Some Clarity About Canadian Health Care

Now normally I stay far away from discussing politics on my blog, or anything not related to programming. However, the debate going on in the US right now over plans to implement some sort of government-funded health care plan in one I find fascinating. I have many American friends that I follow via Twitter and some of the things I have read have made me decide that a blog post from someone familiar with the Canadian health care system might help clear things up.

I must also provide this disclaimer: I am not a doctor, no-one in my immediate family is a doctor, but I do know people who work as doctors and nurses have spoken with them about these issues in the past.

Let's start by looking at my understanding of the US health care system as it stands right now. The US spends more per person than any other country to provide health care, yet it appears that the vast majority of people are unable to benefit from this. I have read / heard anecdotal evidence that suggests that huge medical bills are the cause for the financial ruin of many families, and a leading cause of bankruptcies. This is a tragedy that no-one should have to go through.

On the flip side, the US is the source of many medical breakthroughs. But I would hazard a guess that the quality of health care a system delivers is in no way related to the ability of that system to develop new procedures or new drugs. I see them as two different systems, that interact with each other at the end of discovery. I hope that makes sense.

So, let's take a look at how the health care system works in my home province of Ontario. I was born in Ontario and have lived my entire life here. My only exposure to what some people would call "critical" surgery was when I was two years old. I had eye surgery on my left eye to correct a lazy eye that would've left me cross-eyed (and a circus-show freak as my wife often reminds me). That's been it. However, various family members of mine have been in the position of needing surgery of the "non-optional" variety, so I think I'm somewhat qualified to discuss this.

Now, those who oppose the government getting involved in being the ones who fund the health care system seem to have a few objections. This is by no means a comprehensive list, but some of these objections are:

  • it will cost more than what is being spent on it by now
  • people have to wait for vital surgery
  • people will not have any choice as to what doctor they get to see
  • it will stop innovation in the field of drug research

I think those 4 are enough for me to start with. Let's look at them one at a time.

It will cost more than what is being spent on it now

Yeah, I don't see how this is possible. If you replace insurance companies with the government, despite the government's well-earned reputation for mismanagement it will cost less because the government won't be looking to turn a profit. Canada's costs-per-capita are significantly lower than the US. So I think it's safe to say this objection is not true.

People will have to wait for vital surgery

This is something that both Americans and Canadians like to throw around, especially those who would like to think that by spending some of their own money they can get the health care they need RIGHT NOW. See, this issue is a case of perception vs. reality. I will use my father as an example. My father has had surgery on both eyes, one knee and his shoulder in the last two years. From the time he went to see the doctor to say "I need this fixed" until the surgery in question happened, I would estimate no more than three months elapsed in every case.

Now, if he had needed to get this stuff done right away he could've gotten it in less than a week. If you have a life-threatening problem, they get you what you need incredibly fast. The problem is that one person's life-threatening problem sometimes appears to be a minor inconvenience in the eyes of the health care system. A bum knee that you can still walk on is not going to get you to jump to the front of the line. As I have told many of my American friends, if you have a life-threatening problem you will get the care you need right away. If you are not in immediate danger or disabled, well, you're just going to have to wait. Since I have not run into this in the US, I don't know what to say to people about this. Sorry that paying for it yourself won't let you jump to the front of the line? That's somewhat tongue-in-cheek, but wait times for minor procedures are common in the US too, aren't they?

Also, I wish to tell people that the Canadian health-care system DOES NOT PAY FOR EVERYTHING. It pays for basic medical care and life-saving surgeries for it's citizens. I still have to pay for dental care, optical care and prescription drugs out of my own pocket. Many Canadian employers offer supplemental insurance to their employees to cover this. My wife's company does, my own does not. But if I break my leg playing softball, I know I won't be given a bill as I limp out of hospital. I will have to pay for the painkillers, that's for sure.

So, in our system I'm willing to accept that waiting for non-critical surgery is ok. I think I have presented evidence that makes this objection not valid.

People will not have any choice as to what doctor they get to see

This is totally false. The government does not tell me who I can and cannot see to receive health care from. I am allowed to pick and choose my own family doctor, and I am limited to the choice of any specialist for a particular procedure based only on the availability of that doctor within Ontario to see me. Yes, there are times when the government pays for out-of-province procedures (yes, including going to Buffalo for an MRI if needed) so that option sometimes exists. But that is in extreme circumstances only. So please, don't believe it when an opponent of government-funded health care talks about people only dying waiting for procedures in a government-funded system. It happens in the US too.

I think it's also a good time to give a little insight into how the government actually pays doctors. See, the doctor tell the government what services they have provided for their patients. The government then says "okay, we will give you X amount of money for what you've done according to the following rules" and that is that. Doctors cannot charge above government rates for procedures that the government pays doctors for. That does not mean that doctors are unable to charge what they want for procedures the government health care system does not pay for. My mother had minor cosmetic surgery to remove some moles and skin tags near her eyes and I spit my drink out when she told me how much it cost her. I'm guessing that is the normal reaction in the US.

It Will Stop Innovation In The Field Of Drug Research

I'm not qualified to speak to this, but I will say the following: it will certainly reduce the *profits* pharmaceutical companies make. An American friend of mine tried to explain to me why this was such a bad thing, and that if a company decided to not sell a life-saving drug to the government-run system that it would be a bad thing for patients. I agreed with him, and also agreed that the government shouldn't force pharma to sell them the drugs. Will this cause problems? Probably. Maybe it just opens up a way for a competitor to sell a similar drug to the government instead. But if the pharma industry can't make huge amounts of money, I'm guessing they are reluctant to invest it in R&D, although I think the massive amount of money they would not have to spend on marketing might offset that. So I am okay with saying that this statement *might* be true, unless the government agrees to buy the pills for something resembling a fair return on pharma investment.

So there you have a small and hopefully-informative look at the Canadian health care system. Is it perfect? No. But it delivers a level of service that should be causing Americans to want to emulate it, not demonize it. Basic health care is a right that should be given to all citizens as it benefits society as a whole. You can call me a socialist if you want, but I've seen the benefits of our health care system up close and personal.

If you have something to add in the comments, please be aware that I will delete any comments that I find objectionable. Keep it clean and reasonable.