How Are You Feeling? Healthy? Safe?

Canada believes that Canadians have a right to appropriate healthcare and thus the government’s job is to ensure that that happens. By contrast, the U.S. government believes that healthcare is a very good thing and that it would be a very good thing for all Americans to have it, but it is willing to make sure that they have it only if they are poor and have young children, if they are old, if they are disabled, if they are current or former members of the military, or if they are employees of the U.S. government. That, in terms of spending anyway, gets us about half way--sort of--to where Canada already is.

And even those Americans who do have this access to healthcare have it only within certain limitations. For example, if you are old, you have to pay 20% of your healthcare costs up to a total of a gazillion dollars. Under U.S. Medicare, there is no limit on out-of-pocket expenses which, if you are very sick, can require you to have very large pockets indeed. In Canada, by contrast, people go to the doctor when they need to, and they get the care that is needed, and their payments are very, very small. E.g., my friend who is an asthmatic pays no fee to see her doctor and $10 for the asthma inhaler that she uses regularly. If I go to her Canadian doctor in a non-emergency situation, I will pay, as an American, a fee in the range of $40 (last time I went, anyway) and the asthma inhaler will cost me about $30. Social security will not reimburse me, of course, even though my closest Canadian doctor is two miles away and my closest American doctor is more like 35 miles away (plus an extra border crossing). And both services would cost more in the U.S.

There is always a great to-do in the American press about how Canadians have to wait for services. In my observation, the waiting is not as great as the papers make it out to be (and there are different waiting levels in different provinces and in different parts of each province, and I only see the very southwestern part of B.C., and not much of that). And I haven’t noticed that it’s particularly easy to get into a U.S. doctor’s office without a considerable wait. My Canadian neighbor suffered a sudden-onset viral encephalitis, was air-evacuated to Vancouver, spent 6 weeks in a neurological ICU, 4 weeks in a ICU stepdown unit, and another 2 months in rehab at no cost to him or his family. And without waiting for services, although he did have to go to a rehab unit that was not close to his home. But then he also had to go to a hospital that was not close to his home. That’s what happens when you live in a rural area.

Having had some experience with both systems, I can only say that I don't have a second’s hesitation preferring the Canadian to the American system. Both systems are in trouble now because of the financial pressures, but that is not a fault of the system aspect of the Canadian system. Both systems are suffering, largely, from the fact that we have as North Americans been indoctrinated to believe that only if people have constant use of (as opposed to universal access to) healthcare services can they possibly expect to stay alive, so in both countries, services are overused. But they are considerably more overused in the U.S. (A terrific little essay on this that appeared a couple of days after I wrote this post: http://www.washingtonpost.com/wp-dyn/content/article/2008/03/28/AR2008032802972.html?hpid=opinionsbox1

The story of healthcare in both countries is a long and complicated one, and I can’t do much in just a few paragraphs to elucidate it. But there is this one strange fact that stays with me. The Canadian healthcare system came to be because of the deeply-felt commitment of a politician named Tommy Douglas. Douglas was the Premier of Saskatchewan, a member of the party that eventually became the (far left) New Democratic Party, and he brought single-payer, universal healthcare to that province, and he continued working to extend it to everyone in Canada, and he was successful. He died in 1986, living long enough to actually see the fruits of his labors.

So that was what he gave to Canada. And what did Tommy Douglas give to the United States? Something you might think almost as important given the frequency with which I hear people telling me about the cultural and political importance of the TV show ’24 Hours.’ Tommy Douglas is Kiefer Sutherland’s grandfather, and Kiefer Sutherland, of course, is Jack Bauer, who every week has to torture bad guys to keep America safe. They get healthcare; we get torture. This does not sound like a bargain to me. Well, certainly living well is the best revenge; but Douglas may have done that one better.