Weighing in on the health care debate

[selenay]

I've been trying to stay quiet on the American health care reforms/NHS debate because it's a subject that makes my blood boil so quickly.

Instead, calapine said it for me: http://calapine.livejournal.com/569192.html

And in the same language that I'm tempting to use :-D

While the NHS is the most visibly attacked system for most British people, the conservative right is also using the Canadian system as an example of how terrible socialised medicine is. I remember people asking me when I moved, "What are you going to do about health care when you're in Canada?"

I think this was largely because most people assume that Canada has the same system as the USA. Don't get me started on the English perception of Canada as either the 51st State or a frozen Arctic wasteland populated by penguins. I'm serious about the penguines, yes. Geography, people. Learn some.

The Canadian system, in many ways, is what I think the USA will be going towards if they ever do get true universal health care. Here all the hospitals, doctors etc. are 'private' and the government pays their bills, administered via a couple of large insurance companies. Kind of like government funded health insurance. Some provinces charge a (very small) monthly fee, waived if you're on benefits, Nova Scotia doesn't. And if you have permenant residency here (either through PR or citizenship) then you're entitled to that free care in NS from day 1. Some provinces have a wait period of 30 days when your originating province has to cover you. Slightly more complicated to sort out, but still not costing the user to access health care even during that wait period.

There are a few things it doesn't cover: dental and drugs (unless you are 11 years old or under), eye care and extras like private physios. Although your doctor can refer you for hospital physio if you can't afford private physio. Er, so it's just like the NHS is that respect :-)

Nova Scotia is also one of the first provinces to bring out a government drug plan. Each year my earnings are assessed and they work out how much I can afford to pay in drug costs. When I reach that 'cap', all my drug costs are paid for by the government. So there's no chance that cancer will bankrupt me even if I need $40,000 of treatment. Oh, and all drugs administered in hospital are paid for no matter what happens. So, basically, a hospital stay won't cost me a cent.

All the funding for this is administered through private insurers. Doctors and hospitals submit their bills to the insurer and are refunded, the government refunds the insurers. No need to get pre-authorisation for a procedure or drug because the government will always fund it (apart from the above exclusions).

Do I have private medical insurance? Yes, through my work. It pays for nice extras like a private room in a hospital, dental, money towards glasses and alternative therapies such as private physio, accupunture, chiropracty, a great drug plan etc. Nothing that's essential to my healthcare, but nice-to-haves. The eye care is awesome because that's just the NHS doesn't pay and nor do most private insurance plans in the UK. In other words, private insurers aren't out of business here. And I'm not thousands of dollards out of pocket every time I dislocate a joint, need surgery or get an infection. My family doctor sees me and doesn't present me with a bill at the end. Same with my specialist. This is despite me having pre-existing conditions.

It's an excellent system, just as good as the NHS, and that's why my blood boils every time Republican conservatives scream about the dreadful care, the impossibility of implementing it and the harm it causes. Right now, my uncle is in hospital due to congestive heart failure and a pulmonary embolism. They're doing an excellent job and there was never any debate about whether he'd be seen. And when he eventually dies, nobody is going to be left with a huge hospital bill to pay.

Comments

[wadjet-theperv.livejournal.com]

Don't get me started on the English perception of Canada as either the 51st State or a frozen Arctic wasteland populated by penguins. I'm serious about the penguins, yes. Geography, people. Learn some.****

Not kidding. Word, sista.

[selenay]

*sigh*

[livii.livejournal.com]

Great post. As a note, there are some waiting periods - when we came back to Ontario from the States, after two years away, I had to wait three months before I qualified for OHIP. You are strongly encouraged to have supplementary health insurance during those three months as you won't be reimbursed (and companies will sell you insurance policies for just that three month period!) It's basically a policy to ensure that people don't move abroad and then just come home for treatment. It felt sucky for me but I saw the point, and had some insurance anyway.

Nova Scotia's drug plan is great. There are still a lot of flaws in the Canadian system, but there are so many benefits. One thing I liked about working at the CMA this past year was learning quite a lot about the various efforts at health care reform. Personally, I would love to see extended dental and vision coverage - I think oral health is critically tied to overall health and it only makes sense to encourage it, and vision care is a fundamental necessity for quality of life. So it's not like things are perfect here. But the alternative is staggering to consider.

[selenay]

Thank you :-)

I knew vaguely that there were wait periods in other provinces (I'm so lucky to live in NS!) but didn't quite know how long they were. Thank you for the extra info :-D

I'm really hoping that they roll the drug plan out country-wide. I still have to pay some drug costs (and I won't reach my cap if all I need is the odd course of anti-biotics) but they'll never cripple me. And the way it's worked out, if I'm on a really low or non-existant income then I'll barely pay anything at all. So the people who can least afford to pay big drug bills are the people who don't have to :-D And those on much higher incomes can usually afford really good drug plans or get them through their jobs.

I would like dental and extended vision to be part of the healthcare here. It wasn't in the UK so I'm not suddenly paying for something that was free, but oral care shouldn't be considered a luxury and those of us who require strong, complex eye prescriptions shouldn't be heavily penalised for it.

It's still better than the USA where I wouldn't have a snowball's chance in hell of getting insurance due to my pre-existing conditions!

[boulder-girl.livejournal.com]

My parents are currently living in the states and are constantly biting their tongues when people start ranting about how they have the best health care in the world (they pay the most but don't get the most out of it for sure) and how they don't want the government's noses in their health care.

Personally I like Canada. It cost me $45 to have my baby here and that was $15 per night for upgrading to a private room, if I had stayed in the ward then even without health care for work it wouldn't have cost me a cent. In the states a csection can cost $10,000 or more if you don't have coverage. We actually know a few folks who were working in the states and came home when it came time to go through a pregnancy and birth.

[selenay]

I think that's the thing with the system - all basic care is taken care of, extras like private rooms are something you can choose to have. I'd hate to live in a place where just giving birth could financially cripple me. The way that the US system works ends up putting a huge financial burden on people at the time when they can least afford it. I think that's what makes me mad.

[paranoidangel]

Interestingly, a friend of mine who's a nurse went on a Rotary/work-related trip to British Columbia earlier this year and she found that the people working in the NHS there thought ours was a lot better. But not knowing all the nitty-gritty of what goes on behind the scenes I couldn't say what it is that makes it better.

[selenay]

I think it's mostly ease of use. Here we all have health cards so you have to make sure that you have your card with you (or at least have a current card in the system that they can look up) to get your care. Also, you have to pay for your care in another province and get re-imbursed in your own, which can be frustrating.

OTOH, because it's all private docs and the government acts sort of like an insurer who never says no, you get a lot more choice in your care here. It's no problem to swap family docs, swap specialists, find out who the awesome OB was for your friend and swap to her etc.

The NHS, while simpler to negotiate in some ways, doesn't have that freedom.

Interestingly, my aunt (world-renowned specialist burns/wound care nurse) went on a tour of a facility here and would have loved to move and work there but my uncle didn't want to move so she didn't. Possibly it's a grass-is-greener thing for each side!

[amyty.livejournal.com]

Australia also has NHS to cover the essentials for surviving, and it IS a life-saver! Health is a right, and not a privilege, and basic health care comes at no cost. What's more, we have a system in place ENSURING people in low income households (like myself as a po' student) can get some 'essential extras'.

But we also have a thriving health insurance industry. For about $7 a week I'm covered for dental, optical, and a slew of other things I haven't put much thought into because I don't actual need them (but it's nice to know they're there). If I paid a little more I'd also score myself a cushy private room in a hospital, but I'm actively planning to avoid that necessity until I can afford a bit more.

$7 a week is all I pay and I'm covered for all I need and more. $7 a week means I can get new glasses shortly, and I really can seriously consider getting braces to straighten some crooked teeth, where only my self-esteem is an issue and not the cost.

Of course, the Australian health care system means I can whinge about our paltry communications industry until I'm 110.

[selenay]

I think that's the thing that a lot of people are missing - in countries where there is government-funded healthcare of some kind, health insurance still thrives. And it's actually more affordable for the people who decide to have it because it's not covering the essentials but rather providing a top-up system.

$7 a week is affordable for everyone but the poorest, sounds like you can decide just how many nice extras you want, and there is something in place for the essential extras for those who really can't afford $7 a week.

In fact, it sounds very similar to the Canadian system :-)

No system is perfect, but providing basic healthcare free to everyone as a right rather than a privilege is should be the core of any health policy.

[riverfox.livejournal.com]

The main criminal in the "Canada/British Health Care sucks" bullshit is the drug industry and the insurance industry. They want to keep things the way they are (skyrocketing costs=profit margin and insanely high CEO pay) so they're buying off Republicans, their fucked up pundits, and scaring the shit out of weak-minded among us (who have been bussed to town hall gatherings in order to disrupt any discussion about health care reform).

On our progressive/liberal radio and TV news shows, the hosts of the programs are constantly telling people the truth about Canadian or British healthcare and how badly rated our own is (we're 24th out of 30 world systems). They're constantly trying to get out the word that all the scary shit people are hearing about (some via a heinously lying TV ad) is nothing but lies and disinformation.

We're not likely to get true national health care (reform or otherwise) for quite a while because of all the crooked, paid off members of Congress. Obama has lost his spine (sold us out to the drug industry today), as has most of Congress. But I agree that when we do, it'll be like the Canadian system.

[selenay]

I figured that it was the insurance industry backing all this crap :-(

The big problem is that in a health insurance only system, health care is reserved for those who can afford the policies and have no outstanding/previous health problems that would give insurance companies reason to refuse them. In other words, the people who can most afford their care and are least likely to need more than the odd check-up are the people who can get care. Those who can't afford huge hospital bills and those who are likely to actually need care can't get insurance.

That is just plain wrong.

Basic health care should be there for everyone. It's a human right, IMO. If you can then afford the nice-to-have top-ups, that's what medical insurance should be for. And some kind of government help for the essential extras (like drug plans, eye care and basic dental) is just as important for those on low incomes.

I really don't think the NHS system would work for the USA because it would require the government buying every hospital and putting every health care professional onto the government pay roll over night. It worked in 1949, but would be impossible now. The Canadian system of publically funded private health insurance would work with the system already in place in the USA. And there would still be a place for medical insurance for all the nice extras. Up here, all the funds for the government system are administered by insurance companies! For a nice government cheque :-)

Problem is that as soon as it's publically funded, the government will crack down on the astronomical amounts that are charged for everything. The system up here means that the government assesses that X procedure is worth $X, no matter which doctor does it, and that is what the doctor/nurse/physio/whatever can charge. Full-stop.

Also, as soon as all basic essential healthcare is covered by the government, the insurers can no longer justify the massive premiums. Suddenly health insurance becomes a bit more affordable - nice. More people can take it out, although for less cost per person. I suspect that the insurers aren't noticing that they'll no longer be needing to pay out for Mrs. Smith's yearly check-up or Mr Blogg's cancer treatment so their outgoings will also be much, much lower. Probably the difference between their outgoings and premium charges would balance out so that they wouldn't lose money.

I'm just hoping and praying that those in power do finally see sense and do something. A country that proclaims to lead the way in freedom and quality of life should not have a health care system that only provides for the very rich and ranks near the bottom in every report.

[riverfox.livejournal.com]

I completely agree (about all of it). We have a right to health care. It was never intended to be a money-making business, either, and that greed automatically creates corruption. Many health professionals have been robbed of their Hippocratic oath, too.

And here's the funny (disgusting) thing about the bitchers and whiners against reform: they're all on a government plan, whether it's a Congress member or a senior/disabled person on Medicare. There are a bunch of seniors and disabled people (though they're far from the majority but the press is making out like they are) who go to these Town Hall meetings to bitch (be used by the insurance lobbyists who get them there) who don't understand that their Medicare and Social Security *are* government-run and funded thru national taxes. They actually have to be told and it's far past time for the Democrats to nail boards to their spines and forcefully (loudly) tell people the truth and to stop listening to lies.

Someone made a joke the other day on the radio, telling the listeners that a few of his friends in Canada are calling us the Excited States of America: because we do nothing but take Viagra and scream. *pigsnort* Not the majority of us, but you'd think so with the slanted news coverage we're putting out. ;)