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To Your Health – Wishful Thinking For the New Year

My mother-in-law, who is 74 and lives in Quebec, was on the way home from a bus tour of the western US when she suffered a burst aortic aneurysm near Battle Creek, MI. She was rushed to Battle Creek Hospital. They told us to prepare for the worst, that it was, in essence hopeless. Nevertheless, they ordered a chopper and flew her to the University of Michigan Medical Center. From the time she collapsed on the bus to the time she was in the ER at U of M was less than 3 hours.

Turns out this hospital is the world leader in surgeries for repair of aortic aneurysms. Usually the surgery is done before the rupture. The surgeons told us there was little hope, but they would do what they could.

To make a long story short, she survived, and after 3 weeks in intensive care, she was well enough to be moved to the local hospital in Shawinigan, Quebec. She has been home and recovering for the past month.

Had the aneurysm burst here at home in Quebec, she would have died. The nearest hospital with any possibility of surgery would be in Montreal, 100 miles from here. There are no medivac helicopters here. Even if there were, there would have been no room for her in the hospital. It takes months to schedule even essential surgeries here with government run universal health care.

So far, the bills we have seen for the cost of her care in the US are up to $400,000. Her travel insurance policy covered all of it except for $3000, including 10 days of hotel expenses for my father in law.

The insurer was desperate to move her back to Canada for the entire time after she was in recovery in Michigan. No Canadian hospital could or would take her until she was well enough to come home to her local community hospital.

A Canadian doctor accompanied her on the flight home in late November. To this date she has not been able to see a cardiologist here. She has an appointment with one next month, in Quebec City, again 100 miles away.

I guess, if you have insurance, and a critical life-threatening emergency, the US is a good place to be.

Canada isn’t. Even if you are in a major metro, it’s a tossup as to whether you will survive.

My mother-in-law still has many fruitful and loving years ahead of her, God willing. We all thank God she was where she was when the crisis hit.

I’m an American. I live in the US most of the year, having become a part time Canadian resident just for the past four years. I am wholeheartedly in favor of a government run system of universal health care. Even if it can occasionally provide for the miraculous rescue of a person’s life, the current system in the US is completely broken. A for profit system of care will never fairly distribute health services.I would point out that the hospital that saved my mother-in-law’s life was a not for profit state run educational institution, not a private for profit hospital. Would she have gotten the same timely emergency care from Columbia, or Tenet, or HCA? Who knows?

In Canada, the system is more fair, but instead of universal health care, there’s a universal health care shortage. Canadians pay for it with ASTRONOMICAL taxes. In addition to sky high income taxes, the usual real estate taxes, numerous nickel and dime government fees, Canadians pay a Federal sales tax of around 7.5%, and here in Quebec, another provincial sales tax of around 7.5%.

But is that so bad compared to HMO costs of $11,000 per year for a family of four in the US? And in Canada, if you have chronic medical conditions that require long term medication, the government negotiates prescription drug prices for you. As a result, you save a fortune on drug costs. A heart patient on three or four prescription drugs will save $3-4,000 per year over what an American would pay. And Canada has other social programs and services that make those extra taxes well worth it, in my view.

For example, my stepdaughter is pregnant. Because she works as a nuclear medicine technologist, around radiation, the government told her to take the next year off at 90% salary. Of course, her salary is only 35% of what she would make in the US, but no one here is complaining. She loves her work, and her country. She’s not leaving.

But there is a shortage of medical care delivery in Canada, and especially of health care practitioners. Doctors and other medical professionals are paid only a fraction of what they can earn in the US, at the same time laboring under a myriad of government regulations.

But here again, a big part of the problem is the giant health care mess next door. Doctors may or may not be fairly paid here in Canada–it’s a matter of perspective, but in the US, if they want to, doctors can still become filthy rich. Because doctors can make so much more money in the US than they make here, many do emigrate to the States. The result is a brain drain from Canada. This is not the entire problem, but it is certainly part of it.

Here again, it comes back to fixing the mess in the US. Doctors need to be paid fairly, but they also need to be released from the costs and burdens of trying to collect their fees from the insurers and HMOs who beat them up on price and then hold back their payments for five or six, or nine months. What are the additional administrative costs involved in doctors trying to collect their bills, and fighting with insurers about treatments that they deem necessary for their patients?

The only way to make the system fair is to bring in some form of government run universal health care. Either that, or pass laws and regulations that force the private insurers and HMOs to behave responsibly with regard to both doctors and patients, if that’s even possible. These are corporations for god’s sake. They are crooks by definition.

It is absolutely fundamental that doctors must be empowered to decide the level of care that the patient needs. They must be paid fairly, and on a timely basis, but the society as a whole must decide through negotiation between the government and organizations representing providers, what that fair level of payment is. Furthermore, those costs must be coordinated with neighboring countries with similar income levels. Otherwise, the brain drain from those countries will continue. We must cooperate across international borders to make sure that there are no gross imbalances that prevent one country’s health care system from working.

Remember when the government fully regulated utilities? Things weren’t so bad then, were they?

Sure, the government run system has big problems here in Canada, but to a man–and woman, I have never met a Canadian who would give it up. I also know that there are other countries in the world where socialized medicine works a lot better to serve all of the people.

Unfortunately, as long as Congress and the Administration are in the pockets of the US pharma drug lords and health insurance mafia, we will never see the kind of change that we so desperately need. The very first thing that needs to happen is for the American people to wake up and enact a system of public financing of elections, and free public media time for candidates to end the control of the people’s government by corporate crooks.

A hopeless quest I know. If you’re a believer, put in a word with St. Jude, will you?

Happy New Year

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  1. mdporter

    Doc I agree with you for the most part. If Americans simply took care of themselves better (and most do not even have a clue how to anymore) what would our system look like?

    For example, a friend of mine has diabetes, and has been living with it for about eight years now. During this time though he has not made the necessary changes in his diet and exercise habits to help control his blood sugar more naturally. As a result the diabetes has advanced and he will soon lose his eyesight. Any good doctor or nutritionist could make him a list of “must do’s” that would significantly improve his life. But the patient refuses, requires more and more medicine and medical care, driving up costs for everyone.

    The US system sucks because it does not practice enough prevention. While it’s true that not all uses of the medical system can be prevented (injury, car accidents, etc), I think big improvements can be made with simple lifestyle modifications.


  2. CH

    Being a Canadian living in the US, I think I can comment on the pros & cons of both systems:

    – Firstly, taxes are not astronomical. The top combined income tax rate is 42-44%, depending on jurisdiction. That’s only slightly higher than the US.
    – The Canadian system underspends on medical equipment. The system was conceived in an era when medical care was a labor intensive activity (doctors, nurses, etc.) and didn’t budget for capital and other costs (e.g. MRIs, drugs, etc.) into its cost structure.

    – Medical practice management costs a lot more in the US than Canada. A large Canadian hospital would only have a staff or 3-4 to deal with billings as it’s a principally a single-payer system. That’s comparable to the costs for a single US medical group, which has to worry more about how to code procedures properly, dealing with insurance companies and getting pre-authorizations for specialist visits, etc. and you get the idea
    – Access to care in the US is great, if you can pay. On the other hand, that’s like saying New York City is a great place to live if you make $1 million a year – anything else is a struggle.

    Neither system is perfect. I think that we can learn the experiences of both countries.

  3. Lee Adler

    CH- Agreed.

    I believe that middle-income tax rates in Canada are higher, at least based on conversations with my brother in law. But I haven’t researched that directly. I also have no idea about deductions in Canada. The US has a high standard deduction for middle income payers. Homeowners have a lower effective rate due to the mortgage interest deduction. Also, sales taxes in US are much lower than the 15% rate that applies here in Quebec, where I am at the moment.

    From what I can tell as a part time Canadian resident, government doesn’t work to well here, any more than in the US, but my impression is that Canadians do get their money’s worth from their taxes.

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