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The truth about Canadian Health Care

This morning I’ve been reflecting on the debate about health care that’s happening south of the border.  Like many Canadians I’ve been in disbelief watching the rhetoric escalate.  The outright lies, and Orwellian double-speak by special interest groups in the US have me wondering how my American friends will ever achieve a resolution.

What caused this reflection?  It has been a week since my last posting, and that has partly been due to an experience with our health care system in Canada.

Last weekend I dropped my son off at McMaster University in Hamilton.  It’s his freshman year, so he is living in residence, and he was very much looking forward to frosh week and getting to know the other young people he would be living with.  By Monday evening however, he had developed a stomach problem.  He visited the on-Campus clinic.  The doctors there thought it might be a flu, and advised him to stay in bed, which he did all day Tuesday.

By Tuesday evening he knew it was more than a simple flu bug, as his stomach problem had escalated to extreme abdominal pain, accompanied by fever. He called McMaster Emergency Services and was taken to the emergency department at the university hospital.  We got a call from him at about 7:00 telling us he was there.

I grabbed the 9:00 PM flight to Toronto, cabbed it from Toronto to Hamilton, and was there by 11:30, by which time he had had blood work, and an ultra-sound, and the diagnosis was confirmed as appendicitis. At 1:00 AM he was prepped for surgery, and by 4:00 AM his appendix had been removed and the infection cleaned up.  The surgeon, a Dr. Kellsie, informed us that the appendix had been leaking but not yet ruptured, which made the job easier.

He spent another 36 hours in the hospital, and came home with me last night.  Today he’s walking slowly, but obviously on the mend.

For my American friends who worry about Canadian style health care, and who are enduring the rhetoric around “death boards”, and “protecting our seniors”, I offer the following observations:

  • This was a true emergency, and it was dealt with promptly.  It was just 8 hours from admission to diagnosis to the completion of surgery.
  • The quality of the care was world class. He was attended by a team of five physicians and residents following the surgery, and housed in a semi-private room on a ward with just 12 rooms.
  • The cost to my family was $0.  Not only that, it didn’t drive up insurance premiums, or have any of the other negative effects associated with privately insured health care.
  • The cost of the drugs he is taking during his recovery – two antibiotics, and pain medication, was just over $50, and I can probably get my drug plan to cover it.

I’m sure that the Canadian system isn’t perfect.  While I lived in the US I had gold-standard quality health care as a Microsoft employee, and there is nothing that I am aware of in this country that matches the best of the best in the United States.  However, for those confused or made fearful by the rhetoric being used on Capitol Hill, you need not fear “Canadian style” health care.  It’s head and shoulders above what the tens of millions of un-insured in the United States receive, and the quality is as good or better than what the average insured American receives today. I can only say that because I’ve lived in both countries and experienced both health care systems.

More to the point, however, I would ask the following of my American friends. As you listen to your leaders debate this issue, ask yourselves what three days of emergency hospitalization would cost in your country.  My recollection is that it’s probably well in excess of $30,000. Next ask yourselves whether it’s fair that families be ruined over routine, but unforeseen, medical needs.

These are questions only you can answer.

As for me, I am profoundly grateful for the incredible care that the team at McMaster hospital delivered, and the speed with which it was delivered.

{ 21 comments… add one }

  • Shai Berger September 11, 2009, 7:07 am

    I spent the first half of my life in the US. Second half in Canada.

    Here's my one sentence summary:

    America has the BEST health care in the world… if you're rich.

  • Bruce Stewart September 11, 2009, 7:12 am

    Thanks for sharing this Alec and I'm glad your son is on the mend. My wife recently had a similar experience with her appendix here in the U.S., and thankfully we have good insurance so it didn't cost us much, and she received good care. But I really appreciate you writing this and pointing out the insanity in our "debate" over health care reform in the U.S. I can't understand how we've gotten so far off the mark, and how so much of what is discussed here today has nothing to do with the problems in our obviously broken system, or even health care at all.

    Even though we have good health insurance, I also have an immediate family member with a serious chronic health condition (one that would cost us over $2000/month for just the maintenance meds if we were uninsured) and we live in fear of losing our current coverage and getting stuck in the "pre-existing condition" nightmare of the current U.S. system.

    The costs surrounding health care here have just spiraled completely out of control, and the problems with basing our health care system on for-profit insurance companies seem painfully obvious to me. For one small example, I use a CPAP machine for sleep apnea, which my insurance covers, but I see all the invoices, and am regularly shocked at what I see. If I need a replacement hose or a small piece plastic part that should cost a few cents, it will always cost hundreds of dollars. And I think your U.S. hospital estimate is low.

    Here's hoping some sanity gets injected into the conversation. Thanks for this post.

  • Ian Stevens September 11, 2009, 9:16 am

    Hi Alec. I'm glad your son is OK. I think Canada's health care system is excellent for all but extreme cases, certainly compared to the American system. I personally haven't paid for a visit to the doctor for a checkup or the hospital for emergency services. However, you should disclose that McMaster has a medical school (http://fhs.mcmaster.ca/main/index.html) which "trains physicians, nurses, physiotherapists, occupational therapists, health care researchers, physician assistants and midwives." As such, the quality of the care and the equipment may be different than that received at other hospitals.

    • Alec September 11, 2009, 9:33 am

      It is true that Mac has a medical school, Ian. But like many large cities in Ontario, the Hamilton hospital organizes itself centrally, and then sends patients to the most appropriate institution. In Hamilton it's called "Hamilton Health Sciences", in Ottawa "the Ottawa Hospital", and so on. I bring this up because just as Hamilton has McMaster, Ottawa has a medical school at University of Ottawa, and all residents of the city have access to the faculty and physicians at the medical school. I believe the situation is the same in Toronto, and other cities. So, quality of care may vary from place to place, and indvidual institutions may have differing specializations, but the central hospital is supposed to be charged with ensuring that the patient gets the best care available in the municipality.

  • Owen September 11, 2009, 11:25 am

    Alec,

    great news for your son and you. I have recently had almost the same experience here in the US with my daughter. Now, bear in mind that my wife is a fantastically highly trained internist herself (Harvard and UCSF). basically my daughter had very similar symptoms to your son. We waited, as he was advised to do, then my wife decided enough was enough and we took her to Children's Hospital in Oakland (a VERY reputable hospital for children – my daughter is a teenager). We have very good insurance. You can read more about the ensuing debacle here – http://www.sfgate.com/cgi-bin/blogs/gurley/detail… – but it wasn't pretty and sadly is all too typical now. The summary is that we paid more (eventually about $150 out of pocket but it could have been more), we had worse treatment and the long term outcome was less good – and we had a good 40 hours worth of bureacratic hell.

  • Owen September 11, 2009, 11:25 am

    Alec,

    great news for your son and you. I have recently had almost the same experience here in the US with my daughter. Now, bear in mind that my wife is a fantastically highly trained internist herself (Harvard and UCSF). basically my daughter had very similar symptoms to your son. We waited, as he was advised to do, then my wife decided enough was enough and we took her to Children's Hospital in Oakland (a VERY reputable hospital for children – my daughter is a teenager). We have very good insurance. You can read more about the ensuing debacle here – http://www.sfgate.com/cgi-bin/blogs/gurley/detail… – but it wasn't pretty and sadly is all too typical now. The summary is that we paid more (eventually about $150 out of pocket but it could have been more), we had worse treatment and the long term outcome was less good – and we had a good 40 hours worth of bureacratic hell.

  • Marcelo Rodriguez September 11, 2009, 11:25 am

    Alec,

    I was hoping you would weigh in on this. I know your politics are, generally, libertarian. But I also know from a boozy discussion we had some years back that you would not give up Canada's universal health care for anything.

    Unfortunately, what is being debated on the other side of the border below you is not even close to Canada's system. It is a stop gap measure that is aimed at providing insurance for the uninsured and little else. Canadian-style universal health care is not even up for discussion here, but still, for reasons that boggle the mind, opponents of any kind of health reform (primarily the insurance industry, and its political party) are running ads on TV criticizing Canadian health care.

    It wasn't too long ago when Americans living on the northern border would sneak into Canada to "steal" the health care they were denied here (for some reason, those "illegal aliens" never got the kind of attention those coming from Latin America to "steal" jobs from Americans continue to get). You guys, if I remember correctly, had to issue national health cards to keep the border crossers under control.

    Thanks for weighing in. We in the U.S. need our much more enlightened Canadian neighbors to speak the truth.

  • Alec September 11, 2009, 11:43 am

    Owen, thanks for your comment. Your experience with your daughter sounds appalling, and the $35,000 bill for her appendectomy is in line with what I thought. Did I read it correctly that your insurance only covered $5,000 of that bill?

  • Fiona Jackson September 11, 2009, 12:12 pm

    Hi Alec, My appendectomy experience here is Seattle where we have excellent care was not as good as your son's care. I arrived at the ER around 7:00 Pm on a Sunday evening. I waited 2 hours in the ER before I even saw a doctor. A CT scan was done around midnight and my surgery about 5 the next morning. Other than the wait in the ER, my care was excellent, and I do have good insurance. Still, my co-pays made it a $2000.00 experience, which fortunately we can afford. Not everyone can, though. I would be happy if we had a Canadian system here!

  • Jason September 11, 2009, 2:21 pm

    I'm glad to hear that your son is recovering well.

    First off, I have to preface my comment with this:

    I love the Canadian system, and wouldn't give it up for anything.

    There, now to the meat. :)

    I dislike non-single payer systems, where the middle class has the option of going private (like UK and NZ). For all the inflammatory rhetoric about death panels, public systems _do_ refuse treatment (such as dialysis) resulting in the patient's death within two weeks.

    With medical care, any time there is a queue or budget, people will die while waiting. It's even built into the numbers – just ask an actuary.

    So, while public health care does allow everyone to gain access, the ability to go private means that people can (and will) go private, lowering their desire to properly fund the public system.

    Any single payer system results in budgets and a removal of your ability to do what you think needs to be done.

    For example, Wellington, New Zealand – the capital – doesn't have a paediatric oncology team. Children have to fly to either Auckland or Christchurch. For a long time, there wasn't an allergist (either private or public) – in a city with _insane_ child asthma rates (25%+). Regional population? 500,000.

    Finally, it's a fallacy that large numbers of people go bankrupt (in the US) from medical costs. If you look at the data, it's the loss of income that gets them, not the medical costs. The conclusions in the study were flawed. The researchers didn't properly group or differentiate their data. If you want to stop a bankruptcy, life and income insurance are much better weapons than medical insurance.

  • Marcelo Rodriguez September 11, 2009, 3:25 pm

    Alec,

    I was hoping you would weigh in on this. I know your politics are, generally, libertarian. But I also know from a boozy discussion we had some years back that you would not give up Canada’s universal health care for anything.

    Unfortunately, what is being debated on the other side of the border below you is not even close to Canada’s system. It is a stop gap measure that is aimed at providing insurance for the uninsured and little else. Canadian-style universal health care is not even up for discussion here, but still, for reasons that boggle the mind, opponents of any kind of health reform (primarily the insurance industry, and its political party) are running ads on TV criticizing Canadian health care.

    It wasn’t too long ago when Americans living on the northern border would sneak into Canada to “steal” the health care they were denied here (for some reason, those “illegal aliens” never got the kind of attention those coming from Latin America to “steal” jobs from Americans continue to get). You guys, if I remember correctly, had to issue national health cards to keep the border crossers under control.

    Thanks for weighing in. We in the U.S. need our much more enlightened Canadian neighbors to speak the truth.

  • Alec September 11, 2009, 3:43 pm

    Owen, thanks for your comment. Your experience with your daughter sounds appalling, and the $35,000 bill for her appendectomy is in line with what I thought. Did I read it correctly that your insurance only covered $5,000 of that bill?

  • Fiona Jackson September 11, 2009, 4:12 pm

    Hi Alec, My appendectomy experience here is Seattle where we have excellent care was not as good as your son’s care. I arrived at the ER around 7:00 Pm on a Sunday evening. I waited 2 hours in the ER before I even saw a doctor. A CT scan was done around midnight and my surgery about 5 the next morning. Other than the wait in the ER, my care was excellent, and I do have good insurance. Still, my co-pays made it a $2000.00 experience, which fortunately we can afford. Not everyone can, though. I would be happy if we had a Canadian system here!

  • Jason September 11, 2009, 6:21 pm

    I’m glad to hear that your son is recovering well.

    First off, I have to preface my comment with this:

    I love the Canadian system, and wouldn’t give it up for anything.

    There, now to the meat. :)

    I dislike non-single payer systems, where the middle class has the option of going private (like UK and NZ). For all the inflammatory rhetoric about death panels, public systems _do_ refuse treatment (such as dialysis) resulting in the patient’s death within two weeks.

    With medical care, any time there is a queue or budget, people will die while waiting. It’s even built into the numbers – just ask an actuary.

    So, while public health care does allow everyone to gain access, the ability to go private means that people can (and will) go private, lowering their desire to properly fund the public system.

    Any single payer system results in budgets and a removal of your ability to do what you think needs to be done.

    For example, Wellington, New Zealand – the capital – doesn’t have a paediatric oncology team. Children have to fly to either Auckland or Christchurch. For a long time, there wasn’t an allergist (either private or public) – in a city with _insane_ child asthma rates (25%+). Regional population? 500,000.

    Finally, it’s a fallacy that large numbers of people go bankrupt (in the US) from medical costs. If you look at the data, it’s the loss of income that gets them, not the medical costs. The conclusions in the study were flawed. The researchers didn’t properly group or differentiate their data. If you want to stop a bankruptcy, life and income insurance are much better weapons than medical insurance.

  • Mum September 12, 2009, 6:32 am

    Well said Alec! It is not a falacy that people in the US go bankrupt because of illness. Your dad has a friend in Florida who is in real estate. He owned several properties and was doing very well when his wife got sick. He had a veteran's medical insurance which would not cover his wife. The bills were over $65,000.00. This happened as the real estate market crashed in the states. He had to take a mortgage on his home and sell his other properties to cover her medical bills. The mortgage company foreclosed on the mortgage on his house and he no longer had an income. He had to declare bankruptcy and find a place to rent.
    Some people could argue that all this was bad luck at a difficult time in the economy. However, if he had been insured in Canada he would not have lost all of his property because his wife's illness.

  • Alec September 12, 2009, 8:34 am

    Jason, I agree with all your points. Note also that I asked whether it was fair that families be "ruined". You're absolutely right that loss of income may be a bigger problem than the cost of the medical care.

    Once again, Canada has taxpayer funded employment insurance and disability pensions available. The impact of loss of income shouldn't be as hard to bear here.

  • Alec September 12, 2009, 12:34 pm

    Jason, I agree with all your points. Note also that I asked whether it was fair that families be “ruined”. You’re absolutely right that loss of income may be a bigger problem than the cost of the medical care.

    Once again, Canada has taxpayer funded employment insurance and disability pensions available. The impact of loss of income shouldn’t be as hard to bear here.

  • Shaun September 15, 2009, 1:54 am

    Hi guys i live in Canada right on the boarder of BC/Washington st. Ive been to the doctor in both countries many times because ive had team members from my hockey team injured during games.

    What I am going to say is what Ive experienced , not everyone may agree just what my experience has brought to my mind.

    Now first of all i feel that the US doctors are better doctors because you can get in right away plus they don't rush you out like most Canadian doctors ive experienced.

    However from comparing my Health Care plan to my good friends across the boarder I feel that the overall plan is cheaper and safer.

    I feel that both health care plans have good and bad things about them. dosent really matter who's is better but they should learn off eachother or combine in some way. Because lots of canadians/ americans travel through eachothers country quite a bit. i think Canada could benefit from it by getting more doctors because we so low in doctors. and the americans could benefit from a different plan or maybe our dollar rate to make things cheaper or easier for most people to afford.

    Idont know how exactly it would work through and throiugh, but it just shows that theres lots each country can benefit of its closest friends. thanks for listening

  • Greg P September 17, 2009, 6:41 pm

    The debate is crazy to me. It always boggles my mind that so many people in the States have such a knee-jerk reaction to anything even resembling "socialism." All it takes is a right-wing politician to say, "But this is socialism! The evil that can rip our society apart!" and the clucking begins.

    Never mind that the end goal is caring for the very citizens that make the country great. I am constantly amazed at the American People's need for polarity in debates like this. All or nothing, good or evil….

    As a brand-new dad in Canada, and having lived abroad a number of years, I can say that I'm very thankful that we will be raising our son in this country. For our health care system to be held by the political right in the U.S.A. as pseudo-evidence of something UN-desirable, I can only shake my head.

  • Justin September 29, 2009, 9:13 am

    I have issues with the subsidies Americans pay so that Canadians, Europeans, Indians, etc., can all have cheap drugs.

    When another country enacts a cap on a price for drugs, we Americans have to subsidize the R&D for those drugs. This holds for American-designed drugs, as well as drugs designed in foreign countries ( they sell them to America at higher rates than in their own countries).

    • Alec September 30, 2009, 2:20 am

      Justin, I think you should educate yourself on the issue before throwing stones. Canada and European countries all subscribe to the WTO negotiated patent regimes. Drugs enjoy the same protections here as elsewhere. It's true that brand name drugs cost less in Canada than in the US. Generics, however, cost more. The reason for the price disparity is a market phenomenon of what individuals and provincial insurers are willing to pay for drugs.

      See this study for more details.

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