As the health-care debate rages, my ears twitch when I hear "the Canadian system," "socialized medicine," "single-payer plan" mentioned as near-utopian.
That's because as a U.S. citizen living legally in Canada off and on for 25 years, I witnessed the initiation, implementation and crises from ground zero: medical offices, hospital emergency and patient rooms, pharmacy counters.
Let me explain Canadian health care from a consumer perspective.
Medicare, a comprehensive national Canadian health service for all ages, was enacted in 1966; the federal government paid 50 percent, the provincial governments contributed the remainder. Taxes to fund the system were levied on a sliding scale, with low-income people contributing little or nothing.
Residents received a plastic card with a number -- and later a photo, to discourage fraud, which continues despite the photos. In 1966, I had three preschool children. The first change young mothers noticed was that pediatricians stopped making house calls; too time-consuming, since the government set lower fees. But it was heaven knowing Medicare covered whatever was needed -- hospitalization, tests, surgery, routine care -- with no cap.
Physicians were allowed to "opt out" of Medicare and open private practices with no penalty except some limitations on hospital appointments. Many (including nearly all the psychiatrists) did. Others accepted unofficial co-pays. Even more of the younger ones opted out of the country. Government-subsidized medical schools churned out doctors, who fled south.
At that time, to increase population, Canada offered a good deal to immigrants. Up to 100 languages and dialects are spoken in Montreal alone. They came and they came and they came, creating a sizable population of low-wage earners, therefore low-tax payers, who still needed medical attention, which -- although increasingly stressed -- was still "free."
Health professionals had to work even harder and see more patients to earn target incomes -- which, with a few exceptions, I believe they deserve.
The system went into overload. People still had to buy insurance to cover private rooms or testing at a private lab rather than waiting at a clinic.
And the taxes kept rising.
But I can only testify to what I saw, what I experienced.
Example No. 1:
I once needed several skin cancers removed. My options were to see a dermatologist on Medicare or go to the hospital dermatology clinic on a given day and wait hours. The dermatologist I called was making appointments six months hence for new patients but allowed them to call three mornings a week to see if there were any cancellations. I got one.
The procedure was "free," but -- imagine this -- the doctor explained that Medicare covers only injectable anesthetics at a hospital clinic. Incredulous, to avoid writhing in pain I paid the $40.
Just as puzzling: Ophthalmologists who work out of the hospital are allowed to charge the going rate for an examination that results in change of eyeglass prescription. How can patients work if they can't see? But treatment for an eye infection or an exquisitely complicated eye surgery requiring months of aftercare remains "free."
Example No. 2:
My family physician retired. His office had been too far, anyway. I called several doctors in the very nice, very large Montreal suburb where I lived. None was taking new patients. A telephonist explained that no general practitioners in the area were.
But if you're ill, there are walk-in medical clinics (usually one doctor per venue). By 7 a.m. the line is longer than for Final Four tickets. Therefore, people lacking family physicians (because there are none) end up in emergency rooms at the hospital in the district where they live.
Some hospitals seem OK. Others -- don't ask. I sat in one for 12 hours with a family member lying on a gurney in a busy hallway lined with very sick, groaning patients. Did you know the term "bedlam" comes from "Bethlem," or "Bethlehem," the name of an English mental hospital formerly known for the chaos that prevailed there?
Example No. 3:
I needed a blood test. My choice was to lay out money at a private lab, do the paperwork and be fully reimbursed at a (much) later date by my private insurance. What the heck, I'll go to the hospital lab. I waited more than two hours in a filthy waiting room without enough seats for the disgruntled crowd. The technician did not wear gloves, nor did he wash his hands between drawings.
Horrified, I asked why.
"Lady, if we did that you'd be here for three hours," he answered.
Example No. 4:
Tummy trouble. My GP referred (referrals required) me to a gastroenterologist. I was given an 8 a.m. appointment. Good, I thought; I'll be done early. Twenty-five people were in the waiting room when I arrived. I approached Receptionist Ratchet, meekly saying, "My appointment is at 8 a.m."
"Theirs are, too," she snapped.
I learned that the office had three seatings: 8 a.m., 11 a.m. and 3 p.m. First come, first served. I left, untreated, with a worse tummy ache than when I arrived.
Example No. 5:
The hospitals. Some look like sets for a 1950s horror film, except that the majority of overworked staff, by far, is offshore-trained. This does not denote lesser ability. But I have observed -- and reporters are trained observers -- a difference in attitude toward patients and their families.
Pros and Cons
The system has advantages. I had a relative with a slow but fatal illness requiring several surgeries.
Because the surgery was specialized, he was treated at the crme de la crme of teaching hospitals by noted physicians. I imagine his care over 15 years cost in the millions. Although in a high tax bracket, he paid pennies compared to U.S. health insurance.
Yet, when his condition became terminal, he was admitted to and died in the same grungy hospital where I had blood drawn by ungloved hands.
Drug benefits are awesome, especially for seniors. The government regulates prices. Some drugs cost nothing, others a fraction of the tab stateside. Pharmacies are connected to a computer system that records your every prescription, no matter where filled.
Towns and cities are peppered with free clinics staffed by nurses/nurse practitioners who examine, make preliminary diagnoses and administer injections and vaccinations, but cannot prescribe medications. They refer you to a physician for that. Now go find one.
However, there is security in the knowledge that health care is a fait accompli. Canadians at least have a choice: Use the Medicare for which they are taxed -- or pay a doctor who has opted out. But no pregnant woman goes without prenatal visits, and the indigent are assured of care, eventually.
After not requiring hospitalization since 1974, I've had three surgeries (one at FirstHealth Moore Regional) since returning to North Carolina in 2007, two in emergent circumstances and the third even more scary.
Imagine my delight at the immaculate, pleasant surroundings, efficient and caring staff, amazing food service, minimal paperwork, and good follow-up.
Luckily, through U.S. Medicare and supplementary insurance, I can afford it. If not, it wouldn't make any difference how attentive the physicians or how sympathetic the nurses or how delicious the food, because I wouldn't be on the receiving end.
So be careful when courting a single-payer government health system like Canada's. You might get what you wish for.
Contact Deborah Salomon at email@example.com.
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