All the horror stories about socialized medicine are true--in Quebec

Miscellaneous and Personal Stuff I Must Share
1

Maybe not all, but many. You cannot choose your doctor. Doctors cannot choose their patents. Waiting times in emergency rooms regularly exceed 24 hours (although, to be sure, not in real emergencies, like a heart attack).

So please listen to my tale of woe. My family doctor of > 40 years announced his retirement, as of April 2021. So I started calling around to various clinics only to be told that none is taking new patients. Nor do they have a wait list. Eventually, I was told to register with the provincial wait list, which I in Nov. 2020. Also registered my wife. In Feb. 2022, she got a phone call from a doctor’s office saying she had been assigned to him. So she made an appointment and saw him and got a checkup exam. I asked whether it was possible for him to take me as a patient, especially as he was a geriatric specialist. No, not possible. He had a list from the province and, as spaces opened in his practice, he was permitted to take new patients only from that list. Finally, last June, I got a similar phone call from a doctor who was a 40 minute drive away. (My wife’s doctor was at a place where parking was basically impossible, but a relatively easy bus ride away.) So I saw her. She carried out no actual exam, just treated it as a get to know you meeting. She ordered blood tests. Unbeknownst to me she ordered a PSA test. All the medical guidelines say you don’t get PSA tests for people over about 70 and I was 85. My physician DIL was aghast (and angry). Then I had a second visit and she still did no exam. Instead she spent the entire 15 minutes arguing that I should see a urologist, which I finally agreed to. When he saw the results (around 10) he laughed and said he wouldn’t do anything with any patient my age with a reading below 20, then amended that to 30.

Then in December, less than 6 months after I had first seen her, I got an email that in two weeks she would be leaving the public service and all her patients should get on the provincial list. Which has now grown, so I shouldn’t expect to be assigned a doctor for a couple years, by which time, should I still be alive, I will be 88. In the mean time I have not had a physical exam in maybe 4 years. I probably had one in 2019, but after the pandemic hit, by old doctor that he would no longer see patients in person.

Then a coupld weeks ago, I got a letter that I was now assigned to a group oractice that was located downtown, in a place that is impossible to park, but is easy to reach by Metro and bus. The trouble with the Metro is that the one near us requires descending about 70 steps (there is an up escalator, but not down) and that is very difficult. But I guess I can use the bus. A nurse/practitioner called from there a couple of weeks ago and took a very thorough medical history (including asking when and how my parents and other relatives died) and then attempted to make an appointment near me for a physical exam. She made it at a clinic that is only about a half mile from apartment. So I walked over there and the receptionist asked why I was there. When I told her I wanted a checkup, she said, “Oh we don’t do that; we do only emergency care.” Back to square one. When I tried to contact my downtown group practice, they told me they would call back to make an appointment within two weeks. That was a week ago.

I won’t claim that I would be better served in the US. Although if I lived near my DIL in Boston, I’m sure she would have found arrangement for me (at considerable expense) but the whole experience shows that socialized medicine is not the panacea it is supposed to be. A few years ago, I read that Quebec spends 47% of its budget on medical and has spent years trying to cut costs, mostly by encouraging early retirements. The result is a dire shortage of doctors and nurses.

Meantime, there are foreign-trained doctors drivng for Uber. They are required to do internships in order to practice, but the number of internships available to them is very strictly limited. I am not sure if the limits are imposed by the Quebec order of physicians or the provincial government–probably both.

2

When was the last doctors’ strike?

3

You would undoubtedly be better served in the U.S., IMO.

Not that I am defending our system. It’s horribly inefficient.

But FYI, I’ve had extremely good service from the U.S. system, on the few times I’ve needed it.

4

Basically these horror stories are true all over–and not limited to areas with socialized medicine. Covid led to a major exodus of heathcare professionals all over (early retirements, switching jobs…).

5

IF you had private insurance you would get much better service in the US. Without it your experience would likely be similar, except that there is no “provincial waiting list” and you would just have to keep working the phones until you found a doctor who was taking patients.

6

That’s horrible @Hari_Seldon ,
No one your age should go that long without care.

But the US has its own set of issues, as said above.

Good luck.

7

I guess I shouldn’t have bitched about waiting a month and a half for a (non-emergency) appointment with a new internist.

*At times it felt more like an appointment with his laptop. He did listen and ask questions though.

8

This is a key point.

Every health care system rations care. There are only so many doctors and nurses, only so many resources; all economic systems everywhere must ration. You can ration by need, by market forces, by true rationing, by influence, by luck, but you have to dole out X one way or another. If you lose doctors and nurses, the speed and quality of care will probably decline. It doesn’t matter what the rationing system is. You only have so much to go around.

9

I have news for the OP - the horror stories about the market-based health care system in the US are also true. I guess it just depends on which horror stories you want to deal with.

10

I’m beginning to think no health care system works, period. The hoops we’ve had to go through to get my autistic son an evaluation and treatment in the US are insane - and we have the “good” insurance which we pay out the nose for. But our wait list to get an evaluation is 1-2 years, and in socialized medicine, the wait to have your child evaluated for autism is closer to 4 years. Given the choice between losing all my savings to medical costs (US) and having to wait four years to get treatment for my kid (UK), I think the US barely squeaks by. But talk about the lesser of two evils…

11

It’s not the system. American Medicare is largely based on Canadian Medicare and works quite well. I’ve read the only real difference between them is that the US spends more for better services than Canada does. The failings of the Canadian system are largely the result of political decisions to keep costs low.

12

As many of you may know from some of my lengthy diatribes on the subject, I’m a staunch defender of Canada’s single-payer health care system. Yet I have to say that I agree with the OP, and it’s consistent with other horror stories I’ve heard out of Quebec. In that regard, it’s important to point out that what is often referred to as “the health care system in Canada” is really 13 different systems, with the ten provinces and three territories administering their own systems under the broad general guidelines of the Canada Health Act. Conforming to the broad general standards of the CHA is a requirement for federal funding, but (at least for major provinces) that funding is a relatively small percentage of each province’s health care budget.

So what’s wrong with Quebec’s health care? Surprisingly, it’s not the reasons that may appear most obvious. Quebec has indeed over the years lost a big part of its tax base when rising French nationalism and increasingly draconian language laws drove many large businesses out of the province, mostly to Ontario, fueling the ascension of Toronto as Canada’s financial capital and the decline of the once-great Montreal. But that loss has been compensated by endless free money from the federal government, both in the form of direct transfer payments and in the form of federal institutions and infrastructure projects. One might think that language issues might create doctor shortages, but many bilingual doctors immigrating to Canada – especially those with life-long exposure to the French language – are uniquely attracted to Quebec’s bilingual culture.

So, with all that in mind, what is in fact the problem with health care in Quebec? While we sometimes semi-jokingly refer to single-payer health care as “socialized medicine”, for the most part it’s really just single-payer funding of health care providers who otherwise operate as independent agents in a relatively free market. Quebec, however, has always had a genuinely socialist streak in its political ideologies, and a propensity to heavy-handed bureaucracy in health care policy.

In short, Quebec’s health care system has been characterized by incompetence, oppressive bureaucracy, staff shortages, inflexible union agreements, low morale, silos of responsibility, and bureaucratic rigidity. The government is constantly battling with doctors and their unions. Just as one example, Quebec has a disproportionately high rate of people lacking family physicians despite having more doctors per capita than the Canadian average. One way they manage to do this is by requiring all new general practitioners to take on special medical activities (SMAs; in French, AMPs) during their first 15 years of practice (it used to be 20!). SMAs mean designated hospital work, paid less than their private practices and often involving odd hours. If they don’t put in at least 12 hours a week of SMA, they are fined 30% of their income. And in most cases it’s realistically more like 25 hours per week, since most hospitals require that as a minimum commitment.

Other examples abound. A few years ago Quebec’s then health minister embarked on a major program of centralization, merging institutions, reducing the number of governing boards, putting many facilities under the leadership of a single CEO and gutting the ranks of middle management. Some of this has been reversed but the impacts were predictable. Quebec’s current health minister is trying to introduce new legislation to drastically reform and improve the health care system. This legislation, however, (Bill 15) is a really major shakeup of the whole system – Quebec once again managing health care by fiat from on high rather than incremental changes based on actual real-world performance. Bill 15 runs over 300 pages, contains more than 1,100 clauses, and modifies roughly three dozen laws.

That, in my non-expert layman’s perception, is largely what’s wrong with health care in Quebec. It’s not the single-payer system as set out in the Canada Health Act. I’m perfectly happy with my health care here in Ontario. The only issue I’ve ever had is one that I talked about in another thread. After my hospitalization for cardiac issues (and I have nothing but praise for the excellent doctors who looked after me) I was “assigned” to an outpatient cardiologist operating out of a hospital-affiliated clinic. The place was big, crowded, and impersonal. I asked my family doctor for a referral to a different cardiologist, who has a comfortable and well-equipped private office and who I’m very happy with. This is single-payer as it should be – freedom to choose any doctor or facility you want, it doesn’t matter because the system pays for all of it. The problem with Quebec seems to be the propensity of Quebec culture to let bureaucracy run amok.

13

I signed up with Kaiser Permanente after I lost my group coverage thinking that their model of doing business was the way of the future. IE local group of doctors and labs that share information and you move from primary to specialists as needed.
It kind of works like that but they have you going from one town to another to see different doctors. I am scheduled 39 miles away for an colonoscopy which means I have to get a medical tranport and hire a babysitter for my self who just has to wait in lobby then pour my drunken drugged self into the van. If it was local I would be ok with it. Appointments for non emergency are 2 or 3 weeks out. Only upside I can brag on is their lab technicians. They are always available and local and they are very good at what they do. Always a clean quick stick and draw. They can tell so much about you from that. And the electronic medical records are available to all the doctors ) Payment goes to the KP insurer and the doctors. So I feel like that is a lot like a one payer system.

14

Well, except that unless you pay KP their premiums you get no coverage. And except for the fact that you only have access to a designated network of doctors and no one else. And except for the fact that KP has the ability to deny coverage or interfere with treatment recommendations. And except for the fact that there are deductibles and co-pays.

IOW, nothing like single-payer UHC at all.

15

Thanks, I learned a lot from that post.

16

When my sister first moved to California in 1995, several people told her to go without insurance rather than use Kaiser. I’ve heard varying things about it, and the one common factor is that it was a good idea when it started, but not so much now.

17

I was with Kaiser for a few years in my early 20s. I thought it was fine, but I was young and rarely needed to see a doctor. When I met my wife a couple of years ago, she was with Kaiser. I went with her to a couple of appointments, and was fairly appalled at the poor quality of care that she got. She had two “physicals”, which were very perfunctory, about 10 minutes each, and didn’t involve much actual examination of her body beyond listening to her heart and lungs with a stethoscope. I got her out of Kaiser and transferred to my doctor. In the six months she’s been with him, he and the specialists to whom he has referred her have found two issues that were dealt with early, but could have been life-threatening if not handled when they were. I have no confidence that Kaiser doctors would have found them in time.

18

Excellent post, all of it.

I should add that Quebec is an outlier in the “sign up on a waiting list and you’ll eventually be assigned a doctor” scenario. That’s not how it works in most, if not all of the rest, of the provinces and territories of Canada. In such provinces and territories, you select your own physician—there are no government-run “waiting lists to be assigned a physician.”

If what I’ve seen on other, predominantly American right-wing message boards, is anything to go by; this confuses the hell out of right-wing Americans. “Quebec has a long waiting list before you can be assigned a physician. And Canada has national health care. So that applies to all Canadians.”

Except it doesn’t. Here in Alberta, I can choose my own physician. We don’t have waiting lists to be assigned a physician. You pick up the phone and call one. If your selection has a full caseload, they’ll refer to another one. I could do the same when I lived in Ontario. If I moved to Nova Scotia, I could do the same. It’s important to remember that Canada does not have national health care; rather, it has provincial health care, and the provinces make the rules. What happens in Quebec regarding health care is not representative of the rest of Canada.

19

Both @Spoons and @wolfpup make excellent points. Note that I specified Quebec, not Canada in general. As usual, they have made a bureaucratic morass out of what is potentially a much better system.