Public health care: Canadian perspective on myths and reality
Friday, August 21, 2009 Moms Rising just came out with a great myth busting fact sheet. As a Canadian, I would like to tell you a little about the myths that are circulating and pepper them with a dash of reality from my experience with the public health care system and what I have heard from some of my friends and followers about the American system.
Myth #1: I will be denied the health care services that I need
People seem concerned that in a public health care system, they will be denied services that they need. While there are certainly some isolated cases of, for example, new experimental procedures not yet being covered by the public health care system, for the most part everything you could possibly need is covered. It is as simple as that. If your doctor sends you to a specialist, it will be covered. If the hospital operates, it will be covered. Most doctors have a list posted on their wall of things that involve an extra fee and those are usually optional personal needs (e.g. getting certain vaccinations for a trip overseas, having a detailed physical done and forms completed for a job-related health check, having the doctor fax or call in a prescription renewal to your pharmacy because you neglected to go for a follow-up appointment in time to get a renewal).
But in the United States, with private health care, things you thought were covered may not be as @blm03 found out the hard way. Or, in other cases, it may not be a surprise to find out that something you need or your child needs is not covered by insurance, but it sucks nonetheless. @blm03, like many others, has found that procedures, specialists and therapies that her kids need are not covered by insurance because they are a result of a preexisting condition or are not considered a medical necessity. In other cases, as @hippytrish told me via e-mail, there are waiting periods before you are eligible:For most insurance plans, they won't pay for a birth or prenatal/postnatal care until you have had the plan for at least 9-12 months, depending on the company and plan. So if you happen to get pregnant when you first get insured with a new job, expect to pay the entire cost of birth and prenatal care out of pocket, which is probably around $10,000 these days. If you end up with a c-section, obviously it's more. And you have to pay it all.
In Canada, there is no issue of preexisting condition or waiting periods between jobs and your doctor decides what is a medical necessity, not the insurance company that is trying to protect its bottom line. We do have private dental insurance instead of public in Canada and I have experienced these same frustrations. Things not being covered, only being partially covered, and getting estimates from the insurance company of what they will cover that are impossible to decipher, resulting in surprises when I submit the claim.
Personally, I like knowing that if my doctor says something is needed or even desirable, that it will be covered.
Myth #2: I will be put in a queue and may die or suffer while waiting for service
The nice thing about the public health care system is that people are seen based on how urgent their health issue is, not based on how shiny their insurance card is. So when you see a doctor, go to the emergency room, or need an appointment with a specialist, you will be seen first if your situation is the most urgent. You won't be seen first because you have better insurance.
@BreastfeedingM was concerned that her child would have died in a country with public health care. She wouldn't have gotten the quick care that she needed in a life threatening situation. I have sat in an emergency room in Canada, waiting for my turn. I waited, writhing in pain, with a sprained ankle while people with life threatening situations that came in after me got triaged quickly and taken right in to a doctor. Not people with better insurance, people with a better credit history, people with a doctor that had more pull. No, just people who had a more urgent health situation than mine. A few hours later, I had my x-rays taken and was sent home with crutches and pain meds, happy that the people whose situation was more urgent that mine got seen before I did.
I did wait in line that time in the ER and have other times when my situation was less urgent than others. But when I go to my doctor's office for an appointment, she is generally running on time. Often, if I show up a bit early, I even get in early. That stands in contrast to what some have told me about the United States, like this tweet from @hippytrish:
Unlike in the United States, as pointed out by @fentonslee, Canadian clinics and hospitals won't ask for prepayment of medical services .
You also do not need to fear that a trip to the hospital will bankrupt you. Via e-mail, @kunsthure said "When I was still working as a paramedic before becoming a SAHM, I had patients having heart attacks that didn't want to go to the hospital because they didn't have insurance and couldn't afford the bill". Or in other cases, people will find that their medical bills are piling up due to the co-pays, deductibles, and so on, and at some point they may have to decide not to undergo certain medical treatment because they just can't afford it anymore despite having insurance.
In Canada, if you need to see a doctor, even if your bank account is empty, your credit cards maxed out, and the creditors beating you down with a stick, you will get to see a doctor. And the bill will not be in the mail. Health care is a right, not a privilege. Health care is there to make you healthier or to save your life, not to bankrupt your family.
Myth #3: It is too expensive
Americans worry about paying more taxes. They worry about the cost of socialism. They worry that people who don't work and don't pay taxes will be getting health care on their dime.
First of all, there are plenty of uninsured people getting health care in the United States and are unable to pay the bill. That raises the costs of insurance for those that are insured.
Second, it is much less expensive to keep people healthy than it is to pay for emergency procedures for those that haven't been taking care of themselves. When you have a public health care system, there is a greater imperative for the government and society to work on health promotion to prevent health problems. Things like ensuring women have support for breastfeeding, helping people to quit smoking, battling the food industry when it packs our food full of crap, those are all issues that are public priorities. They aren't seen as simple personal choices. Because these things impact the health of our population, they impact the cost of delivering health care services, and it makes sense for the government to go to bat for its citizens and create an environment that helps them to take care off themselves.
Third, in a public health care system, there is no incentive for hospitals or doctors to do more expensive procedures for personal financial gain. Sure, our c-section rate is higher than it should be, but it is nowhere near as high as in the United States. You don't have to wonder when your doctor recommends a procedure, whether it is truly in your best interest or just a way to put more money in his bank account.
Lastly, in our public health care system there is an incentive for the government to take actions (regulatory or otherwise) to keep the costs of health care as low as possible. In the United States, according to @kunsthure:
As a result, costs are driven up and also insurance companies lobby doctors to convince them to prescribe cheaper alternatives to drugs in order to keep their costs down. So patients either end up with very expensive meds or the wrong med.
But you don't need to believe my anecdotal evidence. Just look at the United Nations data on per capita health expenditures by country. In Canada, our expenditures are US$3173 per person. In the United States, they are US$6096. That is almost double the cost despite the fact that there are not significant differences in the health of our populations (a joint Canada-U.S. study in 2004 found that 88% of Canadians and 85% of Americans reported being in good, very good or excellent health).
More stories
There are more stories, many more stories, about the injustices people have faced in the American health care system. Canada's public health care system is not perfect. There are problems, but they are run of the mill problems compared to the horrific situation of lack of coverage, dismal coverage and skyrocketing costs in the United States. To read more about the human stories behind the American health care crisis, check out Health Care Stories for America.
Are you scared of a public health care option for the United States? If so, what scares you about it? What would you like to know about the Canadian system?
Reader Comments (46)
[...] posted here: Public health care: Canadian perspective on myths and reality (No Ratings Yet) Loading ... Insider tips to your inbox.Join thousands of weeklyreaders. [...]
Great post! That really sums up a lot of what's going on with healthcare.
Absolutely wonderful post! Thank you for sharing the real Canadian health care instead of the paid-for scare tactic commercials we too often get down here.
Yes!!! Yet another reason why I should take my BIL's advice and move up to Canada by him, lol. Your perspective tallies with what I have heard from every Canadian I know with an opinion on the matter. And yet here, the people I know regret getting life-saving surgery because it is bankrupting their family, or avoid the doctor because of the potential costs and the risk of having an officially diagnosed condition if they have to switch insurance in the future--those pre-existing conditions are murder! And mental health care is really given the bottom rung of the insurance ladder. And it's not like we don't have waits for non-emergency care here in America, either. My daughter recently got in to see the pediatric gastroenterologist after a three-month wait just for the first appt. It was the same with a neurologist and a psychiatrist when I was a teenager (not long ago).
First of all, I must address the notion that ER's, or physicians, in the US triage people according to their health insurance company or credit history...that is ludicrous. There is a lot of misinformation in this post, but that is the most glaringly inaccurate. Everyone gets seen in ER's in the US, health insurance or not, and the timeliness of such has NOTHING to do with their health insurance or credit history, but everything to do with the relative urgency of their conditions.
In fact, that is one of the things driving up our health care costs; the uninsured using the ER as a family doctor. I worked ER's ten-plus years ago as a medical student, that was a huge problem then; it's only gotten worse. The 20 million or so non-citizens living in this country undocumented and thus without health insurance often use ER's as family docs (for the record, non-citizens here illegally ARE included in the oft-cited number of 50 million uninsured in this country)...and believe me, they don't have to show shiny insurance cards or provide credit history. And they shouldn't.
The US system is not perfect, and needs reform. So does yours. Neither is perfect, both have their gaps in coverage. I am befuddled by why Canadians become so defensive (and, in posts like this one, offensive) when we say we don't want to adopt your plan. Your country is trying to fix your system, too.
As Dr. Anne Doig, the Canadian Medical Association incoming president stated earlier this week about the conclusions of the CMA conference, "We all agree that the system is imploding, we all agree that things are more precarious than perhaps Canadians realize."
And she said, "We know that there must be change. We're all running flat out, we're all just trying to stay ahead of the immediate day-to-day demands."
And, "(Canadians) have to understand that the system that we have right now - if it keeps on going without change - is not sustainable,"
Here's a link to the article...it was originally in Vancouver Sun: http://www.google.com/hostednews/canadianpress/article/ALeqM5jbjzPEY0Y3bvRD335rGu_Z3KXoQw
Canada and the US truly are world leaders in healthcare. Instead of pointing fingers at each other, I wish we would take an honest look at our respective strengths and weaknesses, examine how each model got there, and blaze a new trail.
Just wanted to add in a personal opinion, for what it's worth: I've worked for the past fourteen years as a doctor in what I suspect might just be the worst public health care system out there (the UK National Health Service), and put up with the bureaucracy and the long waits and the frustration of rationed resources, and seen some things get better and other incredibly annoying things come in instead. And I would STILL take what I've got over what I've read about the US healthcare system. In a heartbeat. Yeah, my patients may have to wait for appointments and put up with stupid health care - but none of them are in a situation where they simply can't get any health care paid for in a situation where they desperately need it.
Love this post. I am sending it to everyone I know!
As a fellow Canadian I feel somewhat bewildered at the attacks being leveled against our system. While we all know it isn't perfect, I think that there are very, very few Canadians who would trade it for a private for-profit system. When we say our system is in peril, we are not suggesting that we want to abandon it or that we would prefer a different system. I think that's important for Americans to understand when they see quotes or articles.
There are two points that I wanted to follow up on from your post. The first is @BreastfeedingM's. My experience as a parent in the system is that children often receive a certain level of priority service. I would imagine this is the same in the US. We recognize that children are a special class, and they are not treated the same way. They receive the urgent care they need, and usually more urgently than an otherwise healthy adult.
The second point is that waiting time at a doctor's office has more to do with the doctor in question and the day than the medical system. There are doctors with crazy wait times and those without here in Canada. It would be inaccurate to suggest that somehow our doctors always run on time. Some do, some don't. Some have good bedside manner, some don't. That's the nature of life, and has little or nothing to do with who pays.
What it comes down to for me is that I don't have to worry about taking my kids to see a doctor. I was recently laid off, and I will lose health coverage through work in a few months. But I will remain covered. There is no concern about how I will pay for a trip to the ER with my baby if I need to do that. That's really the strength of the Canadian system.
Christine,
If people had the option of going to a doctor instead of going to the ER, they would. The reason we spend so much treating uninsured patients in the ER is because there is no other option for them, so they can't get preventative care anywhere else. They have to wait until it gets to the level where they go to the ER to get SOMETHING.
Nobody's saying Canada's system is perfect, but it sure is a heck of a lot better than the sorry excuse we have here in the US.
It seems like the little fact I pointed out was met with some disbelief, if not out and out accusations of falsehood. I wish that were the case. A very close friend of mine had a horrible time last year, when they switched insurance, getting her child with a wretched ear infection in to see any doctor at all. There were "new patient" waits far longer than one would like to see most places, and the only clinic willing to take on a new patient, locally, demanded that they pay the deductible amount because they had filed bankruptcy and were considered too much of a financial risk.
Similarly, in 2004, when I had my mercifully mild stroke, not understanding what was happening, my spouse took me to a walk-in clinic, as it was around 8pm. I had used said walk-in clinic in the past because it was conveniently located and had a small bill that I was paying down on a monthly basis.
i was shocked that I was informed that they had a new policy that all outstanding debt must be paid off before a party could be seen.
Brilliant.
I also recall once overhearing a man in the er being told "i could sew up your forehead, but who's going to pay for it?"
Not cool.
This week after 2 days of fever and misery, my 2 yo developed a stiff neck. I knew this was a bad combo, checked the symptoms online and headed in to ER at 10PM. Triage took 40 mins but 5 minutes into our wait after that we were shown into a peds ER room where my son was given toys to entertain him till the doc made it over to our room, about 15 minutes later. His suspected meningitis could have meant death within hours or neurological damage, but even in a full waiting room his care was deemed urgent and we were rushed to the front of the theoretical line. Luckily he's totally fine. The next problem is as yet unexplained but not meningitis. The doc told me: "He's fine, but if you feel nervous, I'm working every night shift this week."
The Ontario system may not be perfect, it may be in need of an overhaul, it may require a little extra money in taxes to sustain the system, but gosh darnit if I don't flat out love it. I've never ever, ever, ever been worried about my family and I getting health care at the drop of a dime for problems small and large.
Thanks for a great post.
Don't forget how much overhead goes into hiring tons of billing staff for every clinic and hospital in the United States. There are hundreds of insurance companies with different plans, phone numbers, and layers of bureaucracy. That is partially where that 30% more goes to administrative costs for care paid by private insurance figure comes in.
The Unites States IS home to the best hospital in the world--Johns Hopkins.
Canada's healthcare system isn't rated much higher than the USA by the WHO, either.
As a US citizen who has been both with and without insurance, I'm not totally against public healthcare. But I would like to see a more concrete plan *before* rushing into anything and then addressing problems as they develop. The government is woefully ineffecient at handling money, so yes, I do worry about how we're supposed to afford it when there are dozens of examples of misuse or mishandling of government money already.
Regarding the children, from an American with a Canadian-born daughter:
On June 1st, at home, our almost 4 month old was screaming off and on for five hours. I dismissed it as her being colicky, but the pitch and depth f her screams started to change, making my skin crawl. We called Telehealth, a free government service where you speak with a certified nurse about any health concerns you may have and they offer advice, and were told to take our daughter into the emergency room.
For the ride there, and our time in the emergency room, she was PERFECT. No crying at all. The triage nurse checked her out and said she had a normal pulse, temperature etc, and said that if she weren't a child, he would recommend that we head back home. But, since she's four months old and obviously can't communicate any problems she has very well, the triage nurse suggested we stay and see a pediatrician.
Within 20 minutes of registering our daughter, we were seeing a pediatrician. Again, this was obviously NON LIFE THREATENING, hardly even worth concern (it turned out that absolutely nothing was wrong with her and she was just throwing the most epic temper tantrum ever -- and yes, I felt horribly embarrassed). I can only imagine how much more swiftly we would have been served if she were actually screaming, crying, or had any symptoms of sickness.
I have no complaints about the Canadian system. I am so, so happy that I never have to consider money when it comes to my child's health.
Oh, I also want to mention that the next day, the pediatrician called to ask how our daughter was doing. Brilliant!
@Kayris: I'm sure there are world class hospitals in the United States. I haven't seen the WHO ratings of health care systems. Do you have a link? I'd love to take a look and also see what criteria they used. Some things I have read put Cuba's health care system ahead of that of the United States. All health care systems have their strengths and weaknesses, the Canadian and American ones included. And I agree that concrete plans are good. But getting things done is important too.
@MomTFH: I'm sure that accounts for a big chunk of the difference between health care expenditures in Canada versus in the United States.
Thank you for writing this, I LOVE it! I agree completely - and my kids and I have given the Canadian health care system a workout and we're profoundly grateful. I mentioned this post on my blog (and thoughts about it and raising a special needs kid in the US vs Canada): http://momartfully.typepad.com/momartfully/2009/08/my-sons-value-is-beyond-his-price.html
I'm sold!
I'm a citizen of both Canada and the US and have lived in both countries. You didn't need to convince me - I find it shocking that any Americans are actually proud of their current expensive, discriminatory and dysfunctional health care system - but I thought this was a good post. I did have one question, though. How does having a public health care system elminate incentves for doctors and hospitals to perform dangerous and unnecessary sugeries and tests? I know that in the US, doctors and hospitals still have strong economic incentive to do those things even with their medicare/medicaid patients.
Let me preface this by saying that I am an American who is all for my country adopting a public system like that in Canada. Our system is broken, and I see a public option that Obama is suggesting as one step in the right direction.
Having said that, like Christine said, much of your perceptions about the US system are inaccurate. I guess that's what happens when your evidence is primarily anecdotal. I'm surprised you didn't reply to Christine's comment, as you usually take the time to reply to criticisms.
The most egregious misperception is that any factor such as credit history, the influence of a doctor, or your insurance will effect the order you are treated in an emergency situation. This is just untrue. If you come in with chest pains and no proof of insurance, you will be treated before someone with a fever whose doctor might have called ahead. I doubt most ERs even have the capability to check credit history. Even if they do, they don't have the time.
The US system is in trouble, but I'm intrigued by Christine's mention of the potential problems in the Canadian system.
People tend to complain more than they praise, which means that you hear more about when the system fails and less about when it works. I could give you an hours long diatribe about how I've been poorly treated, but I tend to forget all the times the system worked for me or my family.
I do agree with you about health care being a right rather than a privilege. No one should have to worry about pre-existing conditions and the extreme cost of COBRA if you lose your job.
Thanks, Jill.
Here is a very fair look at different health care systems around the world and the myths surrounding them...for example, it's a myth oft repeated that we're the only industrialized nation that doesn't have a public health care system. It's also true there is a lot that needs to be fixed here: http://www.washingtonpost.com/wp-dyn/content/article/2009/08/21/AR2009082101778.html
If you'd like to know why I don't think a public option is a good idea in our country, here's one perfect example: http://www.youtube.com/watch?v=nCbwde1iRLQ Until lobbyists and special interest groups wield less power, we're turning over our health care to other private, for-profit entities.
What we need is an overhauling of insurance industry: no more rescission departments, no more screening for pre-existing conditions, remove federal ban on interstate health care purchases, tort reform. For a start.
@Jill:
I do hope to reply to more of the comments in more detail, but have been busy with my family this weekend and some of them do require a bit more reading and thinking to give an appropriate response.
With regards to your comment, I do recognize that in an emergency situation people are usually seen in the US even if they don't have insurance (and that people with insurance complain about them driving up their costs).
However, what about an important but non-emergency situation? Going to a clinic for strep throat, an ear infection, mastitis, an STD, vaccinations, an annual check-up or pap smear, or just a genuine concern about your own well being or your child's well being? When people get seen by a doctor in those situations, the chances of them ending up in the ER are significantly lower. Although I don't have concrete numbers, the situations that slee (@fentonslee) described in my post and in her comment are awful. In Canada, if you need to see a doctor for any reason at all you don't have to worry about your credit history or ability to pay.
We have a lot of things that need overhauling in the U.S. health care system. And we have spent an enormous amount of time and money "considering options"--truly over decades. More often than not, such considerations are reduced down to angry rhetoric, with lots of buzz words to scare people away from any change. Just last week, I blogged about such fear of change and why we need reform anyway (http://www.basilandbutterflies.com/?p=162 ). I appreciate this article, phdinparenting, because you take the time to address many of the unfair criticisms that are levelled at the Canadian health care system as part of that angry, uninformed, and perpetual argument.
Wouldn't it be terrific if we could move past angry rhetoric and start embracing solutions and change in the U.S. health care system? While the "public option" may not be perfect as currently conceived, it could dramatically improve a system that is based entirely on profits over health...where ER's are the only place many poor people can find any sort of health care, and where insured people often cannot obtain effective health care. I agree that no health system is perfect, but if we don't make some headway, we will continue to embrace mediocrity in one of the most important aspects of living...health. As parents, as citizens, as people, we should demand more than mediocre health care.
I don't have the link right now, I'll have to look for it, but I'm on vacation with a slow internet connection.
I don't think I've ever heard anyone think the US system is great, and I know Canadians who aren't thrilled with the system there either. No plan is 100% perfect.
That said, if you do have a problem paying for your medical services or meds, most doctors and hospitals will work with you without compromising your care. My husband recently negotiated a lower price for a test he had to have that wasn't covered by our insurance. When my daughter had eye surgery and needed a refill on meds, the doctor gave me a tube he had in the office, saving me 50 bucks. During my last pregnancy, I made sure I knew exactly what tests the doctor was ordered and opted out of some of them. (For example, I didn't need a measles titer and a blood typing done when I'd had them done a couple of years prior with my first baby.) And if you're seen at a public hospital, they will either write off money you can't afford to pay or work out an interest free payment plan for you, even if it's just 5 dollars a month.
Like I said before, everything went downhill when medicine stopped being about keeping people healthy and started being about profit. One of many of my posts about this is here (it's old): http://greatwallsofbaltimore.blogspot.com/2008/05/18-month-well-child-visit-today.html But I would still prefer to be a more concrete plan before we rush into anything.
@Christine:
Thank you for your comment.
First, as I mentioned in reply to Jill below, I do understand that people generally get seen in an ER if their case is urgent in the United States even if they are not insured. But do you really think that physicians and clinics in the US will see just anybody regardless of their insurance status and credit worthiness? If that is true, no wonder insurance is so expensive because there are probably plenty of people using the health care system that are not paying into it in any way. In Canada, anyone that earns an income and pays taxes is paying into the system.
Second, you do not have to adopt our plan. It isn't perfect. I actually prefer the German system (I lived there too). But I do think there are a lot of misconceptions about our plan and I wanted to address those in this post and also note that the things people are most scared about in our system are actually just as bad if not worse in the United States. I recently wrote a http://www.phdinparenting.com/2009/08/08/flexible-maternity-leave-parental-leave/" rel="nofollow">post outlining some of the things that I think need to be changed about our maternity leave program. I could write something similar about health care. There are things that should be fixed, that must be fixed. But I still think it is worlds better than the situation in the United States. I wish our system would become even more socialized so that I wouldn't have to deal with so much crap from stupid insurance companies when trying to keep my family's teeth healthy (dental is private). Thank goodness we have good eyesight or I'd be dealing with the crappy insurance company for that too.
Third, I am extremely pleased that the incoming CMA President is concerned about the state of our health care system. That is her job. Did anyone ever get elected President of the United States by saying everything is peachy and wonderful and we don't need to change a thing? No. Every leader that comes into a new position emphasizes what is wrong and what needs to change. It is how they get elected. What you neglected to say is that Dr. Doig is a huge advocate of public health care and she is not advocating abandoning our system. She is advocating looking for ways to improve it. That is fantastic.
I have been shocked by the scare tactics in the US over public healthcare. In Australia we also have a public health system, and while it's not perfect it does guarantee a basic level of healthcare for everyone. A few months ago my daughter had epiglottitis caused by Haemophilus Influenzae Type b (http://www.health.nsw.gov.au/factsheets/infectious/haemophilusb.html) even though she was immunised against it. I took her to our local hospital, she was seen immediately and within about half an hour she was in the operating room to have her airway secured. We were then sent by ambulance to the closest hospital with an intensive care unit where she received care until it was safe to remove the tube. All of this was completely free under our system.
One thing I don't understand is how people can be so concerned about the ability of the government to make healthcare decisions for individuals and yet be completely ok with a company whose sole goal is to turn a profit make the very same decisions.
I agree Amber - waiting in line at a doctor usually has more to do with the doctor than the healthcare system. But I think one of the things that helps here is that there is a cap on how much each physician can earn per year, so they do not have an incentive to take on more patients than they can handle (the downside of that is that there are waiting lists in many communities to get a family doctor and a lot of people have to rely on clinics...but at least they have the clinics).
"One thing I don’t understand is how people can be so concerned about the ability of the government to make healthcare decisions for individuals and yet be completely ok with a company whose sole goal is to turn a profit make the very same decisions."
YES. Thank you.
Try to keep in mind that the head of the CMA is rather like the chief lobbyist of the doctor's union and take anything they say with an appropriately sized grain of salt. Being hyperbolic is just one tool in their arsenal to get attention for their cause... which is generally half "give us more resources" and half "we want bigger paychecks". If they went out and said "Umm, yeah, we're good... everything is working generally well, we have a few things we'd like addressed buy nothing major, don't sweat it, no hurry" then they wouldn't keep their job very long.
If the Canadian system actually WAS "imploding", then given the comparative statistics on system performance between the U.S. and Canada I can't even think of an appropriate word to describe the American system considering it's being outperformed by the Canadian one almost across the board.
One of the things I like about the Australian system is that it enables people to see the appropriate level of professional for their issue. I remember being quite surprised years ago when I first read an American who mentioned taking their kid to a paediatrician for a well baby visit. In Australia you only see a paediatrician if your kid is sick, too sick for a general practitioner. Most Australian kids therefore make it to adulthood without ever seeing one. Well baby visits (vaccinations, checking height and weight, breastfeeding help and general advice & referrals) are taken care of by local maternal and child health nurses. If you live in the suburbs (as most Australians do) there is generally a maternal and child health centre within walking distance or a short drive, those nurses then act as contact points for everything in the local area that is pre-school kid related from playgroups to relationship counselling services. They're free, they're funded by governments because it's the most efficient and effective way of supporting new parents and improving the health of babies and toddlers. They were established by charity groups in the pre-universal healthcare era (between the wars) to cater to those with little or no health insurance. Now we all pay for these centres through our taxes (instead of the centres relying on uncertain charitable contributions) and we (almost) all use them. When economic "rationalist" governments have tried to limit access to maternal and child health centres it has not been popular.
There are many things I would like to change about the Australian health system, but the failings are generally in the areas where Medicare doesn't reach, or where care is restricted (like dental and mental health).
What I would like to see is interviews with the heads of every conservative party in all of the countries that have universal health care. It is not a political issue. No major movement is trying to get rid of single payer or so called "socialized" medicine in any of these countries. No conservative party, as far as I know, has this as a platform.
Only in this country do people let lobbying and special interest groups (i.e. insurance companies) trick people into organizing against the good of the people.
Grant - that is an excellent point.
Thank you for sharing some more examples Slee. People that think this isn't happening are in serious denial. Not only are people being turned away when they need medical attention, but it also turns the decision about whether to take care of your health into a financial decision, which it should not have to be.
Perhaps people that think such things never happen are in "serious denial", but I think there's still a difference between the exception and the rule. For instance, Americans against a public system often bring up long waiting lists in the UK and how people have died on a waiting list for a surgery or procedure. Does this unfortunately happen? Yes. Does it happen all the time? Probably not.
Making new patients wait longer to be seen is standard procedure. I have been on the receiving end of this frustrating policy. But look at it from the other side - if you have been to the same doctor for years, wouldn't you want some form of loyalty? Of course anything pressing should override this policy, but if it's a routine checkup at a new practice, why shouldn't you have to wait?
In general, my problem with this post is how anecdotal it is. Yes, this woman overhead a disturbing comment by a doctor in the ER claiming he wouldn't stitch up a patient w/o insurance. I'm not saying anecdotal evidence isn't powerful, but you need more to form a convincing article.
I'm also surprised at the amount of hostility this seems to be causing (I am Canadian). I heard a news reporter mention that health care seems to be channelling all of the fear and uncertainty that the economy, war, drought, etc. have been placing on USians, especially since it is such a personalized issue. Perhaps Obama's timing on this is wrong because there are so many other precarious things happening, but I understand it was a pretty major part of his platform so he doesn't want to appear to be backing away from it.
Lest we forget, the startup of Canada's healthcare system was not easy, either. The movement came from a political power elected by farmers (aka population not covered by health care) and doctors, insurance companies and big businesses all fought against it (http://www.healthcoalition.ca/History.pdf). It's hard to imagine these companies having that position today.
Oh, and one more thing. Yes perhaps in the scheme of things it's "not cool" for that doctor to say that to a patient. But you also need to realize that the doctors are also caught up in a broken system. They have to pay for their exorbitant insurance and other fees. If they have a large amount of patients that never end up paying, they take a big hit. Medicare routinely pays less than the cost of a procedure. They have to make up for the uninsured and those on Medicare and Medicaid somehow
I think it's important to see the larger system at work and blame the insurance carriers and the private system of insurance rather than the individual actors. This might help you understand why doctors are tempted to do such "uncool" things.
I think we all agree reform is needed and a system to be put in place that would make such decisions unnecessary.
@Jill:
I won't pretend to have the time or resources to do a comprehensive critique of the US healthcare system. I only wanted to dispel the myths about the Canadian system (which I feel I can speak more authoritatively on) and point out that some of those same things that people are so worried about with public health care actually happen in a private system too.
With regards to new patients waiting longer in a non-emergency situation, I think that is fine. That is normal here too. When you start with a new doctor, you will usually be given an appointment to come in for a full physical and that appointment may even be a few months away. Of course, if something urgent comes up in the meantime you can see the doctor. But for a routine check-up, you may need to wait. I wasn't objecting to that type of wait. What I was objecting to is situations where people may be turned away because they have an outstanding balance owing or otherwise cannot or are perceived to not be able to pay.
When I am trying to decide whether to buy a new DVD player, that should be a financial decision (can I afford it, is it a financial priority right now, what else would I be giving up?). But I don't think that taking care of your health should have to be a financial decision.
@Jill: I'm not blaming the doctors. I think it is horrible that they are put in that position.
I think you're missing the point of healthcare reform.
It's not about the hospitals, it's about getting people IN to the hospitals. The insurance, not the actual provision of care. Yes, John Hopkins is a great hospital. Yes, it's in the United States.
There are over 300 million people in the United States.
Very, very, very few of them have the option of going to John Hopkins when they need medical attention. In fact, a great many of them don't have the option of going to ANY hospital when they need medical attention, at least unless they want to face bankrupting their family over it. So... a whole lot of good having John Hopkins in the country does them. I mean sure, be proud you have this really great hospital... but maintain some perspective on what that actually means as far as medical care for the average American is concerned.
And I appreciate bashing the government over waste and inefficiency is a popular national past-time all over the world, and it's often entirely warranted... but please try to take an objective look at the facts. Even in the US, medicare runs with something like 5% administrative overhead... and that's when all the toughest, highest maintenance patients get dumped on them (like, the entire senior population of the country). Private insurers are more like 15% or higher just dealing with mostly healthier younger people. So it doesn't make much sense to be complaining about the "woefully inefficient" government handling of health insurance dollars when the private sector is doing it three times worse, does it?
Hello all, great debate. Thank you for this article. I am a Canadian and have worked in our public health system for over 35 years. My husband also works in the system. Our health care system is not perfect but I am thrilled that we have it. I too have sat in emergency and had to wait while others sicker than I are brought to the front of the line. People with cancer, life threatening illnesses and injuries etc. are seen first. What I love is that it is portable between provinces, accessible - as Canadians we are all afforded insurance, and universal - it covers all life saving procedures (not naturopaths, chiropractors, massage). It has its flaws in that you need to wait for some things which can be a problem but I do not fear that if I change jobs or get laid off that I will not have any insurance.
I agree with you Gayle, getting Canada's health care system going was not easy and was fraught with fear mongering and such. However, it is the one thing that I think we can be proud of as Canadians in that we did not cave in to the fear but saw what the potential good there could be for the majority.
[...] Public health care: Canadian perspective on myths and reality [...]
[...] PhDinParenting provides a Canadian perspective on health reform, debunking myths and sharing anecdotes about what it’s like to live with a public health care system. Among the many interesting comments on this post is one that includes a link to “A Brief History of Canada’s Health Care System.” [...]
[...] few weeks ago I wrote a post called Public health care: Canadian perspective on myths and reality in an attempt to break down some of the myths that I kept hearing about the Canadian health care [...]
[...] Box WordPress PluginMost days, I’m proud to be Canadian. Whether I’m talking about our health care system, our maternity and parental leave programs, feminist leaders, or other topics close to my heart, my [...]
[...] have maternity and parental leave programs which are not perfect, but are a good start. Oh, and health care that is universally available instead of being tied to that crappy job that you really wish you [...]