How do Canadians Feel About Their Healthcare System

[erpowers]

Recently, during a segment of the radio/TV show Democracy Now there was a debate about the American and the Canadian healthcare systems. Other shows like Nightline have also done segments about the differences between the American and the Canadian healthcare system. This morning I thought the only way to get the truth and know how Canadians really feel about their healthcare system was to ask the Canadians themselves or ask people who know Canadians. How do Canadians feel about their healthcare system and the American healthcare?

[SheilaT]

1. Canadians I've spoken to

like it and understand how much better it is than the one here. All those stories about many Canadians crossing the border for procedures here are both exaggerated, and fail to note that these border crossings are almost invariably for elective things, not needed or basic health care.

[wurzel]

2. I don't know the Canadian, but I know the British.

I have relatives there. They sure would not swap it for ours.

[Libby2]

3. I have several Canadian friends

that like it.
While it is not perfect, they claim they sure wouldn't trade it for ours.

[thecrow]

4. My cousins in Canada

seem to like it and have recently been treated for such things as strokes and emergency brain surgery.
They were very appreciative about the care they got.
However they do pay a high price in taxes for what they get, such as health care and subsidized living and heating expenses in winter.
But wouldn't having that be worth it?
I doubt that Americans would like the thought of being taxed more in return for health care.... even if it WAS for their own good.

I wonder how * intends to make his "health savings plans" work for people who have no jobs, possibly hit with catatrophic illnesses.
Besides what about the people who are careless in their savings who WILL come forward and ask for free health care when they need it?

Smirky's plan sounds great if you are rich and able to put away thousands each year, but for persons like myself, who are living paycheck to paycheck this is just anohter slap in the face.

[Zell in Hell]

6. Here lies a major problem..

Being a huge country with a low population, Canada has huge infrastructure expenses and an insufficient tax base to pay for all of it while still getting every service I feel that our governments should be providing.

[iverglas]

11. and that ...

Being a huge country with a low population, Canada has huge infrastructure expenses

... is also why we're leaders in areas of medical technology involving communications, as we are in other areas of communications and transportation.

(Aha, I tried an advanced search to find something I'd once posted about this, and I see what the problem was with the links in that other post. Archives aren't available.)

For instance: http://www.lhsc.on.ca/about/medical.htm
The London Health Sciences Centre is affiliated with the University of Western Ontario in London, Ontario, a city of 340,000 people halfway between Toronto and Detroit.

2001
LHSC conducts the world's first robotic-assisted surgery using videoconferencing technology where one surgeon assists and mentors another surgeon from a remote site, both able to manipulate the robotic technology in the operating room.

What you say is very true -- many of the problems in our system relate to unequal access to services and proportionately large capital expense, and sparce/remote population is a big reason.

[CHIMO]

12. Not Clear to Me

Are you suggesting that some services should be transferred to the feds as they are not running a deficit and that downloading is unworkable because the provinces are underpopulated?

[iverglas]

14. I think

... that what was meant was just that we have enormous expenses in delivering health care equitably in the country, because our population is small (economies of scale not available generally, use of facilitise and technology is inefficient) and scattered (economies of scale not available in many locations, inefficient use) and includes remote pockets (transportation problems, difficulty attracting health care providers).

Various kinds of investments will be the same whether the population that pays/benefits is 1,000 or 1,000,000. R&D is an example: the same R&D is required to produce a new drug or technology regardless of the population paying for it and benefiting from it. An MRI machine costs the same whether the hospital it is in has 50 beds and serves a community of 50,000 or has 500 beds and serves a community of 500,000. If the small community is remote, and its population is to have ready and equitable access to the machine (and to the technicians who operate it, and also to a full range of medical specialties and other kinds of medical services), the investment per capita is going to be much higher.

If a particular population is not large enough to warrant making all diagnostic and therapeutic services available on site, and if the providers can't be attracted to those locales even if there is sufficient need to warrant making particular services available, the population is going to have to be provided with transportation services to larger centres where they are available. Of course, innovative approaches are also going to have to be developed to substitute for having services on site: technologies like LHSC's remote-control surgical robotics are one example, non-physician personnel like nurse practitioners for primary care is another.

The average cost (not price) per capita of providing a particular service in Canada is always going to be higher than in the US, once these things are factored in. Add in that we have a lower GDP per capita, and it's going to be even higher in terms of the proportion of the GDP per capita that it's going to cost.

So if Canada and the US adopted exactly the same universal single public payer system, and paid exactly the same prices to providers and for facilities and technologies, Canada would be left having to
(a) provide fewer services, if the same proportion of GDP per capita were devoted to health care, or
(b) provide the same services and spend less on other tax-funded programs.

On the specific point of provincial management of the system, some provinces and territories do experience these problems to a greater degree than others. Some provinces have lower GDPs per capita than other provinces, so more transfer funding is going to be necessary to make up for the shortfall in the province's proportion of the funding. And some provinces have more problems with sparce and remote populations than others, so their average cost for services is going to be higher.

Ontario, with a large population heavily concentrated in large urban centres, and a high GDP per capita, can provide the same services at a much average lower cost / proportion of GDP than Saskatchewan or Nunavut. Facilities in Ontario centres will serve far more people than in a province with a small scattered population, and thus will have a lower initial cost per capita, and can be used more efficiently and cost-effectively. Transportation costs will be less of a factor. Primary health care (as well as all sorts of social services, and an economic base that provides employment, etc.) will be more readily available to the population in Ontario than in some other provinces and territories, making for a healthier population to start with.

One thing we do need to continue doing is innovate -- find new ways of delivering services that involve lower costs. The initial costs of the innovation are high, of course; imagine what the remote robotics thing at LHSC cost to develop. But ultimately, that sort of thing will make for more efficient use of specialists (i.e. not having to have specialists everywhere they're needed, so needing fewer specialists), reduce transportation costs (and all the social and economic problems that patients have when they have to travel hundreds or thousands of kilometres to get care) and give underserved populations more equitable access to services, and keep them healthier.

[JuniperLea]

5. had this conversation a couple of weeks ago

with the boss's wife who is canadian. i was helping her fill out her new health insurance forms and explaining the benefits. she just shook her head the whole time saying, 'this is rediculous!' and 'we have to pay for this?' and 'in canada, you get sick, you see a doctor, end of story!' on and on and on.


we have been taken for a ride! i think the doctors have been too. seems the only people making money are the insurance companies and the lawyers.

edited to say i don't care about being taxed as long as i'm benefiting. i see very little evidence of my tax dollars making a difference except for big business getting richer. time for a tea party!

[Dr Strangelove]

7. Heavy Taxes???

I know for me to put my wife and kid on my insurance at work it costs 250 a month out of a $1200 a month pay check, on top of the taxes I already pay. Plus the deductible, co-pay and prescriptions. This doesn't cover vision or dental for anybody. Sounds like I could pay some more taxes and get better care for my family at the same time.

PS America is the only industrial nation that does not provide health care.HMMMMMMMMMMMMMMMM with 45 million people lacking health coverage maybe its time America stepped up to the plate.

A friend of mine from Austria was telling me they pay " a little more" than we do, but they get full medical, as well a higher education being free IE his son went to medical school for $0

[thecrow]

8. I guess when you put it in that perspective

We probably pay MORE than they do!
Arrrgh!
I only have one child on my medical plan which costs me $358/month.
My own medical is provided as a benefit.
BUT my one child is prorated at my insurance premium level i.e. 55 years old and he is not yet 21!
Oh yeah... this is supposed to be fair.
Pfffft.

[SheilaT]

9. So you are paying

around $4,000 per year to cover this kid.

I keep on hearing people claim that too many under or uninsured Americans simply make the wrong choices and they could easily pay for health insurance if they so choose. I get so angry at that. Maybe for the middle class person making upwards of 50-60k per year that's true, but not for someone making 24k per year. Or less.

[iverglas]

10. good grief - where are us Canadians here?

I think most of us get as worn out by this after a while as I do. Not that we don't like our system, and think you deserve one like it and so you need to know the truth about it. We just have day jobs. ;)

There are several threads at DU with tremendous resources in them.

Here's one compilation:

http://www.democraticunderground.com/discuss/duboard.php?az=show_topic&forum=117&topic_id=3831

Well shit. I don't know what's wrong, but none of the links to DU threads in that post are working. Anybody?

Anyhow, here's what I always offer as a primer for USAmericans:
http://www.newrules.org/equity/CNhealthcare.html

And this one, a Washington state / British Columbia cost of living comparison that includes health care expenses (see "Taxes, public spending and private costs" near the beginning):
http://www.policyalternatives.ca/bc/wa-bc.html

This is my anecdotal discussion of my dad's recent experiences in our health care system:
http://www.democraticunderground.com/cgi-bin/duforum/duboard.cgi?az=show_thread&om=32286&forum=DCForumID60

The update is that he was admitted to hospital in late January 2003 on the day I wrote that post, immediately after the biopsy that was taking place on that day, when his blood oxygen levels did not stabilize. He was 73. He remained in hospital until early March. He was determined to have bone cancer, and to have breakages in a shoulder and hip. He had radiation therapy, scheduled on 2 days' notice. He would have had an MRI, also scheduled on 2 days' notice, but his pacemaker prevented it. He was seen daily by at least one of the internist, oncologist and orthopaedic surgeon handling his case.

It was hoped that his pain could be managed (he was on morphine) and he could be released, to have chemotherapy and live a few months. Ultimately, because the pain was unmanageable and worsening, he was scheduled on a Friday for hip surgery on the Sunday morning, but rejected from the OR because his overall condition (I assume cardiac and respiratory) made him a non-candidate for surgery. On the Wednesday night he was delivered to my sister's house 30 miles away by ambulance, and we cared for him (hospital bed, morphine and pump, visiting nurse, even disposable sponges on a stick for keeping his mouth moist, and the same with mouthwash) until he died on the Friday afternoon.

We were left with a lot of questions. We had not been prepared for the suddenness of his death, or the nature of it (he was in severe pain and distress, but only for minutes). The funeral director whom I asked to preserve the pacemaker (some nurse had mentioned a rumour that it was malfunctioning) contacted the coroner. The coroner contacted me and heard our concerns, and ordered a post mortem. It was found that my father had metastacized melanoma involving all his major organs (because he could not have an MRI, this could not have been diagnosed) -- but actually died of a blocked coronary artery he did not know he had, because he had been physically active (bicycling) until a few weeks before being hospitalized and never had a symptom. A bizarre coincidence, and one of those blessings in disguise.

Anyhow, the out-of-pocket cost of all of this to my family was: ZERO. Not one penny. Oh, except that the prescription for sublingual Atavan to help him in the last two days wasn't covered by the govt. senior citizens' drug plan (which peeved me, because he was not conscious and therefore could not swallow the form that was covered), so it cost me about $25. And hospital parking can be a bit pricey.

Me, I don't go to the doc much. I'm supposed to benefit from my dad's post mortem by now getting myself checked over because the condition is hereditary ... but haven't. See -- even when it's free, people don't even use it when they should. ;) And although I badly need new glasses (about 4 pairs, my bat-like shortsightedness having changed with age so I need a different strength for about every foot distance from my face), I failed to use the health plan to see my optometrist for the last 3 years, and now the new Ontario govt. has de-listed optometrist services for adults, so I'll have to pay. Last time I did that (when the previous govt decided to cover adults only every 2 years, and I wanted to go in the off year) it was about $50.

But I could tell you about my co-vivant, who was diagnosed with Type II diabetes 3 years ago, and the couldn't-be-better care he has received since: from the doctor at the neighbourhood community health centre and the nutritionist and food-care provider there, the opthalmologist and endocrynologist he sees regularly, the cardiologist he has been seen by, and of course all the lab and cardiac tests he has regularly. We pay for the drugs (no employer or other group supplemental insurance), but for the expensive ones the clinic doctor gives him samples (her low-income patients are generally on drug plans as part of their social assistance, so she has spares).

And my mum, now 74, who was a patient at one of those "world-class" medical centres, an eye institute, for her glaucoma, until this spring when she decided to go to someone locally where she moved 2 years ago instead of driving back to the old home town for her quarterly checkups, and got an appointment on a couple of months' notice. She's trying to decide whether to have shoulder replacement surgery (a horrible bicycle accident when she was in her 40s), and has been told that she can expect it to be scheduled within 2 weeks to 3 months from when she decides (in the 905 area, the region on the outskirts of Toronto). She has also just switched to a dermatologist there for her regular skin-cancer checkups and treatments. She pays $2 per prescription (annual $100 max) for any medications (this is separate from the health plan itself).

Just by the bye, she lives in a govt-owned senior cits' apartment building, where seniors pay about 1/3 of their income in rent. A senior on the lowest fixed income (i.e. no private pension, no employment-based public pension, with all available supplements) gets close to $1000/month.


So I should answer your question. What do I think of our healthcare system? Wanna guess? ;)

If you want to read critical comment on the system from the left, have a look here:
http://www.healthcoalition.ca/

[Spazito]

13. Our system always needs tweaking but I wouldn't trade it for any...

other system. I pay $56.00 a month and it covers all basic health care. I have never had a long wait either to get into my doctor or in emergency.

I only know what I have read of the US health care system, that it is very expensive and limited in the coverage you get for your dollars.

[canuckforpeace]

15. I wouldn't trade our system for yours.

It's much cheaper and EVERYONE gets coverage regardless of income or lack of it. That being said, I do know that there are long waiting lists for people to get surgery and MRI appointments. I just happened to see something on T.V. this morning about the system in Germany. They have a combination public/private system. People over a certain income bracket can opt out of the public system. Folks in the public system pay a percentage of their income. There is a 10euro charge for doctors visits to a maximum of 40 euros. Doctors are on salary plus incentives. They have a much more efficient system for processing people so that people don't have to wait for an MRI. The MRI is done the same day as the consultation visit. And oh, they have direct access to specialists, don't need to be referred by a family doctor.

As a Canadian I abhorr the thought of private health care but maybe we have to have an open mind about it. I read something a while back that said with changing demographics and increased costs for treatments we won't be able to avoid blending to a public/private system.

[Kellanved]

16. all true

But the German system isn't very cost effective. It is almost as expensive to run as the US system; the tendency for doctors to have their own CT-machines results in an absurd number of x-ray uses.
Even the public system is operated by half-private insurance groups, with varying service.

The private option is great in theory, as it results in a healthy competition between doctors and hospitals, benefiting the public as much as the private system. In practice however it often amounts to a two-class medicine system.

Anyway, the basis of the German system is Imperial; the system is in dire need of reforms. The €10 charge is a small start in that direction: it only applies for specialists, if the family doctor wasn't asked first.

[iverglas]

17. thanks!

In practice however it often amounts to a two-class medicine system.

Exactly. I experienced that first-hand in the UK ten years ago. My mum fell and injured her head (damn those stupid paving stones) and my London friend and I rushed her to the nearest hospital. It turned out to be the NHS hospital in the heart of a working-class/immigrant part of London. In a nutshell, the ER nurse was unable to provide ice to put on the lump on her head, and because he also couldn't provide change, I had to cadge coins from others there, to buy cold Coke cans from the vending machine to put on it during the 5 hours we waited ... for a resident to tell her to go home and put ice on the injury. Nobody ever did clean up the blood that had been bled on the reception desk and the waiting room floor while we were there.

Meanwhile, my friend's partner was languishing in a brand new hospital in the West End, where she had room service menus and a bright skylit atrium to lounge in while waiting for the results of her tests. She had gone private, of course.

But there's more to the problem. The top-tier (private) / bottom-tier (public) gap can only widen, as the people in the private top tier abandon any allegiance to the public tier, and after voting against it for themselves with their feet, they begin to vote formally against it for anyone else: to withdraw political support for funding the public system.

Any time that opting out of a universal public system is allowed, what is left will only deteriorate. Let the rich opt out of the mandatory public pension plan, and benefits will decline because the base that is needed is eroded. Let the rich opt out of the public education system, ditto. (At present, they may opt their children out, but not opt out of paying for the public system through taxes -- and sure enough, we're seeing pressure everywhere for those voucher things, to enable them to get their tax dollars back out of the public system.)

The public systems are left covering those least able to pay, and most in need of services (in the health care system, those with "pre-existing conditions" that private insurance won't cover; in the educational system, children with special needs; and so on).

If all this money is available to fund private health care, why aren't we just taxing the buggers who have it, to fund the public system?? I'm one of them, by the way. And there's no way that I would want the option of going private, because I know full well that it would cease to be an option and become a necessity, in very short order.

[Mother Jones]

18. There are so many myths floating around about our health care system!

It's ridiculous. I wish I had a dime for everytime an American told me (online) things they believed were true and were nothing but fantasy.

Someone posted a wonderful explanation above regarding the problems of servicing the lesser-populated areas and how it was costly. Yes, there are flaws in the system and yes, its expensive to maintain. But I wouldn't trade it for anything in the world!

FYI - We are free to choose any doctor we like, there are no restrictions on that (unlike U.S med plans)
There may be wait lists in some areas, but in Ontario, in my lifetime I have yet to experience one, or come in contact with anyone who has ever waited for treatment. This coming from a family full of cancer right now and each and every one getting timely treatment.
When I had my own scare, I called my dr. immediately...she referred me for a mammogram. I called to book an appt, and they asked me if I could come in within the hour!!

I am so sorry for my brothers & sisters in the U.S who are not as fortunate. But as long as republicans maintain that TAX is a four letter word, you will see your crisis continue.

[auntAgonist]

19. I'm Canadian, living in the USA.

Give me Canadian (Ontario) healthcare ANYDAY! please! I have an HMO. I pay 55.00 per pay (every to weeks) to cover my husband and me. Dr visits, when you can get in, usually a couple of weeks away are 10.00 per. To see a specialist you must have a written referral. You can't just choose any Dr you want to go to, he /she has to be within the system. Prescription drugs are expensive or at least the co-pays are. People have a LOT of hoops to jump through to receive good care here. I miss the excellent Dr I had in Ontario. I never had a complaint about any treatment I got there. Just my 2cents.

[Canadian_moderate]

20. We've got our problems, but I wouldn't trade it

for a totally private medical insurance arrangements like in the USA. To me, access basic healthcare is a right, not a priveledge as many people in the US seem to think. I can't imagine having to live worrying about being able to afford visiting a doctor or hospital, if needed.

Yes, Canada's various provincial health plans need reform to adjust to changing population and changing needs. The longer waiting lists need to be addressed, but the system is definitely not broken. It just needs updating to make sure that funds are allocated more appropriately and that the delivery process if more efficient.

In terms of administrative costs, Canada public health insurance plans spend approximately 1/3rd of the amount that the US' private plans spend on admin costs.