A Rather Off Topic Post On Health Care Misconceptions (or Adam Smith is Stupid)

Yes, you can all gasp now. But before I go on to further explain let me say that Gracie is doing really well. Her eye hemorrhaged again, so it's all red, but other than that she seems to be doing well. We've noticed no adverse reactions from the platelets transfusion and she continues to bounce and run and scream and basically be far too energetic. My how that anemia hits her hard.

 Now onto the title of my post. Being Canadians living in the USA during this past election there are a few of phrases we hear quite often, some of them include "Aren't you glad you are down here and can get good health care?",  "Is Canadian health care as horrible as they say it is?" and "I'm told you get what you pay for". 

First off I must say that the majority of Canadians LOVE our health care system (67% in 2006). It has been something I've felt passionately about for several years now, since I was taking a political science class on health care in university. Second I must add that I can't really get into highly intelligent debate as I'm  not exactly a scholar on the economics of health care, nor is this the place to do it if I was. This is a blog about Gracie and retinoblastoma. This is not a political forum nor will it ever be. I'm just frustrated with all the misconceptions I've heard about Canadian health care and if I hear it once more I think I'll scream. As such I'm going to vent for a little bit, but only for this one post. Then it will be back to the good old We Love Gracie.  Most of my opinions come from first hand experience of both the Canadian and US systems. Really I think I'm quite intimate with both of them now. I lived for 28 years in Canada  and was a health care provider either as a PCA, student nurse or registered nurse for 6 years. My mother has been a registered nurse working in Canada for 35 years and in the USA for 8 or 9 years now. My sister is an RN specializing in emergency care and has worked in the USA and Canada as well for about 10 years total. We've discussed and compared the health care delivery between the two nations at great length. My experience with the US system is solely as a recipient. I've never worked down here. But in the year and a half we've been here my son has gone through extensive physical therapy since he was 4 months old. He has gone through testing to determine if he had a progressive neuromuscular disease (which he doesn't) and he continues to be tested for metabolic disorders to determine why he has global hypotonia.  Gracie as you well know has been receiving cancer treatment for the past 3 and a half months.  The most common misconceptions that I hear are about long wait times and quality of care.

Quality of Care

The Canadian and US health care systems both provide excellent care with highly educated physicians, nurses and other providers. I've had to put aside one of my own misconceptions when I moved down here. I know a number of people (I can think of at least 5 off the top of my head) who were not able to get into medical school or dental school in Canada so went to the USA to get in.  It's just easier to get into med/dental school down here. As a result I was honestly worried about the education of my doctors when I came down here. When I voiced that concern to my sister she told me that I was silly and almost all of the doctors she'd worked with were very good. I must agree I really like most of the doctors we've had down here. Perhaps Canada should learn something from this. Perhaps by requiring such a high GPA for students to get into medical school we're turning away a lot of candidates that could be excellent doctors. The staff I've dealt with down here have been really really good for the most part. But the staff I've worked with in Canada have been really really good too. The technology we have in Canada is also really high. We are far from a developing nation.  In fact when they do the genetic testing for retinoblastoma they send it from here to Canada as the lab in Canada has the most sensitive testing and they don't give up if they can't find a mutation. In such a case they keep the sample to test later with future methods so that they can determine the mutation. 

Wait Times

I'll have to admit there are longer wait times for some things in Canada. I'm too lazy to actually research and compare what they are. However we triage in Canada. So often if it's an elective procedure you're going to wait, but that's mostly because you're being bumped by life threatening procedures. A few years ago my brother did sit and wait in the ER with appendicitis, but that's because the OR's were stuffed full of people from multiple traumas that night. His condition was potentially life threatening, but theirs were imminently life threatening. (This isn't an every day occurance, it was just a bad night to have appendicitis). Being a family member of someone who had to wait I must say I'm 100% okay with that, because if it was my brother in the trauma I'd be really grateful. My dad has had to wait for knee replacements, but you don't have to wait to start cancer treatments. I've talked with the retinoblastoma people in Canada. We would have been in a week earlier there than we were here. I've talked to another family in the last couple of days that said the exact same thing about another health treatment. They actually went to Canada for the treatments because they'd receive it quicker there than they would have here. For the most part you only wait if you can afford to wait (ie medically stable). Plus if you've got a doctor worth their salt then they can anticipate most elective procedures (ie hip & knee replacements which are the ones with legendary waits) and get you on the waiting list before it's causing too much discomfort. That way when you actually need the replacement it's your time to get it any way. Truthfully we would have had to have waited longer for my sons procedures in Canada than we did here. He has had an electromyography and a muscle biopsy as well as several blood tests for metabolic disorders. That waiting would have been hard because it would have been not knowing, but there wouldn't have been a rush for anything other than emotional reasons to find out what his condition was. In Canada they probably would have done blood tests to determine if he was a candidate for muscular dystrophy or spinal muscular atrophy and the major metabolic disorders (outside the ones screened at birth) and when those came back negative they wouldn't have been worried as much and they would have ended the push for the diagnosis. They would have taken more of a let's wait and see approach. Down here they have pushed harder for the diagnosis which we still haven't received. So either way we would end up in the same boat we're in now, he's progressing forward we don't know what's wrong, let's wait and see how he does (and he's doing really well). Now there may be the odd factual horror story of people not receiving urgent medical care in Canada because of long wait times with disastrous results. This would not be a phenomenon unique to Canada. Since being here I know of at least one case that has made the news of a lady who died in the US while waiting in the ER. There may be more, but I don't actually follow the news too carefully so I really can't say.  In any of these cases I'd say that the individuals providing the care actually need to take some responsibility in these cases. If I tell someone having chest pain to wait in the lobby and they die of an MI while waiting it's not the systems fault, it's their inept triage nurse. I was talking to a mother in the cancer center on Thursday who told me that her 9 month old daughter was vomiting blood and her stools were black for a full week all the while her doctors told her it was just a virus. Finally the mother insisted that blood work be done and it was determined that this little girl was in renal failure due to acute myeloid leukemia. She ended up being airlifted to Austin where she was admitted to the PICU and proceeded to have a 7 month inpatient stay. An unacceptable wait for emergent care right here in the USA. But it's not the health care systems fault, it's a "What on earth was this doctor thinking" problem.  Triage people, TRIAGE! It may be inconvenient to wait for relatively minor things, but if it's you who's life is on the line you'd be awfully glad that's the way it works. 

Insurance Companies

Really I'm thoroughly annoyed with insurance companies. We've had to fight with them to cover the surgery to put in Gracie's port as the only pediatric surgeons in Austin were not covered by them. They've tried to say Gracie's zofran (nausea medicine) is not medically necessary. Now they've got issues with covering genetic testing to determine if any of our other children have the retinoblastoma mutation. Why is it them deciding what Gracie needs and not her doctors. I hate having to worry about insurance.  Insurance companies are far too powerful. And while I'm talking about this I might as well add how frustrating it is that hospitals and doctors overbill for services. I really don't think that the hospital should be able to charge $15 000 for a 1 hour procedure. And this doesn't include the doctors, drugs, or any thing else (trust me their nurses aren't getting paid enough to justify these costs either). That is simply the hospital fee. Yes, our insurance paid most of this fee but it simply shouldn't have been that high to begin with. There is no way it costs that much. By making health care a capitalist business hospitals, doctors, insurance companies and everyone else involved are all trying to make as big a profit as possible and it's insane. As a friend said, they're like the Roman fire fighters that would negotiate the price of putting out a fire right there while a house was burning down. You kind of have to pay what they tell you to pay. If you need it, you need it. And then you have to worry about price in the aftermath. I thought the idea was that the consumer was supposed to drive the market. Well I'm sorry, the consumer isn't driving anything. They're utterly powerless. I think it's sad that when  people find out Gracie has cancer one of the common responses we hear is "Oh, I hope you have insurance". What if we were self employed and couldn't afford insurance? We'd have debt that we wouldn't be able to climb out of in our life time. These are peoples lives we are talking about, not just another great way to make a profit. It can ruin lives. People are worried in socialized medicine that it would be abused. I'd far rather have several people abuse it than have even one person who needs it not be able to receive it. Plus if you don't think the US health care system is abused, talk to an ER doctor or nurse, they see it all the time. 

Universality

One of the key principles of the Canadian Health Act is that it is universal.  Canadians are entitled to health care no matter where you are and how much money you make. And you don't get lesser care because you can't afford it. Some people complain about how much money they have to pay in taxes to provide for universal health care. We've learned that we pay FAR MORE money in insurance premiums down here than we ever paid in taxes in Canada. And then when you go to the doctor down here you still have deductibles and copays to pay on top of insurance premiums. An unexpected illness in Canada will not leave you penniless, whereas it's the leading cause of bankruptcy down here. As for the theory that you can shop around and have more choice in health care in the American system. I find that down right laughable. Your "choices" are limited to whoever is in network with your insurance company. Your "choice" in insurance company in edicted by whoever your employer has contracted insurance with. Of course you may be self employed. If that's the case good luck in actually being able to afford the insurance premiums for any descent coverage without an employer paying part of it. 

Portability

Anywhere you go in Canada you have health care coverage. You don't have to check to see if the hospital you go to is in network with your insurance. You don't have to worry that your in network hospital has shipped your blood they drew to an out of network lab and that you'll be slapped with the whole bill as a result. It's ALL covered EVERYWHERE.

Fear Mongering

 While in my political science class I watched news coverage from back when they were moving the Canadian health care system into a more socialized system. It was highly comical decades later to see the irrational fears people had about what would happen if we moved to socialized health care. The government would know all about your health. PLEASE! Do people really think the government cares that you had a vasectomy last year, or what your cholesterol level is. I think they've got more important things to do with their time. They were prophesying the decline of the quality of care that would come as a result. Their fears were irrational, but they would simply stir each other into a frenzy about the horrors that would ensue if we moved to a socialized system. And look here we are 40 years later and like I said mostly we Canadians are really pleased with the result of what was so vehemently opposed initially. I find those news clips even more humorous now as I'm watching the exact same fear mongering occur now. When I was talking to our case manager from insurance she mentioned that we shouldn't ever move back to Canada as they just don't have the ability to care for us there. She mentioned that they only had 10 MRI's in the whole country. I was completely shocked that an intelligent being really believed this. This is simply not true and I told her so. Most of the horror stories that you'll hear about Canadian health care are just that, stories. Where they come from, I'm not exactly sure. Our case manager claims they came from a Canadian doctor she knew. Well, I'd take with a grain of salt any story that comes from disgruntled Canadian doctors (or any other person), they may not be entirely unbiased or accurate. Even in the non embellished  stories one bad experience does not reflect of the quality of the entire system. 

I found that this quote (which I got from wikipedia) sums up my opinion nicely. In a letter to the Wall Street Journal, Robert S. Bell, M.D., President and CEO of University Health Network, Toronto, said that Michael Moore's film Sicko "exaggerated the performance of the Canadian health system — there is no doubt that too many patients still stay in our emergency departments waiting for admission to scarce hospital beds." However, "Canadians spend about 55% of what Americans spend on health care and have longer life expectancy, and lower infant mortality rates. Many Americans have access to quality health care. All Canadians have access to similar care at a considerably lower cost."

So what do I say when people ask me if Canadian health care is really as horrible as they say. I simply say that I LOVE IT! Is it perfect, absolutely not it still has a long way to go and I hope we keep trying to improve it to make it as good as we can. But it's pretty darn good, and Tommy Douglas is one of my heros. In regards to the recent election I might not agree with everything Mr. Obama had proposed, truthfully I didn't pay much attention as I can't vote here any way. But I did pay some heed to health care, and in my opinion the only one who proposed a better health care plan than Obama did was Hilary Clinton. So there you have it. You don't have to agree with me. The vast majority of you will strongly disagree with me I'm sure. And like I said I have no intentions of debating it, because I've never claimed to be an expert on these matters. It won't be mentioned again, definitely not on this blog. But these are my opinions and now you'll know the next time I get asked about the Canadian health care system and I roll my eyes what I'm really thinking. And this concludes my venting. 

p.s. The bit about Adam Smith is just because James laughs every time I say that. Really I haven't read the Wealth of Nations or any of his other works so I'm not sure what I think about him. I only have a high school education on that subject. James points out that although I say I'm in favour of socialized health care this may not be entirely accurate. I definitely am in favour of universal health care, but I'm not entirely sure I'm using the correct terminology to describe my beliefs, or for that matter what exactly my beliefs are. One of my goal for 2009 is to embark on a study of economics so that I can become more knowledgeable on the subject. Maybe then I can discuss it and feel somewhat intelligent while doing so.