My friend Jim Stillman recently wrote asking if I'd seen the Michael Moore film 'Sicko' and asked for comments on it. I must confess, I have not seen the movie and any knowledge of it I have has come through newspapers, TV reports and blogs. I gather that what Moore has tried to do is show how the Canadian system of univerisal health care is superior to the pay as you go system of the USA.
Let's start off by debunking a great myth of our (CDN) system. It is NOT free. It is paid for through the taxes we submit every year to our great and glorious government. This causes great concern between those of us who realize it and those of us who do not. One person may live their whole life without needing to access health care while the next person may end up in hospital every other week. They both pay for the benefit, albeit on a sliding scale according to their income. One will feel cheated while the other feels he/she is getting a 'freebie'.
The coverage I have in Ontario is just as valid in British Columbia or Prince Edward Island as it is here. Alberta will pick up the tab for any services I might need and simply bill Ontario for reimbursement. No fuss, no muss. But don't get the wrong idea. Not all medical services are covered by our universal plan. Elective surgery (tummy tucks, breast augmentations, tattoo removals, face lifts, etc.) is not covered and must be paid for out of pocket. Unless you happen to be in prison, where you can sue the government to pay for your sex change operation, but that is another story.
Let's dispel the myth that we don't have a two-tiered health system. We do but it is very subtle. When I moved back to this neck of the woods, I had no family doctor. My parents live beside a doctor and one day I mentioned to him some trouble I was having with my left ring finger. He set up an appointment for me, diagnosed trigger finger and before you know it, I was being operated on. Don't think for a minute that doctor deals aren't made on the golf course. Of course they are.
This all came about because ten years ago Mr. Bob Rae of the NDP Party gained control of the government and decreed that we were graduating too many doctors from our universities. He capped the allowable limit and so we're faced with a shortage of doctors today. Knowing they are in short supply, doctors ask for, and get, the moon when they express an interest to locate in a certain community and then go further by refusing to treat people who might smoke. This is bull shit and again, another story.
When I was a younger man, a fellow I had been going to school with was involved in a horrendous boating accident which eventually took his life. He was rescued to Detroit Metropolitan Hospital where everything that was done for or to him was catalogued and added to his final bill. His parents ended up losing their home because of this. They simply couldn't afford his treatment, never mind the glass of orange juice that he might have had. That wouldn't happen here. When my first son was born, the hospital, as what I assume was a sick joke, presnted me with a bill. Five large. I almost fainted. The nurse explained I didn't have to pay it, they just wanted to let people know what actual costs were. A year later, he developed an infection and was kept in isolation for ten days. The bill came to a whopping 15 G's. In neither case did a penny come directly out of my pocket. You can bet dollars to doughnuts that I kissed my OHIP (Ontario Health Insurance Program) card to death.
I've spoken with a number of Americans about the differences between our two systems. I asked one fellow, "Who pays for the treatment of a patient who doesn't have insurance?" He assured me that no American leaves a hospital facing a huge bill. He wouldn't tell me who does absorb the costs and left me with the cryptic, "I vote with my wallet!" Huh? Did I miss something here? Where does that comment fit in? A friend of mine who emigrated to the States told me years ago you'd have to be an idiot not to have a private insurance plan. His plan cost him $400.00 back then. I thought fine for you, but what about those who can't afford the $400? What do they do? Another friend of mine is a nurse at Detroit Metro Hospital and told me that those who were unable to pay their bills were kept longer and used as guinea pigs for nurses in training. The nurses could use them to perfect their technique in administering injections, wrapping bandages etc. Maybe this was all the better for the patients. I tend to think of them as homeless people who would want to stay in a nice, warm building and to hell with what they had to put up with.
The private insurance that Americans purchase seem not to be all they are cracked up to be. It seems the providers still control your life in that they can dictate which doctor you are allowed to see, what hospital you may go to, how much you're allowed to spend a year, etc. While we have private clinics here, they are strictly for non-emergency use. If you need a note for work, you go to the clinic. If little Johnny stubbed his toe and you want someone to look at it to make sure it's not broken, you go to a clinic. If you've run out of pain killers and need a refill prescription, you go to the clinic. And none of this involves you diving into your pocket to pay for services rendered.
There is, at present, a great debate about opening 'for profit' clinics. The pros argue that if you have the cash, you can jump the queue and get fast treatment. Because not everyone is rich, the clientele will be less than at a government run hospital and your treatment will be more personal and intense. The cons claim that a 'for profit' clinic is in it only for the money and thus will give you nothing but assembly line treatment. Charge the person $100.00 for something, spend about $25.00 worth of time with him, show him the door and call "Next" and you get to pocket the remaining $75.00. The jury is still out on this and I can see both sides of the coin. I believe however, that the marketplace would separate the wheat from the chaff in this case and word of mouth would quickly shut down any clinic that blatantly puts profit before patient care.
We don't have to look too far to realize that we already have a (at least) two-tiered health system. Rock stars, athletes, government officials are all treated well before the average Joe would be. Perhaps if they had to wait in line the way the rest of us do, they'd come up with a system that treats patients in a more timely manner in a hell of a hurry.
Our two heath care sytems are not that far apart. I suppose the only difference is, how does one pay for their care? An American is handed a bill when he leaves a hospital and goes straight to the bank to re-mortgage his house to pay it. I would have to have an incredible amount of luck not to ever use the system, and if that was the case, I would save a ton of money. How much does it cost to remove tonsils? Would you have it done if you really couldn't afford it? I won't go into it here, but I think that's why we see all the ambulance chaser adverts over here. The Americans need all the help they can to pay the bills. You don't see that here. In fact, until recently, lawyers here weren't allowed to advertise their specialties. Thank God those days are gone, but we still don't have to run to the courts right away to try to put the blame on doctors in order to help pay the horrendous fees hospitals charge.Here in Canada, I walk out the door of the hospital a free man. No bills to worry about. I know you and your neighbour all contributed to paying that bill for me, as did I, and I am grateful. And if I never use the system, I don't mind chipping in to help the guy down the street who needs medical services.
Zach Larkins
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