August 10, 2007

Setting the record straight: observations on universal health care from actual Canadians

By Warren Pease 

“There are only two ways to allocate any good or service: through prices, as is done in a market economy, or lines dictated by government, as in Canada's system. The socialist claim is that a single-payer system is more equal than one based on prices, but … Canadian health care is equal only in its shared scarcity.” – Wall Street Journal editorial, June 13, 2005.

 

Thus spoke the leading apologist for US-style vampire capitalism. And that’s a microcosm of what most Americans hear about the Canadian health care system. It’s inefficient, slow, technologically backward, understaffed and, of course, socialist – proving that the ideological demons that provided the rationale for the Cold War can be re-purposed to inspire fear and distrust of virtually anything the American plutocracy deems threatening to its continued economic dominance.

The latest smear campaign, engendered by "Sicko," Michael Moore's box office hit documentary/expose on the US health care system, has been hilarious for many Canadians, although some express frustration at watching their successful single-payer, universal-access health care system get trashed in US mass media by dozens of propagandists or idiots whose claims of Canadian inadequacy go largely unchallenged.

 

Lucky Americans: CMcL's saga
About a month ago, I got the following email from CMcL, who lives in Florida, detailing her experiences in getting a simple series of blood tests – and getting her insurance company to pay for them.

 “I am in the middle of dealing with three medical problems. In order to get some simple blood tests performed this week, I had to do the following:

1.      Phone call to primary insurer to ensure coverage
2.      Phone call to secondary out-of-state contractor to find approved lab
3.      Phone call to doc's office to get procedure code – not known
4.      Phone call to first (erroneously chosen) lab to get procedure codes
5.      Phone call to secondary insurer to give procedure codes. Lab is not approved even though the hospital it is attached to is approved
6.      Phone call to approved labs to find out whether I need new form – no answer at either facility
7.      Series of six runaround voice mail messages at lab 1 – after reaching correct person, I get cut off
8.      Series of four runaround voice messages at lab 2 – asked to be called back and never was
9.      Direct call to lab 2 to confirm procedure code – must have new form from doc
10.     Phone call to doc to get new forms – two voice mail messages
11.     Phone call to lab 1 – no new form required

“All of this required two hours of my time. For one blood test. In all I was transferred or left a voice message or had to listen to menu options a total of 22 times. For one blood test.” 

All this abuse is expensive; to keep CMcL and spouse insured, it costs more than $11,000 annually in premiums, deductibles, co-pays and the usual arbitrary "gotchas" the industry loves to spring on us. That sum doesn't include one-time costs such as the $3000 out of pocket expenses incurred earlier this year for "routine tests." And then there are pharmaceuticals; if your doc prescribes non-generics, you're probably going to be spending $40 to $150 for a month's supply.

Well thank the deities CMcL isn't in Canada, where we're told the experience at the hands of the soulless state-run health care system would make the US for-profit model look like nirvana. Or possibly not…

 

Here’s a weird idea:  let’s ask some Canadians
Given all the horror stories we in the US hear about waiting times, lines, inefficiency, understaffing and such, I decided to ask Canadians how similar blood work would be handled there, what it would cost, what the waits would be like, and so on. So I asked Canadian participants on a couple of popular political/social-issues bulletin boards to react to CMcL’s story.

Just regular people from nearly every province – no government officials, no spin, no propaganda, no weird agendas. As it turned out, their sole common denominator was the desire to set the record straight and, in the process, inform their southern neighbors that we’re being lied to every single day by paid apologists and cheer leaders for the status quo.

I got 24 separate responses. Unfortunately, all of them won’t fit here, so I included only the 12 replies that focused narrowly on blood tests in particular, rather than using other medical procedures as evidence to refute the argument for the US market-based model.

(And there were quite a few of the latter; one from Angiej, a Canadian temporarily sentenced to living in Houston who maintains that her father in Quebec would have died under the US system because he would have been denied coverage and couldn't have afforded the procedure out-of-pocket. It's a constant source of worldwide amazement that lack of medical insurance in the richest country in human history can carry the death penalty.)

I don’t pretend these stories are representative of the experiences of all Canadians in similar circumstances. Nor do I pretend this is a random sample large enough to draw statistically valid conclusions. It pays no attention to demographics, so responses can't be weighted accordingly. I didn’t ask a series of scripted questions. In short, the whole thing is just anecdotal. (For serious statistical analysis, go here to pore over the numbers compiled by the World Health Organization comparing the overall effectiveness of 191 countries' health care systems. More on that study below.)

All respondents preferred confidentiality, so screen names are the only identifiers used here. Each respondent is also identified by gender and province. Date and time stamps from emails are included. All statements are verbatim, except where edited for length or clarity (in italics). So, anecdotal or not, I think you’ll see a common theme emerge fairly quickly…

 

In their own words
We don't often hear the unvarnished truth in a country that has perfected the art of spin. But when a dozen people who don't know each other all say pretty much the same thing on the same subject, the circumstantial evidence mounts up quickly. I suppose they could all be in on some vast socialist conspiracy to subvert capitalism by ruining the best health care system in the world – as the US mess is routinely rated by our chest-thumping mass media shills. But probably not… Read on and decide for yourself.

 

daleo – male, Alberta
Thu Jul-12-07 01:34 PM

I haven't had a blood test for a long time, but my experience has been:

Go to doctor.
Doctor gives you form.
Go to clinic, get blood test.
No bills.

 

Spazito – female, Alberta
Wed Jul-11-07 10:53 AM

At my doctor's office, after an examination, etc., my doctor would fill in a form detailing the tests to be done and give me a copy to give the lab technician.  In the small city I lived in, prior to moving to a larger center last year, I would have to go from my doctor's office up to the hospital where the lab is located, give the form to the clerk manning the desk at the lab and, either wait while the lab technician finished up prior work or go right in and have the blood work done.

After that is complete, I go home and await a call from my doctor's office, usually within the week, telling me the results.

There are no phone calls needed to okay the tests or anything else. There are no payments asked for or made.

 

SidDithers – male, Ontario
Wed Jul-11-07 11:01 AM

If your family doc wants to test your blood, they will write out a testing requisition form, indicating the type of testing to be done.  The patient then takes that requisition form to either their local hospital, or one of a number of private labs to have the sample taken.

We're fortunate in that there is a lab that operates out of the waiting room at our doctor's office.   My daughter needed a blood test not too long ago, and it was very easy. At the appointment with the family doc, we were given the blood test requisition, and then we walked across the waiting room to the lab office, waited about 10 minutes for her turn, and then had vials of blood drawn from her arm. No phone calls to insurers, no hassles and no cost to us.

 

Lautremont – male, Manitoba
Thu Jul-12-07 10:36 AM

I … decided to get a check-up finally after several years and much prodding from my wife. So I had to get a gamut of blood tests, and did so this past Monday. I walked down a couple of blocks to a doctor, having made no appointment. I showed them my provincial health card. They copied down the number, took my blood, and away I went.

I'd brought along a book to read, because after all, wait times in Canada are horrendous, right? I mean, that's what the right wing would have us believe. I didn't have time to read more than a paragraph before I was called in, and I was in and out of the place within 15 minutes. Free and easy like it ought to be. Yes, I know I pay for it with my taxes, but nothing will make you happier about paying taxes (and not nearly such onerous ones as you might think) than medical care that doesn't bust your bank account.

 

ducati588 – male, Ontario
Sun Jul-22-07 12:43 AM

In Canada the doctor completes a card (5X8) for all of the required blood tests. You take this card to a blood/X-ray clinic, which is usually in the same facility, and the clinic staff draw blood as required. The results are sent to the doctor within a few days or quicker if necessary.

Virtually no wait in the clinic, and the tests are covered under the government plan. The tests are free.

 

Glarius – female, Ontario
Thu Jul-12-07 10:46 AM

This is very timely...  I just went in this morning for blood tests....
        
The procedure here is this: My doctor, (who we choose ourselves and not the government, despite what right-wingers in the U.S.A. claim) on my visit yesterday gave me a requisition for blood tests which I took into the local lab this morning. The tests were performed promptly (I waited about 20 minutes) there were a few people ahead of me. That was it. No appointment necessary for the lab and NO COST. This is about the 8th time I've had these tests and it's always the same. The case you describe here (CMcL's experience) is absolutely ridiculous. No patient should have to go through that kind of (nonsense).

Somehow or other it seems to me that the right wing conservatives in your country have convinced your citizens that Universal Health Care is akin to that devil...communism… I keep hearing them say that our government runs health care.... choosing our doctors and deciding on treatment, etc. Nothing could be farther from the truth. Our doctors and hospitals make ALL the decisions and send the bills to the government. The government PAYS and that's it.

GET UNIVERSAL HEALTH CARE AMERICA! YOU GOOD PEOPLE DESERVE WHAT THE REST OF THE CIVILIZED WORLD HAS!!!!!!!

 

Hand – male, Nova Scotia
Thu Jul-12-07 11:00 AM

I get blood work twice a year. Here's how it goes.
        
1. My doctor fills out a form specifying the tests she wants done.

2. I take the form to the hospital where blood work is done.

3. I take a number deli-style, wait until it's called, hand in the form and show them my provincial health card.

4. I sit back down and wait until my name is called.

5. I go in and get my blood samples drawn.

6. I leave. I don't stop at the cashier because there's no cashier.

7. The lab faxes the results to my doctor. I make an appointment to review them.

The whole process takes maybe an hour, maybe less, maybe more. Depends on how busy they are. Everyone does it this way. Nobody jumps the line, and as far as I know, nobody is denied service. If your health card is expired, they tell you to get a new one (free), but you still get the tests.

End of story. It's based on the assumption that my doctor knows what tests I need and that no one is silly enough to ask for unnecessary blood work. What a concept.

There are no fees for these tests – the service is paid for via tax revenues.

 

gula – female, Quebec
Wed Jul-18-07 08:56 PM

Pretty much the same (as Hand) here in Québec, except that I go to a local community clinic (CLSC) for the blood samples as it is much faster than the hospital. They, the CLSC then send the samples to the hospital which then sends the results to my doctor and so on. And of course, there is no cost involved.

 

ironflange – male, Alberta
Tue Jul-17-07 10:58 PM

I get mine done four times a year.  Other than that trifling difference, my experiences are identical to yours (referring to Hand, above). The only variation is (4); I've learned the best times to go and don't even have to sit down the odd time. I also have one particular test that has a standing order on it, I can go in anytime and get it with no form or anything. Oh yeah, I've forgotten my card at home a couple of times, so it's a waste of twenty minutes when I have to retrieve it.

 

Bragi – male, Ontario
Fri Jul-13-07 07:43 AM

I just had my annual check up and my doctor ordered the usual tests (actually, about a dozen or so specific tests were checked off on the list.) The process went exactly as others here have described. It took about 45 minutes in total at a walk-in, first-come-first-served lab.

One thing I did have to pay for, though, is the (quite unreliable) blood test for prostate cancer, which for some bizarre reason is not covered by the Ontario health plan. I think paid $25 for that test.

 

MrPrax – male, British Columbia
Fri Jul-13-07 08:25 AM
        
My mom had a blood test last week – she went to her GP for her check-up and he sent her for the usual blood test at a lab she likes to go to. No phoning involved, other than maybe phoning the doctor's office for the test results.

I think the only time anyone has to call their provincial Medicare office is to inform them of a change of address or to get their premiums (in BC) adjusted because their income changed drastically and have to apply for a subsidized rate.

 

GirlinContempt – female, Manitoba
Tue Jul-31-07 06:51 AM

A couple of weeks ago, I called my doctor.  I got in to see her within a few days. We talked about my concerns.  She wrote me a little slip for blood work.  I went down three floors in the clinic, sat down, and 15 minutes later had my blood taken.  One week later, my doctor had the results.  No money changed hands.

 

Stats back up the stories
That's a dozen stories from the socialist hellhole to the north, where blood work doesn't seem to exact quite the mental and financial toll it does in the lower 48. But these tales don't exist in a vacuum; they're supported by mountains of demographic and epidemiological evidence that sits in a gigantic World Health Organization database. When the WHO did its groundbreaking study in 2000 comparing health care systems in 191 countries, the US ranked 37th overall in a compilation of key indices that include average life span, average disease-free life span, average birth weight, infant mortality rate, access to necessary health care services, cost of those services and so forth. Thirty-seventh.  

Which puts us among such famous mainstays of medical superiority as Slovenia (#38), a small part of the former Yugoslavia, and Domenica (#35), a Caribbean island nation of about 70,000 people comprising 289.5 square miles. And I think it's safe to speculate that the US has fallen further in those rankings since 2000 because of growing inequity of access and steeply rising per capita costs. 

Canada was ranked 30th at the time, but there are interim studies based on WHO methodology that suggest it’s climbing into the top 10. And who was number one? Think “freedom fries” and “freedom toast.”

 

A word on the democratization of health care
Here's a picture you'll never see in America:  a member of Congress waiting in line with the commoners for his turn at the doctor's office. Here it's generally understood that the rich, the powerful and the well-connected have access to better quality health care than what's available to the serfs, and that's accepted by many as just another perk to which America's modern feudal lords are entitled.

Canadians see things a little differently. Let's let Hand of Nova Scotia describe his experiences under a single-tier, equal-access health care system:

"One time I needed a chest x-ray, which is done by the same procedures that I and others have described – get the form, go to the hospital, hand it in, show your card and so forth.

"Since this is a public first-come-first-serve service, there's often a bit of a lineup, which there was this day (took maybe half an hour from the time I walked in the door). Anyway, while I was waiting in line, I noticed my federal MP (member of the House of Commons, equivalent to a US congressman) also waiting in line in his suit next to the usual lineup of people in jeans and t-shirts or whatever. He didn't jump the line, didn't think of pulling rank on anyone and was content to hang out until his name was called like everyone else.

"I talked to him on the way out since I had voted for him and liked what he said in Commons – he was just there to have an old basketball injury checked on. That's pretty much the way it works in a near single-tier system – to the greatest extent possible, everybody's equal and gets the same level of service.

"That's perhaps the greatest benefit, in my opinion, of a single-payer universal health care system – it's as near to fully democratic as it can be (given that folks with money and/or education generally tend to be able to take better care of themselves). In that way, it helps bind together all strata of society in very real and very important ways. I think people are aware of this and do not begrudge the taxes they pay for the health system, even though the benefits may go more to others than themselves."

Amen.

 

# # #

 

Comments? Care to add your own experiences? Suggestions for health care activism and advocacy? Email the author at war_on_peas@yahoo.com and win great prizes like this week's special, a partially-expenses-paid weekend for one in Tuba City, Arizona's capital of questionable dining and romantic sublimation (airfare, lodging, rental car, meals, drinks and pharmaceuticals not included).

This article originally appeared on August 13th in Online Journal.

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