At a recent conference I met two sisters from Canada who, after finding out what I do, asked me what is going to happen to health care in the United States with all the talk of changes in Washington.
The older sister, Vidica Simpson, 56, of Toronto, said she loves Canada’s single-payer, government-funded system. Her husband recently underwent coronary artery bypass grafting after entering the hospital with chest pain, and finding out he had blocked arteries. He had the procedure done within five days of his diagnosis and he’s now home, fully recovered, and doing better than ever.
Wait, I thought people in Canada had to wait too long for their care?
Canada’s single-payer health care system makes people wait longer for appointments than in the U.S., but seems to deliver emergency care in a timely fashion.
Apparently not, according to Simpson. She noted that in her mind the Canadian system is really good at “triage,” or prioritizing those who are really sick from those who do not have such serious medical problems.
“If you have a life-threatening condition, you are pushed to the head of the line and you will be taken care of immediately,” she said.
I asked her if that meant long waiting times for less urgent conditions.
“It might,” she said, “but if you are getting worse, or if there is a medical reason, you will receive care as fast as possible.”
I was intrigued. In the U.S, we have this belief that people in Canada wait forever to see their doctors, and if they are referred to a specialist, it could take a very long time.
Simpson’s sister chimed in with her own story. She is six years younger, lives outside of Vancouver, and has been happy with her choice of a family doctor for the past several years. Five doctors recently retired in her local community and the government is providing all sorts of incentives for new doctors to come into the area.
The sisters felt they were well covered for any medical emergencies that might arise, and were confident that their health was in good hands in Canada.
But this woman is lucky. She can go see her doctor anytime, just by making an appointment. There is no payment necessary. Medications are covered, and she is encouraged to go for regular checkups and to do routine testing for cholesterol, sugar and blood pressure. If her doctor isn’t available, there is a walk-in clinic nearby, and for those who don’t have a primary care doctor, they can access their care this way as well.
“What happens to those who aren’t working or lose their job?” I asked Simpson, wondering about any similarity to those who are uninsured in the U.S. She noted that in Canada, citizens are given medical cards for care, and that’s independent of working, or having money, or being poor, it’s just available to all. A few years back, there was a proposal to create different tiers of care, but it wasn’t acceptable to the Canadian public and was voted down.
Simpson did say that although Canada does have access to primary care doctors, she thinks there isn’t enough emphasis on prevention. She’s a health/life coach and hoping to work with people who want to change their habits before they get sick or even have high cholesterol.
She’s finding it hard to get traction for her future career plans, as many people don’t have any incentive because there is no fear that they won’t be able to afford health care if they get sick. I said we have the same problems promoting lifestyle changes in the U.S., but there was no guarantee of affordability for future care. Insurance premiums go up regularly here, and people are often priced out of coverage, creating their own type of rationed care.
Her younger sister admitted that wait times can be an issue, particularly with specialists, and that she recently waited six to eight weeks to see an orthopedist about her shoulder after a work injury. Eventually, she got an earlier appointment when there was a cancellation, and had diagnostic testing done including an MRI as well.
But when I asked her if she would have wanted to have something done sooner, she felt that if she had pain, or was getting worse, she would have received care more promptly, and knowing that made her feel like the wait was a fair tradeoff. If said if she was the one “jumping the line,” she wouldn’t feel right if it wasn’t really necessary.
Neither woman had any reason to ever seek care in the U.S, nor knew anyone who did. But they were both sure that any care in our country would have to be paid for in cash, unless it was for an emergency, because their health insurance is only good in Canada.
“Going to the U.S. is only for rich people,” Simpson said.
A paper done by the National Bureau of Economic Research looked at health care, health status and inequality in both countries regarding their health care systems and found that Canada had a lower infant mortality rate and greater life expectancy and spent less of its gross domestic product on health expenditures.
People in the U.S. reported having better health overall, but had higher rates of depression. Rates of chronic illness such as high blood pressure, heart disease and asthma, were also higher in the U.S. Many confounding variables may be responsible for this.
The study found that waiting times were greater in Canada, but the limitations on care were noted to be from a lack of supply of doctors, not a lack of insurance coverage. More studies need to be done to compare individual health outcomes in both countries to get a true representation of the differences in a single payer system versus a private and age-based system like we have here.
The sisters felt they were well covered for any medical emergencies that might arise, and were confident that their health was in good hands in Canada. They both wondered if such a system would ever be available in the U.S., and I can only hope someday it will.
The U.S. doesn’t need to copy Canada’s health care system to be successful, but something needs to change.
Kathleen Kozak, M.D., is an internal medicine physician at Straub Clinic and Hospital. She is also a part-time medical director for UHA Health Insurance and is the host of “The Body Show” on Hawaii Public Radio.