One Canadian's perspective

In a recent edition of LFCA, Joy wrote:

"This is a request for non-U.S. bloggers - we need your healthcare stories! Yesterday in my gym I heard a woman tell another woman that in the U.K., once you get to be over 60, you're 'put on a list' so that you can be denied joint replacements and other health care measures for which you are now 'too old.' Please set the record straight about whether you like your health care, how long you wait, and how your older friends and loved ones have fared. The misinformation here is incredible and insulting to you, our UK / Canadian / Aussie / South African / friends. We can link to these blog entries and try to inject some real experiences into the conversation." dispel some of the myths and fear-mongering being tossed around south of the border about "socialized" medicine in other countries.

I hesitated about whether I should post anything on this subject. The debate over health care reform in the States has gotten so ridiculously (over)heated, and I am not a person who enjoys or invites conflict of any kind.

But as a Canadian, I can't believe some of the stories being tossed around south of the border about our healthcare system. It would be funny, except there are too many people who actually believe this stuff -- and too many people who are being denied basic health care because too many people believe this stuff. So I decided to share a few thoughts with you from my own perspective. Other Canadians may share my opinions or disagree with me.

First, you should probably know that my mother is American, & that I have lots of American relatives, and so I am familiar with some of their experiences with the American health care system.

Of course, we pay for our "free" universal health care in Canada through our taxes. They are somewhat higher than what Americans pay, although I've seen studies that show the difference is not all that great, depending on how you slice things. Everyone is entitled to a basic level of health care, regardless of income.

Some provinces, including the provincial government of Ontario, also charge health care premiums. Here in Ontario, the premium is calculated as part of your annual income tax payment. It's based on a sliding income scale and costs up to $900 per person. (My dh & I pay less than that.) People with incomes of $20,000 or less are exempt.

Most workplaces of any size offer employes additional medical and dental coverage. My dh & I work for the same company and co-ordinate our benefits. Our company offers "flex credits" that we can spend as we choose, & anything above & beyond a very basic level of coverage, we pay for through payroll deductions. Almost all of our medical & dental coverage is paid for through credits. Depending on the kind of plan you choose, this additional medical coverage pays for some, most or all the cost of things like prescription drugs, medical devices, ambulance services, etc. (sometimes to certain plan maximums, which are spelled out in your policy information).

Annual vision checkups at the optometrist, once free of charge, were de-listed by the provincial government a few years ago -- but our workplace medical insurance covers the cost of one standard visit every two years.

Terms like co-payments, deductibles and billing are foreign to Canadians' health care vocabularies. The only times in my life I can ever remember being billed by a doctor (outside of fertility treatments):

• dh has a PSA exam done every year (to detect prostate cancer) which costs about $35. I would need to dig through my files to confirm this, but I believe I've had the cost reimbursed through our workplace medical plan.
• likewise, I paid for a CA125 test suggested by my dr at my checkup two years ago -- can't remember the cost -- it was slightly more expensive than dh's PSA test.
• and when we went to hospital to deliver Katie in 1998, the admissions clerk insisted that if I wanted a private room, I had to pay for it -- even though my dr had told me I was GETTING a private room & didn't mention anything about cost. Dh forked over the credit card & we were charged ($150 for one night, I think). I brought it up with my OB, sent him a copy of the bill & the charges were reversed. Even if they hadn't, my workplace insurance likely would have covered most if not all of the cost.

The only thing we have to do to access care is to show our provincial health card at each visit to a dr's office, clinic or hospital. There is no insurance coverage to sort out or credit cards to hand over before anyone agrees to see you, and no paperwork to deal with afterwards. The dr bills the province for each visit/procedure & is reimbursed by the government.

The only paperwork I ever have to deal with is the claims I submit for the "extras" that my workplace medical insurance covers. Much of that is being automated, too -- our dentist's office submits our claims electronically and we're reimbursed with a deposit to our bank account almost immediately. For prescription drugs, we have electronic swipe cards. When we first got our cards, I took them to the pharmacy where I regularly have my prescriptions filled, & they put us into their system. When I get a prescription filled there, their system automatically files the claim & calculates the discount. I most cases, I pay only a small fraction of the actual cost of the prescription. The pills I take for my thyroid condition, for example, cost me under $4 out of pocket for 100 pills. My Epi-pen has a price tag of $100, but I did not pay a cent -- the entire cost was covered.

When I was going through infertility treatment (clomid, injectable drugs & IUIs), my workplace plan covered some of the drug costs -- up to a lifetime maximum of $2,500 (it's $3,000 now). As you can imagine, it didn't take very long to blow through $2,500 in fertility drugs. All of my diagnostic tests, bloodwork, ultrasounds and the IUI itself were covered by the provincial government's plan -- but the sperm wash cost $350 (go figure). In-vitro fertilization is not covered in Ontario, except in cases where both fallopian tubes are blocked -- then the province will pay for up to three IVF attempts. Last year, the provincial government assembled an expert panel on infertility & adoption, and its recent report recommended that the province should fund up to three cycles of IVF for women under 42 years old, with single-embryo transfers mandated in most cases. Whether these recommendations will ever become policy/law is anyone's guess...

What else?

I have never, ever heard of people being deemed "too old" for a hip replacement or other such surgery. This reminds me of a few years ago, when my extremely athletic & healthy 50-something boss broke her hip while on a skiing vacation. She eventually had to have a total hip replacement. (She did have some trouble finding an orthopedic surgeon in the city to see her right away, but was able to access one outside the city, in a smaller centre where she & her partner own a second home.) She told us how happy she was one day to walk into the waiting room & see someone else around her own age waiting, because just about everybody else was a senior citizen. She got talking to this other 50-something -- & found out she was just there, waiting for her 86-year old mother, lol.

We chose our own family doctors (a friend referred us to him -- although he no longer takes new patients). The government does not choose for me, or for anyone else. Obviously, in a large urban area like Toronto, there is more choice than in a small town with few larger centres in the area. I'm sure it's the same in the States.

My family dr refers me to any specialists I need to see. If I don't like them or am not satisfied, I can ask for another referral. (I'm puzzled when I hear that Americans think universal/single-payer coverage or even a public option means the government will make decisions about their health care for them, which drs they can see, etc. First, in Canada, anyway, it's simply not true, and second, don't the insurance companies do that for you in the States anyway, under the current system -- telling you which hospitals and drs you can see within their plans and denying claims because of "pre-existing conditions," etc.?).

Being young & relatively healthy, I have not had any health problems that were too serious. Aside from having my wisdom teeth out at age 28, I have never had surgery (knock wood). But throughout my life, I've been referred to various specialists for various issues that came up. The time I've waited to see a specialist has ranged from a few days to a few months.

For example, when my ob-gyn referred me to an RE to begin fertility treatments, I had to wait six weeks for my first appointment. Another example: when I had my annual checkup with my family dr last year (in mid-September), he gave me a referral for my annual routine mammogram & my first bone density scan. I called to arrange the appointment myself, at a breast clinic at one of the city's top hospitals. The earliest I could get in was mid-December. However, had there been a reason for concern, I know I would have been seen much earlier.

Equal access to care is the goal, but unfortunately not always the reality, in both rural areas & some cities. Hospitals, especially in the cities, have bed shortages, and there are staff shortages -- of family drs in particular. Sometimes, your ability to "choose" your healthcare provider is limited by what's available -- and certainly, if you live in a small rural community, you will need to travel to a larger centre to access specialists and more acute care. I doubt the situation is much different in comparable areas of the States.

My own family dr, whom I've seen for the past 24 years, is 71 and plans to retire when he's 75. I don't know if he plans to turn the practice over to someone else, and if he doesn't, I'm not sure what dh & I will do then. He doesn't make house calls (who does, these days?) but he does have an answering service & is great about returning calls. He's even called me at home to check up on me if I've been having a hard time with something.

Besides family drs, the system in Ontario (& most other provinces) includes a free telehealth service, which you can call 24 hours a day to speak to a registered nurse or pharmacist with questions about symptoms you may be having or medications you are taking. If you don't want to wait on the line, you can leave a message & someone will call you back. I've never had to wait more than about 40 minutes for a callback. Most larger communities have walk-in urgent care clinics, and then of course, there is always the hospital emergency room -- which does tend to get overused/abused at times when the dr's offices & walk-in clinics are closed, or by people who don't have a family dr in the first place.

My family dr is in the city, close to where dh & I had our first apartment, & a 15-minute subway ride from my office. If I've been feeling crappy when I'm at work & he can't see me that day, there's a walk-in clinic a short walk from my office, where I've never waited more than an hour to see someone. I used the walk-in urgent care in the community where I live once, when I was feeling too sick to make the trip downtown to my family dr. And I've used the emergency room at the local suburban hospital several times. Naturally, incoming patients are triaged and the most urgent/serious cases get seen first. Most of my visits to the ER have been for prolonged bouts of vomiting, suspected allergic reactions &/or ailments that were eventually chalked up to anxiety attacks. I've waited as little as 10 minutes and as long as 10 hours (ugh), with about two hours being common.

Yes, some Canadians do seek treatment in the States, because they think they can get it faster, because they have a rare condition that few drs here have handled, because there's an experimental treatment available in the States that they want to try, or just because they want to consult with someone there (even if they ultimately wind up being treated at home). Sometimes the provincial government will pay; sometimes it's out of pocket. I grew up in Manitoba, in the Canadian Prairies. The world-famous Mayo Clinic in Rochester, MN, is just a day's drive away, & I know several people (particularly cancer patients) who chose to go there for consultations &/or treatment.

But for the most part, care in Canada is on par with that offered anywhere else in the world. And you just don't hear of people in Canada being bankrupted and losing their homes because they got sick and couldn't afford the huge medical bills. It just doesn't happen.

I know that American members of my own extended family have been touched by the lack of affordable health care south of the border. In my own family, I know of:

• one retired couple, who were paying $1,100 a month for health insurance -- & that was several years ago (I'm sure it's more now).
• a couple in their 40s who recently lost their house, staggering under the debt of medical bills.
• someone who needs surgery but whose insurance company will not authorize it because money is still owed from a previous surgery.
• a woman in her 40s with a chronic medical condition who is covered by her husband's workplace insurance, but even so cannot afford to take all the medications she needs as regularly as she needs them.
• several relatives who are well over 65 but continue to work, because they fear losing their medical benefits.

Few if any of these scenarios would ever exist in Canada. The closest situation I can think of is I have heard that some expensive, relatively new cancer treatment drugs are not covered under provincial or private drug plans -- but people are fighting back and, in some cases, winning a significant reduction in the cost of the drugs they need for their treatment. These cases make the news precisely because they are exceptional -- they are not the norm.

When my American grandparents were still alive, Medicare paid for most of the care they needed, but the paperwork involved just about drove my mother around the bend. My mother has lived in Canada since her marriage almost 50 years ago; she is a proud, flag-waving Republican, but even she thinks the U.S. healthcare system is insane & ours much preferable.

I am not saying the Canadian system is perfect. Every system has its pros & cons.

I'm not saying the Canadian system should necessarily be adopted wholesale in the U.S. If you don't want our system, fine. There are many different ways that different countries deliver & pay for their citizens' health care. You have lots of models to look at.

But I am saying that the status quo in the U.S. is completely unfathomable to those of us who live in countries where some form of universal healthcare is available to all. It's hard for us to believe that so many people lack basic healthcare -- and, because of it, get sick, go deeply into debt, lose their homes, line up by the tens of thousands outside of sports arenas to be seen by teams that normally deliver health care to Third World countries (I saw a story on "60 Minutes" along these lines that had me in tears), and, yes, die -- all in the richest and most powerful nation on the face of the earth.

And I am saying that I'd never trade what we have for the U.S. system, and the vast majority Canadians wouldn't either.

As I stated early on, I don't care for conflict. I will be happy to answer any thoughtful questions about my/my family's healthcare experiences, but I will delete any comments that are less than civil.

For some further perspectives on Canadian vs U.S. health care systems, from Canadians as well as Americans who are now living in Canada, here are some links I've found recently that I thought were interesting:

• Debunking Canadian health care myths (Denver Post)
• A puzzled Canadian ponders surreal U.S. health-care debate (Toronto Star)
• Words you'll never hear in the Canadian health care system (Life Without Borders blog)
• Will they get fooled again? (We Move to Canada blog)
• The Daily Dish: The View From Your Sickbed (Canadian Edition)

The New York Times has an ongoing series in its Economix blog about regulation in Canada, including several articles explaining various aspects of our health care system, which provides a pretty good overview. There are many Canadians commenting on each article as well. I would recommend these if you're really interested in learning more about how Canada's health care system works.