I don’t see the issue. Take my recent experience as an example. I had been having chest pains on and off for most of a week. Finally on a Friday afternoon, I was having a glass of wine and making a snack and decided to hell with this, I’m going to get it checked out. It was too late to try to get a doctor’s appointment so I left everything in the kitchen and got myself to the ER, expecting I’d be back in a couple of hours at most with a prescription and some innocuous diagnosis.
I’ve pretty much told the rest of the story before. I got admitted with high blood pressure and cardiac issues that were non-urgent but needed attention. Over the next few days I got lots of testing done, medications administered, an angiogram done, bypass surgery was recommended, spoke with a heart surgeon about options, a meeting was convened to see if I was a candidate for stenting as an alternative to bypass, the answer was “yes”, the procedure was done later the same day, and I was home the next day.
So what was it about this that was lesser quality than your cardiac experience? What took longer? What value would you assign to guaranteed unconditional full coverage with no out-of-pocket costs – and most importantly, no meddling insurance company to say “you must have bypass” or “we won’t pay for this particular stenting procedure because it’s a new procedure (as indeed this was) and we deem it ‘experimental’” – as Aetna did to this unfortunate girl? Or this even more unfortunate one?
No offense, and I’m not blaming you, but based on my experiences over half a century of living with the health care system in Canada I find your friend-of-a-friend story to be not credible and the result of the typical kind of distortions and omissions that happen when verbal stories are told and retold, exaggerated and embellished, until they become unrecognizable. It seems like no coincidence that it fits the right-wing propaganda narrative of “people wait so long to get health care in Canada that many of them are dying!”. That’s not what the health outcome statistics say. In fact they say the opposite, compared to the health of the average American. And that’s not what my personal experiences say.
Because he’s the one making outrageous unsubstantiated claims.
I’ve only skimmed that article but it looks like one of the more thorough analyses of major health care systems I’ve seen in recent years. I like the comprehensive discussion of each country’s system in a separate chapter. I wish more people would read them and educate themselves.
But as you’ve suggested, some of the numeric stats in the earlier part need to be interpreted in context and with a grain of salt. One can cherry-pick a number like a big portion of Canadians have supposedly said that the health care system needs “fundamental reform”, and you’re right to be skeptical – it’s also odd how one would reconcile that with other surveys that show 85+% are satisfied or very satisfied with it. One could also note that only a slightly smaller percentage of Americans think their own system needs fundamental reform, and that percentage is smaller only because quite a large chunk of them are in the “needs to be completely rebuilt” category.
You’re certainly correct that the Canadian health care system isn’t perfect, and if I sound like I’m claiming that it is – and sometimes I do tend to sound that way, I admit – it’s partly because I’m so sick of hearing it attacked with complete falsehoods by the American insurance lobby and those who’ve bought in to their propaganda, and also partly because it’s served me and my family so well for so many years. But no, it’s not perfect. And some of the problems are problems that we have in common. There aren’t as many GPs in family practice as we need, for instance, and that’s a problem in the US, too.
The problem of wait times is the most talked-about and also by far the most misunderstood. I’ve tried, over and over again, to explain the all-important distinction between waiting for some trivial appointment where the wait presents nothing but a minor inconvenience, and having access to timely medical attention when you need it – even if it’s not urgent, but when time does matter. I think the Canadian system generally handles this very well, while managing to control costs for the overall system and providing guaranteed universal coverage for everyone with little to no out of pocket costs.
The other obvious point that’s often misunderstood is that “wait times” refer to procedures scheduled for outpatients. Once you’re admitted to hospital, wait times are generally pretty much how long it takes them to wheel you over to where the procedure is done.
True, it does. It does that by allowing the health care provider system to be so enormously profitable that expensive resources sit idle and underutilized. That’s not a smart or sustainable way to run a health care system when a single piece of equipment like a modern MRI machine can cost millions of dollars, plus the staff to run it.
The absence of a central authority to negotiate and standardize provider fees is one of the fundamental structural problems with private insurance. The other one, which is a direct consequence of the first, is that they have to try to control costs at the individual case level, so there’s enormous paperwork and scrutiny associated with each claim, and each claim comes with the risk of being cut down or denied. Which is why my position has always been that private business is totally the wrong model for health insurance. At best, it’s a force-fit of a square peg in a round hole that would have to be very tightly regulated. Switzerland manages to do this with reasonable results – to an extent that American conservatives would never find acceptable – but they still end up with the second-highest health care costs in the world.
If your argument is going to be “all health care must be immediate, because you never know what you might find”, then you’d better have the statistics to back that up. You’d better also have an infinite amount of money to provide it. The real world just doesn’t work that way. I know you provided the anecdote about your blood clot. IANAD and I can’t say whether there were obvious red-flag indications of urgency. What I can say is that misdiagnoses happen from time to time on very rare occasions, and they can happen under any kind of health care system. If there was a systematic issue of people’s health being at risk from lack of timely medical attention, it would be reflected in UHC statistics. It isn’t. In fact, as I said before, people in Canada live longer, healthier lives than Americans on average, and infant mortality is lower as well.
Since you mention hip replacements, it’s a good example of the importance of triage. It’s often dredged up as an example of awful “wait times”, and the fact that a broken hip can be very dangerous in an elderly person is often thrown in to highlight the problem. This is a bunch of convoluted nonsense. Joint replacements like hip and knee typically have fairly long wait times when they’re needed simply as a result of gradual aging, but not if something gets broken as a result of a fall or an accident.
This is another example of “nice theory, but it doesn’t happen”. There are many wealthy people in Canada. They’re mostly fine with the health care system. Paying money to bypass the UHC system isn’t done because it generally isn’t legal. Some Canadians have indeed traveled to the US for medical care, but a careful analyses of these cases generally turns up the fact that they’ve done it in order to get some form of new highly specialized treatment that’s only available in one or two research centers, and not for mainstream health care.
