Reality check: Canada's government health care system

[Exterminator]

KINGSTON, Ontario (CNN) -- For Shona Holmes, simple pleasures such as playing with her dog or walking in her plush garden are a gift.

After suffering from crushing headaches and vision problems, she was diagnosed with a brain tumor four years ago. She was told if it wasn't removed, she could go blind or even die.

"They said to me that you had a brain tumor and it was pressing on your optic chasm and that it needed to come out immediately," Holmes said.

Holmes is Canadian, but the "they" she refers to are doctors at the Mayo Clinic in the United States, where she turned after specialists in her own government-run health care system would not see her fast enough.

"My family doctor at that time tried to get me in to see an endocrinologist and a neurologist," Holmes recalled. "It was going to be four months for one specialist and six months for the other."

Even with the warning from U.S. doctors in hand, Holmes said she still couldn't get in to see Canadian specialists. Because the government system is the only health care option for Canadians, she says she had no choice but to have the surgery in the U.S.

Her treatment at the Mayo Clinic in Arizona cost $100,000, and she and her husband put a second mortgage on their home and borrowed from family and friends to pay for it.

When she recounts that part of her painful story, she weeps.

"That's the stuff that I find so tragic -- having dinner with my friends and I know how much money I owe them," Holmes says, tears streaming down her face.

With the health care reform debate raging in the U.S., Republicans in Washington are seizing on Holmes' story and other accounts from Canada to warn against government involvement in the health care system.

The Senate's top Republican, Mitch McConnell, R-Kentucky, asserted several times on the Senate floor last month that a government-run health insurance option, which President Obama and Democrats want, could lead to a government-controlled health care system like Canada's.

McConnell singled out Kingston General Hospital in Ontario as a prime example of what Americans should be fearful of: staggering delays in treatment.

CNN went to Kingston General and played a DVD for its chief of staff Dr. David Zelt of McConnell slamming the hospital.

Zelt insists McConnell's numbers -- an average of 340 days wait time for knee replacements, 196 days for hip replacements -- are an exaggeration.

"I find it very frustrating that someone of that stature would not really have true knowledge of the numbers he is actually quoting on things," Zelt told us, saying the average wait time for a knee replacement is actually 109 days, and a hip replacement is 91 days.  Watch Zelt talk about Canada's health care system »

However, Zelt does concede that in Canada's system, where every Canadian citizen is covered, there are limited resources, shortages and often delays.

"In our health care system, we're looking at what we have to do to prioritize patients -- critically ill versus purely elective surgeries," Zelt said.

"I'm not going to say we don't have issues with timeliness for some things. It does happen. But again take the other side of the coin -- these patients have access. They're on somebody's waiting list if they have a problem, and I think the senator would need to look at that issue. Yes it may take time, but they will get seen."

McConnell's remarks have not only ruffled feathers with Ontario's doctors but also with government officials across the border.

Canadian Sen. Hugh Segal, whom we met up with at Kingston's picturesque waterfront, says his "fellow conservatives" to the south are dead wrong about Canada's health care system.

"The notion that we have some bureaucrat standing next to every doctor between the patient and that doctor is a complete creation, there is no truth to that at all," Segal said.

"What you have is a longer life span, better outcomes and about one-third less costs. That's what you have."

What Segal, Zelt and other Canadian officials underscore is that their government-run system is driven by the value of the care and that the quantity of tests and procedures don't necessarily equal quality.

"You can have a patient from the hospital with abdominal pain as an example, and you can run him through every high-tech equipment, CT scan, MRIs -- it's unlimited," Zelt said.

"But then you have to take a step back and look at that. What's the cost of doing those types of investigations, and what's the value really added to the patient?"

Despite Shona Holmes' horror story about her inability to get timely treatment for a brain tumor, Canadian officials and doctors insist most life-threatening cases are treated quickly.

Toronto's Doug Wright can attest to that. The 40-year-old father of three young boys found out last month he has cancer -- a tumor on his leg.

But he says he never had to wait more than five days to see a specialist or get a test. And from diagnosis to surgery, it will be just over a month.

"The community medical system thought this process could not have been any better. I have not had to wait to see some of the best specialists in the country, who are renowned internationally," Wright said.

An investment adviser, Wright has the money to go to the U.S. for his care, but says there is no need.

But Wright recognizes one reason he has gotten such a rapid response from Canadian doctors is because he has cancer.

"The bad news is I didn't have to wait for anything, because you don't have to wait when it's a serious issue," he said.

Still, people can wait for months, or even years, for elective surgery.

Wright's friend Rick Hession has a heart condition that could cause a stroke, but he has a three-month wait or more for an operation to help correct it.

He says he can't exercise the way he would like to until he gets the surgery, but he's willing to wait. He calls it a small price to pay for free health coverage for all Canadians.

"I'm OK with it, and I think most people I talk to find they really are [willing to wait]," says Hession. 

The reality is that despite GOP rhetoric to the contrary, no Democratic plan now on the table calls for a Canadian-like government run health care system.

But in talking to doctors, government officials and even average Canadians, they concede their system is far from perfect, but there is one statistic they are quite proud of: All Canadians have health coverage. That's 33 million people, compared with the 47 million uninsured in the U.S.

[Henry Hawk]

smoke and mirrors

[Exterminator]

smoke and mirrors

Yes, that is all the repubs have offer.

[LOsborne]

smoke and mirrors

Huh? I thought it was a very even-handed article, pointing out pluses and minuses in both systems. Kindly tell me which paragraphs you thought were flim-flam. (You did read it, didn't you?)

[Anne]

Can patients sue doctors for malpractice in Canada?

[LOsborne]

Can patients sue doctors for malpractice in Canada?

Looks like it.

http://www.medlit.info/guests/mmpcanadian/medlit.htm

[Henry Hawk]

I did read it...LOsborne....my only reason I claim the smoke and mirrors is...in MY opinion, it is just another juicy article that supports MORE government control of our lives...and in a nutshell, that WILL be the case IN a National Healthcare....

I can find all sorts of articles where National Healthcares from other countries has some devasting effects upon the personal lives of those who are on it......

I STILL, believe, that the best way to handle this is to give MORE incentives for the private industy to provide healthcare insurance for it's employees....

I will say that Obama IS trying to make something happen that the majority wants....I just do not support more governmetn intervention.

[Anne]

Looks like it is a lot harder in Canada than here. There have been some terrible malpractice decisions and awards (IMO) in the US over the years. People want to sue over everything and somethings bad things happen and it is really no one fault, unless of course you want to blame God. Medicine is not an exact science.

[Henry Hawk]

Okay, I am stepping OUTSIDE the box here....and raising my eyebrows on this article that supports Canada's system.....I am cautiously optimistic....but MAYBE, it IS a starting point, that we can BUILD off of....this is interesting....and I am reminded that it IS a view from a PRO Canadian healthcare writer....


Ex, LOsborne and my left wing buddies......I want it to be noted, that I am TRYING to be open minded here...




Mythbusting Canadian Health Care

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. A few reasons for this:

First, as noted, they don't 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 don't 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 aren't 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 don't realize how much stress the American doctor-insurer fights put on the day-to-day quality of care until you see doctors who don't 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 doctor's debt is roughly half that.

Finally, Canadian doctors pay lower malpractice insurance fees. When paying for health care constitutes a one of a family's major expenses, expectations tend to run very high. A doctor's 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, it's no wonder people are quick to rush to court for redress.

Canadians are far less likely to sue in the first place, since they're 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 don't have to include coverage for future medical costs, which reduces the insurance company's liability.

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. 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 country's health care system. (And no, it had nothing to do with the fact that he was also Kiefer Sutherland's grandfather.). In spite of that, though, grousing about health care is still unofficially Canada's third national sport after curling and hockey.

And for the country's newspapers, it's a prime watchdogging opportunity. Any little thing goes sideways at the local hospital, and it's 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 it's certainly one of the things that keeps the quality high. But it also makes people think it's 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, 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.

They'll 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, you'll never get sick. (Like all good theologies, there's 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, it's 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 can't complain. It was their own damned fault; and it's not our responsibility to pay for their sins. In fact, it's recently been suggested that they be shunned, lest they lead the virtuous into sin.

Of course, this is bad theology whether you're applying it to the state of one's soul or one's 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: it's 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 one's health as one of your duties as a citizen. You do what's right because you don't 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 you're 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 they're still small and cheap to fix.

Third, there's 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, there's 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, 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.

[LOsborne]

Medicine is not an exact science.

That's why they call it "practicing" medicine.

P.S. Well done, Henry. Thanks for including the link.

[Exterminator]

Ex, LOsborne and my left wing buddies......I want it to be noted, that I am TRYING to be open minded here...

Too bad we can't get you to do so with virtually every other subject under the sun.   

[dan foster]

Huh? I thought it was a very even-handed article, pointing out pluses and minuses in both systems. Kindly tell me which paragraphs you thought were flim-flam. (You did read it, didn't you?)

...and exactly why we need the Dem proposed system; a public OPTION, not just a public system.  The proposed system eliminates most of the profit-from-pain for the insurance companies.  Fantastic!

[Anne]

My concern is what begins with an OPTION will quickly turn into the only option.

[Gryphon]

my senator, who, a few weeks back, sent his constituents an email filled with fear mongering and flat our wrong information, this morning sent me his proposal--a $2000 voucher for singles and $5000 voucher for families to be used for the purchase of health insurance.

Fine and good. But Im concerned that wont get enough people covered. Of course, those amounts dont come anywhere near covering the cost of a decent policy. (my dear old dad lamented that his firm rates went up again and it now costs him over $800 a month per employee, and if employees elect to cover their families, it is $1700 per MONTH). Clearly, $5000 would help those folks, but a secretary making 40 grand a year still wont be able to cover her family.

[Exterminator]

My concern is what begins with an OPTION will quickly turn into the only option.

Those who try to plan for every possible contingency never accomplish anything beyond planning.