Let’s help Americans get their health care
One of the people in this video, Kathryn, is a friend of mine. Have a gander at what she is saying, which is that due to a preexisting medical condition in her young son, there is no way she ever return to live in the US, because his condition would bankrupt her.
I travel and work a lot in the US and two things always stand out to me about the lack of public health care in the US. First, many people I know have been kept from doing truly interesting work because they have had to remain slaves to a job they hate only for the benefits. To be able to go out on your own and make creative contributions to the world often means leaving behind a health care package. It is a life decision and one which is tantamount to playing dice with your life. When I left my government job in 1999 to start my company, I had nothing to worry about. With the exception of things like glasses and dentistry, I didn’t miss my health benefits at all, and this was a package from a unionized federal government job.
Second, I have never understood the argument that somehow single payer health care is unAmerican or that it restricts your choice of doctors. Listen to Kat’s story above. I have never been restricted by anyone in receiving medical advice. I can switch doctors at will, limited only by how many patients each has in his or her practice. In my own case, I have been hospitalized twice for surgery and seizures as a kid. Two members of my family have been to the emergency room on multiple occaisions for accidents, and several extended family members have had cancer, heart disease and other serious life threatening illnesses. Several of my friends have had rare and dangerous health conditions and only one of them chose to go to the US for his treatment to see the world’s only specialist in a very particular type of brain surgery. In every case, the only plastic card that was ever produced was a CareCard.
In short, although our health care system has many flaws, and we could all find stories to show how it fails people from time to time, it works. We are free here to see any doctor we wish, no one lacks health care, you are never asked to pay FOR CARE before receiving it, and no one sends you a bill. We pay a little more than $100 a month for our family of four for premiums, but if I couldn’t afford that, it would be free. We pay higher taxes, but most Canadians would say that of all the things we are taxed on, health care is the one we most appreciate. Most politicians run on a health and education platform. These things are sacred cows.
So here is my suggestion. There is so much good about public health care, and so many lies distributed in the US about our system here, that I propose that we Canadians help out our American friends by making ourselves available to answer questions. If you want to find out what it is REALLY like living with a publicly funded health care system, drop me an email (chris at chriscorrigan.com) and I will answer you questions. If you are a Canadian who would like to share your story, leave your contact info in the comments. If you are an American with a question, leave it in the comments. I promise to tell you exactly what my experience is.
Instead of getting the story from pundits and PR firms, just send me an email. Let’s talk instead.
Great idea.
And let’s remember that those pundits and PR firms are often working for big insurance companies. Companies that have a financial interest in NOT paying for the healthcare people need.
An American friend made some good points in his post here: http://queerjoe.blogspot.com/2009/08/asking-again-im-asking-all-u.html
I think your post about limiting creativity is important. Because small and medium sized businesses are the engine of the economy. They create proportionately more jobs. Just think how many jobs are NOT being created because bright creative people with great ideas aren’t even starting out in those businesses.
And health care costs are the single biggest cause of bankruptcy in middle class American households. Those are mostly people who HAVE benefits.
Canadian/ US citizen living in Canada, and happy to answer questions.
fuzzykittykitty (at) gmail.com
I am one of the people in a dull job for the health care. Hubby is a writer so our private insurance was $24,000 a year.3 people, healthy, no chronic problems except the ubiqiutious high blood pressure for him.
I am stuck because of the health insurance.
My husband had stage 3C melanoma ( the next stage is 4 and nthen the patient lives for only a few months) and received excellent care in Canada, including interferon IV’s and then injections for over a year., I understand the cost for interferon alone is in excess of $36,000. My husband has passed the 5-year mark for survival and no remaining cancer has been found. I think Americans are being misled by large compnies with the result that so many Americans are not insured or are so underinsured that a illness will cost too much to treat.
We have to ask the hard questions, though. Such as: if you are already having health problems at such a young age and expect them to continue indefinitely, why are you entitled to have society carry these costs?
It is a difficult subject because nobody wants to let someone die. But, the more we come up with to cure people, the more it costs to use this never-ending stream of invention.
I think we should have, at the very least, a co-pay system so that you share some of the burden. Someone is bearing these costs, and it’s easy to say that cost is not an issue when you don’t have to pay for something.
If we can’t go that far, we should be presenting a non-payable invoice to everyone who goes for healthcare so that they can see their cost to taxpayers and not remain ignorant of it. At least, then, you know what you are costing the system.
It’s also tempting to consider the concept of a lemon law — that there is a maximum we are willing to spend on your over your lifetime, after which you have to accept that life’s simply not fair.
There is absolutely nothing in the Canadian system that encourages someone to lead a healthy lifestyle. There is no increase in insurance premiums for smokers, for example.
I don’t think the philosophy of the US system is wrong, but there’s definitely something up with the implementation. But I will never support a system concept that frames healthcare as a “right” and suggests that you’re entitled to be kept alive at no expense no matter what, regardless of your own behaviour.
With the usual caveat that the system is not perfct, let me respond to your points Matt.
First, the philisophy that anchors our systems is absolutely a choice and it is a choice I think that says that essentially that health care is a right and it is right that no matter what your condition, you will be cared for. To value one human life over another, or put a cap on the amount of money that is a conscious choice that Canadians rejected when we decided on universal medical care. You are entitled to have society carry these costs because as a society we have decided that THAT is the ethical and moral thing to do.
Second, we do have a co-pay system. We pay both taxes and medical insurance premiums, those of us that qualify to pay for those. If I were to make a list of the things I actually WANT to pay taxes for, medicare is at the top. Most Canadians would agree with me, I’m willing to bet. We all share the burden together and in doing so, we actually have a more affordable system than the Americans do.
I have no trouble presenting an invoice to people…it would be interesting to see that. BUT I draw the line if the reason for that is to make people think twice about access the system because the will feel guilty for using resources. Perhaps an invoice on demand, if you want to see what you are costing the system. Having said that, the invoice process will mean more red tape, and that is exactly the costs of the medical system that people hate to pay for.
The idea of a “lemon law” is egregious and inhumane in my opinion. What in God’s name would you set the price of a human life at? What are you worth?
In terms of prevention, there could be multiple ways of doing that, including premiums on smokers. Already smokers pay huge taxes which is good. Perhaps the next step is taxing fast food restaurants or something. But better than punative taxes are signifcant tax credits for things like gym memberships, recreational sports leagues, fitness equipment and so on. Eating local fresh food should win you a tax break as well – you could simply deduct the expenses at the end of the year from your income like we already do with medical costs, or this year, home renovations. There is lots already in the system that encourages a healthy lifestyle, and lots more that can be done, but I don’t think that the American system has very many lessons for us on this score.
I think the US philosophy is wrong. We can disagree that health care is a right – I believe it is – and I furthermore think that there is a serious ethical line to cross to say that some are worth care and others not. In the US, you receive care if you can pay for it. Can you imagine doing this to your own family? To say to your brother or your partner or your child or your mother, I will only care for you if you pay me to? If you can’t imagine that for your family, then you can’t believe in the maxim that all are created equal and have the same rights.
Creating a society on BUILT IN and designed inequality is not, I think, what the ongoing Canadian conversation is about.
Thanks Chris for responding to Matt’s comment. Though I suspect his comment is just proving what many of us think is wrong with American society, and are finding it hard to believe about it.
But I also want to address his point about smokers. The economic argument about smokers is just plain wrong. Smokers do NOT cost the health care system more.
Although the health care costs to treat emphysema or lung cancer are very high. The fact is that someone who dies of one of those diseases in their 60s (or earlier) will cost the system much less over their lifetime than someone who lives to 90 with no major illness.
As we age, our bodies start to break down. This is natural. And we need more routine primary healthcare. This costs money. And over a lifetime is much more expensive than the kind of high profile saving of lives that Matt speaks of in his post.
But as a society we think that people are entitled to this. That we are willing to pay for it. Because we ARE a society and not just a collection of individuals.
The things that are probably costing the system unnecessary money are actually relatively benign things like multiple ultrasound scans during pregnancy (for no demonstrated medical need), all kinds of fancy diagnostics because we want technological proof that nothing serious is wrong with us. More frequent routine diagnostics despite little statistical evidence that they improve population outcomes enough to be worth it (think yearly PAP smears versus 3-yearly), etc.
And in the US there is an incentive in the system for doctors to order such tests and procedures for those who can afford them even if the medical benefit is slim.
Thanks for starting this debate here Chris.
Chris, we already routinely abort human lives — especially if they are disabled but also because they are simply unwanted — so there’s no righteous argument about valuing human life to be made as far as the Canadian system goes.
re: the “lemon law”, why should we spend millions to keep someone alive that nature clearly does not want to have alive? We are often talking about natural systems but shy away from human death — an essential part of a natural system — for some reason. We know from industrial farming that it takes a great amount of resources to fight nature’s will.
re: the “price of human life”.. well, unfortunately, the price of human life seems to increase as we find more and more cures to save it with. We can’t stop innovation, so we should address it from the other side. It almost seems as if everyone is being born with something wrong with them these days. What am I worth? I am not worth a million dollars.
re: myriad tax credits on “goods”: sounds like an administrative nightmare to me. We don’t necessarily want people to go to the gym (use energy to dispose of energy?) or eat what the government decrees are “healthy foods” (includes Kraft Mac & Cheese if you look at the label), we want them to lead healthy lives such that they stay out of the healthcare system. I prefer to make information free and let people decide what they want to do with it using their own wits and intelligence. What we don’t want is for people to over-use the healthcare system, so make that expensive.
re: co-pay system. Paying taxes isn’t really a co-pay system. If you don’t get sick, you still have to pay. And if you get sick more, you don’t have to pay more. $20 flat to visit the hospital would be a start. As for medical insurance, it is for extras, right? Semi-private hospital beds and things like that…
Jo, good point about smokers. I don’t know if it’s true or not. Smokers may suffer from more ailments along the way before they finally croak (i.e. heart disease). But, the main idea was that we don’t have any way of making people pay more for their healthcare if they continually get involved in risky behaviour. I also have a problem with the tendencies of government to try to control people’s behaviour because “we pay for their healthcare”.
I appreciate your point about insurance setting up an incentive to “get the most for your money” and have unnecessary things done (if that was your point). You see this at the dentist, which is private and where this does take place. But, at the dentist, at least you get an invoice and can see what is being billed in your name. At the doctor’s office, you have no idea. Who knows if you’re being billed for things that weren’t even done?
Well I think we’ll have a clear difference of opinion on abortion.
Also, I am not opposed to euthanasia either.
Wondering about why it seems as if everyone is being born with problems these days. I suspect it might have something to do with unecessary diagnosis and prescriptions. Seems to me in a public system you have less chance for abuse than in a private one (and your example of dentists bears out in experience for me – and I don’t have a dental plan.)
Regarding tax credits I was trying to point out how there ARE in fact soe incentives in the system for healthy living, but not near enough is done on the prevention side, and as a society we don’t operate according to the precautionary principle at all, so there is lots of stuff in our environment and bodies that kill us on a routine basis that never should have been there in the first place.
No we don’t have a co-pay system. We have a tax funded system. My point is tat it isn’t free, it is funded by taxes, and most Canadians I believe, think that’s a good idea.
In the end though the quibbling we are doing here pales in comparison to creating a system in which 25% of your people are one disease away from ruin. I can’t imagine that we would ever choose to do that. I can’t believe that some Americans are actually arguing that that system is just and ethical.
Anyway, thanks for the spirited thinking here.
Thought I”™d share this little anecdote: five years ago there was a ”˜reality television”™ type program that enlisted the nation to vote for the Greatest Canadian of all time. There was a nomination process, then a short list of 100, then the top ten. Week after week the nation voted and narrowed down the list of great Canadians: not even the invention of the telephone, insulin, remarkable athletic achievements, international fame, or leading the country proved enough to stay in the race. Guess who the nation chose as the greatest Canadian? Tommy Douglas, father of universal health care in Canada.
I think we chose him because overall, we recognize that health care for everyone improves our quality of living, and allows us to be free from a persistent, nagging worry about the costs of receiving care if we (or our loved ones) were to experience an accident, injury or illness.
And, I think it might be interesting to know that the general mindset of Canadians does not lean towards abusing the system. People still put off going to see a doctor or other healthcare professional ”“ but whatever their process is for deciding when it is time to seek advice or care, fortunately financial implications of the choice are not a factor.
Granted, there are many ”˜tweakings”™ to the system here that I would love to see to advance the provision of healthcare towards promoting optimal health and well-being ”“ but the general philosophy supports a healthy citizenry.
I have been quite fascinated to listen to the concerns of our neighbours, because frankly the notion that access to healthcare could be threatening baffles me completely.
The difference between abortion and euthanasia and a “lemon law” is who is making the decision.
A “lemon law” imposes a value on everyone. This is what you get. No individual choice.
Abortion is a choice. Not all unwanted pregnancies are terminated. Nor do all prenatal diagnoses of disabilities lead to termination. In fact some people refuse prenatal tests that are freely available because they have already decided that knowing will make no difference to them.
But this is the parent(s), having consulted with those important to them and seeking appropriate medical advice, who are making the decision.
As a society, we say that a range of options are available. Then we leave it up to individuals to make use of the system and make their own decisions about the value of a life.
Many Canadians also refuse treatment for advanced stage cancers and write “living wills” that indicate their own personal line in the sand.
Having the government draw this line in the sand seems to be advocating for more, rather than less, government involvement in personal life. Something I understood was anathema to the “average American.”
Good points, all.
Christie, Tommy Douglas also believed in eugenics, particularly in respect to sterilizing mentally and physicalled-disabled people (which is compatible with the idea of abortion, I think). Who knows if this was a part of his thought process as to how costs would be controlled in such a system…?
He also suggested that it should be harder for such “subnormals” to marry, and that it would be cheaper for society if they were segregated from mainstream society.
So, we don’t quite have the healthcare system he imagined.
The genius of the Canadian system is single-payer. Health care provision isn’t, and will never be, a true market because in a private system, too much market power is in the hands of physicians or insurance companies.
Markets only work when either party can walk away from the deal, and they work best when there are lots of buyers and lots of sellers.
If I want to buy a new plasma screen TV, I can shop around: look for sales; look in the classifieds; shop on eBay. And in the end, if I can’t find what I want at a price I’m willing to pay, I can walk away. I can always buy something later.
But if I break my leg, or my wife is hemmorhaging on the delivery table, you can charge me whatever you want, and I’ll pay it because the alternative is death. You can extort any amount you want, because the consequences of my “walking away” are too dire for most to consider it.
I think it’s entirely rational to use the power of the state to counterweight the imbalance of market power in health care, and say to physicians: you may only charge this much, and you may only bill the government. But that’s as far as we should go.
Where we go too far in Canada is in insisting that everything be publicly run. This is what leads to unnecessarily long wait times and other inefficiencies.
What we ought to do is set the price and then invite anyone who so desires to set up a clinic or hospital of whatever description. Want to set up a multidisciplinary practice involving doctors, chiropractors and dieticians? Go for it. Want to set up a specialized surgical facility for hip and knee replacements? Be our guest. Want to open a hospital in the south end of Calgary, where one has been overdue for decades, because you’ve run the numbers and know you can make a business case for it while charging the legislated rates? Excellent!
Almost four years ago, the Alberta Hip and Knee Pilot project reduced wait and surgery times to one-tenth their usual length — and with better patient outcomes. But changing the practices of Alberta hospitals, even in the wake of such stunning results, has faced huge implementation challenges.
If we allowed doctors, nurses, etc. to set up their own facilities, we’d get more of this kind of innovation (not just when the government decides it’s time for a pilot project) and when results like these were published, facilities that could adapt more quickly would serve more patients.
While no health system is perfectible, I believe that the single-payer model is the genius of our system, but insisting that all facilities be publicly-run is unnecessarily slowing down the adoption of innovation in healthcare; we’re the poorer for it.
I am one of those Americans unable to move on from a corporate job because my husband and I need the health insurance. We’re too old, and we’ve had prior conditions. If we ever could obtain it on the open market (doubtful), we’d never be able to afford it.
I am aghast at the direction my country is taking: One of your readers asks, what is the value of human life? What kind of question is that to ask? To ask that should fill you with shame. You sound like Scrooge in A Christmas Carol when he says `If they would rather die,” they had better do it, and decrease the surplus population.”
America is becoming a frightening country full of misled, angry, mean people. I only wish they could be visited by three ghosts who might tear the right-wing scales from their eyes.