Posted on 04/28/2016 4:37:41 PM PDT by SeekAndFind
Conservatives are rumbling around the talk show circuit bellowing about the socialist threat to the (literal) American body politic. And, as usual, Canada is once again getting dragged into the fracas, shoved around by both sides as either an exemplar or a warning and, along the way, getting coated with the obfuscating dust of so many willful misconceptions that the actual facts about How Canada Does It are completely lost in the melee.
Im both a health-care-card-carrying Canadian resident and an uninsured American citizen who regularly sees doctors on both sides of the border. As such, Im in a unique position to address the pros and cons of both systems first-hand. If were going to have this conversation, it would be great if we could start out (for once) with actual facts, instead of ideological posturing, wishful thinking, hearsay, and random guessing about how things get done up here.
To that end, heres the first of a two-part series aimed at busting the common myths Americans routinely tell each other about Canadian health care. When the right-wing hysterics drag out these hoary old bogeymen, this time, we need to be armed and ready to blast them into straw. Because, mostly, straw is all theyre made of.
1. Canadas health care system is socialized medicine.
False. In socialized medical systems, the doctors work directly for the state. In Canada (and many other countries with universal care), doctors run their own private practices, just like they do in the US. The only difference is that every doctor deals with one insurer, instead of 150. And that insurer is the provincial government, which is accountable to the legislature and the voters if the quality of coverage is allowed to slide.
The proper term for this is single-payer insurance. In talking to Americans about it, the better phrase is Medicare for all.
2. Doctors are hurt financially by single-payer health care.
True and False. Doctors in Canada do make less than their US counterparts. But they also have lower overhead, and usually much better working conditions. A few reasons for this:
First, as noted, they dont have to charge higher fees to cover the salary of a full-time staffer to deal with over a hundred different insurers, all of whom are bent on denying care whenever possible. In fact, most Canadian doctors get by quite nicely with just one assistant, who cheerfully handles the phones, mail, scheduling, patient reception, stocking, filing, and billing all by herself in the course of a standard workday.
Second, they dont have to spend several hours every day on the phone cajoling insurance company bean counters into doing the right thing by their patients. My doctor in California worked a 70-hour week: 35 hours seeing patients, and another 35 hours on the phone arguing with insurance companies. My Canadian doctor, on the other hand, works a 35-hour week, period. She files her invoices online, and the vast majority are simply paid quietly, quickly, and without hassle. There is no runaround. There are no fights. Appointments arent interrupted by vexing phone calls. Care is seldom denied (because everybody knows the rules). She gets her checks on time, sees her patients on schedule, takes Thursdays off, and gets home in time for dinner.
One unsurprising side effect of all this is that the doctors I see here are, to a person, more focused, more relaxed, more generous with their time, more up-to-date in their specialties, and overall much less distracted from the real work of doctoring. You dont realize how much stress the American doctor-insurer fights put on the day-to-day quality of care until you see doctors who dont operate under that stress, because they never have to fight those battles at all. Amazingly: they seem to enjoy their jobs.
Third: The average American medical student graduates $140,000 in hock. The average Canadian doctors debt is roughly half that.
Finally, Canadian doctors pay lower malpractice insurance fees. When paying for health care constitutes a one of a familys major expenses, expectations tend to run very high. A doctors mistake not only damages the body; it may very well throw a middle-class family permanently into the ranks of the working poor, and render the victim uninsurable for life. With so much at stake, its no wonder people are quick to rush to court for redress.
Canadians are far less likely to sue in the first place, since theyre not having to absorb devastating financial losses in addition to any physical losses when something goes awry. The cost of the damaging treatment will be covered. So will the cost of fixing it. And, no matter what happens, the victim will remain insured for life. When lawsuits do occur, the awards dont have to include coverage for future medical costs, which reduces the insurance companys liability.
3. Wait times in Canada are horrendous.
True and False again it depends on which province you live in, and whats wrong with you. Canadas health care system runs on federal guidelines that ensure uniform standards of care, but each territory and province administers its own program. Some provinces dont plan their facilities well enough; in those, you can have waits. Some do better. As a general rule, the farther north you live, the harder it is to get to care, simply because the doctors and hospitals are concentrated in the south. But thats just as true in any rural county in the U.S.
You can hear the bitching about it no matter where you live, though. The percentage of Canadians whod consider giving up their beloved system consistently languishes in the single digits. A few years ago, a TV show asked Canadians to name the Greatest Canadian in history; and in a broad national consensus, they gave the honor to Tommy Douglas, the Saskatchewan premier who is considered the father of the countrys health care system. (And no, it had nothing to do with the fact that he was also Kiefer Sutherlands grandfather.). In spite of that, though, grousing about health care is still unofficially Canadas third national sport after curling and hockey.
And for the countrys newspapers, its a prime watchdogging opportunity. Any little thing goes sideways at the local hospital, and its on the front pages the next day. Those kinds of stories sell papers, because everyone is invested in that system and has a personal stake in how well it functions. The American system might benefit from this kind of constant scrutiny, because its certainly one of the things that keeps the quality high. But it also makes people think its far worse than it is.
Critics should be reminded that the American system is not exactly instant-on, either. When I lived in California, I had excellent insurance, and got my care through one of the best university-based systems in the nation. Yet I routinely had to wait anywhere from six to twelve weeks to get in to see a specialist. Non-emergency surgical waits could be anywhere from four weeks to four months. After two years in the BC system, Im finding the experience to be pretty much comparable, and often better. The notable exception is MRIs, which were easy in California, but can take many months to get here. (Its the number one thing people go over the border for.) Other than that, urban Canadians get care about as fast as urban Americans do.
4. You have to wait forever to get a family doctor.
False for the vast majority of Canadians, but True for a few. Again, it all depends on where you live. I live in suburban Vancouver, and there are any number of first-rate GPs in my neighborhood who are taking new patients. If you dont have a working relationship with one, but need to see a doctor now, there are 24-hour urgent care clinics in most neighborhoods that will usually get you in and out on the minor stuff in under an hour.
It is, absolutely, harder to get to a doctor if you live out in a small town, or up in the territories. But thats just as true in the U.S. and in America, the government wont cover the airfare for rural folk to come down to the city for needed treatment, which all the provincial plans do.
5. You dont get to choose your own doctor.
Scurrilously False. Somebody, somewhere, is getting paid a lot of money to make this kind of stuff up. The cons love to scare the kids with stories about the government picking your doctor for you, and you dont get a choice. Be afraid! Be very afraid!
For the record: Canadians pick their own doctors, just like Americans do. And not only that: since it all pays the same, poor Canadians have exactly the same access to the countrys top specialists that rich ones do.
6. Canadas care plan only covers the basics.
Youre still on your own for any extras, including prescription drugs. And you still have to pay for it. True but not as big an issue as you might think. The province does charge a small monthly premium (ours is $108/month for a family of four) for the basic coverage. However, most people never even have to write that check: almost all employers pick up the tab for their employees premiums as part of the standard benefits package; and the province covers it for people on public assistance or disability.
The basics covered by this plan include 100% of all doctors fees, ambulance fares, tests, and everything that happens in a hospital in other words, the really big-ticket items that routinely drive American families into bankruptcy. In BC, it doesnt include extras like medical equipment, prescriptions, physical therapy or chiropractic care, dental, vision, and so on; and if you want a private or semi-private room with TV and phone, that costs extra (about what youd pay for a room in a middling hotel). That other stuff does add up; but its far easier to afford if youre not having to cover the big expenses, too. Furthermore: you can deduct any out-of-pocket health expenses you do have to pay off your income taxes. And, as every American knows by now, drugs arent nearly as expensive here, either.
Filling the gap between the basics and the extras is the job of the countrys remaining private health insurers. Since theyre off the hook for the ruinously expensive big-ticket items that can put their own profits at risk, the insurance companies make a tidy business out of offering inexpensive policies that cover all those smaller, more predictable expenses. Top-quality add-on policies typically run in the ballpark of $75 per person in a family per month about $300 for a family of four if youre stuck buying an individual plan. Group plans are cheap enough that even small employers can afford to offer them as a routine benefit. An average working Canadian with employer-paid basic care and supplemental insurance gets free coverage equal to the best policies now only offered at a few of Americas largest corporations. And that employer is probably only paying a couple hundred dollars a month to provide that benefit.
7. Canadian drugs are not the same.
More preposterious bogosity. They are exactly the same drugs, made by the same pharmaceutical companies, often in the same factories. The Canadian drug distribution system, however, has much tighter oversight; and pharmacies and pharmacists are more closely regulated. If there is a difference in Canadian drugs at all, theyre actually likely to be safer.
Also: pharmacists here dispense what the doctors tell them to dispense, the first time, without moralizing. I know. Its amazing.
8. Publicly-funded programs will inevitably lead to rationed health care, particularly for the elderly.
False. And bogglingly so. The papers would have a field day if there was the barest hint that this might be true.
One of the things that constantly amazes me here is how well-cared-for the elderly and disabled you see on the streets here are. No, these people are not being thrown out on the curb. In fact, they live longer, healthier, and more productive lives because theyre getting a constant level of care that ensures small things get treated before they become big problems.
The health care system also makes it easier on their caregiving adult children, who have more time to look in on Mom and take her on outings because they arent working 60-hour weeks trying to hold onto a job that gives them insurance.
9. People wont be responsible for their own health if theyre not being forced to pay for the consequences.
False. The philosophical basis of Americas privatized health care system might best be characterized as medical Calvinism. Its fascinating to watch well-educated secularists who recoil at the Protestant obsession with personal virtue, prosperity as a cardinal sign of election by God, and total responsibility for ones own salvation turn into fire-eyed, moralizing True Believers when it comes to the subject of Taking Responsibility For Ones Own Health.
Theyll insist that health, like salvation, is entirely in our own hands. If you just have the character and self-discipline to stick to an abstemious regime of careful diet, clean living, and frequent sweat offerings to the Great Treadmill God, youll never get sick. (Like all good theologies, theres even an unspoken promise of immortality: f you do it really really right, they imply, you might even live forever.) The virtuous Elect can be discerned by their svelte figures and low cholesterol numbers. From here, its a short leap to the conviction that those who suffer from chronic conditions are victims of their own weaknesses, and simply getting what they deserve. Part of their punishment is being forced to pay for the expensive, heavily marketed pharmaceuticals needed to alleviate these avoidable illnesses. They cant complain. It was their own damned fault; and its not our responsibility to pay for their sins. In fact, its recently been suggested that they be shunned, lest they lead the virtuous into sin.
Of course, this is bad theology whether youre applying it to the state of ones soul or ones arteries. The fact is that bad genes, bad luck, and the ravages of age eventually take their toll on all of us even the most careful of us. The economics of the Canadian system reflect this very different philosophy: its built on the belief that maintaining health is not an individual responsibility, but a collective one. Since none of us controls fate, the least we can do is be there for each other as our numbers come up.
This difference is expressed in a few different ways. First: Canadians tend to think of tending to ones health as one of your duties as a citizen. You do whats right because you dont want to take up space in the system, or put that burden on your fellow taxpayers. Second, taking care of yourself has a slightly expanded definition here, which includes a greater emphasis on public health. Canadians are serious about not coming to work if youre contagious, and seeing a doctor ASAP if you need to. Staying healthy includes not only diet and exercise; but also taking care to keep your germs to yourself, avoiding stress, and getting things treated while theyre still small and cheap to fix.
Third, theres a somewhat larger awareness that stress leads to big-ticket illnesses and a somewhat lower cultural tolerance for employers who put people in high-stress situations. Nobody wants to pick up the tab for their greed. And finally, theres a generally greater acceptance on the part of both the elderly and their families that end-of-life heroics may be drawing resources away from people who might put them to better use. You can have them if you want them; but reasonable and compassionate people should be able to take the larger view.
The bottom line: When it comes to getting people to make healthy choices, appealing to their sense of the common good seems to work at least as well as Calvinist moralizing.
10. This all sounds great but the taxes to cover it are just unaffordable. And besides, isnt the system in bad financial shape?
False. On one hand, our annual Canadian tax bite runs about 10% higher than our U.S. taxes did. On the other, were not paying out the equivalent of two new car payments every month to keep the family insured here. When you balance out the difference, were actually money ahead. When you factor in the greatly increased social stability that follows when everybodys getting their necessary health care, the impact on our quality of life becomes even more signficant.
And True but only because this is a universal truth that we need to make our peace with. Yes, the provincial plans are always struggling. So is every single publicly-funded health care system in the world, including the VA and Medicare. Theres always tension between what the users of the system want, and what the taxpayers are willing to pay. The balance of power ebbs and flows between them; but no matter where it lies at any given moment, at least one of the pair is always going to be at least somewhat unhappy.
But, as many of us know all too well, theres also constant tension between what patients want and what private insurers are willing to pay. At least when its in government hands, we can demand some accountability. And my experience in Canada has convinced me that this accountability is what makes all the difference between the two systems.
It is true that Canadas system is not the same as the U.S. system. Its designed to deliver a somewhat different product, to a population that has somewhat different expectations. But the end result is that the vast majority of Canadians get the vast majority of what they need the vast majority of the time. Itll be a good day when when Americans can hold their heads high and proudly make that same declaration.
Rebuttals welcome.
Single payer is socialism. Period.
And in Canada the wait times are both inane (ten month wait for prenatal care) and lethal when cancer patients die before their treatment is scheduled.
And that their health care sucks is best illustrated when no end of their political leaders have to come to the USA for treatments they can’t get in Canada on a timely basis.
http://www.upi.com/Top_News/US/2010/02/23/Canadian-premier-defends-US-surgery/33941266929997/
Not exactly the most conservative entity in the world....
http://www.huffingtonpost.ca/nadeem-esmail/canada-free-health-care_b_3733080.html
I’ll take the system these guys have figured out any day of the week....
https://www.youtube.com/watch?v=0uPdkhMVdMQ
Future Trump “talking points” to support his argument about single payer...
“he files her invoices online, and the vast majority are simply paid quietly, quickly, and without hassle. There is no runaround. There are no fights. Appointments arent interrupted by vexing phone calls. Care is seldom denied (because everybody knows the rules). She gets her checks on time, sees her patients on schedule, takes Thursdays off, and gets home in time for dinner.”
I suspect we have at least some doctors who couldn’t resist the temptation to file a few extra invoices. Who would know?
The U.S. insurance companies, though ostensibly private, are defacto government agents, at least to some large extent, by virtue of government’s regulatory requirements.
The U.S. has already, arguably, a “socialist” health care system. The contracts between patient and doctor, and patient and insurance company, is far from free and clean. Both are heavy laden with infringements by the 3rd party of government.
.....
Also... re #1... his argument is semantic. Socialism is a wide term.
I guess this person can not be bothered to hear about stories of people leaving this country (doctors and nurses for jobs) and patients (seeking more timely care) to the United States. Also, clerical and janitorial staff in hospitals being paid more than their private sector counterparts, making hospitals big union shops controlled by groups like CUPE (Canadian Public Employees Union) and OPSEU (Ontario Public Sector Employees Union). What about also people dying while waiting for treatments that they probably would have gotten faster had the hospitals not been these union shops? Saying stuff like this at my parents’ home would be a surefire way to get the china flying there.
Vermont tried single payer and ended up canceling due to anticipated costs. It might be nice to hear what the U.S. experience was and match it against this piece.
1) Canadian health care IS socialized medicine with wage and price controls, the argument that it is not because it is managed by one insurer is a total lie.
2) As in most socialized systems, there IS longer wait times for most Canadians for all sorts of procedures and that is why it is routine for Canadians to take their money and go across the border to get faster necessary service. Notice that there was not one mention of the actual amount of time Canadians wait here.
3) Most new drug discoveries are happening in the US, not in Canada. This makes it harder to get the newer expensive drugs in Canada and I have personally known Canadians to come to the US for treatments for conditions like liver, heart, and kidney disease because Canadians simply do not have the resources a (formerly) free market US health care system has.
Canadian drug coverage is also heavily subsidized by the Canadian tax payer and people routinely rip off Canadians for getting them to subsidize their out of country purchases. So Canadians pay twice. Once for their own drugs and once for other people buying theirs.
4) Canadian Doctors are NOT compensated well for their work. I have had personal testimony of Canadians bribing their doctors for service and personally have known Canadian physicians who leave Canada to practice in other countries to supplement their incomes. Another lie.
True. when state leaders, who can afford the very best, go outside their own system for medical care .... well, what does that tell you?
Fascicized medicine then, to be accurate. Fascism is just socialism by govt regulation and rules and licenses. The veener of private property exists so that govt has a private sector to blame for economic failures.
I’m on Medicaid.
I’m very happy with it. Small co-payments, no insurance forms to fill out, I get to see my own doctor and I don’t have to face financial ruin for big-ticket expenses.
I haven’t even bothered with Obamacare, which is simply ridiculous and is not single payer at all.
RE: Canada extorts American pharmaceutical companies, essentially telling them that if they don’t lower their prices to a specific amount, Canada won’t respect their patent. In turn, pharma recovers their losses in the American market.
Next question — what will happen if a President Clinton or Sanders followed the same Canadian type extortion? Where will the pharma’s go to recover their loses?
When the government pays the bill the government will control (ration) the care. For years Canadians have been coming across the US border for health care that is either not available or available only with a long wait back home. Both a Canadian MP and the Premier of Newfoundland caused a furor when they went to the US for their medical treatment
If I could summarize the comparison between Canadian and U.S. health care as simply as possible, I'd say this: Canada is superior for simple things, while the U.S. is where you want to be if you have complex injuries or illnesses.
I should also point out that this isn't really a comparison of a socialist system vs. a capitalist system. The U.S. doesn't really have a capitalist health care system. Any industry that is built on a system of third-party payments is bound to function just like a socialist bureaucracy -- and it doesn't matter whether the "third party" is a government agency or an insurance company. The mere presence of a third party in the process means the conventional market forces of pricing related to supply and demand go out the window.
RE: Im on Medicaid.
Im very happy with it. Small co-payments, no insurance forms to fill out, I get to see my own doctor and I dont have to face financial ruin for big-ticket expenses.
_________________________
Then You should be happy with Obamacare, most of the Obamacare enrolees have been placed on Medicaid, like you.
Paid for courtesy of working folks like me.
If you like this system, Hillary is your President.
RE: Canada is superior for simple things, while the U.S. is where you want to be if you have complex injuries or illnesses.
Is Child birth considered simple or complex?
Two female friends of mine had pregnancies. One paid just $15.00 for her child’s birth in Canada. The US friend paid $5000 for her child’s birth ( her rich uncle helped pay for it as she did not have the means to pay ).
Agreed.
In a single payer system, all you have is one public address of payment to health care providers.
Voters can decide if their health care is affected by voting for politicians who make sure the system is adequately funded.
It doesn’t mean the government necessarily runs the health sector.
Obamacare isn’t a free market plan for what kind of free market plan prevents you from buying health insurance 9 months out of the year?
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