White Coat Underground

People who support our current abominable health care system like to cite Canada’s supposed failures as an example of what could happen to us. The argument is a non-starter—it’s a straw man designed to scare people. We are a very different country, with a different economy and different needs. Even with a single-payer system, we are unlikely to have the exact same successes and failures as the Canadians. Still, the Right has latched on to any lie they can to try to scare us. That’s why a recent article from my hometown newspaper is so upsetting.

Any of us who have practiced medicine near the border have seen Canadian patients—not a lot, but some. I’ve heard very few horror stories, but that’s not the point. The point is the fundamental idiocy of people in the mainstream media trying to write about this.

The article give examples of how the Canadian system uses ours to provide some services. The key point here is not that people were denied services—they were not:

“I go to the hospital in Windsor and two hours later, I’m done having angioplasty in Detroit,” he said. His $38,000 bill was covered by the Ontario health ministry.

So he got the needed procedure in a timely fashion because of cooperation between the US and Canadian systems. What’s the problem here?

I think people don’t realize that our system has certain limitations. From the same article (emphasis mine):

Agreements between Detroit hospitals and the Ontario Ministry of Health and Long-Term Care for heart, imaging tests, bariatric and other services provide access to some services not immediately available in the province, said ministry spokesman David Jensen.

“Bariatric” refers to obesity-related disease. In the U.S., where obesity is a horrible problem, we have basically no services for prevention and treatment for obesity. Very few insurance plans cover these services, and government plans almost never do. If you have excellent insurance and need bariatric surgery, you’re probably going to have to wait one to two years while you follow a comprehensive program (often paid for out of pocket) to show that you’ve tried to lose weight. Then the insurer may consider paying for the surgery.

If you have Medicaid, you can forget about getting any help for obesity. You can get care for some of the complications of obesity like diabetes, but you’ll still have to pay more than you can afford for diabetic testing supplies and other necessities.

Our system isn’t as wonderful as we think it is. The reported waits for MRIs and joint surgeries seen in other countries? Have you ever tried getting an MRI or getting an operation without insurance in the US?

Our system is unworkable as it stands. Single payer. It works for Medicare. Why not for the rest of us?

Comments

#1 Tony P
August 24, 2009

When I started having inner ear issues it took over a month to get me in an MRI machine and then another month to get the results.

Luckily it wasn’t a tumor but my past ear infection scar tissue wreaking havoc now that I’m older.
#2 garth
August 24, 2009

great post. its important that doctors start speaking up louder…the lunatics that have some indefinable stake in this are shrill, loud, and willing to say anything at all to “win” (which to them means leaving us all sicker and less hopeful).
#3 intransigentia
August 24, 2009

Obviously the Canadian system isn’t perfect, but I don’t understand how people don’t get this: yes, we do have to wait for some things some times, but we all have something to wait for.

Of course we have these scary-looking wait time statistics, because pretty much everybody who needs treatment is on the waiting list, and the statistics are out there because we actually compile them. I’m not aware of similar statistics being compiled for the American system, and even if some exist, I doubt, as you’ve said, that those statistics include people who never make it onto a waiting list because they know they won’t be able to afford the treatment anyway.
#4 Egaeus
August 24, 2009

I do know that Medicaid does pay for gastric bypass surgery. My sister just had it (two weeks ago today), and she’s on Medicaid (single mom, marginally employed, student). You do have to jump through quite a few hoops, but when they had to remove her gall bladder (she’s 23), they agreed to pay for it.
#5 catgirl
August 24, 2009

I hate it when people point out the problems in other countries while remaining oblivious to the fact that we have those exact same problems in our current system, right now. Long wait times? I’ve always had to wait at least 6 weeks to see any specialist, except one time when I was having heart palpitations and I could see a specialist withing 2 weeks. I remember being very surprised by that, but my doctor said it’s only because heart problems aren’t something to mess around with.

Rationing? We have that too. My (relatively good) insurance has tried to deny paying for things on minor technicalities. For example, I had an echocardiogram of my heart, after getting a referral from my PCP. I got a letter from my insurance company saying they would pay for the echocardiogram, but not for the actual doctor to look at and analyze it, because that hadn’t been specified in the referral. My really great PCP worked it out and got it paid, but so much money and time was wasted with the paperwork. And of course, my minor problem is nothing compared to the people who get cancer and end up going past annual or lifetime limits which just won’t cover the treatment they need, or the people who can’t get quality coverage because of “pre-existing conditions”. On top of that, we have millions of people with no coverage and thousands who die every year because they lack coverage. No matter how bad Canada’s system is, it can’t be any worse than what we already have, right now.
#6 PalMD
August 24, 2009

Medicaid is contracted out to multiple insurers, so some may cover it—-it’s damned rare though.
#7 Jared
August 24, 2009

Egaeus, medical care should not require you jump through hoops. I have nothing further to add.

Oh, wait, yes I do, I love the argument that “I shouldn’t have to pay for someone to get procedure X because “it’s not a real condition”/”they don’t need it”/”they deserve to have condition y“/”insert inane comment here”
1) Do they not realize that insurance works by the exact same model? Large base of people who probably won’t need major procedures pay for procedures of those who do. As a benefit to this, they receive basic treatments and checkups which are not very expensive. Both parties benefit, although some more than others.
2) When did they become medical experts?
3) Do they know how or why this person has said condition? Maybe he or she is genetically predisposed, maybe this individual has this condition due to trauma, maybe, just maybe this person acted in a way placing them at risk for this condition, but why did they? Did the man who now has major lung damage from smoke inhalation get it from smoking or because he was a fire fighter? Does the cause change the need for treatment?
#8 Kim
August 24, 2009

If you read bariatric surgery communities at all, you’ll see a vast amount of advice and angst about insurance coverage for the procedure.

One of the bitter ironies to the whole process, IMO, is that for many of these folks, once they’ve gotten their coverage straightened out the pre-surgery counseling required and possibly provided through their surgeon’s program is the first time they’ve ever had access to good dietary education and support (vs., say, getting a dorky little pamphlet in the mail, which is my insurer’s strategy). I really wonder how many of these folks could be diverted away from invasive and frankly rather risky surgery if the non-surgical interventions were more available much earlier.
#9 Keith Harwood
August 24, 2009

On waiting times under `socialised’ medicine:

Last time another lump turned up I called the Head Nurse at the head and neck clinic. She booked me in for the next morning. I had to wait a whole night to get in.

That morning the surgeon ordered a PET scan. I had to wait over five hours to get that done.

Then it was over a week before I could get into the operating theatre for a three hour operation.

Do you get delays like these under the non-socialised US system?

And cost? All it cost me was the time off work.
#10 24fps
August 25, 2009

It’s upsetting to see people like Shona Holmes, who didn’t have a life-threatening condition, piss and moan about waiting her turn.

Our system up here isn’t perfect – there’s always room for improvement. Part of the problem where I live is a lack of specialists – it’s a national problem, but it’s much greater in small and medium-sized centres, and it’s not the government-paid medical system that is the problem but the College of Physicians and Surgeons who often refuse to allow foreign-trained doctors to practise. That said, it only took two weeks to have my grandmother, showing signs of dementia, looked at by a neurologist. In my province, if we have a serious illness that can’t be treated at home because of physician availability or a lack of beds, the government will pay to send you to a neighboring province or into the States. They will even pay a little sometimes for next of kin to go with you, but that varies from province to province.

About the second article — it actually makes more sense to send someone from Windsor to Detroit for treatment if it isn’t readily available at home than to send the same person to Toronto. It’s a lot further (Windsor and Detroit being separated by a bridge and a border station), much worse for the patient. Windsor isn’t that big a city and I doubt they have as many or as large facilities as either Detroit or Toronto. Cooperation just makes sense.

I’m really ready for people to stop lying about our health care system. Seriously. The sooner this sorts out, the better.
#11 gg
August 25, 2009

I don’t know if you’ve seen it, but a number of high-ups in the Canadian health care system participated in a video to respond to some of the wilder accusations. You can watch it here.
#12 24fps
August 25, 2009

I have, actually. Roy Romanow is our former provincial premier. I’m in the province that started all this crazy socialized medicine in Canada under the leadership of Tommy Douglas.
#13 Rjaye
August 25, 2009

Thanks to Canadians and Brits, hopefully Americans will learn how different kinds of systems work, and how they are nothing like the portrayal in the American press.

I live next to the Canadian border, and worked at a hospital for over a decade. Yes, our hospital saw Canadian patients, but it was covered by the Canadian insurance plan, and most lived here in the US part time.

The fact that gets overlooked is how many Americans still go to Canada for drugs and dental work. Dental is very rarely covered under plans, and for friends and family, going to a Canadian doctor is a plus-plus–excellent care at a reasonable price. Why aren’t we hearing about the number of Americans going outside of the country for their medical needs?
#14 Dianne
August 26, 2009

Have you ever tried getting an MRI or getting an operation without insurance in the US?

I have. For my patients. It’s not easy. Begging and trading favors are involved. But at least when the test/procedure is done it’s done at a major teaching hospital and is (usually) done right.

Another problem in the US is that if you have insurance and/or money you can get an MRI quickly…but it may not be useful. There are lots of free standing private MRIs in the US but their quality is…mixed. A patient of mine with hepatoma was having trouble getting scheduled for the hospital MRI so got an MRI done at “Joe’s MRI shack” (not the real name, obviously). They told the patient that it showed no residual disease. Unfortunately, it showed no disease because it was so blurry that it showed nothing whatsoever. I was not happy to have to explain to the patient that he did still have cancer.