fundamental problem with measuring Canadian “system” results is I believe it’s very hard to measure any system if it’s chronically understaffed. It would be like measuring a hockey team who only played 4 players (sorry, couldn’t resist using the hockey analogy in a U.S. forum
). Of note, for Richard your comment re: the Canadian System I think falls into this category. It’s not “designed” to cause difficulty to transition to specialist care. There are difficulties because it’s understaffed.
RE: Canadian-Trained Healthcare providers moving to the United States for higher salaries - First, I think with the revaluation of the $CAD vs $USD, I do not see that trend occurring nearly as much as we did in the 80’s when it was a significant problem. That being said, I think there’s an easy solution to that. As most Americans may not know, Canada heavily subsidized post-secondary education, and most heavily medical field training. Under the current system, those individuals are allowed to take that subsidized training (which should be accounted for in our healthcare costs) and relocate anywhere in the world without restriction making the Canadian taxpayer investment ROI equal to exactly zero. If we are going to continue a medical training subsidy, the structure needs to modified so that students are billed at full rates during their training and then are granted loan forgiveness over a period of 10-years or so. The end result is to create a barrier to bolting to other jurisdictions after receiving upwards of $200,000 in educational subsidization from Canadian Taxpayers.
RE: What Canadian Med Schools teach: The other problem I have is of the graduates, we are generating far too many vanity-focused doctors and too few emergency specialists. Our $200,000, and most importantly that key medical school spot is going to train someone who is going to open something akin to a high-end spa providing cosmetic enhancements such as botox, breast enhancements, skin peels, etc. I have no problem if doctors choose to go this route, however such specialization should not be subsidized as it’s not part of what we really need.
RE: Alberta specifically - I don’t what to say on this issue. I have two sets of uncles and aunts and five cousins in Alberta and they say things very similar to you. That being said I think it’s primarily a mismanagement issue as opposed to anything else and I put most of that Klein and now Stelmach. I used to sell custom software into the oilsands projects and in 2005 flew out to Fort McMurray and received facilities tours of both Syncrude and Suncor. I was absolutely baffled by the lack of forward planning across-the-board considering the long-term planning timelines surrounding oil sands development. The fact Klein hadn’t put money to expand the 2-lane highway from Alberta which regularly resulted in unnecessary traffic accident deaths, as well as the urban planning mismanagement within Fort McMurray were mind-blowing. As a side note, the recent oil royalty review by Stelmach was another mindnumbing read. Bottom Line: I’m not there, but considering the fact your province is generating fiscal surpluses of billions per annum, I find your provincial government’s management of most folios….let’s call it confusing. My gut instinct is that if you put someone like Gwyn Morgan (former Encana CEO for those who don’t know) in charge and I think your provincial services could be 100% better in very short order. Good Lord, I’ve got Dalton in charge and as awful as he is, I wouldn’t trade you for Stelmach, and I’d trade Dalton for a ripe turnip.
Matthew.
P.S. Just for some additional background information, my grandmother needed an emergency hip replacement after a fall and she received that within 48-hours of that fall. She subsequently received comprehensive physiotherapy to heal all of which costs $0.00 out of pocket. She now lives in an assisted living nursing home that is subsized by the provincial government. I flag this because nursing home subsidies constitute an ever-larger portion of healthcare spending but its inclusion is often omitted from the debate. In the last year, I have a female friend who is a hotel sales rep in Niagara Falls whose mom was diagnosed with breast cancer and she was in chemo within 2-weeks and I talked to her just about every day during the treatments and the service was apparently outstanding. The biggest problem that exists in Ontario remains Emergency Room wait times and again that has to do with understaffing. Fix the understaffing and suddenly things aren’t too bad. Sadly I don’t expect Dalton to do anything smart in this respect but it’s important to recognize that “the system” cannot really be separated from the provincial leadership and management.
Nov 25, 2007 - 1:17 pm 23. Chevy:First of all, I think it’s great that you managed to change your mind; to see what was really happening, and not ignorantly believe that health care is free. In the US, the situation is not great but fortunately nothing like your “free” health care in Canada. I wish more doctors would refuse to take insurance, and treat only patients who pay out of pocket. I truly believe that this would keep health care costs down. Why? Right now, people rely on health “insurance” to pay most of their costs. How is that possible? It’s not, which is why both costs go up- the cost of insurance, and the cost of medical care. Furthermore, why should I need insurance to go to the doctor? An office visit without insurance typically costs around $200. Why? The doctor certainly did not do $200 worth of work in fifteen minutes. My co-pay for an office visit is $30. Easy for the doctor- the rest of the money is paid by the insurance company, so doc gets paid, and I can still go to the doctor for an office visit whenever I like, because it is only $30. However, this keeps the price high! There is no place else I can go that is going to offer me a lower price and bring competition to the market. No doctor that will say “Hey, I will look at that poison ivy for only $15 and write you a prescription!” So here is the problem; I have to use my insurance, because otherwise my poison ivy is going to cost me a ridiculous amount of money, and insurance rates will continue to rise, because insurance is used for things as stupid as poison ivy. I can see having major medical insurance, because who among us can afford to pay out of pocket for something terrible? But that is truly insurance; what we have now is mostly just pre-paid health care, except for some reason (as a job perk because we can’t afford the health care) our employers usually are pre-paying for us.
Nov 25, 2007 - 1:40 pm 24. Richard Cook:You write that maybe its not up to the government to help you. I think that is not correct. The electorate will decide what the government is for, for good or ill. I understand what your opinion is but it seems it will be many moons before any move away from the “safety net” is made. Canada has and the US is on the way to placing itself in a trick bag. The government could provide everyone’s desire for low cost health care but the electorate is unwilling (in the US) to bear that burden. They want something for nothing. Canada has accepted higher taxes but those taxes are buying a relatively constant amount of care as demand goes up. Also in the US malpractice insurance drives doctors from some specialties such as OB-GYN is an example. I really don’t know what the answer is and there may not be one until people’s view of what public spending can accomplish changes. To carry that view one step further how long will publicly supported services of any kind be tenable in view of rising costs, desire to maintain a certain standard of living and demand?
Nov 25, 2007 - 2:46 pm 25. Richard Cook:I think, boiled down, in the US we will have to prioritize which entitlements we want because we will not be able to afford everything at the current tax rate. Canada will need some kind of user fee to stop its overloading. From my perspective (Chicago area) I cannot see support for raising federal taxes since the local and state taxes are slated to go though the roof soon. We essentialy have a “socialist” system now, albeit a very badly organized one. We should make it official and deal with it instead of keeping with the charade.
Nov 25, 2007 - 4:35 pm 26. Heather Cook:Richard,
You are right, the electorate will decide what the government is for.
At the moment, whether the Canadian health care system is SUPPOSED to help us or not - it can’t.
Necessity being the mother of all inventions… perhaps a new system will emerge.
Chevy, I haven’t even touched on the mess of billing in the Canadian health care system… whole other article there!
Heather
Nov 25, 2007 - 7:25 pm 27. Matthew:Heather: “At the moment, whether the Canadian health care system is SUPPOSED to help us or not - it can’t.”
I’m sorry Heather, but I’ve got to call you on that one. For half the cost of the U.S. there are millions of healthcare service transactions provided per year from physicals, to flu shots, to prescriptions, to subsidized nursing homes, to emergency services, etc., etc., etc. all currenty at $0 out-of-pocket for those requiring service (again important to contrast vs the U.S. system where they often forget to add their cash costs on top of their deductibles on top of their insurance premium costs on top of their tax contributions). There may be instances where we don’t get Westin-level service for our money but that doesn’t negate the fact that based on our relatively small investment (on a per capita basis) we get a tremendous amount of coverage especially when contrasted to U.S. spending and their entitlements.
By the way, just to go back to a previous comment in which we were in agreement which was that the doctor shortage regardless of the single-payer system dramatically impacts our systems capabilities, I think we need to define what that staffing level should be. At present we are in a position where we as potential patients are competing for scarce doctors. That needs to be reversed so that doctors are numerous enough they start competing for us. Now if you follow that logic through (especially when you include the provision of user fees we agreed upon earlier) what that means is that even with relatively flat budget spending, service levels could rise dramatically very quickly as more doctors actually fight for positions (which in turn could actually create health industry wage deflation).
Nov 25, 2007 - 8:42 pm 28. Matthew:I actually heard this on the radio this morning on my way into work. I thought it interesting in the context of ths debate because although I would never relate such errors to the U.S. healthcare funding model, if this had happened in Canada I’m quite certain it would’ve generated significant coverage due to the HMO and Insurance Lobbies and the blame would’ve been placed squarely on our universal single-payer system.
Decide for yourself. If this article was about a hospital in Toronto, how would you have all responded?
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R.I. Hospital Fined For 3rd Brain Surgery Mistake
(CBS) PROVIDENCE, R.I. Rhode Island Hospital has been fined $50,000 and reprimanded by the state Department of Health after its third instance this year of a doctor performing brain surgery in the wrong side of a patient’s head.
“We are extremely concerned about this continuing pattern,” health department director David R. Gifford said in a statement Monday.
The hospital issued a statement saying it was re-evaluating its training and policies, providing more oversight, giving nursing staff the power to ensure procedures are followed, among other steps.
….continues
http://wbztv.com/topstories/local_story_331110858.html
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Nov 27, 2007 - 7:08 pm