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Brain -> RE: Why not get the Single Payer Health Care System? (7/30/2009 2:34:46 PM)
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U.S. debate reminds us our medicare is worth it
André Picard
http://www.theglobeandmail.com/news/national/us-debate-reminds-us-our-medicare-is-worth-it/article1235958/
Montreal — From Thursday's Globe and Mail Last updated on Thursday, Jul. 30, 2009 07:23AM EDT
Shona Holmes has become a central figure in the bitter debate about U.S. health-care reform.
The Waterdown, Ont., woman is featured in a TV ad telling her tale of horror – how she had a life-threatening brain tumour but would have had to wait months for treatment. So Ms. Holmes remortgaged her home and flew to the Mayo Clinic in Arizona for treatment, paying $97,000 cash for her care.
“Now, Washington wants to bring Canadian-style health care to the U.S.,” the narrator says gravely in the ad, paid for by Patients United Now, an offshoot of the Americans for Prosperity Foundation, a conservative group that promotes less government and lower taxes.
Ms. Holmes has also recounted her nightmare story in countless media interviews, warning that “free” Canadian health care comes at a heavy price – lack of access – and lamenting her inability to buy private insurance to get quicker care.
“My agenda, if I have one, is to tell them [Americans], be careful what you wish for,” Ms. Holmes told The Washington Times.
Discussions surrounding the provision of health care always elicit strong emotions and outbursts of rhetoric, and Ms. Holmes's case is no exception.
She is, of course, entitled to bash medicare and promote the idea of private health-care insurance both at home and abroad. That is the beauty of free speech. (And, to be fair,
Ms. Holmes has always praised the quality of care in Canada; her issue is access and timeliness.)
But a few important details are missing from the “commercial” version of this socialized-medicine-kills tale.
Ms. Holmes did not have a deadly brain tumour, she had a benign Rathkes cleft cyst. Yes, she had vision loss, but it was temporary and reversible. This is not to suggest what she went through was not awful and frightening, but it was not life-threatening.
Initially, Ms. Holmes said she had a six-month wait to see a specialist. Later, she amended that to three months. Canadian hospitals and physicians won't say how long the wait was nor comment on the gravity of her condition because of privacy rules.
For the sake of argument, let's acknowledge that the wait to see specialists like neurologists can be long. It's a problem that needs to be fixed, and the situation is already better now than it was in 2005, when Ms. Holmes had her health problems.
The reality is that, in Canada, we “ration” care. Under our state-financed insurance program, we try to provide universal care efficiently and cost-effectively. We make choices. Getting the balance perfectly right is difficult.
The United States, by contrast, has over-capacity. That is one of the principal reasons that, per capita, care costs about 50 per cent more there than in Canada.
Money buys you access, and lack of money denies you care. In Canada, we have a not-always-happy medium: Universal access with sometimes frustrating waits.
So what happens when a patient feels they are waiting too long for care? Ms. Holmes had a “gut feeling” that her life was in danger and made a radical choice to pay out-of-pocket for immediate care in the United States rather than wait for “free” (read: tax-financed) care in Canada.
Now, she wants to be reimbursed by the Ontario Health Insurance Program. She is also a party to a lawsuit against the Ontario government arguing that a “government-run monopolistic” health system that prohibits the sale of private insurance for medically necessary care is unconstitutional. (The case, very similar to the Chaoulli case in Quebec, is backed by the Canadian Constitution Foundation. It is still before the courts.)
There are complex legal issues here and competing rights that the court will need to balance. But what insurance program, private or public, would ever allow clients to determine their own treatment and reimburse them without question?
In the discussion flowing from Ms. Holmes's ad, it has been noted often that some 45 million Americans do not have health insurance. For them, the right to buy private insurance is moot because they cannot afford it and the Canadian-style system looks pretty appealing. But that is largely beside the point here.
Ms. Holmes is insured – albeit by a state-financed plan. The question is: Can insurers (and providers) delay and deny care, and can they limit and deny coverage?
Of course they can, and they do so all the time. In the United States, health insurance is expensive and it is often tied to employment. Even those with good insurance see their claims denied because of “pre-existing medical conditions,” insurers' attempts to hold down “medical losses” (the industry term for paying for care), and caps on total payouts.
Ironically, for all her lauding of private insurance, someone like Ms. Holmes would find it virtually impossible to buy insurance, given her medical history.
The infamous ad claims that Canadians have long waits and are denied all manner of care because the “government says patients aren't worth it.”
On the contrary, medicare – universal state-financed health insurance – means everyone is worthy of care and entitled to care.
If nothing else, Ms. Holmes' foray into the U.S. health-care debate should remind us of how medicare, despite some shortcomings, is worth it.
Americans can only dream of having such a system to bemoan.
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7/30/2009 11:27:50 AM#
Well done. M. Picard. I couldn't have said it better. The only thing I would like to ad is a suggestion to all those folks in Canada who blog and twitter that they should bombard America with the beauty of our system, the simple fact that people are cared for when they are sick without having to wonder whether they can pay or not.

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7/30/2009 11:24:24 AM#
Does anyone know how this two tier system works in France?
I was told that you go to your doctor pay for the visit, and then get the money back from the gov. Is that true? How about hospital stays, surgerys, outpatient procedures?
It seems to me that is the government (all taxpayers actually) who foots the bill in France too. The difference being that you pay out of your pocket and file for reimbursement. How is that different than what we have? The only difference is the money does not change hands twice in our case. But doctor's office is still a private business, as is the medical tests lab.

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7/30/2009 11:17:55 AM#
All systems are imperfect, but some are more imperfect than others. To get a good measure of the merits of the Canadian versus US health insurance systems, all you need do is ask one question: how many people have been driven by medical expenses into personal bankruptcy in the US and in Canada? In the US it can happen even when you think you are covered by private insurance. Has anyone heard of such a thing in Canada, the UK, France, Germany.....?

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7/30/2009 11:14:11 AM#
Does anyone care about what Ms. Holmes says?
She appears on messages paid by right wing interest groups, doesn't that make her a bit biased before she even opens her mouth?
Fraser Institute has been feeding us stories about lack of access and lack of proper care for....years. Good thing they are only a think tank and not policy makers (yet).
I don't think anyone plans to bring canadian style healthcare in US, but if they would I am sure they could easily find a poster boy/girl like Ms. Holmes to promote their interests.
As for Ms. Holmes bashing her country...I guess she's free to do that. What is sad is the fact that I think she does it not by her own conviction, but because she was asked (maybe paid) to do so.

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Mr Smith 7/30/2009 11:13:49 AM#
Randy:
Ah the old private health care makes us evil and money grows on trees argument, I stand corrected.
Oh wait, all the best ranked medical systems in the world are two tier and money does not in fact grow on trees.
I am sure you have very good reasons for your strong opinions but since you have no knowledge to refute my points with please do some research. The demographics of our country mean that in the near future a huge percentage of our population is going to retire greatly reducing payment into our coffers and greatly increasing payments out. This will strain all parts of government and cuts will have to be made. This is without even talking about how well most industries become more efficient (read cheaper) over time the healthcare industry actually becomes more expensive. I am not advocating that we should remove free access to healthcare for all in fact I am discussing how we can continue to afford it. If you don't want to lose CPP EI or maybe even universal care itself you might consider taking a realistic long range view point now rather then keeping your head up there in the clouds. I am sure you and your friends have a great time discussing how evil us realists are though.

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