Tuesday, August 5, 2008

Socialized Medicine

Two weeks ago, the authors at the Oh Get A Grip blog offered their views concerning health care. Several people commented on socialized medicine, and I decided to ask my own 'experts'.

My sister Wendy is a Social Worker, and has been living in Canada for about ten years. I asked her to share her views of the issue, since she is an American citizen who works for the Canadian Health Care. She and her husband Chris are taking over my blog today, to share their views.

I am an American living in Canada. I am familiar with the Canadian medical system both as a patient and as an employee.

As a patient:
1) My employer pays the monthly premium (around $200 for a family for BC medical) so we basically have free health care. That means . . .
2) If I want to see a Doctor . . . I go . . . I don't have to worry about deductable's,etc. We have a Family Doctor who is wonderful but if one of the kids has an earache or something after business hours, I can take them to a walk-in clinic.
3) The Province of BC has a 24 hour Nurses line. If I have a question or concern, I can call them for direction. After the birth of David, I called them several times a day and they were great!
4) My son's birth turned into a C - section (unplanned). I recovered in a private room (given on first come, first serve basis so I got lucky) for five days. I had several consultations with a lactation consultant before I was discharged and I didn't pay a dime!
5) After my children's birth a Public Health Nurse came to our home within a week of my being discharged from hospital. This visit is mandated by the government and all mother's are visited regardless of socio-economic status, age, race, # of babies,etc. The Public Health Nurse weighed the baby, ensured that I was comfortable bathing my baby and was there to help if had problems with nursing and/or bottle feeding the baby.

As a Social Worker who works for a Health Authority, I believe that the Canadian medical system is ethically superior to the U.S.
1) The Canadian philosophy is that medical care is a basic human right; it is not treated as a business.
1) Everyone has medical coverage. Yes, there is a monthly premium, pro-rated based on income ($200 per family is the highest monthly rate). However, most employers pay the premium (it's considered a standard benefit). If you are unemployed or disabled then your medical is covered.
2) I work with disabled adults, most of whom are on disability through the government. Doctor's appointments, medications, medical equipment and medical services (OT,PT, SLP, etc.) are covered.
3) Paid Respite is available for families who are caring for a disabled family member

These are just a few examples that I personally have experienced or have knowledge that the services exist. Perhaps that greatest difference between the Canadian and U.S. systme is this . . . In Canada, you don't have to fear that an accident or serious medical condition is going to result in the lose of your home and savings or create crushing debt.

Let me jump in here a moment, Wendy...what about issues with long waits? James said, in his post, "And we come to socialized medicine. At various points in my life, I had an opportunity to see socialized medicine in action. It sucked. Yeah, the price was right, but the service was lacking. What would normally be a thirty minute doctor’s visit could easily take up to 8 hours of waiting. And if a hospital is only operating on what ever money the government deems necessary to keep the doors open, how well do you think the staff is paid? So, by the time you actually get back to see the doctor, nine times out of ten you find a surly person, who has half their thoughts on how they are going to make that month’s rent and all the patience of a jackal with its hind leg stuck in a trap. Tread lightly, it’s late in the day and they are fed up with all the bullshit they had to put up with from the patients before who came before you."

What's your take on it?

Yes, there is some truth behind the waiting comment. I guess it's all relative though. In a Canadian hospital everyone is triaged and the folks who are truly in crisis get seen first. Waiting is inconvenient, but let's put it in perspective, the person waiting for 8 hours isn't someone who is going to die.

For me, it comes down to ethics . . . in the U.S. the medical system is a business and so yes, you get all the benefits of a well run business . . . and good customer service is paramount (i.e. short wait times) but you PAY for this service. In the U.S. folks who can't pay can be refused admittance to an emergency room. People have died while driving from one emergency room to another because their HMO didn't approve of a hospital or the hospital doesn't take folks without insurance. Refusing to see patients would certainly cut down on the wait time.

As for the comment about the wages of employees, I work for a Health Authority and as a Social Worker (BSW) I am paid well. In Canada, Doctors are not paid millions. Salaries are more equitable as all members of the medical team are valued and compensated accordingly. Let me be clear, Canadian Doctors are making six figure incomes and I'm not. However, on my salary I'm able to maintain a comfortable middle-class lifestyle.

On a final note, be wary of all the reasons and excuses that you have been given for why socialized medicine is bad. In the U.S. the medical system is BIG business and millions of dollars have been put into advertising that is geared to convince you that the U.S. way is the only way and the right way. I love the U.S. and it saddens me that the medical system is elitist. Is a lawyer with insurance who has to have her stomach pumped after a suicide attempt more deserving of care then a 2 year old with a ruptured appendix who's parent's don't have insurance? In Canada it's not a business equation, both people need help and both would receive medical services.

You have sparked a few interesting conversations between your sister and I. We have both worked for the health system in one way or another and also lived in Canada so maybe we can answer a few things. Here goes, in no particular order:

First of all, contrary to what the American Medical Association would like you to think, socialized medicine does work and is the norm in every first world nation on earth. Canada, Australia, the UK, Germany, Italy, France, etc etc. all have had such a system for at least 30-40 years. It is the US system that is odd and frankly, the rest of us think YOUR system does not work.

Health care in Canada is considered an essential service much like water, electricity, emergency services etc. It is not a business. We have 100% healthcare coverage for everyone and can not imagine the wealthiest country on earth leaving roughly 50 million of it's citizens without coverage. That is more than the population of Canada.

Medical staff in Canada and other countries are not underpaid, surly(ok, we have a few grumpy types that would be grumpy anywhere!) etc. at all. Here are a few samples: Care aids: $40,000, Nurses $60,000+, Doctors(standard GP) $200,000++, Specialist Doctors: $300,000+++. Bear in mind that this is US dollars and all are bare miniumums. Most doctors make more and experienced nurses can go much higher. Billing rates for doctors are standardized and it is illegal to bill additionally. I realize that US medical staff (mainly doctors) do earn more but I would hardly call them impoverished in Canada. My understanding is that salaries are similar in most other countries that have socialized medicine.

All billing goes through the provincial medical services plans and there are no additional charges for services. No deductables. If you have no additional medical insurance you will pay for prescriptions but that is all. Furthermore, if you want more medical insurance coverage you can pay for it so that prescriptions, alternative medicine, additional services etc are covered.

Canadian medical coverage covers all basic medical needs including essential dental work. Physiotherapy is covered too along with any other required specialists such as lactation consultants, etc. Home care nurses visit after births and surgeries. Cosmetic surgery is not covered unless it involves disfigurement, visible cysts etc. Dental work will not cover braces etc but will cover pulling teeth etc. Same for eye doctors. You get an eye exam free every couple of years but you buy your own glasses. And again, you can buy higher levels of medical insurance privately if you so choose.

The huge difference between the sytems is that the US system is a business and the Canadian system is an essential government service. Because of this the US system caters only to those that can pay. Customer service is a high priority under the US system since all patients are private customers and expect to be treated as such. Costs are much higher since you have both a profit motive and higher salaries for medical staff, though I suspect it is mainly doctors that reap those rewards. US medical services cost about double what they do in Canada.

Hospitals in Canada are not privately owned. Clinics are most often privately owned and employ doctors for a percentage of their billing. Doctors that wish to make more of a business of their profession can choose to own a clinic and employ other doctors. Since there is no issue as to getting paid a private clinic will never turn away patients. When it comes to services not provided under standard public health care it may be different. I suppose when it comes to different insurance plans for those services they could likely pick and choose. Specialists will have their own offices for their particular specialty though most of them are affiliated with a hospital for surgical facilites.

Costs for medical coverage in Canada are about $150/month for a single person and I believe about $250 for a family. If you are a lower income person it is pro-rated or free. If you are behind on payments you will not be denied services. Kind of like if you don't pay your property taxes the fire department will still come to your house! Also bear in mind that companies in Canada that are not fortune 500 level are more inclined to have medical benefits because they are less expensive than they are in the US. I have not heard of anyone I know paying their own medical premiums in years unless they are self employed.

Some other differences that you would notice is we don't have HMO's. You choose your doctor. You go as often as you want. You do need a referral to see most specialists but that referral is not based on what the insurance company will pay for, it is based on what the GP feels is needed for your health.

As Wendy mentioned, you can have waits at busy times (saturday night for example) in an Emergency Room. However, those waits are generally only for people that have chosen to go there with non emergency problems because the clinic or their GP's office is closed. Emergencies see immediate service and have priority over junior with a splinter! Again, the system is not customer service based, it is based on health needs.

There can be a wait for some services or surgeries that are not considered essential. A bit of discomfort (ie knee replacement) may be let slide when they are prioritizing surgery booking over someone in need of a heart transplant. All will be served but some may wait. You can pay privately if you don't want to wait and I think that some of the additional insurance plans may allow for faster service. Again, always nice to be rich, but your life will be saved regardless of who you are under the Canadian system.

A huge factor that is glossed over is preventive medicine. Many diseases such as cancer have a much higher survivial rate if detected early. If you are poor and must pay for every visit or at least must come up with a deductible you will usually wait longer before visiting a doctor. In Canada you just go when you need to. I suspect that many deaths occur in the US that could be prevented with early detection. You might want to check average life expectancy broken down by socio-economic status in the US. It could be informative.

The upside to the US system is that you have wonderful research facilities and you can provide fantastic service to those that can afford it. The downside is that it does not cover many of it's citizens.

I hope that helps.

Thanks you two:) Kiss the kids for me!


Phoenix said...

I like it. Socialized medicine seems like a benefit in the overall scheme of things. I like chosing my doctor. I like making a lot of those health decisions. But seriously, when a family like ours has to pay around 1500-2000 a month for coverage, it's just not right. I'd rather wait 8 hours and know that my family is covered regardless of what is needed.

jackie said...

Very good interview Molly! As far as the whole 8 hour wait, I have had to wait a very long time, at times, to get into the emergency "room", itself. It isn't as bad inour small local,but larger cities have this sort of incident often.
Now, We here in the us have a form of socialized medicine, but on general it isn't recognized. It's called medicaid. Usuallt, it is looked down on as well, because of the big business ideology the US has.
But it does exist here. Now, my wonder for your sister is how do the taxes compare to those of us here? The universal healthcare is funded by the tax system isn't it?

anny cook said...

Excellent information. Thanks!

Cindy Spencer Pape said...

This is the same understanding I have from my dad's siblings in Canada. Sure there are some problems with any system, but at least they HAVE a system!

Unknown said...

Thank you so much Molly for getting your family to share this information with us.

I think we all hear so many conflicting stories about whose healthcare "system" is better. It's nice to get some honest facts from people who are not trying to get you to buy into their hype.


Unknown said...

I have long thought the Canadian medical system is far superior and desirable to ours in the US. We went without medical insurance for a year while DH was out of work because the premiums would've been about $1,000 monthly through my employer. We held our breath the entire year and we got lucky nothing bad happened. Our system sucks.

Anonymous said...

Very nice article. I am selling optional health insurance (yes, we have such thing, it covers dental care, drugs and some other minor stuff) in Toronto term life, so I am a bit also "from the other side".
1. Word "free" shouldn't be used, it's paid by your taxes. Even your employer is not paying it with "his" money, it's your money. The difference is more successful
pay more. I don't mind, I am willing to spend some of my taxes for the less lucky.
2. Yes, it's more humane, not seeing other people helpless. But I don't like you can't get something special, even if you are willing to pay cash for it. Everything is regulated by the government.
3.How long will our system survive, after birth rate will decline and working people will retire?
4.There is no motivation to take care of your health.

Generally, I am fan of our health care, I just think, we shouldn't fall asleep :)

Anonymous said...

Good words.