Debunking Canadian health care myths - by Canadian living in the US for 17 yrs

[Guest guest]

Debunking Canadian health care myths

By Rhonda Hackett

Posted: 06/07/ 2009 denverpost.com

_http://www.denverpost.com/opinion/ci_12523427_

(http://www.denverpost.com/opinion/ci_12523427)

(http://www.denverpost.com/opinion/ci_12523427#ixzz0iDPhqU7S) As a

Canadian living in the United States for the past 17 years, I am frequently

asked

by Americans and Canadians alike to declare one health care system as the

better one.

Often I'll avoid answering, regardless of the questioner's nationality. To

choose one or the other system usually translates into a heated discussion

of each one's merits, pitfalls, and an intense recitation of commonly cited

statistical comparisons of the two systems.

Because if the only way we compared the two systems was with statistics,

there is a clear victor. It is becoming increasingly more difficult to

dispute the fact that Canada spends less money on health care to get better

outcomes.

Yet, the debate rages on. Indeed, it has reached a fever pitch since

President Barack Obama took office, with Americans either dreading or hoping for

the dawn of a single-payer health care system. Opponents of such a system

cite Canada as the best example of what not to do, while proponents laud

that very same Canadian system as the answer to all of America's health care

problems. Frankly, both sides often get things wrong when trotting out

Canada to further their respective arguments.

As America comes to grips with the reality that changes are desperately

needed within its health care infrastructure, it might prove useful to first

debunk some myths about the Canadian system.

Myth: Taxes in Canada are extremely high, mostly because of national

health care.

In actuality, taxes are nearly equal on both sides of the border. Overall,

Canada's taxes are slightly higher than those in the U.S. However,

Canadians are afforded many benefits for their tax dollars, even beyond health

care

(e.g., tax credits, family allowance, cheaper higher education), so the

end result is a wash. At the end of the day, the average after-tax income of

Canadian workers is equal to about 82 percent of their gross pay. In the

U.S., that average is 81.9 percent.

Myth: Canada's health care system is a cumbersome bureaucracy.

The U.S. has the most bureaucratic health care system in the world. More

than 31 percent of every dollar spent on health care in the U.S. goes to

paperwork, overhead, CEO salaries, profits, etc. The provincial single-payer

system in Canada operates with just a 1 percent overhead. Think about it. It

is not necessary to spend a huge amount of money to decide who gets care

and who doesn't when everybody is covered.

Myth: The Canadian system is significantly more expensive than that of the

U.S.Ten percent of Canada's GDP is spent on health care for 100 percent of

the population. The U.S. spends 17 percent of its GDP but 15 percent of its

population has no coverage whatsoever and millions of others have

inadequate coverage. In essence, the U.S. system is considerably more expensive

than Canada's. Part of the reason for this is uninsured and underinsured

people in the U.S. still get sick and eventually seek care. People who cannot

afford care wait until advanced stages of an illness to see a doctor and then

do so through emergency rooms, which cost considerably more than primary

care services.

What the American taxpayer may not realize is that such care costs about

$45 billion per year, and someone has to pay it. This is why insurance

premiums increase every year for insured patients while co-pays and deductibles

also rise rapidly.

Myth: Canada's government decides who gets health care and when they get

it.While HMOs and other private medical insurers in the U.S. do indeed make

such decisions, the only people in Canada to do so are physicians. In

Canada, the government has absolutely no say in who gets care or how they get

it.

Medical decisions are left entirely up to doctors, as they should be.

There are no requirements for pre-authorization whatsoever. If your family

doctor says you need an MRI, you get one. In the U.S., if an insurance

administrator says you are not getting an MRI, you don't get one no matter what

your doctor thinks — unless, of course, you have the money to cover the

cost yourself.

Myth: There are long waits for care, which compromise access to care.There

are no waits for urgent or primary care in Canada. There are reasonable

waits for most specialists' care, and much longer waits for elective surgery.

Yes, there are those instances where a patient can wait up to a month for

radiation therapy for breast cancer or prostate cancer, for example.

However, the wait has nothing to do with money per se, but everything to do with

the lack of radiation therapists. Despite such waits, however, it is

noteworthy that Canada boasts lower incident and mortality rates than the U.S.

for

all cancers combined, according to the U.S. Cancer Statistics Working

Group and the Canadian Cancer Society. Moreover, fewer Canadians (11.3 percent)

than Americans (14.4 percent) admit unmet health care needs.

Myth: Canadians are paying out of pocket to come to the U.S. for medical

care.Most patients who come from Canada to the U.S. for health care are

those whose costs are covered by the Canadian governments. If a Canadian goes

outside of the country to get services that are deemed medically necessary,

not experimental, and are not available at home for whatever reason (e.g.,

shortage or absence of high tech medical equipment; a longer wait for

service than is medically prudent; or lack of physician expertise), the

provincial government where you live fully funds your care. Those patients who

do

come to the U.S. for care and pay out of pocket are those who perceive their

care to be more urgent than it likely is.

Myth: Canada is a socialized health care system in which the government

runs hospitals and where doctors work for the government.Princeton University

health economist Uwe Reinhardt says single-payer systems are not

" socialized medicine " but " social insurance " systems because doctors work in the

private sector while their pay comes from a public source. Most physicians in

Canada are self-employed. They are not employees of the government nor are

they accountable to the government. Doctors are accountable to their

patients only. More than 90 percent of physicians in Canada are paid on a

fee-for-service basis. Claims are submitted to a single provincial health care

plan

for reimbursement, whereas in the U.S., claims are submitted to a

multitude of insurance providers. Moreover, Canadian hospitals are controlled

by

private boards and/or regional health authorities rather than being part of

or run by the government.

Myth: There aren't enough doctors in Canada.

From a purely statistical standpoint, there are enough physicians in Canada

to meet the health care needs of its people. But most doctors practice in

large urban areas, leaving rural areas with bona fide shortages. This

situation is no different than that being experienced in the U.S. Simply

training and employing more doctors is not likely to have any significant

impact

on this specific problem. Whatever issues there are with having an adequate

number of doctors in any one geographical area, they have nothing to do

with the single-payer system.

And these are just some of the myths about the Canadian health care system.

While emulating the Canadian system will likely not fix U.S. health care,

it probably isn't the big bad " socialist " bogeyman it has been made out to

be.

It is not a perfect system, but it has its merits. For people like my

55-year-old Aunt Betty, who has been waiting for 14 months for knee-replacement

surgery due to a long history of arthritis, it is the superior system. Her

$35,000-plus surgery is finally scheduled for next month. She has been in

pain, and her quality of life has been compromised. However, there is a

light at the end of the tunnel. Aunt Betty — who lives on a fixed income and

could never afford private health insurance, much less the cost of the

surgery and requisite follow-up care — will soon sport a new, high-tech knee.

Waiting 14 months for the procedure is easy when the alternative is living in

pain for the rest of your life.

Rhonda Hackett of Castle Rock is a clinical psychologist.

===

Actions...

Subscribe: _Healthcare-NOW! – Organizing for a National Single-Payer

Healthcare System_ (http://www.healthcare-now.org/)

_Don't let Dennis get skewered for keeping his pledge and voting in the

public's interest. Make a contribution to the Kucinich campaign today._

(http://action.firedoglake.com/page/m/5958d68c/4597da9f/6360ba73/3dc65497/143611\

14

59/VEsP/)

Demand that we at least begin with a robust public option:

_I introduced H.R. 4789, the Public Option Act_

(

) . This _simple four-page bill_

(http://grayson.house.gov/UploadedFiles/Public_Option_Act.pdf) lets any

American buy into Medicare

at cost. You want it, you pay for it, you're in. It adds nothing to the

deficit; you pay what it costs.

_Demand a Vote on the Public Option_

(http://salsa.mydccc.org/o/30019/p/dia/action/public/?action_KEY=17)

Call your member of Congress NOW at (202) 225-3121.