Health Care: Which country has the right idea?

by Diane Russell, Feature Writer

Canada's health-care system: some say it defines us as Canadians, yet some say it short-changes us. Recent articles in both Readers Digest and Macleans indicate that, although an overwhelming majority of Canadians agree in principle with universal health care, a significant number are dissatisfied with certain aspects, including wait times and access to primary care physicians. Nonetheless, most Canadians would be quick to point out how much worse our neighbours to the south have it. After all, hasn't everybody heard about a family somewhere who lost their house in order to pay a hospital bill? Exactly how bad do the Americans have it?

My quest for answers is by no means conclusive. I haven't the means to question health-care experts, and have limited my pool of interviewees to members of my Toastmasters and hiking clubs. Their insights may surprise you, and I leave you to draw your own conclusions.

Some pay for it

Many people have health care insurance through their employer, and there are plans available to the self-employed to purchase. Deductibles customarily range anywhere from $2K-$10K; most also have some sort of co-payment, either a dollar figure or percentage cost per visit. I know a man in his fifties whose premiums are $336/month for single coverage; he must also pay 20% of the cost of each visit. His "catastrophic" coverage will pay up to $2 million, but with a $10K deductible.

And some do not

Anyone earning under a certain income is automatically covered by Medicaid. The State pays for everything. In addition, low-income workers with no insurance can purchase Medicaid coverage at subsidized rates. No insurance? I'm told that if someone presents at a hospital, that hospital is legally obligated to treat them, regardless of coverage.

However, any shortfall the hospital incurs (as a result of treating those with no insurance or Medicaid) is apparently compensated for by charging more to those with insurance plans or who can pay privately.

Waiting times

Ah, the bane of Canadian health care. Personally, I have waited 6 months for an MRI, 3 months to see an orthopedic surgeon (that was just for the consult) and 10 months for the actual surgery. That was 2 years ago, but some well-placed phone calls to the same orthopedic surgeon's office last week ascertained those times are still the norm.

In America, an MRI can be booked and completed within a week. Most hospitals have one, and there are also mobile units. Need cardio-vascular surgery? If you present to Dartmouth-Hitchcock hospital, you could receive it within 24 hours; or immediately if an emergency.

A lady in my hiking club said she plans to have shoulder surgery in September and a knee replacement 2 months later. Neither appointment is booked yet, but she knows wait times will be less than 2 months. I stared, open-mouthed, while she told me this. You can actually plan what time to have surgery? We Canadians take whatever we can get!

Physiotherapy

Need physiotherapy treatment? Facilities on either side of the border can usually see you within a few days. However, facilities in Kitchener-Waterloo charge an average of $42 per visit after the initial visit. I paid $90 in Vermont for each visit.

User fees—do they help contain costs?

My pet peeve: those who visit emergency rooms for non-emergency purposes. Happens all the time in Canada, where many perceive health care to be "free".

A hospital administrator confirmed that it happens in the USA too— with one significant difference. Those engaging in hospital visits for "every little ailment" tend to be those who pay nothing for their coverage. An emergency room visit is automatically more expensive than the same visit at a physician's office (yes, in Canada too). Those who must co-pay a portion of each visit tend to think twice before utilizing the assistance of a hospital.

So, do Americans envy Canadians for their health care?

Those without any health-care insurance certainly do. How about those who pay those hefty premiums? Surprisingly, many I asked were quite comfortable with deductibles and co-payments. It would appear that people generally accept whatever they are accustomed to; health care is no exception.

About Diane Russell

Diane Russell is dividing her time between Canada and Quechee, Vermont. She welcomes questions and comments.