• A bit about health care – A DRAFT

    by  • 10/18/2008 • health, life • 0 Comments

    What follows is an early draft of an essay I’ve been poking at. The aim in this isn’t to claim that there aren’t problems in the Canadian health care system, but to dispel some of the bogus charges leveled at the system both from within Canada and from without. I need to add a handful of other charges, but with so many to choose from, it’s difficult to pick…


    I’ve had a number of discussions with people who tell me about the evils of so-called socialized medicine. People who tell me about the horrors that happen in Canada to people who are forced to live with socialism of the most vile sort; Socialist Healthcare! Thanks to the Internet, these discussions take place with people who aren’t even aware that they’re talking to a Canadian.


    I don’t think Canada’s system is perfect, but I really believe that it succeeds in places where the American system fails. Sure, I could talk about communities that are under served by general practitioners, or where there are no surgeons, but that’s not what this is about. Sure, I could talk about some of the things that aren’t covered that should be, but these are all other issues for another time. This essay is about busting some myths and lies that I hear repeated over and over again.


    Basic single-payer coverage in Canada


    There are levels to the Canadian system that people outside aren’t often made aware of. There is the basic system of medical coverage, which is provided by the province, and does vary to a degree across Canada. For the most part they all cover medically required services provided by a physician, maternity care, x-ray and lab services. There are varying levels of coverage for children in low and moderate income homes for dental and eye care.


    This is all billed to the provincial medical service. Everyone who is a citizen, married to a citizen, or the dependent of a citizen, gets a card. You can not be denied basic services if you are a citizen; this card can’t be canceled, you can’t be cut off, and you can’t be turned away from the doctor due to bills. Some of these cards have small fees attached for those that are deemed to be able to afford to pay in to the system, but even if you do not pay those bills, you can’t be denied service. The cost to those who can afford to pay isn’t high; it’s a matter of maybe a hundred dollars per month for a family. This cost is lower, or even nothing, if you’re in a low to moderate income household.


    This basic level of coverage doesn’t typically cover any dental work, glasses, hearing aids, counseling, prescription drugs, podiatry, massage, physiotherapy, or the services of a variety of quacks alternative health practitioners.


    Extended health care benefits in Canada


    There is also a level of private-insurer provided health insurance, more of the type of insurance that our American friends might be more familiar with. This kind of coverage is optional and, depending on what you or your employer buy into typically cover 40-100% of the costs of prescription drugs, eyeglasses, dental, and other services. When you’ve used up your plan’s maximum for dental benefits or other services for the year on the extended policy you have, then you can either pay full price or wait until next year. Policies like this are often paid for by the employer, even if that employer has you flipping burgers or sweeping floors for minimum wage. As these jobs become harder and harder to staff for minimum wage, the employers are getting better value out of offering a group insurance plan than out of offering an extra dime per hour on the paycheque.


    When I was self employed, I bought a policy for my wife and me, as it made sense just to have the policy to get the discounted prices on prescription drugs for her asthma and to cover some dental work I needed to have done. Pre-existing conditions and waiting periods never entered into the equation. We had really good coverage levels for less than $250 per month, though policies are available at nearly any price you’d like to name.


    So, here in Canada, we have the basic level of coverage with the single payer insurance that the nation holds as a group, paid for by the state. We also have the extra level of coverage that we can either purchase or have provided for us by our employers. What are the problems that outsiders believe exist in our system?


    People will cheat the system!


    People under a private system are trying to ‘cheat the system’ when they try to gain access to services for problems that their insurer has deemed to be pre-existing conditions. People do not try to have their gallbladder removed just because they can, unless they have some sort of mental problem. I’m a Canadian, and I don’t feel that I am entitled to anything but what I need, but when I have need, I’m glad that it’s there.


    I burned my hand pretty severely last year, and I needed to go to the Emergency Room. We didn’t even have the money for a cab, let alone to pay a doctor to assess my blistering hand. We left the E.R. about six hours after we arrived; I had a burn that managed well with only ice for the pain, so I was lower on the trauma scale than a compound fracture or a stabbing. When we left, we left without worry about cost, and the doctor even gave me a small kit of tape and gauze to handle dressing changes for a couple days. When I returned for a follow up visit, they were happy enough with progress to just jab me with a tetanus shot, slather some Flamazene on the burn, and wrap it up again, sending me on my way with more sterile gauze and tape.


    I’d rather not worry about the cost of my visit to the doctor in such a case, or possibly risk my life by opting not to go at all, chancing infection or further complications. I am free to visit the doctor or other medical services when I require them, and I don’t feel that I to get my ‘fair share’, and nobody in their right mind does, either. I can’t just walk in and take a handful of opiates at my doctor’s office.


    I don’t want to pay for someone else


    What do you think your medical insurance is? Not all of your premiums go into a trust account in your name; they go into a fund that’s used to pay for all of the people who share the same insurance company. This is socialism regardless of how you slice it. You pay a membership fee to belong to the community of those who expect to have their bills covered, regardless of how large those bills are.


    With insurance, you or your employer pay a bill every month, and all this money from the bills goes into a big pile in the insurer’s back room; be it the private insurer or the public one. Now, they love to roll around in that money just as any of us would like to, but that money needs to cover operational expenses in addition to the costs of the medical care you expect.


    Neither the public nor the private insurer exist to lose money, so they make business decisions every day that have an effect on your levels of service.


    The private insurer often makes case-by-case decisions regarding what will and what won’t be covered out of necessity; they simply can’t provide (let’s just use a round numbers) $5000 yearly of services to each person holding a policy who has paid in $5000. Providing 100% payout would be bad business, and the insurer simply wouldn’t be around for long.


    With the Canada’s basic insurance, the system is not built to make a profit, so paying the health care workers is the expense. There’s no large claims or accounts receivable systems to add to the overhead, and no legal teams that need to sue families or healthcare providers. The cost of running the system is lower when you don’t have all the overhead that is required to generate revenue.


    Even with all of the extended benefit insurance companies I’ve dealt with here in Canada, I’ve never had one of them question why Tania needs an asthma inhaler, or have them refuse to cover their portion of the cost.


    Private insurance in the United States, as a business, has become about maximizing profits in order to maintain shareholder approval. Shareholders like to see that they’re earning money on their investments, and one of the easiest, most reliable ways to maximize profits is to deny service to the customer.


    You’re assigned a doctor and you’re stuck with them


    I once heard a person say that they had moved to Canada and needed to see a doctor. They had been here six months, and were complaining that they had yet to receive a letter from the government telling them who their assigned doctor was. Somehow, this woman and her husband had arrived in Canada for school, and had somehow come to believe that they would be assigned a Comrade Doctor who would be their only allocated physician. Maybe this is one of the lies that the AMA, HMOs and health care unions have been spreading?


    I really don’t know this little gem came to be, but there is a belief among some foreigners that we in Canada have our medical care closely monitored, structured, and doled out by the government. This is simply not true. I can go to any general practice doctor’s office, and assuming that they are accepting patients, I can schedule an appointment or even walk right in. I don’t need to talk to a member of The Party or petition the Politburo for a new doctor if I don’t like the one I’m seeing; I can just walk up the street or call another office. If I don’t have or want a family doctor, I can visit one of a number of ‘walk in clinics’ for all the services I would get with a GP. All without the government’s direct involvement in my decision.


    Now, this is in the city; in rural areas here, as in the US, sometimes there’s only that one doctor for hundreds of miles. There might only be one podiatrist in your timezone that does the procedure you need done, but that’s a function of more than just the medical insurance system.


    You don’t get to make decisions about your care


    If the doctor orders lab work, testing, or x-rays, the government pays for them. The doctor does not work for the government, and does not get his paycheque from the government. The doctor bills the insurer, just as is done in the US system, and the fact that there is only a single insurer to deal with allows the process to be streamlined. The doctor doesn’t need to a staff of people just to fill and deal with the dozens or hundreds of types of forms that are required to be submitted to all the different insurers. The doctor here also doesn’t have to continually place follow up calls to insurers looking for payment, only to give up and then invoice the patient directly.


    You can’t get access to an MRI when you need it


    Why do you think you need an MRI? Do you measure your return from your healthcare costs in how many MRIs you can talk your doctor into running on you annually? Maybe a CAT scan or an X-Ray is a better diagnostic option, but with two you get eggroll MRI.


    more to come…

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