canadian health care myth busters

Canadian Health Care Myth Busters

Check out Sara Robinson's post over at Blog for America. She carves

up-and serves up-those scary universal health care urban legends that

the doomsayers are so quick to drag across the border.

A few highlights:

1. Canada's 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.

3. Wait times in Canada are horrendous.

True and False again -- it depends on which province you live in,

and what's wrong with you. Canada's health care system runs on

federal guidelines that ensure uniform standards of care, but each

territory and province administers its own program. Some provinces

don't 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 that's 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 who'd consider giving up their

beloved system consistently languishes in the single digits.

(...)

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, I'm 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. (It's 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 don't 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 that's just as true in

the U.S. -- and in America, the government won't cover the airfare

for rural folk to come down to the city for needed treatment, which

all the provincial plans do.

5. You don't 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 don't 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 country's top

specialists that rich ones do.

6. Canada's care plan only covers the basics. You're 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 doctor's

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

doesn't 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 you'd pay for a room in a middling

hotel). That other stuff does add up; but it's far easier to afford

if you're 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

aren't nearly as expensive here, either.

Filling the gap between the basics and the extras is the job of the

country's remaining private health insurers. Since they're 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 you're 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 America's 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,

they're actually likely to be safer.

Also: pharmacists here dispense what the doctors tell them to

dispense, the first time, without moralizing. I know. It's 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 they're 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 aren't working 60-hour weeks trying to hold

onto a job that gives them insurance.

9. People won't be responsible for their own health if they're not

being forced to pay for the consequences.

False. The philosophical basis of America's privatized health care

system might best be characterized as medical Calvinism. It's

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 one's own

salvation turn into fire-eyed, moralizing True Believers when it

comes to the subject of Taking Responsibility For One's Own Health.

10. This all sounds great -- but the taxes to cover it are just

unaffordable. And besides, isn't 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, we're not paying out

the equivalent of two new car payments every month to keep the

family insured here. When you balance out the difference, we're

actually money ahead. When you factor in the greatly increased

social stability that follows when everybody's 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. There's 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, there's also constant tension

between what patients want and what private insurers are willing to

pay. At least when it's 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 Canada's system is not the same as the U.S. system.

It's 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. It'll be a good

day when when Americans can hold their heads high and proudly make

that same declaration.

I can't wait to hear how the naysayers address the truth straight from

the horse's mouth of a health-care-card-carrying Canadian.

Thanks, Sara.

Crossposted from The Crone Speaks

Labels: Canadian Health Care Myths, Health Care for All. Mythbusters,

the big con

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