Another story from a single-payer world:
The major benefit of living in Canada, which is drilled into the heads of all young Canadians, is that health care is free; my friend will not have to pay a cent to have her knee repaired (aside from a lifetime of high taxes, of course). But, as I’m sure that you are aware, she will have to wait. Instead of having her knee fixed as soon as possible (perhaps on her own dime), she will be forced to endure time on the Medicare waiting lists in order to obtain these government-rationed medical services. Unless she seeks treatment outside the country, she can do very little to speed along the process.So how long is my friend expected to live with the chronic pain of an ACL injury, the inconvenience of a brace, and no chance of playing the sport she loves dearly?
12-18 months.
The Government of Canada will force her to wait between twelve and eighteen months to receive the treatment she needs in order to resume the life that she wants to live.
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{ 11 comments }
Hi Kevin,
As a Canadian living in BC, if I had your friend’s injury, I fully admit I would go to one of the pay clinics and get treated. Yes, pay clinics exist in Canada – there are ways around the system.
That said, my husband was in a very bad ski accident in January at Whistler Mountain, broke his tibial plateau, humerus, clavicle and scapula. He was airlifted to Whistler hospital, where X-rays were taken, then he was ambulanced 2 hours to Vancouver General, where they operated, pinning his clavicle and humerus. He was in the hospital for 5 days, where he received physiotherapy. An occupational therapist helped me organize the wheelchair and the bathroom equipment he would need while unable to weight-bear. Then once he was home, a physiotherapist came to our home. He has had 4 follow-up appointments with the surgeon. The cost for all of this was $0. I think that if we lived in the States we would have had to remortgage our home to pay for it all. Thank goodness I live in Canada!
So, no doubt there are problems with the Canadian system, but so far, my experience has been pretty positive, and I don’t think I’d trade it for the American system.
All the best!
Vreni Gurd
That was an interesting story, thanks for putting it out there.
I’d have to disagree, however, with your statement that “the cost for all of this was $0″. Nothing could be further from the truth, and that sort of misrepresentation of the nature of the system really perverts the debate. You’re paying exorbitant taxes to cover that, it’s far from free. If I buy a car with no money down, but agree to pay 40% of my income to the dealership for the rest of my life, is that car free? No more so than your health care. Looking only at the point of sale provides a pretty myopic view of the situation.
That said, I’m glad it worked out ok and that you feel good about it. I just strenuously object to the extremely common misrepresentation of the financial end of the situation.
Hi Matthew,
Your point is well taken that this kind of care is paid for by our taxes. However, I have never paid anything close to 40% in taxes. I think it is important to understand that it is a sliding scale, and those below a certain threshold pay nothing in tax. Tax rates are lower the lower the income, and higher the higher the income. Even those in the top tax bracket only pay a higher percentage on the net income above a certain threshold. All income below that threshold is taxed at a lower rates. And income tax rates are continuing to come down regularly, because the Canadian government realizes that lower taxes are necessary to remain competitive.
Besides, I don’t mind paying higher rates in taxes if it means if disaster strikes I’m not left in financial ruin. It is simply a different system, and it works for me!
Vreni
I hear you, I didn’t mean to give the impression that I was citing your tax rate, it’s just a number I pulled out of the air to prove the overall point.
It’s all well and good that you don’t mind paying more taxes, but the problem is that your willingness to do so translates directly into eliminating that same choice for everyone else. The more market oriented the system is, the more choices people have and the fewer freedoms that are coercively taken. Once you’ve given away a freedom or granted control to government over an entire sector of the economy, it’s difficult to get it back. Preservation of limited government is vital.
Also, please consider that the income tax isn’t the only tax you’re paying, and a lot of the items you buy in the store as a Canadian are priced higher due to, for example, GST tax. Everything imported to Canada is taxed that way (at least from the US). You pay more for goods. You’re paying a lot more than you think you are.
Hi Matthew,
The bottom line is that the system in Canada is no longer single payer, no matter what the government says. There are plenty of private clinics popping up at least in the major cities where people can pay for service. The whole 2-tier thing is a major issue in Canadian politics, but there is no denying the reality of it. The worry is that physicians will leave the public system in droves to run private clinics, and consequently the waiting times for those that cannot afford to pay will lengthen further.
In the building where I work is a fee-for-service emergency clinic and advanced diagnostic centre. If I so chose, I could get an MRI of any body part I wanted tomorrow. The idea that Canada is single-payer is simply not reality, even though most Canadians wish it were, and are shaking their hands in frustration over it.
Vreni
Mattew, it depends on how you look at it. For the wealthy, by paying taxes some of their choices are limited. But for the vast majority of middle class and lower-income people, by having everyone contribute a small amount regularly, their choices are enhanced. By having the cost of healthcare shared among all of society, everyone has a stake in it and everyone has access.
The main stickler in this debate is that we don’t think it acceptable for people who don’t have enough money to be denied healthcare. It may to some degree limit our individual choices, and it may seem “socialist” to many Americans, but just because someone doesn’t have the money to pay, does not mean their life is worth any less.
And every time I come accross a story of a long wait, I think of the thousands of other “stories” of no wait at all.
Vreni,
That’s really interesting, I wasn’t aware of that. I think that if what you say is true, that pay for service health care facilities are becoming more common, it really only shows that perhaps it isn’t actually the case that most Canadians want only a single-payer system with government rationed health care. The demand for a better system that bureaucrats don’t directly control is clearly there.
One thing I always wondered (I don’t expect an answer, I’m not sure there’s a way to even get one), is that when pollsters try to figure out what it is that people actually want in a health care system, how much does the framing of the question influence the answers? If people are being asked questions with misleading or blatantly false terminology like “free health care” or “universal coverage for everyone”, it’s going to color their responses. I’m sure that if I were to ask around and see which people want a “coercive, governement run monopoly on your health care that will cost more than we can even imagine”, I’d get a different response than if I asked who wants “health care that’s free at the point of service, and everyone’s guaranteed at least some coverage”. Both depictions are essentially true, but slanted in very different directions.
The reason I ask that is that, although I don’t live there, I’ll bet that most Canadians are brought up to think that their health care is both “free” and “universal”, when in fact both of those are demonstrably false terms. Your first post was a case in point, and although I don’t know how widespread that misconception is, it seems likely to be pretty common. What do you think? Is that true in your experience? And how does the expansion of pay for service health care show you that most Canadians favor bigger government?
And furthermore, my understanding of the American system (which may admittedly be quite incorrect) is that those who do have medical insurance pay fairly hefty premiums each month for that coverage. I wonder if those monthly premiums were added up, how it would compare to the “high taxes” we pay. We don’t have the premiums but we do have the taxes – maybe it all comes out in the wash. At least we know we won’t be bankrupted by medical bills, and we don’t have to worry about bills that we thought would be covered, being declined by insurance companies. That lack of worry is actually very liberating, as when one is sick or injured, adding financial stress to the picture does not promote healing.
Interesting conversation! Thank you!
Vreni
I really only know my experience, and I pay about $20.00 a week for full coverage, myself only. My employer picks up the rest of the tab for my insurance. The American system is so complicated and varied, it’s hard to even know how to start counting, to be honest. The government pays for health care for a lot of people under Medicare and Medicaid, employers pay a lot of the tab because of the way congress has set up employment law, and some people are self-insured. No one is denied emergency coverage due to lack of insurance, although some hospitals do turn people away due to overcrowding, or at least, that’s what I’ve read.
I think that polls in both countries show that the majority of the people are happy with their health care. I know that’s true in the US, and I’d be surprised if it wasn’t in Canada also. I think that’s why a lot of my opinions on the subject rest on the basic philosophies underlying the strategies for handling health care rather than arguing particulars and anecdotes that no one ever agrees on.
Across the board, government is almost invariably the least efficient, least adaptable, most frustrating and clumsiest way to handle pretty much anything. With no competition, there are no incentives to control costs, and no one has motivation to innovate. That’s true in any industry, and I’ve never see any reason to think health care is any different.
Hi Matthew,
We just cross posted … I think your term “coercive” is rather over the top. “Government run monopoly” I can accept as being true, but I don’t see what you mean about coercive. It is not like anyone is being forced into anything. People still get choice with respect to what kind of treatment they want. The government will pay for all the standard treatment options, so there is still full choice on the part of the patient.
As for costing a lot, my impression from the research that has been done, is that government-run health care is actually cheaper than for profit clinics, as the profit motive is not there. And because the cost of health-care is rising with an aging demographic there is a huge motivation on the part of government to do what is necessary to deliver care in a more efficient and innovative manner. Governments don’t want larger and larger percentages of their budget spent on health care, yet they know that the electorate will turf them if they allow the quality to slip, as health care has always been one of the top priorities of the nation. This dynamic ensures quality care at a reasonable cost.
I think that if all treatments could be given in a timely manner under the government-run system, practically 100% of the population would be behind the system. The problem is the wait times for non-essential operations like ACL repairs, hip replacements etc. Most life-threatening stuff gets treated pretty promptly with the odd exception. A girlfriend of mine was told she may have breast cancer from a mammogram screen, got the confirming biopsy and was treated all within a month. I don’t think that is too bad.
The private clinics that are opening are filling the wait-time gap – people that don’t want to wait for hip replacements, MRIs to diagnose herniated disks etc. can pay to be treated immediately. I don’t know how widespread the private clinics are – they probably don’t exist in rural Canada or small towns.
However, if the government were able to solve the wait-time problem, I don’t see why anyone would choose to pay out of pocket for a service that is covered under “universal health care”. No sense completely wasting your money even if you do have a million bucks.
Anyway, that’s my take on it.
Vreni
Hi Matthew,
Weird cross posting like that!
Certainly the $80 to $100 bucks a month for the insurance that you are paying is on the lower end of the scale that I thought Americans are paying. Just goes to show you how we all have misconceptions about the other system!
And I think you are bang on that people’s views on health care are dependent on the underlying philosophies and belief systems which are quite different in the two countries. On the surface, Canadians and Americans may seem similar, but we really are rather different from each other if we were to look below the surface…
Stay well, and once again, thanks for the conversation!
Vreni
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