My View on Canadian Health Care

Warning: This post is long, political and totally NSR. Skip it if you want.

One of my American readers asked for my opinion on the Canadian health care system given our experience with Avery. I am so incited by this topic that rather than respond to her e-mail alone, I am posting it here (and you can flame me if you like...I have been reading up on this topic for more than ten years and I am good to go!).

Here are some early provisos:

• For those of you who have seen me on other forums, Facebook or Twitter, you will already know that I advocate, at the very least, a public option for my American friends.
  
  
• Canadian health care is a mix of private and public in that we have some private services (all x-ray services [covered under the public plan], dentistry, physiotherapy [that is not prescribed by a doctor], psychological counseling, drugs, etc.) and private insurance that covers those private services. (Note: These private services are covered by a benefit package through work. Since this insurance tends to just cover the "extras", employers are not burdened with the high costs associated with benefit packages as they are in the United States.)
  
  
• Ironically, Canada is one of the most privatized and expensive systems in the world (i.e., we are hardly the socialist panacea you may be looking for) spending almost 10% of the GDP on providing health care. My European friends (who average 8%) will know that, in many of their countries, all health care workers are employees of the state. In Canada, all doctors work privately and merely bill their province for services rendered. (In Canada, the federal government mandates that all Canadians have a right to care but it is the province itself that actually administers health care. Some of this is cloudy now that there is a layer of "regional care" to compensate for disparities in our geography [massive] and population [1/10 of the United States]).
  
  *And to round out the stats, American spend 17.6% of their GDP on health care.
  
  
• Finally, before I get into our experiences with Canadian health care, know that we lived in the States for four years, Tristan was born there and save wait times at my GP, I had nothing but a positive experience with the health professionals who tended to my care. And, once any itemized bills did come to the house, I was grateful for my employer-provided insurance! ($8000 for a perfectly normal pregnancy and labour [save the pitocin], two days in the hospital and no nursery bailouts for a new momma? Whoa!)

Avery's Care

• Avery was diagnosed while I was still under sedation (as a result of the c-section).
• She was prepped for transfer to the University hospital (from the one in the south) within a few hours of birth.
• By midnight, she had her first catheter surgery through her belly button (Christmas night).
• Once stabilized, she was jetted to Edmonton (three hours north) to have her arterial switch operation. (Note: Care in Western Canada is regionalized due to long distances and the expenses incurred with attempting to reproduce those services in each major city. The experts in the field are centralized and all children are transported there. In the case of the Stollery in Edmonton, the physicians and research outcomes are some of the best in North America [esp. given mortality rates as a comparison of overall outcomes].)
• Once stabilized in Edmonton, Ave had to wait two weeks for her surgery due to the Christmas holidays (the doctors wanted to at least have the day off with their families!), the arrival of donor hearts and her sepsis infection. None of these situations were predictable (given that she was not diagnosed before birth and almost a month early), but Avery's oxygen saturation levels in her blood were good enough that she could wait. Would I have liked it to be done sooner? Of course...however, Avery was one of the most fortunate babies in all of the NICU at that time. I wouldn't even think to put some other baby's needs (or their parents for that matter) ahead of mine simply because of my impatience.
• While we were in Edmonton, Avery had access to every medicine, procedure, specialist and piece of equipment they thought she might need. In addition, the hospital provided us with a social worker to make heads or tails of everything from the hospital logistics to simply finding a place to park that was cheap. Nothing was ever skimped on and we placed full faith in the surgeons, nurses and various specialists assigned to Avery.
• As part of her post-op care, Avery has access to anything that is deemed necessary for her development (be it cognitive, psychological, physiological, etc.). And that is above and beyond, her post-op cardiac/respiratory care. I am grateful to all my fellow Albertans who pay into the system so that Avery can have the care she has received. In turn, I am not at all reluctant to pay my taxes to see that each of their needs are duly taken care of.
  
• In conclusion, at no time do I believe that her care has been rationed. And sadly, Avery could never make the decision to move to the United States herself...because of her pre-existing condition, there would be nary an insurance company to take her on.
  

Conclusion (Or "You're Canadian...Why Do You Care?")

A lot of my good friends and colleagues are American. More importantly, so is Tristan. He eventually could make the choice to live down there and for him, as well as all Americans, I don't think medical costs should be the albatross that it is (or could be).

I lived in Northern California at the height of the boom. It was expensive. We lived close to work and so we paid ~$1400 rent for a 700 square foot apartment (and that was only our housing costs!). We had fun but we didn't spend frivolously (people seriously asked us why we lived as spartan as we did) and we saved our money so that we could one day buy a home. After living there for a while, we were both sure that we wanted to raise our kids in Canada for the following reasons: a) to be close to family, b) to be able to own a home without a 90 minute commute [both ways!] and c) be middle-class as we understood it (particularly if it meant that one of us could stay home with the kids...an impossibility in the Bay Area).

Frankly, I was shocked at the cost of living there. Yes, we were in a major metropolis but so are many of you (unfortunately, too few jobs are found in the middle of either Canada nor the United States where land is cheap!). Housing, utilities, food, insurance, etc. were all costly...to add medical costs on top of that (i.e., had Avery been born there) would surely have made life a struggle. There would be no extras (dance or gymnastics), we would barely have a semblance of a family life (since I would have to work and the kids would be in day care) and the stress (already an issue) would be unimaginable. I just couldn't do it. I felt bad for my friends who couldn't just up and move and had no other choice. (Those that wanted to move felt they couldn't disconnect with family especially as they were starting their own.)

And so, I think that the evidence is overwhelming that a move to a public option is necessary. Be it the hidden costs of the uninsured (particularly those due to a lack of preventative care), the drain on the economy (e.g., when a Toyota plant gets built in Canada versus the United States due to the costs of insuring its workforce), a rapid rise in costs in the current private-based system*, or simply a moral imperative, I think that no matter what your rationale for change, change is indeed necessary. Good luck.

Errata - Some Links of Note:

• Primers from the American Medical Student Association on the American uninsured, the Canadian system, other international systems and why this association is an advocate for the single-payer option.
• Costs associated with American health care.
• An article from Forbes comparing American costs to those of other developed nations.
• From the NY Times, cost per person amongst the wealthiest countries (with an estimated base of 15% of the population uninsured in the United States [not counting the underinsured]).
  
  

*From the CBO: "Total spending on health care would rise from 16 percent of gross domestic product (GDP) in 2007 to 25 percent in 2025, 37 percent in 2050, and 49 percent in 2082. Federal spending on Medicare (net of beneficiaries’ premiums) and Medicaid would rise from 4 percent of GDP in 2007 to 7 percent in 2025, 12 percent in 2050, and 19 percent in 2082."