Thursday, January 10, 2008

Health ... and Canada

The World Heath Organisation has once again ranked the countries in the world on their health care. If you're reading this in the US, you're not going to be happy.

Again this year (as it has for the last several years), France had the best healthcare in the world, the fewest deaths due to preventable causes per capita, etc. Japan was #2, Australia #3.

Canada ranked sixth. But before you snigger, consider this: the US ranked #37. That's the absolute worst among industrialised nations. To me, this is pretty shocking stuff.

So why did the US do so very badly, when we all know the quality of the health care we see in the US is actually pretty good?

The reason, according to the WHO, is that not everyone in the US has access to good-quality medical care. A staggering 47 million people do not. I know I'm not there any more, but that's just embarrassing. It boggles my mind that this is not one of the top three issues out there on the campaign trail. Yes, all the (Democratic) candidates announced health-care plans, but has anyone actually read them or tested that they would work? It doesn't seem to be much of a priority to anyone, at least not anyone in the media.

As you know, Canada does not have this problem. Everyone is on a provincial-government-run health care plan (which varies from province to province -- another US myth shattered). Despite the protestations of blowhard millionaire talk-show hosts, this system is in use almost everywhere in the world apart from the US, and the evidence (deaths from preventable causes per capita, infant mortality per capita, cost per capita of coverage) is overwhelming: socialised medicine actually works very well indeed.

Next time someone gives you some stick about "socialised medicine," remind them that the fire department and police department are socialised. Try to imagine how well that system would work if private companies ran it. Now imagine those companies responding to a 911 call in your local Cracktown area. Yeah. I think this case is now closed.

Anyway, this gives me an excuse to talk about my own (very limited so far) experience with Canada's health-care system. Let me first state that I, as an immigrant, am not in the system, and won't be for some time. As far as doctors and pharmacists in Canada are concerned, I'm just an uninsured US visitor.

I take a couple of prescription medications for hypertension (high blood pressure): Norvasc and Lisinopril. When we lived in Florida, we were covered by United Healthcare, which in our view was the best of the corporate insurers in Florida for employed people (your mileage may vary). Doctor visits were $20, and my pills were $40 for both per month (as name brand drugs) and were $30 for both when I tried the generics (which didn't work as well for me).

For the math-challenged like myself, that works out to $1.33 per day for my medication, and a reasonable fee for doctor visits. We are both pretty healthy, so I never had to put United Healthcare to the real test (ie a medical emergency involving a hospital stay). Seems pretty reasonable so far.

In Canada, I'm presently uninsured. This means that when I went to a doctor up here to renew my prescription, the visit cost $70 (and I was in and out of there in 15 minutes flat!). The pills (name brand) now cost me a combined $50/month (compared to $40/month under US insurance). So my "health bill" has gone up, but only because I'm not yet "in the system." A person in my situation in the US who does not have insurance would pay approximately double (for doctor visits and prescriptions) of what I'm paying up here.

When that happens, which should be in a month or two, my costs will go back down to about what we paid under United Healthcare in Florida: a monthly premium of around $100/month for the two of us (yes, health insurance in this province isn't "free"), smaller (much smaller) payments for the prescriptions and smaller office-visit fees. Where Canada's coverage tops the US is in two areas: sliding-scale fees based on income mean that everyone is covered (which saves a dramatic amount of money overall, according to the government) and when it comes to high-cost medical needs such as hospital stays, surgery, long-term care and so on. My costs do not escalate if I need those things. My premiums do not go up if I need those things. If I need them, I will get them. Guaranteed. Done.

That's a lot of peace of mind my "premium" just paid for.

An interesting "side-note" to this story: pharmacies in Canada have what I guess is best described as a nurse-practioner on staff. If you're suffering from something you think is minor, you don't even bother with the doctor, you just go see the pharmMD (as they might call it in the states) and they write you their own prescription and fill it on the spot. This is a trend that is starting to appear in the US (hello, Shelly!) and I hope it catches on big time, it's a great idea.

The topic of health care has been much on my mind lately, in part because the candidates and the media in the US relentlessly lie about Canada's health-care system, and in part because while I am not presently in need of Canada's advantageous way of covering emergency/surgical/therapy/long-term needs, I know someone who is.

Meet Brian Maguire.

He wasn't a close friend of mine, he was just a guy I knew and admired in Orlando. He played drums for a lot of bands, most notably the Delusionaires. He had a motorcycle accident (probably his own fault, he wasn't wearing a helmet, but that's kind of unimportant right now). He hit concrete. With his head. He ain't doin' so good, as Rev. Jarvis might say. I'm happy to say that reports are that he's moving uphill rather than downhill on the recovery scale, but he's a long way from enjoying any hookers-n-booze-fueled after-gig parties. Heck, he's a long way from walking and talking.

Suffice to say he's in a bad way. It pains me to read the MySpace blog following his progress, because (obviously) he's now at the mercy of a health care system that just wants him to stop costing them money. The quality of the care he's getting right now (at ORMC) seems to be good, but of course they're trying to move him (read: slough him off to some lesser facility) to get him off their books. I don't blame them, I blame the system. From what I understand, Brian's on Medicaid only, one of the many with no real health insurance. This is the fear of everyone who's been struggling along with him to get better: that the system may ultimately fail him because he ain't rich.

The fact that such matters are a non-issue here in Canada is one of the reasons why their health care system is better than in the US. It's not about the quality of care; the US would probably edge out Canada on that score. It's about whether it's there for the person who needs it most and can afford it least, like Brian.

We're pulling for you from up here, Brian. You've got a great bunch looking after you and you're in our thoughts. Hang tough and get better.

The rest of you reading this -- rent Sicko if you haven't seen it yet. Then have a good long think about what would happen to you if you had an accident like Brian Maguire.


Anonymous said...

Really, you are shocked that the US came in last in health care? H should tell you some of my story...

I hope you are both doing well. I dream of joining you there, north of the border.

-T in Iowa.

Anonymous said...

Good blog entry, Chas.

My mom takes Lisinopril, too.

Thanks for the Holiday card!

Ben in Orlando

Anonymous said...

Hello Chas,

I am not surprised. I pay nearly 400 USD a month for family coverage with Blue Cross and Blue Shield. The service you receive is not same as the money put into the insurance extortion racket.

My wife recently had her gall bladder fail. It had to be removed. She is much better now. Before we took her to the hospital we made absolutely sure the insurance company knew of the emergency and had approved for us to get her emergency medical treatment.

Their care was `barely adequate` considering they were also doing disaster drills at the same time. I was asked to leave the hospital outside in the surgery waiting area. I basically told the person my wife is having surgery and I was going to break a foot off in their ass if they did not leave me alone.

It pains me the country of my birth is so backwards in its ways. I am nor a Republican or a Democrat. I'm Green. That said, I do not believe in a national healthcare system. I believe the individual states should run their own systems. The sliding-scale system should replace the insurance extortion system.

Troy in Portales.

Anonymous said...

You should also point out that the medicare premiums you'll be paying don't exist in all provinces. In fact, I think that only B.C. and Alberta have them. Plans for prescription drugs vary widely from province to province. Also, a three-month waiting period is standard for anyone moving into a new province. If I was to move from Ontario to Manitoba, I'd have to wait 3 months before getting coverage. Of course, I'd have my Ontario coverage until Manitoba's kicked in!

I remember when my daughter was born, almost 17 years ago, all we did (when my wife was ready) was show her health card at the hospital, and that was it. Same thing 4 months later when she had to go in for gall bladder surgery. This was good, since neither of us was working at the time!

Chris in Eastern Ontario

dona83 said...

$70? Which clinic do you go to? Carepoint is expensive but if you go to a lesser known one it should only be $50. I'm not too sure though.

I developed DVT in 2006 and I think we up here just take it for granted that we can walk into a hospital, any hospital, if we're sick. I go to the doctor and I have to go through the insurance company to see how much they'll pay for things like cleanings and night guards but it's not an emergency situation. I can not imagine having this sort of dilemma say if I were to be hit by a car. Am I going to live or am I going to be stuck paying a mortgage for a hospital bill.

$54 for provincial health + $20 for private extended medical coverage per month, what a bargain. Family coverage would be a whopping $108 provincial + $40 for extended health...

Anonymous said...

You have some good points. I've been in Canada 10 years and have no health issues. I agree it's a shame there is no universal health care in the states. My observation is this: if you have a minor problem, Canada will handle it no problem. But if you have a major issue you are in deep trouble. Why? It's because they RATION the health care here, through the wait lists. Ask the woman that died last week of flesh eating disease, as she waited for care in a Calgary hospital emergency room. She had been waiting almost 24 hours before dying. It is better than the states, but you better watch out for yourself if you have serious health issues.