Wednesday, October 13, 2004

Health Care

Have you ever heard the saying about how the grass is always greener on the other side of the fence? When it comes to health care, this is a very true statement.

I spent most of my life living in Canada, and one of my children was born there, but for the last few years I've been living in the US and my second child was born here. So, I have had the experience of living on both sides of the border and experiencing two very different health care systems.

The health care systems in Canada and the United States are very different. In Canada, we have completely socialized medicine - anybody living there pays into a government-provided healthcare system as part of their taxes and is issued a "health card" that can be used at any doctor, specialist or hospital. Here in the United States, it is almost the opposite, a free-enterprise system run for-profit.

When I was living in Canada, you would always hear on the radio about how some doctors are leaving Canada because they can get more money in the United States. You'd hear horror stories about patients on waiting lists for surgery and certain procedures (like MRI scans), and you'd hear people negatively comparing the Canadian heathcare system to the American system. I was very surprised when I came to the United States to hear people griping about the high cost of healthcare here, hearing horror stories about people being bankrupted by major illness, people not able to afford health insurance, and you'd hear people wishing for the Canadian system here. Grass is always greener on the other side of the fence!

Having experienced both systems, I can appreciate that both countries have quality doctors and quality healthcare, but I do think the Canadian system has its advantages. Because doctors do not have to deal with billing patients, calling their insurance companies to make sure their coverage is still valid, collecting co-pay fees, or haggling with insurance companies about whether services are medically necessary, the administrative overhead in Canada is much lower. When I first came down here to America, I was surprised to see that in a typical doctor's office, you have three or four administrative personnel for each physician. In Canada, some clinics have eight or nine physicians to each administrative person because the administrative workload is so low (they just swipe the patient's health card through an electronic machine that looks like a credit-card reader and the doctor automatically gets paid).

One time in Canada, I took my daughter to a specialist's office - there was a guy behind the counter who swiped her health card and asked us to wait in the waiting room. I was surprised a few minutes later to see the same man wearing a labcoat and a stethoscope call us into the exam room - it turned out the receptionist wasn't there that day and the specialist was covering for her himself and running the office by himself. You'd NEVER see that in the United States, the administrative workload is just too high here.

In Canada, it's also much tougher to sue a doctor for malpractice. Because it's socialized medicine, there are no medical bills to fix the mistake, and Canadian courts are not nearly as generous with awarding damages for pain-and-suffering. As a result, doctor's malpractice insurance is less expensive in Canada than the US.

Doctors in the US make more money, but doctors in Canada get to keep more of what they get paid. Which system is better for the doctors? Hard to say - I know Canadian doctors practicing medicine in the United States and American doctors practicing medicine in Canada who would give you very different perspectives on that argument.

One interesting point: despite the fact that it is free for everyone, Canada spends significantly less on healthcare per person than the United States. Also, if a person gets so sick that they cannot continue to work (cancer, etc.), the system will cover that person in Canada. In the United States, health insurance is usually tied to your job, and if you lose your job you can be in trouble.

For me, as a Canadian citizen, I have the inalienable right to return to Canada, and I know if I do that I will be covered by the Canadian medical system no matter how sick I am. Part of me feels a bit guilty about that, in the fact I am living and paying taxes in the United States, and yet I still have that Canadian safety net available to me if I get sick (a luxury none of my American coworkers have).