Friday, March 26, 2010

An Open Letter to Americans

I am begging you to explain your country's fear of universal health care. I do not get this at all.

With the passage of the health-car reform bill in the U.S., it seems the debate is far from over and the crazies are becoming even crazier than before. From Sarah Palin's website that paints cross-hairs over the states that supported the bill to people making threatening phone calls, it all seems surreal.

Even, conservative pundit David Frum was fired from a right-wing think tank for disagreeing with the conservative approach to health-care reform. This is the sort of thing he has said that got him into trouble.

“In a democracy, there are competing teams, and each team has to bring its best game to the table ... health-care reform is here to stay, it isn't going to be repealed, and it was within our grasp to help formulate it and we failed to do so. Instead, we decided to do whatever we could to make Democrats look wicked and evil.”(Today's Globe and Mail)

So he gets fired for being reasonable because that is not the conservative way, apparently.

Why are people so upset about this issue?

The U.S. currently pays more of its GDP for health care than does Canada yet it has worse outcomes. You pay almost twice as much per capita as France, almost 2.5 times as much as Britain. As a matter of fact, the U.S. pays a higher percentage on health care than any other country yet does considerably worse on basic measure of health performance (life expectancy and infant mortality.) As an example, the U.S. has the same infant mortality rates as Malaysia -- a country whose average citizen earns 1/4 that of an average American. Being born into an uninsured household in the U.S. increases the probability of dying before the age of one by about 50 per cent.

It's not that the Canadian system is perfect. It has many flaws. I don't think anyone would disagree with that. I'd like my country to look across the Atlantic to countries like Sweden and France to see how we could improve on ours. But I'd never want to lose what I already have.

Though I am no expert, I have lived with a government-lead system my whole life so I am at least semi-qualified to explain it. Here is the low-down on Canadian health care.

In Canada, no one loses his or her life savings for becoming ill. Our emergency care is second-to-none. If you show up in dire straits and need care, you'll get the best in the world. No one has to approve required tests or procedures. That's between you and your doctor.

If you require palliative care, you get it. If you require a transplant, you go on the list. You don't need to prove that you have $1 million in your bank account to afford the after-care needed before you can go on the list. You get to see your doctor whenever you need to. No one gets to approve or disapprove of your visit. Mammograms, checkups, blood work, etc. It's all covered.

Our health care does not cover prescription drugs however, seniors and those on welfare receive theirs free. Some provinces also have plans for the working poor. Our drugs are cheaper than yours. We can use generic ones which is why American seniors flock to Canada (yes, there are even bus tours for this) to buy their prescriptions.

In Canada, no one tells you which health care provider to see. We choose our own.

It is true that there are caps set on certain government-covered services such as eye exams that are paid for every two years. This doesn't stop anyone from electing to go more frequently. You would just pay out of your own pocket for more regular visits.

Again, no one tells you what you can or can't do.

Like you, we also have privatized coverage. Many employers offer additional coverage to their employees. Costs are often split between employer and employee 50/50. As with your privatized plans, this is where we run into the issue of someone telling us we can't have something because it isn't covered. Still no insurance company can tell us which health-care provider to see.

For anyone who is interested, here is a link to Health Canada. It's not the best website in the world, but it gives you an idea of what is covered.

There are two main downsides to the Canadian system as I can see. The first is cost. Unlike many, I disagree with the statement that we are spending too much. Between 1992 and 2006, spending rose from 10 to 10.3 per cent per capita. That's hardly the spending spiral we've been led to believe.

However, and this leads me to problem #2, we do need to look at better models of health care and avoid looking south of the border when we do. We have to shift our system to one that focuses on prevention and education. Shifting to a community-based model would be wonderful. We all know that if we decrease smoking and obesity, for example, our health outcomes would be better and cost us less. (The same idea as spending money on education decreases spending on prisons.)

So, according to me, the Canadian system needs some creativity applied to improve our delivery and results.

Now it's your turn.

Tell me why the American people are so frightened of having their less-than-stellar system modified? Why are they frightened of taking power away from HMOs and keeping it for themselves? Why don't they want to save a bit of money?

It's time for those of you who want health care reform to get vocal. Write and call your representatives. Make sure that the only voices heard aren't those of the opponents.  

Lucy! You got some 'splaining to do.



  1. It baffles me every waking moment of every day. I have experienced both health care systems. I am an American living in Canada. Even my most liberal family members still don't quite understand how we (Here in Canada) don't have deductibles, co-pays and out of pocket expenditures. Not a single thought goes to money when we get sick or have an accident, doesn't even cross our minds. I truly don't think they can comprehend a life like that. But I know you wanted to hear from Americans living in America so I'll vacate this space. This is just a huge passion of mine so I couldn't resist commenting. Thanks, Colleen, for your article - great job! Jean Snow

  2. Hey Jean! It's great to have you here and your viewpoint is very welcome and especially valid since you have experienced both systems. I apologize for not responding to you before now... I had entered a comment, but for some reason it didn't post.

    I sometimes think that anything that hints of socialism (and there are few Canadians who would consider our country to be socialist) is considered by Americans to be the same as Communism whereas countries with universal health care look at it as taking care of its citizenry.

    I'm glad the bill in the U.S. finally passed and hope that it results in helping those who need it and that the lunatic fringe settles down.