Well, first of all, it's NOT free. Working people are taxed heavily for it.
And secondly, as it turns out, I know a fair number of Canadians in my circle of Medievalists, so I sent out a questionnaire to them, asking, among other things:
What do you like about your health care system?
What do you NOT like?
Have you ever required treatment in an ER? How long did you have to wait?
Have you gone to a Walk In-type clinic, and how long did you have to wait there?
Have you needed to have surgery, and how long was it before you were able to get it?
Have you ever needed to see a specialist, and how long was it before you were able to see one?
Overall, the answers were fairly consistent: they liked that there was no worry over having to pay a bill, but *didn't* like that it didn't cover dental, required long waits to see a doctor, longer waits to see a specialist, and sometimes months or years to get surgeries that were needed but not life-threatening. One lady said she moved to a new city four years before and was still on a waiting list to get a General Practitioner assigned to her--none in her area were taking new patients.
This boils down to money. The way it works is, they collect taxes on working Canadians to pay for the health coverage. If you are NOT working, you not only get health coverage, but it's free. There are lots of welfare programs, so if you're the kind of person who doesn't want to work, it seems easy to skate by--free food, free housing, free health care. I know several people who are "disabled" (in both the US and Canada--so don't think I'm just bashing the Canadians), who are "unable to work" but can play on Facebook or WOW for 10 hours a day, or sit in a chair watching TV doing embroidery all day. If you can sit in a chair for that long, you can do data entry or answer phones instead of killing orcs. It's not that they *can't* work, it's that they haven't found the job that can accommodate their physical limitations.
So, anyway, there's a limited amount of money collected from taxpayers and it has to be spread around to everyone who needs to see doctors. When they run out of money, there's no more paying doctors, paying for medical equipment, paying for medications, etc. They have to cancel non-urgent surgeries, which is why you have to wait 18 months for that hernia operation. With fewer doctors on the payroll, fewer appointments are available, so you might have cancer, but the next oncology appointment is in six months. Sorry. Hope you survive.
This week that we got to see, first-hand, the chaos of the Canadian medical experience. As you may know, a close family member was admitted to the hospital after a stress test led to further testing, resulting in disturbing results from an angiogram. They wanted to admit him that very moment, but he didn't have anything with him for an overnight stay (PJs, toothbrush, insulin), so he came back the next morning and was checked in. They put him in a small private room that was built in 1959 (and seemingly not updated since). It looked very much like a concrete version of Lower Highland hall--small closet, built in drawers, very plain-jane. Not a big deal, but there was nothing state-of-the-art in this room. With the exception of the small flat-screen TV that they brought in (which had to be rented, along with the phone in the room), it still looked like 1959. They wired him up with a heart monitor that had a hand-held size receiver on it that fits easily into the pocket of a pair of sweat pants, and told him to rest and they'll schedule him for surgery.
In a week or two.
Not satisfied to wait for surgery and hope that the ticker held out, my sister and I began helping him source other options. In order to do so, we needed to get a copy of his records, so we called and eventually visited the Records Department.
This records room looked like a scene from Harry Potter--the Hogwart's School of Recordkeeping. First of all, it was not in the 1959 building...it was in the original hospital across the alley, that was built around 1906. Once in the front doors, we descended down what I believe may be the oldest elevator in operation into the basement...what was the morgue. We followed the long hallways and all the asbestos-wrapped pipes to the very end where the only room still in use was filled with disgruntled workers. These people looked like wizards trying to dress as muggles. There were no computers that I could see. The files were in stacks and piles and assorted clusters in yellow expand-o-files the likes of which have not been seen since the advent of the Rubic's Cube. They were clearly the Keepers of Knowledge and were not prepared, nor willing, to give any of it up. And certainly not in a timely manner.
The logic and reasoning that these people were operating under is nothing short of asinine. Circular. Impossible.
We can't get the records until he's released. He can't be released to a new hospital or doctor without the records.
We can't give you any records of anything that was done before or during his stay.
Change that--we can't give you any records of anything during the stay, but can from before he was admitted.
We can't release the records to another doctor unless he has an appointment with them, but can't get an appointment with them without sending them the test results.
He needs to sign the paperwork to release his records.
I mean, he needs to have his signature witnessed.
And by that, I mean that he needs to have the people at the records department witness his signature, so he'll have to descend 10 flights of stairs, go out of the building, across the parking lot, down the ancient elevator, follow the long hallway full of asbestos to our office so we can witness the signature. Even though he's a patient in the cardiac unit and he's not allowed to leave the floor.
Oh, and he needs to write a letter indicating what he wants the records department to do with the records once we've located them.
Oh, and it'll take 4-6 weeks.
Long story short, we were not allowed to have the records.
Luckily, we figured that the nurses on the floor where he was housed would more than likely have his current labs and test results on hand, so we were able to obtain them to send to any other doctors we wished.
In the end, the point was moot. He got the surgery two days later and is resting in the hospital bed, recovering, and thanks to the system, he isn't going to be forced out too soon like our Drive-Thru-Medical style in the US. I am, however, a little concerned about the state of cleanliness in the facility--there are signs everywhere telling you to use the alcohol-based hand rub, but the floors don't look clean enough, the furniture is filthy (in the lounge, especially), and there are computers in the hallways that are covered in grime. I'd love to see what a health department worker would find.
Do I think the US has problems with health care? Definitely. Do I think Canada's system in the answer? NO. Take the broken bits of the US system and fix *those*. Don't replace a broken system with another broken system.
If I were Queen of the World, here's what I'd do:
- Get the insurance companies out of the decision-making process--the doctors need to tell the patient what to get done, and the insurance companies should pay for what they say they will cover without pressuring the doctors to avoid certain procedures or push certain drugs.
- Insurance companies should cut their premiums in half. At least. They're spending big bucks on buying stadiums and sports teams. They clearly have too much income.
- Make a basic health insurance plan cheap and easy to get. No one should go broke due to an unforeseen disaster, and if you're generally healthy, that's really all you need. The more people that pay into it, the cheaper it is. This is Econ 101 material.
- Seeing a doctor for 10 minutes shouldn't cost more than going to a movie. If all you need is for someone to look at your finger and say, "No, you don't need stitches. Keep it clean and stop juggling knives," you don't need to pay $150 at a walk in clinic.
- Everyone who has a job should have some kind of medical coverage. Part time employees should get at least disaster insurance. 3/4 to full time should have full medical benefit options. These benefits should be written into the employment contracts so that businesses cannot hire you as "full time" and then reduce your hours down to less than full time to avoid giving you benefits...when you are hired as a full-time employee (whether it's for a large corporate bank or a burger joint), you keep your full-time benefits until such time as your contract is satisfied or a new one is signed.
- Disabled and unemployed (but actively looking) should also be covered as part of their unemployment benefits. All veterans should be able to go to any vet hospital & get treatment. I think that's already the rule. People who are just lazy and sponging off society I have far less sympathy for. Sorry.
- The ER is not a walk-in clinic. If it's not an emergency, they should be referred to (triaged to) the walk-in clinic next door, which should be open 24 hours. People cannot be turned away for inability to pay, but should be turned away for inappropriate use of the facility. Just like calling 911 for non-emergencies...if someone with the flu feels icky and uses the ER instead of a walk-in clinic, it means that the guy who broke his foot falling off the ladder has to wait longer in agonizing pain.
- Stop advertising prescription medications on TV, on radio, in print. Tell the doctors what you've got to offer them and let them decide what medications to give their patients. THEY have the knowledge to make an informed decision about whether a medication is right for you. Save the money for research.
- There is a difference between *necessary* or *recommended* surgeries and *elective* surgeries.
- Simplify the billing system. Anyone who has had hospital stays will know that you end up with three or more bills, many times without details printed on the invoice. I got one that was 18 months after service. Any longer than 6 months should be treated like a stale-dated check...not honored.