broadsideblog

How Universal Health Care Works. You Get Sick, You Get Care and You Don't Get a Bill

In Medicine, politics on July 12, 2009 at 12:06 pm

Fantasy?

Reality.

Not in the United States, where editorial and op-ed pages are currently bristling with competing ideas and fears. We’re facing more class warfare as the wealthy are asked to kick in more tax to pay for the rest of us. Those who have good health care benefits through their jobs don’t want those benefits taxed or messed with. Those who can’t even afford to see a doctor are desperate. The one-third of us who work freelance, temp, permalance or don’t have access to a subsidized group healthcare plan are paying through the nose for market-rate prices — one New Yorker I know is paying $1,200 a month for his family of four. He runs his own company in an industry that’s been hammered by the recession and has already had to lay off many of his long-time, full-time employees. Do you have a spare $1,200 a month right now? Who does?

In the current health care economy, it’s every man for himself. For many of us, it’s ugly and frightening and unworkable and it has to change.

Universal health care is a reality in Canada, where I grew up and where my 72-year-old mother and 80-year-old father and many friends live. It means knowing, from cradle to grave — whether you’re a student, unemployed, part-time worker, full-time worker, stay at home mom, divorced mom who can’t afford health insurance, self-employed — your taxes are paying for everyone’s undeniable right to see a doctor, (yes, you may wait; details later) and get good care, often excellent care, and not receive a bill. The bill is pre-paid. Your taxes paid it. In Canada, you can easily drop $12 for a candy bar and a few magazines — thanks to the 15% GST (goods and services tax) slapped on many purchases, even stamps. Gas costs twice as much there as in the U.S. (taxes.) Liquor costs more (taxes.) Higher taxes are a fact of life in Canada. But they buy everyone health care and access to heavily subsidized university tuition, at the very best schools, of $5,000 a year –no, that’s not missing a zero.

Here are a few stories of life under that system from the two provinces whose care I have seen firsthand, Ontario and British Columbia (Newfoundland, a much poorer province, to name only one example, is different, as a powerful and frightening Globe and Mail series on health care disparities across the country uncovered.) These are stories I have been trying to sell, and tell, through U.S. publications for a while, to no avail. You — voters, readers — need to hear what it’s like. And not just from the AMA or HMOs who have deeply vested financial interests in this issue.

My mom’s brain tumor. Seven years ago, she was living in a small town north of Vancouver. To reach the major city hospital that alone could perform the necessary tests, she had to travel by ambulance and ferry, more than three hours each way. There are very few CAT and MRI machines in British Columbia because they cost millions; unlike the U.S., where machines are plentiful and close at hand, in Canada, there are fewer of them (because the government does have to make decisions where and how to allocate its resources) and patients have to go to them. While we waited for answers, her GP (internist), sat with me at her local community hospital for 90 uninterrupted minutes, explaining what might be wrong, what would happen next and explaining that I, her only child, might also burn out from anxiety and sleeplessness. He cared as much for my health — never having met me before — as for my mother’s. Once diagnosed, with a meningioma 4 inches wide, she was quickly scheduled for surgery, a six-hour ordeal. She was assigned the chief of neurosurgery at Vancouver General Hospital, a major teaching hospital. Before the operation, the surgeon sat with me, patiently answering my many questions. She emerged in great shape, and needed six weeks in the hospital to recover. No bill, ever. No fear of a bill, ever. During my time in Vancouver, I sat for two hours with the hospital’s social worker, a young woman who gave me her undivided and compassionate attention. Not only was my mother’s physical health at issue, the condition of her sole family member at the bedside, me, was equally compelling to the many members of her healthcare team. It was a terrifying time but the care — and I mean that here in an emotional, not strictly medical sense — we both received was extraordinary. I remain forever grateful.

My mom’s breast cancer. Again, quickly diagnosed and given quick access to surgery, this time her surgeon was the head of oncology for another major teaching hospital. We are not wealthy or socially connected. We didn’t have to make calls and pull strings or pay extra or wheedle friends to get this treatment. It’s what the system — tax-payer supported, government-financed — gave her as a tax-paying resident of that province.

My stay at Toronto General Hospital. I was doubled over with stabbing intestinal pain, and my GP diagnosed appendicitis. I was admitted to this major teaching hospital within hours. Turned out to be some stomach bug and I was discharged the next day. When you show up to the doctor’s office, or to the hospital in agonizing pain and alone, filling out reams of forms and discussing insurance is not top of mind. In Canada, you show your health insurance card, and you’re done. There’s no additional pre-admission clearances or the terror of getting hit later with a five-figure. even six-figure bill you didn’t anticipate.

The system is not perfect. If you have a non-emergent condition — like cataracts or torn cartilage in your knee, to name two I’ve seen personally — you will wait for treatment or surgery. You might wait six months. Now that I’ve lived in the U.S. for 20 years, I’ve become spoiled and, like fellow Americans, expect great care fast. I’ve had two knee surgeries here, both to remove torn cartilage, damaged over decades of athletic activity. I got my MRIs and surgeries within weeks of diagnosis. I’d have been really frustrated to have waited a long time — and six months is a long time if you’re a highly athletic person, let alone in daily pain — for this resolution. So, I see both sides of the issue. My mom needed cataract surgery and faced an equally long wait, as this wasn’t (versus cancer, say) an emergency. If you live alone in a rural area and need to drive everywhere, seems to me that’s pretty urgent. She decided to pay for the quick treatment herself, and was fortunate to be able to do so.

One of the many arguments made in the U.S., a nation where one-third of us are overweight, and many obese, with soaring concomitant rates of diabetes, is that people need to take better care of themselves. Which is true. The elephant in the room is this — why whould I pay additional taxes to pay for you? Or your kids? Or your smoking, junk-food-eating, couchsitting relatives? In the land of the individual, what works for me is what seems to count most. A compromise that works for all of us? Not so much.

Life isn’t fair. Some of us are genetically pre-disposed for diabetes, cancer, heart disease. Some of us will simply get really sick and need a ton of costly surgery and treatment through no fault of our own, no matter how meticulously we have cared for ourselves, our kids, our families. Why should we be punished financially by a system that simply doesn’t allow for bad luck? If you have a job with benefits and lose that job, you’ve got COBRA for 18 months — if you can afford it. That pre-supposes, within those 18 months: 1) you even have the cash to buy your own insurance, now unsubsidized by your former employer 2) you will have found a new employer who is offering you benefits and 3) have not been fired or laid off from that job and 4) can afford COBRA again.

That’s a lot of assumptions. And in this recession, which isn’t ending any time soon, I’m not sure they’re correct.

  1. “We’re facing more class warfare as the wealthy are asked to kick in more tax to pay for the rest of us.”

    Class warfare? Oh come on can’t we have a discussion on this topic without the right wing talking/scare points. There is nothing “class warfare-ish” about a progressive income tax. Canada ranks 14th in the word for life expectancy, the US 45th, hows that for a scare tactic.

  2. Right. What kind of people are we to not provide free critical and reasonably priced care options to every human being who walks our soil, as does our neighbor to the north and the old country, England? I can’t think of a better, or more humane use for our taxes.

  3. Brian, I agree with you….I think taxing the wealthy is fair and our only humane option. The middle class and below are totally strapped as it is.

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