The Blighted Hellscape of Socialized Medicine

Tobias Buckell had some heart issues a while back, and the stress of Worldcon aggravated things a bit:

By Sunday morning, I was feeling completely sapped, and not getting enough sleep. I tried to nap before the pre-Hugo ceremony, but felt like I'd hit a brick wall by the time I'd walked over. I had to duck out of the Hugo ceremony briefly to lay down. By the end of the night my pulse was racing a bit, so I went back to the hotel to sleep. When I woke up my pulse was even higher.

After checking it several times, I decided it was high enough that I would follow standing orders to check into an ER when this sort of thing happened. I took a metaprolol a bit early and told Emily we needed to pack and go.

I was a bit nervous, and asked for an ER, but mentioned needing it for my heart. I was taken to the Clinique de Cardiologie de Montreal by a taxi driver.

Thus began a trip into the horror-show of Canadian health care, as Toby describes in detail. Luckily, the impersonal bureaucrats of the Quebecois Death Board were in a good mood, and all he got was quality medical care followed by a single bill, rather than mandatory euthanasia. Thank God we don't have socialized medicine here in the US-- no American should have to face that.

(I really hope the sarcasm in the above is obvious enough, but experience with the Internet suggests that it's probably not. So, if you've clicked through to the full entry to post an irate comment about how I'm misrepresenting the reality of Canadian health care, do us both a favor and smack yourself in the face with your keyboard. Thank you.)

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But who knows what he was infected with. I bet in two weeks he'll be running around with a hockey stick trying to check John Scalzi into a wall.

I'm not going to lie; Canada's health insurace system isn't perfect. However, the problems are all regarding chronic care and not emergent care... and in some ways the problems are those of success, in that we have more people living long enough to accrue chronic conditions now instead of them dying off before they manifest.

No matter what, do NOT believe the talking-points people and their yammering that's as nuanced as a trip hammer, folks. Single-payer insurance is far less broken than they claim even if it isn't perfect, and it certainly is better than the apalling train-wreck that is the HMO-driven system the US is saddled with today.

Here's hoping Mr. Buckell is feeling better! A votre sante, mes amis.

-- Steve

He only had to pay $480 dollars?! I took my infant to the ER one night with a high fever and was billed $1400 -- they took a urine sample, drew some blood, and then gave her Ibuprofen. So obviously, even when paying cash, there is some sort of increased efficiency in the Canadian system.

Pretty much all the problems with the Canadian health system are the general-case problems of making a large bureaucracy do what you want it to do, instead of what it, systemically, wants to do, which is get larger. And, credit where credit is due, Alberta, where there is the closest thing to a constituency for two-tier health care in Canada, is also where the folks running the public system have been doing the best job of dealing with this issue.

The main thing, though, is that if you have any health-care system *at all*, getting the bureaucracy or other system efficiently organized is a problem you have to solve. It's not like having a pure free market system would avoid the problem.

The problem is, both systems have a million stories like this. There is a reason that Americans overwhelmingly love their health care and Canadians overwhelmingly love theirs. It's because both systems do a good job in the 95% of standards cases, and only show their respective flaws in the tough, marginal cases. Meanwhile, Canadians hear horror stories about Americans dying in the streets due to lack of insurance, and Americans hear horror stories about Canadians with metastisized cancers being told they'll have to wait a year for chemotherapy. The best way to compare medical coverage is with aggregate data, not sarcastic anecdotes. A scientist should be the first one to realize that.

I do have to partly agree with my doppelganger above. Anecdotes don't prove much of anything. But, on the other hand, anecdotes are what tend to strike people the most, so there is probably a benefit to having such positive one's out there. Dare I say, it's an example of good "framing". But I do agree that you just want hard facts in actually crafting the policy.

And speaking of carefully looking at aggregate data, other Josh, you may want to do so before declaring that either or both systems do a good job in 95% of cases. That claim seems doubtful. I don't know about Canadians but I'd think many Americans aren't happy with their health care. I'm basing that on the aggregate data of who won the U.S. presidential election. Obama certainly ran on a platform including health care reform as a big ingredient. Clinton even more so and she nearly beat BO in the primaries.

By Josh (the othe… (not verified) on 12 Aug 2009 #permalink

Sorry if that last comment seems a bit snarky. I'm finding the whole health care debate so childish and annoying that thinking about it puts me instantly into a foul mood.

By Josh (the othe… (not verified) on 12 Aug 2009 #permalink

The problem is, both systems have a million stories like this. There is a reason that Americans overwhelmingly love their health care and Canadians overwhelmingly love theirs.

You forgot a clause: Americans who have health insurance love their health care.

But yes, it's absolutely correct that anecdotes don't prove anything. However, since the anti-health-reform argument seems to consist primarily of making preposterous shit up and shouting it at maximum volume, I'm comfortable with arguing from anecdata.

Actually, your posts capture the dichotomy of American views on healthcare perfectly. A recent ABC News poll found 82% of Americans rating their own healthcare favorably (which seems to justify the descriptor "overwhelmingly"), but also indicated that 54% of Americans are dissatisfied with the overall state of healthcare. In other words, "mine is great, but I'm worried about other people" seems to be the public's attitude. So obviously the American system is getting the vast majority of its interactions with the public right, otherwise we wouldn't be so satisfied with our own care.

Chad, it's like mom always used to say, "If your friend Billy jumped off a cliff..." I too am dissatisfied with the general level of discourse on healthcare reform (though I'm coming from a limited government perspective), and some of the arguments from my side against the current proposals make me want to tear out my hair by the roots. (See the recent IBD article on Stephen Hawking's poor chances under the British NHS as an excellent example of how NOT to argue against the bills going through the legislature.) But if I stoop to arguing about how aunt Jenny was treated on her Canadian vacation instead of using cancer survival rates just because Paul Krugman thinks a good argument for a Nobel prize-winning economist to use is that opponents are closet racists, then I only add the the cheapening of discourse that I despise.

By Josh (the first one) (not verified) on 12 Aug 2009 #permalink

"Meanwhile, Canadians hear horror stories about Americans dying in the streets due to lack of insurance, and Americans hear horror stories about Canadians with metastisized cancers being told they'll have to wait a year for chemotherapy."

The difference is that the first is the norm for many people who cannot afford insurance in a country where the uninsured and under-insured have dire health care options, while the second is a very unlikely scenario under Canadian Medicare (and more likely a gigantic lie by scheming Republicans).

"I took my infant to the ER one night with a high fever and was billed $1400 -- they took a urine sample, drew some blood, and then gave her Ibuprofen. So obviously, even when paying cash, there is some sort of increased efficiency in the Canadian system."

I know what you mean. I walked into a US ER with mild chest-pain (it turned out to be stress-induced heart-burn) when I was between jobs (and insurance plans), and got a bill for $3500. Trained staff and high-tech equipment cost money, of course, but I figure that was at least double what it should have cost.

What's going on is that US hospitals have high "sticker prices" for their treatments, but they are nearly always paid for by insurers, who negotiate hefty bulk discounts, bringing the net fees to reasonable levels. People paying for themselves get stuck paying the undiscounted fees, however.

I wonder what would have happened if you had offered to pay, say, 70 percent of the nominal fee. They would have bitched about it, but thirty percent off sounds like a better deal for the hospital than most collection agents would offer.

By Johan Larson (not verified) on 13 Aug 2009 #permalink

"I wonder what would have happened if you had offered to pay, say, 70 percent of the nominal fee."

One of the reasons why free-market approach to health care doesn't work is that when you need it most, you're not in a position to bargain about the price.

By Roman Werpachowski (not verified) on 14 Aug 2009 #permalink

I would say that where you live in the US also has a huge bearing on how satisfied you are with your healthcare. When I lived in DC, it was a HUGE hassle to find docs that took my insurance (which was BC/BS, so nothing too weird) in certaon specialties that were also accepting new patients. By the time I moved away, a specialist I need to see for a chronic health problem would only schedule appointments 6 to 8 months in advance, no exceptions (and that was for existing patients). Too bad if you felt sick or something.

Many people I knew in DC (even with insurance) were pretty unhappy with the health care system. A lot of docs were switching over to "boutique care" where they take no insurance and charge an annual fee to be a patient, but also have more off hours access and same day appointments. Happily for me, I moved to Canada, where I get those things without paying extra! (And my take home pay on a slightly lower salary is higher despite the higher taxes since taxes + benefits in my Canadian job are less than taxes + benefits working the Federal govt).

By Anon Fornow (not verified) on 16 Aug 2009 #permalink