3 posts tagged “canada”

When I used to give talks, I would sometimes lead with the observation that as a healthcare writer and consultant I've learned very little about health and a lot about economics.  The best way to understand how the economics of healthcare differ from the economics of other goods and services is to read Robert Kuttner Everything for Sale: The Virtues and Limits of Markets.  He makes a persuasive case that while capitalism is an excellent mechanism 

Everything for Sale: The Virtues and Limits of Markets

Robert Kuttner

Overreliance on market mechanisms is ruining the health care system, contends Kuttner, a contributing columnist to Business Week, because of enormous hidden costs engendered by opportunism, fragmentation, underinvestment in public health and prevention, and inefficient use of home care and nursing care. In a humane society, whole realms of activity necessarily depart from pure market principles because market norms drive out nonmarket norms, i.e. civility, commitment to the public good, personal economic security and liberty. 

I knew (and respected) the theory, but in moving to Canada I've had the opportunity to live the reality of socialized medicine.  Canada has perhaps the most socialized of all healthcare systems since there are no alternatives at all to the public system.  Your money simply will not buy you more health care in Canada.  I also had the opportunity to consult within the Vancouver regional health care system, so I got to see a bit of it from the inside.  

Let me first say that no system devised by humans is without fault. No health care system will give everyone everything in the optimal time and quantity.  That having been said, the Canadian system is quite impressive.  One thing you notice right away is that the investment in public health and primary care is enormous.  Everyone knows that dollars spent on prevention are the most effective of health care dollars.  The primary care access is simply unbelievable.  There are free walk-in clinics everywhere, and plenty of private primary care physicians (at least in this city -- probably not in all parts of Canada).  My own personal physician spends over an hour with me annually, and employs a level of testing and referral that I am reasonably certain would not be covered in most HMO settings. The breast imaging center is state-of-the-art -- the technology is a big step up from the one I was going to in Port Angeles Washington before I was eligible Canadian coverage.

Primary care physicians here are in private practice (although they are paid by the government).  Specialists are largely employed by the healthcare system.  My subjective impression is that they are not as cranky as U.S. physicians, and definitely not as harassed with regard to paperwork, malpractice insurance and limits on their decision-making.

Like the U.S., Canada also does its fair share of spending on "futile" care, (something like 80 percent of health care dollars are spent in the last 6 months of life).  But, as a volunteer hospice worker I do see many patients who have been helped to understand that major invasive surgery for cancer that has already spread is probably not in their overall best interest.  

Where Canada does fall short is in the waiting lists for elective surgery -- particularly orthopedic surgery.  Although they have made some progress in shortening the queue and managing it openly and fairly, it could be years before you get that hip or knee fixed.  The reasons for these delays are complex, but one of the reasons is staffing.  There just aren't enough orthopedists who are willing to stay in Canada when they can make a fortune south of the border.  Orthopedics is big money in the U.S. and the demand is virtually unlimited.  

There's more to say, but in a nutshell, by and large Canadians love their healthcare system. I read somewhere that British Colombia males are the longest lived on the planet.  Premiums are very low for everyone and zero for those in need. Standards of care are high, even if waiting rooms are shabby.   Public health is taken seriously and is not the orphan child it is in the U.S.  I have more confidence in Canada's ability to manage an epidemic than I do in that of the U.S.  And, the icing on the cake, the costs are dramatically lower:  In 2006, per-capita spending for health care in the U.S. was US$6,714; in Canada, US$3,678.^[5] The U.S. spent 15.3% of GDP on health care in that year; Canada spent 10.0%. 

When Barak Obama was sworn in, I shared the tears of millions of Americans realizing that finally, we have a leader we can be proud of.  As he has managed his first bumpy weeks in office, I was particularly impressed that he was able to gracefully utter the magic words that seem to elude most politicians of lesser stature and confidence.  “I’m sorry.  I screwed up.”  Well, halleluiah!  It was almost as moving a moment as him taking the oath of office.  With all its problems, the U.S. needs and deserves a sane and smart leader with his ego securely in check.

At the same time, the recent approval of our permanent residency means that we are deepening our roots here in Canada.  We are officially landed immigrants here, and will soon apply for citizenship.  Canada allows for dual citizenship, so we will have two passports. 

When I think about the word “immigrant” and what it means to be an immigrant, I reflect upon the experience of my grandparents coming here from Italy. In a time when airplane trips were a rare luxury, they left friends, family and a familiar language and lifestyle behind forever.  My paternal grandfather’s strategy for coping with all of this was a “never look back” attitude.  He forbade any family members to speak Italian in his presence. They threw themselves into their new world with intensity.  Their passionate love for their country was strikingly at odds with the tight-lipped and entitled descendents of the original New England settlers we lived among.  My family didn’t take the privileges and opportunities of being American for granted.  They were (and remain) almost religiously patriotic.

By comparison, moving to Canada requires much less adjustment.  Our countries speak the same language; eat the same basic diet; and share a long undefended border.  I can leave here at a civilized time of morning and be in a meeting in San Francisco by mid-day.  Moving here is a less dramatic culture shift than moving from the east coast of the U.S. to the west coast – I can tell you that from experience!   

But there’s something special about becoming Canadian.  Not being a superpower allows Canada more freedom of thought about what’s going on in the world. The national conversation (and there is a national conversation thanks to the excellent, publicly supported CBC) has a more modest and nuanced tone.  There are no real equivalents of Rush Limbaugh (well, maybe in Alberta).  The CBC runs serious documentaries with adult language if it’s called for.  Canadians are largely secular, which contributes greatly to the national I.Q.  There is no identified “moral majority.”  There would never be a national outcry over a “wardrobe malfunction.”  Most Canadians have seen naked breasts on the public airways and seem unscathed by the experience.

The Canadians I have met, at whatever level of formal education, participate thoughtfully and intelligently in their communities.  More than anything, what’s possible to experience here is a sense of belonging – something maybe my grandparents felt when they moved to a younger and more naïve America.