September 29, 2020

A Perspective on Canadian Healthcare

canada-healthIt seems like everyone from everywhere has been chiming in on healthcare issues, so I thought I would add a Canadian perspective.  I have read a number of comments about Canadian care which have not been overly accurate, so I thought I would help set the record straight as much as I am able.  I will not be drawing comparisons, because frankly I do not know other systems well enough to do so.  You may draw your own conclusions with your own comparisons, but I will leave that up to you to do in the comments.

Anecdotal evidence

Let me start with some Canadian scenarios which we have experienced in our family in the last number of years.

1.  Wife has baby.  Complications resulting in week long stay in hospital for both mother and child.  No bill.

2. Son breaks foot on the school playground requiring emergency visit and x-ray.   No charge for the visit but had to pay $50.00 for crutches.

3. I get attacked by a virus that attacks my pancreas which stops producing insulin.  Diagnosis is Type 1 diabetes.  Visits to the diabetes clinic are covered by government healthcare.  Insulin, test strips, and needles are not.  Cost approximately $1000 a month.  In my case I am currently covered by my employer’s healthcare plan, but when I was unemployed I was not.  There are some programs you can apply to which cover a small portion of it.  Generally medicine is not covered at all for those under the age of 65.

4. Dental care.  Not covered by general health insurance.  I have coverage through my employer’s group plan.

5. Father got cancer.  Many tests.  Surgery.  Spent a week in hospital.  No bill.

6. Father in law got cancer.  Many tests. Brain surgery.  Spent three months in hospital where he died.  No bill.

In other words:  Visits to the Doctor result in no extra charges.  Medicine and Dental are not covered by the general government insurance.  I do see a lot of bad teeth in the poorer areas of town.

Choice

I can choose my Doctor or Surgeon.  Theoretically everyone receives the same level of service in Canada.  Under Canadian law I cannot pay extra to get quicker or better service.  (Hockey players and pets somehow seem to be exempt from this.)

Competency

I have rarely questioned the competency of the Doctors who have treated me or my family.  They have been very professional, thorough, and well trained.

Wait times

Generally, wait times for service in Canada can be lengthy.  My experience has been that the more critical the procedure the shorter the wait time.  In both parents case, surgery for cancer came soon after diagnosis.  On the other hand, a neighbor who needed knee replacement surgery waited for a year and a half!  The current wait time in the province for knee replacement surgery is 220 days which means that 90% of patients get the surgery done with 220 days of diagnosis.

Taxes

Tax rates in Canada are similar to those in the U.S.  The general health care we get is funded through taxes and premiums charged to employers (Ontario).  For those whose health care expenditures are greater than 3% of their income, the amount over 3% is tax deductible.

Sustainability

This has to be the elephant in the room.  Will we be able to afford our universal care in the future?  The graph below shows how costs are growing rapidly in Canada.  With the Baby Boomer bulge hitting retirement these per-capita costs are going to continue to grow significantly.  I think it is going to lead to some very uncomfortable questions about end of life issues.

 

HealthcareTrend

 

 

 

 

 

 

 

 

 

 

 

So, speak up Canadians.  Am I missing some important points here?  What can you add to this discussion? Our American and overseas friends:  How does this compare to the service that you receive?  Which system would you prefer?

Comments

  1. Mostly the same in B.C., except the more urgent doesn’t always equal faster wait times. Our health care cards (all provinces now charge a monthly premium to the card holder, my employer covers it) get charged and our province pays the card. This has been open to fraud (in BC there are 6 million people but 9 million health care cards), but they are cracking down a lot more now. If you are low income, then your fee is wavered, but you must file a tax return as proof.

    I have to get blood monitoring done for my medications (immunosuppressants, so very expensive and covered by my employer) as well as see my rheumatologist once every 6 months or so, that is all covered by my care-card. Blood-work is done in a private lab that bills my care card, it is billed to the care card because my doctor has ordered it. Last week a woman was asking the lab if they could tell her her blood type, but her doctor hadn’t ordered it, so they said they would have to charge her $40 or she needed to get her doctor to order it for her.

    I have a child with a pretty complicated neuromuscular disorder, and all his hospital and doctor visits are free – billed to his care-card. up until he is 5 years he gets his speech therapy, occupational therapy and physic therapy for free through the Govn’t agency responsible for social services (not health, go figure). After 5 it switches to the govn’t agency responsible for education and that is less well funded (no Occupational or Physical Therapy unless the child is severely handicapped, but Speech Therapy is usually well covered, all for free and not through our care cards). None of it is income dependant (thankfully).

    The wait times are for non-pregnancy, non-quick medical monitoring needs are long. They wanted to look for bone degeneration because I had “frozen shoulder” and ordered an MRI. I had to wait 11 months for an MRI (it would have been longer, but they had opened up an evening time slot to move backlog and asked me if I could get to the hospital in an hour, it was late, but I said yes and drove off). That is something I have learned, if you ask to be put on a cancellation list, you often get in much earlier, but it is usually short notice. But 11 months for an MRI for a non-urgent procedure is normal. I could go get it done at a private clinic, but my health care would pay zero, not a thing. It is pubic or out of pocket in Canada, employee benefits don’t cover private either.

    Pregnancy care is fully covered, I chose a mid-wife with my second child and that was covered by my health care as well (a registered mid-wife, who worked out of the hospital).

    Medications are funded provincially, so BC is different than Ontario and so on. BC will cover catastrophic costs (arthritis medication is catastrophic these days), so usually around July, the BC Pharmacare kicks in and I am no longer billed for any prescription medication (until then my employee benefits covers most of it).

    The huge difference health care made for us was our decision to adopt a child with special needs. Every US adoption article I read about special needs children was about how to handle health-care costs, I was like skip, skip where is the emotional stuff about adopting a kid with needs? The emotional stuff was all about finances! None of that was applicable to us. Kids are well cared for in Canadian health care, many doctors will sign off on anything for kids. It is long-term chronic adult stuff that is frustrating. But kids with medical needs get full medical services for free. We live near the specialist hospitals, so all I pay for is a bit of gas and parking, if I lived far away I would have to cover my own airfare and hotel stays, but in the Northern Territories, that too is covered. Wheel chairs though, aren’t covered, but there are programs to support families who need expensive devices.

    What I think I am getting from the ObamaCare stuff is that it is just another insurance option. In Canada, our Provincial care is really our only option. Private clinics may do a few things – MRIs, Plastic surgery or knee replacements, but if you have a heart attack, a baby or a kidney stone, the ONLY place you can go in Canada is to a public hospital (the Catholic hospitals all run as public). Private hospitals don’t do a large range of services. You also can’t sue hospitals – they have NEVER been sued (they have some legal protection, not sure what). So that is something to think about. It keeps costs down.

    • “What I think I am getting from the ObamaCare stuff is that it is just another insurance option.” I guess you haven’t been paying attention. It is NOT an option, it is COMPULSORY insurance, and for middle income , self insured people, at a much higher rate than we have now,

      • Not everyone is requred to buy through the exchanges. You’re just required to buy insurance so you don’t freeload off the taxpayers at public hospitals. Even through the exchanges, you still buy from the same old insurance companies. The rates for most people will be lower, not higher. Those who now choose to carry inadequate insurance, will of course pay more for a more adequate policy.

    • Anonymously Yours says

      What I think I am getting from the ObamaCare stuff is that it is just another insurance option.

      No…unless an industry or political group (like Congress) has an exemption, Obamacare is the only option. It is against the law now for an insurance company to sell group or individual insurance to anyone unless what it covers is approved by the Affordable Care Act. My employer is cancelling my insurance effective in January because it isn’t “good enough.” It is a high deductible plan, so it is not great, but neither I nor my employer nor the insurance company has any say in what kind of insurance it can sell to me now. Either my employer foots the bill for a very expensive insurance plan, or I sign up for Obamacare…which, by the way, would mean I would have to pay a higher premium and have a higher deductible.

      The whole “if you like your plan, you can keep your plan” was an outright lie. Now Obama has said, if you want your old plan back, you can go back to it for a year. Fat chance. Although I may needle my managers, a few of whom I know voted for Obama, that Obama said I can have my plan back, it would still be illegal for my employer’s insurance company to sell me the plan again, because it wouldn’t comply with the Affordable Care Act.

      • Anonymously Yours says

        Actually, I have to admit I have not been honest about part of this. I live in a state which has chosen not to expand Medicaid. I did my research, so I found out I make too much money to qualify for my state’s traditional Medicaid, but I do not make enough money to qualify for a subsidy on the federal exchange (because my state also did not set up a state exchange). So once my health insurance is cancelled, I will have nothing, and I will not be making enough money for pay the full freight for an Obamacare plan out of pocket.

        I work in the retail sector, and I would like to get a better-paying position somewhere, but my prospects look bleak. Corporate retailers are slashing hours to avoid the ACA’s requirement to cover full-time workers. I could look for an employer with less than fifty workers so they could give me full-time hours without running afoul of the ACA. But, at first blush, this would mean I would probably have to work for a retailer run by immigrants, which, on the social level, does not bother me. But I left my past employer partly because the immigrant owners were dishonest (and sold the company to another set of immigrants, who went out of business, and now the company is gone and bulldozed, so I would have lost my job, anyway, had I stuck it out), and the immigrant employers who have employed my immigrant friends routinely break labor laws (employing people under the table, paying less than minimum wage, taking all of the tips from the waitstaff, not paying overtime, etc.). (While I could argue against certain labor laws from a right-wing perspective, the law is the law, and we should follow it, absent extreme moral justification to break it.)

        Under Medicaid, everything would be paid, but my options about where I could go would be very limited. I know because two of my closest friends have had Medicaid. If I got a job where I could get a subsidy, the subsidy helps pay the premium only. My deductible would still be higher than my current deductible. Much higher, I believe.

        I am trying to remain anonymous, so I have tried to keep where I live and what I do a mystery. But I shouldn’t lie about my particular place in life just to make a point. So I apologize.

        • Your state needs to get in and help make the program work. Because insurance is based on something called math, the more who participate, the more effective the program eventually will be.

  2. “Tax rates in Canada are similar to those in the U.S. ” I know that is not true. For one, why do folks in Niagara Falls cross the bridge to buy their gas in Niagara Falls NY? Because when we buy it in Canada 45% of the cost of gas is pure taxes. Never find provincial taxes vs. state taxes, sales taxes… Why did my mom cross the bridge and have her MRI done in Buffalo instead of Canada? Because she’d rather pay for it than have a ‘free’ MRI at some point more than a year down the road.

    Competency, Wait Times: Why are more med students switching from learning to be a family doctor to learning to be a veterinarian? Because working on animals instead of humans means less paperwork, less regulations, for often more money. Your dog can get an MRI quicker than you can.

    ” Will we be able to afford our universal care in the future?” No we will not, which makes this post a moot point. Once govt. invaded the traditional role of the extended family, taking care of me in emergencies/when I’m old, naturally selfish people quit having extended families, so their lives could be easier and more ‘fun.’ But that means fewer future tax payers to pay for the nonsense–instead of a demographic ratio of 5 working taxpayers for every retiree, it will be soon 2 to 1, and then…. so unless the largest cohort of the population are civic minded enough to consider mass euthanasia, naah, it will just bankrupt us. It’s a fantasy that requires an ever expanding base of ‘suckers I mean taxpayers to keep going…

    I last went to the hospital in Canada for a very serious case of pneumonia. I later received a pretty hefty bill in the mail for the 5 minute ambulance ride. So much of what used to be doctors’ work has been downloaded onto the nurses, the nurses were very hard to find and rude, and many of them hard to understand due to their poor English.

    I thank God every day for CN Rail, where I stumbled into a job with great benefits. It’s a pretty demanding place to work, but I’d recommend it for the perks, like free dental, free glasses, paying almost the whole bill for prescription drugs… If you know some young person looking for a job, consider CN maybe, nobody ever gets laid off because rail is such a foundational bedrock of the economy…

    • Hi Will,

      I was just thinking of Provincial and State Taxes. But you are right there is also Municipal and Gas Taxes. I still don’t believe they are radically different. A larger share of our taxes goes to healthcare, but a smaller proportion to military spending.

      • Hi Michael Bell,

        Didn’t you say you were in Dundas, or am I misremembering? I’m downtown, near Cannon and Victoria.

        The military spending thing, I dunno, if you look at the percentage of the USA budget it’s not quite the monster you’d think, based on how much it’s mentioned, not compared to ‘entitlements’ and the ‘unfunded liabilitiies’ –the trillions they owe to retirees over the next few decades, the same demographic crash the West faces in general. Ah well, take care.

        • I am in Dundas. Used to be an East-ender. Not too far from you. (Gage and King, and Main and Kennilworth.)

          • Fantastic! We’re waiting anxiously for the Cannon St. conversion from one-way to two-way. Should calm down the traffic flow, hopefully do for us what it did for Locke St….Hamilton is great.

  3. Thanks for the facts from way up north, Mike! I did not know that medicines were not covered for the under-65 crowd, which leads me to a question—

    Does employer health insurance or any other type of coverage on the market cover medications at ALL? Is there any way to NOT have to pay full price for drugs??? This is mostly a selfish concern (not that I plan to move to my grandmother’s Quebec any time soon!) because although I have several health issues, they are WELL controlled by medications. Lots and lots and LOTS of medications!

    I spend about $3500 a year on copays for drugs; the actual prices without insurance would be about $62,000 a year!!! (And these are generics, whenever a generic version exists.) Considering that this is more than I earn in a year, I would be seriously up a creek. Can you fill me (us) in on how this works??

    As a sidebar, what does your employer based coverage cost you….and how much does it cost them? And what exactly do you get for your money….?

  4. My employer health insurance pays for my drugs. I pay $1.50 per prescription, they pay the rest. Other employer plans are not as generous. My wife’s plan for example pays 80% of the first 2000, but then pays everything after that. Plan also provides $300 per person per year for each category of chiropractic, massage therapy, physiotherapy etc. They also provide Out of Province emergency coverage, new glasses or contacts every two years, Dental care to a maximum of $1000 per year, and some life insurance, typically up to the equivalent of one years salary. My plan covers some orthodontics. My wife’s plan does not. How much the employee pays is up to the employer. It our case it has ranged from nothing up to $100 a month for family coverage. How much does the employer pay? No idea really.

  5. Internetmonk has gone off in a whole new direction that has nothing whatsoever to do with Michael Spencer’s legacy of Jesus-shaped spirituality….

    • Bob, if we believe that all of life is sacred, that our bodies are important, and that to be Jesus-shaped means caring for the poor, then I don’t see why we shouldn’t talk about this topic. Besides, the focus of the earlier article this week was on how evangelicals in the U.S. have, by and large, spoken against government involvement in healthcare, and how in other countries government healthcare grew out of a Christian concern for society. It’s absolutely appropriate.

      Michael wrote a lot about political topics too, you know. Check the archives.

    • Anonymously Yours says

      I was thinking the same thing just yesterday. Ironic, too. Internetmonk began as a right-wing Christian blog. Now it is a left-wing Christian blog.

      • Wow, there’s a loaded statement.

        I’d be more inclined to say centrist.

        • Anonymously Yours says

          Ha, ha, yeah…to the leftist, his ideas always seem centrist and moderate. 🙂

          • The way I see it, the “right” has moved farther and farther right, and the “left” has moved farther and farther left, and I don’t feel comfortable identifying with either of them.

        • Anonymously Yours says

          I say this blog was right-wing because that is what Michael Spencer said about what he used to post way back when.

          • It also used to be Calvinist, for a season. Now some say it’s too Lutheran. About half of our regular writers are Catholic. Others are non-denominational evangelicals. Last week we had an Episcopalian from Australia weigh in. Fr. Ernesto is Antiochian Orthodox. I refer to Anabaptist teachers all the time. Next week, I have a post scheduled by a Presbyterian and from one who has joined a tradition but writes that he cannot fully participate in that tradition because of all the things he respects and gleans from other traditions.

            I guess we’ve worked ourselves into a narrow corner, haven’t we?

        • Left of center.

          • I forgot to add: When it wanders from the strictly spiritual…

          • Fair enough. But I’ll only accept that designation for myself. I won’t speak for the other writers.

            And, I would add, when it comes to politics, what is left-centrist today is more like some of the moderate Republicanism I grew up with.

          • Chaplain Mike, who did you grow up with? Nelson Rockefeller? Jacob Javits? Hardly moderate Republicans. The term used today is RINOs – Republican In Name Only.

            • Everett Dirkson, Nixon, Ford, Dole. More Midwestern Republicans. As I heard someone say the other night, there has always been this rift in the Republican party, between a more mainstream, moderate style, and one that tends toward libertarianism. One of the things that has changed the equation dramatically has been the Culture Wars of the 70’s and 80’s. Prior to that, most Republicans and Democrats alike were not as outspoken about social issues, with the notable exception of Civil Rights (and on that issue it was the southern Democrats who were the “conservatives”). The media age and other factors have also changed our politics dramatically. Politicians used to stay in Washington, have dinner together, even share housing, often across party lines. Their families knew each other and spent time together. Many were friends and colleagues despite their differences. Now, because of the money involved, the Culture War mentality, and redistricting, our representatives go home most weekends to whip up support and raise money. They only really work in Washington about half the year. They don’t hang out together. They spend more time with special interest groups.

              All these factors and more have led to deeper divisions between the parties, and the 24-hour news cycle has magnified every difference to an unprecedented degree. Sure, politics has always been an ugly game, but I doubt that we’ve seen such division since the Civil War.

            • Bob, I would also point to the fact that the Affordable Care Act’s program was essentially a Republican idea, and a system very much like it was instituted in Massachusetts by some guy who just ran for President as a Republican. That’s one reason why, after the election, I recommended an article I read to my Facebook friends, which explained how, when Americans elected President Obama, they actually elected what used to be called a moderate Republican, slightly left of center.

      • I kinda don’t think you’ve ever really seen the right or left wings. They’re nothing like here.

    • On the other hand, I think this website keeps getter better and better. I was just reviewing your series on the Magnificat…thanks…

    • At times I also wonder if Jesus has left the building. Here are a couple of my own thoughts on that:

      1) I don’t have to read posts that don’t interest me. And if I find more and more posts don’t interest me, I’ll come to Internetmonk.com less and less.

      2) Just because a topic doesn’t seem to have anything to do with Jesus-shaped spirituality doesn’t mean we can’t see Jesus and God in the discussion of it. I learn A LOT about God and Jesus when I read/hear the thoughts and opinions of Christians who don’t think exactly like I do, whose beliefs aren’t exactly like mine. I’ve said this before: one thing I know for certain is that my view of God isn’t 100% accurate. I need to see what other people think, and I need to understand why they think that way, for my own view of God and Jesus to become more accurate. Healthcare, immigration…these issues may not have much to do with Jesus-shaped spirituality, but when I read about other Christian perspectives on those issues, then Jesus begins taking shape. And while I may not like or agree with leftist Christians or rightist Christians, I can’t ignore that they have a view of God that might fill in the parts where I’m wrong.

      Bottom-line…it might seem like Jesus left the building, but he’s in here somewhere. Just gotta look.

      • “Bottom-line…it might seem like Jesus left the building, but he’s in here somewhere. Just gotta look.”

        Or just sit down, Rick; he’ll find you. 🙂

  6. Lila Wagner says

    We do NOT have health-card premiums in Saskatchewan.
    We have a prescription drug plan for low-income families that pays some portion of the cost, and seniors pay only $20 for meds on the drug list–for each prescription. My husband is now on kidney dialysis because of lupus, and someone, either the Kidney Foundation or the province pays 100% of his drug costs. These are extensive because his lupus has affected brain, heart, kidneys, joints and skin.

    Ambulance costs are quite high, and not completely covered by any public funds — limited subsidy for low-income seniors

  7. All of these testimonials are enlightening, but not one of them has broached the subject of how it is paid for. A general statement that “the government” pays for it, but how does the government get the money? Taxes, of course! But taxes on WHAT? How much? And does the government dictate how much physicians and practitioners get reimbursed? And how does that compare to pay in the USA?

    Anecdotal evidence is great, but hardly enlightening. One fact DOES stand out though, and that is the system depends on an ever increasing population in order to survive, but as a nation becomes more prosperous its birth rates begin to decline and tax revenues correspondingly decrease. How can the system survive?

    When it comes to Christian theology (I HATE the word “values”) is there a directive that allows us to coerce others into giving? Our democracies allow us to tax ourselves but is it really a Christian notion to take from others against their will? Does the admonition to “remember the poor, the widows and fatherless” mean that we abrogate our personal responsibilities because “government” takes care of those things? And why is it that in western nations that have gone to a more socialist model that personal charitable giving just plummets?

    The whole subject of health care just seems to me to smack more of “ME”, with a slight nod to “OTHERS”, and this is what happens when we think that we can make a nation conform to Christian “values” (There! I said it!), Try as I might I just cannot find Jesus’ admonitions to governments to do the things that we, personally, are charged to do. and just because it SOUNDS Christian to pass laws that do these things, it does not necessarily follow that it makes the nation a better place. Consequences HAVE to be weighed.

    • “One fact DOES stand out though, and that is the system depends on an ever increasing population in order to survive, but as a nation becomes more prosperous its birth rates begin to decline and tax revenues correspondingly decrease. How can the system survive?”

      Correct, and
      It can’t.

      So it’s a silly debate. We had it exceptionally good by any reasonably historical standard, and soon the party will be over.

      “I have heard that wait times for cat scans and MRI’s are very long because of lack of equipment and incentives to open new facilities” Sure. That’s why all the cars in the Buffalo MRI clinics have Ontario license plates. They even give us free parking…

    • Final Anonymous says

      “And why is it that in western nations that have gone to a more socialist model that personal charitable giving just plummets?”

      Because the needs decrease.

      • Exactly. And isn’t that a good thing? When people trot out the “But socialists are less charitable!” argument, they seem to be saying that societies are better off maintaining a struggling population so that the wealthy can have opportunities for personal growth through charity. Because apparently preserving the virtue of the wealthy is more important than meeting the basic needs of everyone.

      • But I think you’ve made the point for many of us. I would argue that it was better (and of course, much more efficient) when people gave money directly to charities and those in need, as opposed to having it taken out of your paycheck every week. First of all, if you’ve ever been to a post office, you know how inefficient govt is. Better to channel the money through those who have a passion for serving the needy (or better yet, get involved yourself). How much of the money we “give” to the govt to support these programs goes directly towards supporting the govt? Why not cut out the middle man (the govt)? The fact of the matter is that the so-called SS trust fund should have trillions of dollars in it from the 75 years that people have paid into it. But, all it has instead is a football stadium sized room full of IOU’s. They took the money and co-mingled it with the general fund.

        The bottom line for me is, it was better when govt was not involved and when people gave on their own. But, I also believe the left had an agenda to make govt God. Sadly, they’ve succeeded.

    • “When it comes to Christian theology (I HATE the word “values”) is there a directive that allows us to coerce others into giving? Our democracies allow us to tax ourselves but is it really a Christian notion to take from others against their will?”

      Here it is:

      Leviticus 23:22
      “‘When you reap the harvest of your land, do not reap to the very edges of your field or gather the gleanings of your harvest. Leave them for the poor and for the foreigner residing among you. I am the LORD your God.'”

  8. Where’s the incentive for innovation and expansion?

    I have heard that wait times for cat scans and MRI’s are very long because of lack of equipment and incentives to open new facilities.

    This, I believe, is where the free market excels. Meeting needs because of a profit incentive.

    • Free market rhetoric assumes that people are only motivated by profit. There is plenty of political incentive to innovate in Canada. And there is plenty of moral incentive – our universities and health care system have ongoing, vigorous debates and research programs to improve health care.

      • Headless Unicorn Guy says

        And the Free Market Rhetoric I’m used to is more like “A equals A! Who Is John Galt! A equals A! Objective Truth! A equals A! A equals A! A equals A!”

        AKA There is no God but Ayn Rand and *I* Am Her Prophet.

        • Patrick Kyle says

          God forbid that Rand should have ever said anything useful or true, so let’s demonize her and use her name to tar and feather anyone who doesn’t quickly and wholly swallow the leftist line. Same as screaming ‘Socialist! Socialilist!’ just the other end of the spectrum. Hey, have you read any of Saul Alinsky’s stuff?

    • The free market, profit incentive system is not perfect (no system is), but it is the best so far that man has come up with. It’s brings the best possible life to most of the people. And then it is up to us to help those less fortunate. Or it should be.

      • Headless Unicorn Guy says

        Are you going to hold up Victorian Industrial England as the Perfect Type Example of the Free Market Economy? My local county newspaper does; when they’re not ranting against Moochers and Takers and Socialists and Statists.

        • Yes, he seems to be forgetting the global aspect– “the best possible life” for Americans. Never mind what it is doing in the Global South. And this is also assuming that “the best possible life” equals the most materially prosperous life, never mind both parents having to work, people moving halfway across the country and breaking up bonds with extended family to find work, etc.

  9. Can Jesus help us do the right thing? Is the Holy Spirit visible in these comments? Are the issues we discuss here relevant to our spiritual path when so many around the world have little access to modern medicine? The answer depends partly on what we do with the money saved, the time saved, and how much we consume.

    Three comments from an American health care worker:
    1. Freedom: I imagine that Canadians can change jobs or start their own business with much more ease especially if they have pre-existing health problems in their families. Choices about jobs might be based more on what you want to do, rather than what kind of insurance you get. That is a freedom not found for many Americans unless they are rich or very poor.

    2. A tale of two docs: Real comparison: Family doc in Ontario takes home ~twice as much money as Family doc in Vermont, working equally hard. The Doc in Vermont has to run a business of 8 people to do all the billing, coding, and paying of payroll. The doc in Ontario – so simple that just he and wife run the practice. Huge waste. Lots of jobs to do administrative work in America compared to Canada – just at the office level.

    3. America is moving not toward a government take over, it is moving toward more corporatization of medicine. Which would you rather have? Walmart’s network of doctors – salaried with their set hours, and well organized policies, or private practitioners with their separate, variable practices and longer term relationships?

    • I cannot speak for all of Canada, but all the places I know of physicians are private practitioners with their own practices. I have several friends who are doctors. The only ones I know of who are not are hospital doctors. Sometimes they join an existing practice (such as a walk-in), and in that case they will have to pay a percentage of their billable to the owner.

      They all bill the same insurer.

  10. I don’t know enough about the Canadian healthcare system to comment on it, but I appreciate this straightforward defense of it because it treats it as a non-religious issue. I would contend that how a society provides (or doesn’t provide) healthcare to its citizens is not a spiritual issue, but a practical one. The healthcare method an individual supports may, of course, grow out of his or her spiritual convictions, but, in a very diverse country like the US, for it to be adopted by the society as a whole, the supporters must make a case that convinces people of many differing points of view.

    I suspect that most of the countries with a single-payer system are (or were at the time of the adoption of single-payer) much more culturally homogeneous than the US is, and so consensus was relatively easier to reach.

    We in the US are having a great deal of trouble reaching consensus partly because we demonize the opposition. We should, rather, recognize that the problems our opponents observe might not be the result of selfish greed on the one hand nor of grasping socialism on the other. A good starting place would be to recognize that whatever solution we come up with, it will not be perfect: some will not fit, some will die, there will be tragic mistakes or bureaucratic stupidity or cases of appalling selfishness. Truly “Universal” healthcare is an unattainable goal in this fallen world; but that doesn’t mean we can’t keep working to make healthcare better.

    • My post was not trying to be a defense, rather apolitical observations. As such it was not intended to be “left” or “right”, just a statement of how things are.

  11. I am Canadian and I love the health care system here. I have had 3 family members who had cancer and one with serious heart problems and all received top notch care without having to mortgage their house. No system is perfect and there are places where we could improve, but I like it.

    The way that the GOP and its pundits have tried to drag our health care system into the American debate it shameful. As is the rhetoric about not being responsible for anyone else’s care but your very own.

  12. Anonymously Yours says

    Chaplain Mike wrote:

    I guess we’ve worked ourselves into a narrow corner, haven’t we?

    I have, I suppose: a charismatic who wants to be involved in the house church movement, but with no idea how to find a house church that is like my old house church (which believed in the fivefold ministry, including apostles, but whose apostle is now dead), which quit meeting and supposedly will meet again in the future. So I began attending a denominational Pentecostal church that is in the process of building a church building. Ha, ha.

  13. Thanks for the objective information.

    Although I don’t believe that Obamacare is the best plan for the U.S. to cover our uninsured, I am happy to hear that your system works for you. May God continue to bless you and Canada.

  14. I am generally happy with the healthcare we receive in Canada.
    Compared to much of the world, both Canada and the US are quite wealthy. Our middle class does better than the middle class in most countries. Canadians get envious at times about middle class wealth in the USA, and the seemingly cheaper prices. But viewed in absolute terms we have it good.

    I don’t think in Canada we view all social policy in terms of left or right. All political persuasions in Canada tend to view healthcare as a given. The difference comes in how we view the system needs to be improved.

    Having lived all over the world I still am puzzled as to how Americans can manage to turn this into a religious question and say things such as Jesus would never endorse this because it is a forcing people to pay for others. That sounds suspiciously close to saying to your parents ‘I cannot give because my wealth is dedicated to God’ which Jesus had problems with. To my ear that is untrained in American nuances some of the argument seems to sound like ‘my wealth is for me and my family alone’.

    In a modern industrial society we are taxed. It goes to all kinds of things some of which individuals do not like. Some problems by their sheer size are best handled at a national or state level. We already believe that for roads, infrastructure and defence. Why not healthcare?

    • OK fine, but here’s a real world issue that hasn’t been touched on in this article or the comments. I’ve got to address several commenters here who wish to demonize (read…intolerant…oh the irony) those of us who believe in individual responsibility.

      If I eat McD’s everyday and junk food galore and never exercise, and you are a vegetarian who exercises faithfully, why should you pay for my medical biils? Health insc should be like car insc. Why do I drive slow and obey the traffic laws? because if I don’t, I know my car insc payments will go through the roof. With my healthcare, it doesn’t matter. The guy who sits next to me at work is a workout freak and eats super healthy. Why shouldn’t he pay less than I do, when we have the same coverage??? I get that the analogy to car insc isn’t perfect because there are people with issues that are just random. So, you’d have to have some side program to deal with that. But the majority of health issues in this country are from poor lifestyle choices.

      Also, and this won’t go over well on a leftist blog, but it’s beyond absurd that in Obamacare, abortions are covered, but hearing aids aren’t.

      Another question must be answered. The UK also has a single payer system. But, I read not long ago that private medical care is springing up (again) there due to the demand for medical procedures that can’t be met by the govt. In this new private system, people are paying out of pocket to get needed procedures done. That’s the beauty of the free market: businesses will be created to meet a market demand. Competition among those businesses will drive innovation, which lowers prices.

      CM, If you could find anyone who is from or has ever lived in S. Korea, that would be an article you should have written (about healthcare there). As much of a non-govt guy as I am, that at least sounds intriguing. Everyone there has some skin in the game (as I understand it, you see a direct line item tax on your paycheck that pays for the system. The funds are not used by a shady govt to pay for other govt programs). Also, Dr’s are incentivized to treat as many patients as possible, so that keeps wait times short.

      Lastly though, even putting aside all other issues, it much be acknowledged that nationalized healthcare for a country of 35M people (Canada) or 50M people (S Korea) is a different animal than healthcare for a country of 300M people. Funny, CM mentioned how it worked in Mass. The irony of course in mentioning Mass is that it only serves to prove the point of limited govt, which this leftist blog hates so much. Govt works better, the more it can be pushed down to a local level (state, city, etc). If the good people of Mass want to have a state run system, good for them. But programs like that should never be forced down on people against their will. Well, at least that’s what I read in a little known and never followed document called the US Constitution.

  15. Mike, thanks for the post. It’s good to hear from someone who actually has interacted with the Canadian health system, as opposed to news stories.

  16. On the subject of sustainability, the Canadian governments (federal and provincial) actually spend less per capita on health care than the American governments, and get way more for that money. So I’m not sure if the American system as it is or as it recently was is any less sustainable than the Canadian system.

    And at the risk of opening a big can of worms, I have heard that Canada’s abortion rate is lower than the US’s. Some say this is because people with unplanned pregnancies don’t have to worry as much about how they’d handle costs of the child’s health care, especially if there are complications.

  17. For all its faults (primarily that it takes oodles of public money and the politicians are forever trying to reorganise it to make it more efficient, with not too much thought for how that affects the frontline staff), I don’t think most British people would want to swap our National Health Service for the systems described above. Yes, there can be frustrating delays and it’s difficult to find an NHS dentist, for example, so there’s a private system operating alongside it catering for the better off and those who belong to private / insurance-based healthcare schemes, but it’s difficult to knock the basic principle of the NHS which is that treatment should be free to everyone at the point of delivery.

    It’s not entirely free inasmuch as most people have to pay standard prescription charges and fees for dental treatment, etc., but those charges are mostly much less private treatment and various categories of people do not have to pay them.

    I was particularly interested in example 3 of Mike’s anecdotal evidence as my wife also became Type 1 diabetic without warning earlier this year. In her case prescription charges are now waived and she will get free insulin, needles, test strips and associated treatment such as eye tests and annual foot checks for the rest of her life – this is normal practice for anyone with a chronic condition.

    OK, we all pay for it in other ways, but it’s not such a bad system.

    • Ali Griffiths says

      +1

    • We all pay for it, yes.

      But it is time to stop making the most vulnerable in our country suffer neglect.
      There is a limit to greed and profit-making by insurance companies.

      Healthcare should not be administered just to those who can ‘afford’ it. There are moral considerations, and somewhere between the profound neglect of the poor, and the colossal profits of insurance companies, there must be a better way forward.

      I’ve heard we Americans (USA type) are the ‘richest’ people in the world.
      Then shame on us for letting politicians and health insurance lobbyists rule the day . . . it is irresponsible and unjust to so many of our citizens. Let people ‘make money’ some other way than off the backs of the sick.

  18. *much less than for private treatment*

  19. I heard an interesting rumor that the Republican Party is trying to learn from studying how Pope Francis impresses and influences people.

    And all I could think of was something I saw in the last election, this:
    http://www.youtube.com/watch?v=PepQF7G-It0

    so, if the rumor IS true, then I certainly hope Pope Francis WILL BE a good influence on the ‘Let Him Die’ crowd.

    Maybe times they are a’changin ?
    Or cynically, if this is just another way to ‘get votes’ and then it’s back to same ole, same ole?

    We shall see.

    I hate cynicism, but after a while, it is hard to see any light through the cracks showing, the darkness has been so deep. I want to be hopeful again.

    (Wonder what the Nuns On The Bus think about this ?) 🙂

  20. Patrick Kyle says

    ” Under Canadian law I cannot pay extra to get quicker or better service. (Hockey players and pets somehow seem to be exempt from this.)”

    Why does such a law exist on the books unless there is a black or grey market for such things? And if there is such a market, I take it to mean that there is a need by some to get better or quicker health care. I would really like to know if patients ‘die in line’ waiting for their procedures in Canada.

  21. Headless Unicorn Guy says

    All I know is that in seven years nine days I will qualify for Medicare. Until then, I am stuck in my current job because of health insurance. (Or alternatively, “Don’t Get Sick”.)
    Seven years nine days…
    Tomorrow it’ll be Seven years Eight days…

  22. I would like to point out that group coverage in the US continues to be fantastic, provided your employer choses to spend its money on health care and provided you don’t lose your job. If it weren’t for those two facts, PPACA would never have gotten off the ground, even though there are millions of Americans without group coverage. My employer, for example, offers for 2014 a family plan for $100/mo. with a maximum out of pocket of $250 per person or $500 for the family. And our $9/hr. line workers get this coverage, not just salaried employees. A competitor down the road pays 100% of all employees’ health care. These are not the norm, but any company can choose to invest in the health of its employees. In my opinion, PPACA is the natural consequence of the evolution of health care post WWII followed by companies spending less and less on health care (the Michelin case study is a great example of a company that nearly went bankrupt paying for health care).

    • Your right about the group care… but why divide the country up into the lucky and the unlucky? Why, other than for greed, ignorance or stubbornness, do we tolerate such a system?

      • I have no clue. There is a reason nationalized health care is the norm among developed countries – the outcomes to cost ratio is significantly higher, and no one is denied health care because of socio-economic status.

      • Well, if you really want to know. It’s govt intervention that got us into this mess. Does anyone know how we came to have a system where med insc is tied to your employment? It started at the end of WW2. The govt instituted price/wage controls and said that businesses could only pay certain wages for certain jobs. So in response, to get better workers, and since they were restricted in what they could pay in wages, companies came up with the idea of paying for your health insc. So again, govt caused this problem.

        I agree, it would bre great if your health insc was not tied to your job. But, you can’t have this discussion without addressing another huge problem that this leftist blog won’t bring up: the govt law that stifles competition by not allowing health insc to be sold across state lines. Again, with car insc (an industry that few have an issue with) you shop for the best rates, it doesn’t matter what state the compnany is in. But with health insc, our wonderful fed govt does not allow companies to sell across state line. Open up the competition and watch rates sink like a rock. If we truly allowed the free market to exist and stopped tying to health insc employment, the VAST majority of people in this country (I believe north of 90%) would easily be able to afford a good plan. Well, provided that they realized that health insc was more important to buy than the latest smartphone (which would replace the one they bought 3 months ago). For those 10% (or whatever it would be) who still couldn’t afford it, charitable orgs would take care of those people.

        Finally, I simply must mention what Ron Paul wrote about healthcare in his excellent book “Revolution”. Long before he was a congressman, Ron Paul was a medical Dr (yes, hard to believe, but some people who got into politics actually did something in life before they got on the govt gravy train). He practiced medicine in south Texas, hardly Beverly Hills. With virtually all of his patients, he dealt with them on a cash basis. For those who didn’t have much, he asked them “what can you pay?” They told him an amount, and that’s what they paid. Nowdays, Dr’s who accept Medicare and Medicaid spend most of their time wondering if they’ll ever get paid by our wonderful govt.

        • Leftist blog, huh?

          How about a discussion blog that invites a variety of opinions, including yours?

          However, I guarantee that using labels like that will not enhance the discussion.

  23. A few points I think of in these discussions about our (US) healthcare…

    1. I haven’t lived in other countries but I have read and heard enough to know numerous things about our USA system are wrong and unjust and frankly inefficient and irrational – and something is doubly wrong when every time someone tries to address those problems, the country’s self-proclaimed keepers of ‘christendom’ rise up against it…

    2. The social democracy systems are not all alike – in fact they all have some significant differences and hence pros and cons. I feel if more people here knew of these or had experience with them, maybe more people would be open to sensible reforms instead of obstinate defense of the status quo… but alas there’s so much ignorance…in fact willful ignorance because everything else is deemed “socialism”…

    3. I don’t know if it was this post or the comments or the other one about healthcare where someone talked about this – but yes some, maybe many evangelicals have a pretty calloused view… My workplace is predominantly christian and conservative at that and I’ve heard implied numerous times and in numerous words and ways that yes, if you can’t afford our capitalist/corp healthcare system’s high costs then you should probably just die… now I doubt they’d apply this to their church members but outside of that exception, yes you die or suffer… because “socialism” is a much greater evil!

    4. Another baffling element… the missing-the-forest-for-one-tree obsession with blaming it all on “big gov”… when clearly our connected-to-Wall Street profiteering insurance and healthcare provider private “enterprise” has played a role, if not a major role in driving up costs and putting a litany of hurdles to good care or prevention. What I don’t understand is – what is “socialistic” about addressing that or even admitting it? If local, state or federal GOV isn’t going to reign in that free market beast that loves to chew people up and spit them out – then who? I’d love to see the church confront it more (and I think we could) but again, we’re back to our present situation where it’s often ‘christians’ who have no intention of confronting that system – in fact they’re more likely to defend it!

    And it’s for that reason that this discussion is a spiritual/religious one…because the attitudes and actions of ‘christians’ have an impact on my and other’s receptiveness to what they believe and practice…some american evangelicals and their message looks less attractive, caring or Christ-like because of what they say and believe about healthcare…honestly this is one of a few areas of american evangelicalism (not all) that turns me off the most… their “faith” will begin to look more like Good News when they stop sticking up for life’s big-money winners and start opening up to and supporting any means (church, charity, local, state, federal) that lifts the least of these up, rather than stomping them down…

  24. I read this post and all the comments because I don’t think the ACA or the Massachusetts model are sustainable. I was encouraged to read this Canadian point of view because Mike Bell included the sustainable aspect. John G. is correct about the supporters of any approach must convince a diverse group, It will be difficult for a leader in the US to do the convincing for us to go Canadian on healthcare….eh? But I think it could be done, it would be the best approach, and would take much wisdom and honesty. So just some random thoughts. Since you already know I’m persuaded to go the Canadian way, no new comments about selfish greed on one hand or socialism on the other.
    It is imperative for whoever makes the case for scrapping the ACA has a thought-through plan to offer.
    You have to listen, include, show how the new plan approaches all the questions of all sides.
    Both the left and the right don’t like ACA, and often for similar reasons- there is no way insurance companies should be getting the bulk of 1/6 of the economy.
    It is the right that has the biggest fears of single payer- you have to show them all the evidence of all the developed countries that have government systems have kept the private practices of the health-care providers in tact better than an insurance company system.
    You have to cover why people in single payer systems want to come to the US for health-care. It’s not because of insurance, but health-care. Scrapping insurance to private companies to government, in this case, can be the best way to keep good health-care.
    You have to talk about taxes and health-care to convince people that the switch to our neighbors system is better. It’s not about taxes going up. It’s not about another entitlement program. It is about being the most practical approach.
    There are huge cost/benefit ratios to a Canadian system, and it doesn’t take reinventing the wheel.
    My last random thought has no research to back it up…..but I think a Republican LEADER ( a person with the wisdom, preparation, and skill) would probably be the best person to pull this off. My reason for thinking this is because of the culture in the US. It would take more insight to overcome the fears of the right.

    • PPACA was a direct result of the unsustainability of the former US model. The most conservative models put healthcare costs reaching 100% of GDP by around 2030. I appreciate the questions in your post, but I’m sure you’ve realized by now that these questions have been asked by very many think tanks and professionals for nearly three decades. There are plenty of good books on the subject which you might find fascinating. For example, as a percentage of people receiving care, more Americans travel abroad for health care than Great Britain or Canada – but is that a reliable metric of care quality? More often these cases involve getting medicine which is illegal in a given country (the main correlation is experimental procedures – most of the people who come to the US are looking to be involved in a new cancer trial or something similar, while most people leaving the US for care are looking for alternative treatments or inexpensive surgery in India, etc.). Here are some good books to start with from easiest read to most complex:
      Health Care Reform by Jonathan Gruber (literally a comic book explaining PPACA)
      The Battle Over Health Care by Rosemary Gibson (looks at PPACA’s potential outcomes)
      Delivering Health Care in America, A Systems Approach by Leiyu Shi (the most comprehensive, and required reading for anyone who wants to be informed in this conversation)

      Cheers!

    • Final Anonymous says

      Good point about the Republican leader. And one of the reasons I was most disappointed with Romney — after his success with his state’s healthcare overhaul, I thought we’d finally found someone who could bring both sides together and create an intelligent system. Sad.

  25. I can only speak from my own experience in California, USA: We couldn’t afford the $850 per month for health insurance, but make too much to be covered by state funded plans, so… End stage glaucoma–had to wait 5 years for surgery to remove eye, which was done as an outpatient procedure (if you can imagine! I was in at 9:00 am and out by 12:00 pm)–I had to pay $4,000 for surgery and $2,500 for prosthetic eye. Recent 3 day stay in hospital for gallbladder complications–no surgery–billed $40,000–will be in debt for the rest of my life (I’m 60). I should have moved to Canada–but not Toronto 😉