Tuesday, August 18, 2009

Universal Health Care - Your Mileage WILL Vary (Updated)

Last week after I announced in the weekly e-flyer the newly re-designed anti-Obama shop at Reflections Apparel, an email came in with an interesting question:

"Quick question here...As a Canadian, how would you rate the health care in Canada?"

I found it an interesting question on several levels, considering I'd already been thinking about writing about this subject. Even more interesting, since I'm not a Canadian, but an American living in Canada with an American perspective on what good health care looks like. Certainly not the proposed Obamacare which is even being shot down by more than a few Canadians who have suffered through Universal Health Care and can see a mile away how much it looks just like what we have here, despite Obama insisting it isn't or won't be the same.

The problem with topics like this however, is that almost every John or Jane Q. Public opinion is subjective based largely on personal experience. Even the so-called "professionals" will report success rates and stats with a slant toward their own personal bias. Five minutes on google will yield tons of professionals that insist the Canadian health care system is a wonderful success, and tons of more professionals telling us it's a tremendous failure. Who are you going to believe?

What I have to offer is entirely my own perspective and that may not apply to anyone else, or anyone else's situation. It certainly can't be said that my personal experiences on either side of the border would be normative as far as health care goes, but I'm going to share a few of those experiences all the same. (I have decided after receiving some very concerned emails, to strongly emphasize this portion of my post. I am one person with one opinion based on personal experience and some research. I am not a professional health care analyst or any other kind of authoritative voice. I am simply a resident of Canada, and a citizen of the US, with a perspective on both health care systems that I chose to be honest about, both good AND bad. Hence, the reason for the title of the post - your mileage, whether American or Canadian and whether good or bad experiences on either side of the border, WILL vary.)

Before I do this however, I want to make it perfectly clear that this is not a case of Canada-bashing. I like Canada, I just can't stand the Canadian health care system and I'm definitely not alone. My husband, sister in law, mother in law and father in law are all Canadians and they all have their own personal grievances with this health care system. I've seen blog posts, newspaper and magazine articles and several recent youtube vids all from Canadians, that basically say the same thing: "don't believe the hype - it doesn't work as promised".

Being born and living in the states for 33 years, I definitely have an American view of what good health care looks like, and how it should work. I wish to also say that I have been greatly blessed in those 33 years in that I almost always had very good health care, minus the odd exception now and again of an insensitive or air-headed nurse here or there.

In WA state, if you need a doctor (general practice or specialist), you call one and make an appointment. In certain exceptions, you just call your family doctor and ask for a referral to a specialist in the field you need, and they'll send you right over. In Ontario, it does NOT work that way. You cannot just call a doctor and make an appointment. First, you have to find a doctor in your area that is accepting new patients. The actual "finding" of the doctor can be a rather tricky procedure. If you happen to know someone who knows of a local doctor accepting new patients, you're in a good position. If not, good luck. You can always try the Ontario Health Care Connect program, but bear in mind the results posted here, and you'll see how effective the government actually is, at matching people with a health care provider. Take a very good look at those results. In the areas reported over 12 thousand people registered with the program to be matched with a local doctor, and barely half of them were actually matched with a doctor. Keep in mind as you browse that chart, that this is a program run by the same government that brought us universal health care to begin with - and they can't even find their own citizens enough doctors?? Guess where the other half went, that didn't get matched up? Some of them did what they've been doing all along while they wait for a local doctor, and they either go to the ER for health care, or they go to the local community walk-in clinics, or they simply do not receive health care at all.

I've had some experience with these walk-in clinics, and all but one visit was a negative one. The way these clinics work is essentially this: different doctors staff these clinics on different days of the week, and it's a more or less first come first served basis. Anything "urgent" and they will tell you to go to the ER. These doctors do not know you, they do not know your medical history, and the doctor you see today will quite likely not be the same doctor you see the next time, or the time after that, or ever again. Your wait time can be anywhere from 20 minutes to 6 hours, and you will be sitting in a very small waiting room (or standing outside, which is quite common) with sick people from 2 years old to 100 years old. Coughing, sneezing, feverish, vomitting people (yep, I've seen it first hand) all jammed into a little waiting room for hours. Some folks opt to stand outside (even in sub-zero Canadian winters) and ask someone to notify them when their name is called, just so they don't have to be jammed in with sick people while they wait. Some walk in clinics are very nice, while others are quite reminiscent of pics you may have seen on tv of third world country "doctor" offices, complete with gigantic stains of God only knows what, covering the carpeting in the waiting room, and odors you can't quite figure out but are fairly certain cannot be a good thing. Oh but never fear, almost all of them have those handy little hand pumps filled with antibiotic hand wash, and optional paper face masks if you have a bad cough. I only wish I were making that up.

When I first moved to Canada and became pregnant with my now 10 year old, I had a crash course in how health care here works. Unable to locate a local doctor accepting new patients, I visited the walk-in clinic once. I waited for about 3 hours to be seen, and once seen and treated more or less like a number instead of a person, I never went back. The waiting room was indeed filled with very sick people and it was the kind of walk in clinic with the gigantic nasty stains and horrific smells. There was no way I was going to expose myself to that again. I went through that pregnancy without any pre-natal care, because the only care available to me, was at the walk-in clinic. Where the doctor didn't bother to ask me any of the routine questions you'd ask an expectant mother (I'd had 4 kids before, I knew the routine quite well), and seemed far more interested in getting me out and getting to the next patient as fast as possible. The next time I saw a doctor was 3 days before she was born. Needless to say we opted out of the "universal health care" available to us, and prayed like crazy through the pregnancy.

When I became pregnant with Samuel (and still did not have a family doctor), I went to the walk-in clinic once, and one of the receptionists told me that she was breaking the rules by doing this, but was going to give me the name of a local OB/GYN taking new patients. She did this because she said in her opinion, the doc on staff that day at the clinic wasn't someone I wanted to see. I didn't ask why as I'd been there before. The rule she was breaking was, a general practice doctor had to recommend you and she wasn't a doctor, therefore the referall wasn't considered legit. She encouraged me to call but wasn't sure if I'd be able to get in, since I didn't have a legit referral. I did call that day and was able to get in, and had good pre-natal care with Samuel. Praise God for that indeed. (Please keep in mind that I have not had the time to check the fine points of the laws, rules, policies and regs of the Ontario Ministry of Health on how all these specialized referrals work and/or how the walk-in clinics are governed, I'm just going by what the employee at the walk-in clinic told me. I assumed she knew she was breaking the rules since she slipped the name and number of the doctor to me on the sneak, and made sure I knew it was not permitted for her to be doing that).

With Ruth a few years later after we'd moved to the country, we were blessed to get a name from a friend of a friend to a fairly local doctor, and again I did receive good pre-natal care (even though that doctor moved away mid-way through my pregnancy and a new doctor took over his practice, and that doctor was on vacation the day she was born, and yet another doctor actually delivered her).

Amazingly enough, when Kev was rushed to the ER in January with intense stomache pains, everyone that heard he was rushed into surgery THAT day was completely stunned. He did receive excellent care but the shock was that he was operated on so quickly. It just doesn't work that way normally, unless you're knocking on death's door. My sister in law suffered through 5+ years of pain so intense they maxed out on the amount of morphine shots they could give her in the ER, when she would come in 2-3 times a week. She was diagnosed with endomitriosis, but because it wasn't considered "life threatening" the surgical procedure would not be covered by OHIP (Ontario health insurance) and she'd have to pay directly out of pocket for it. So, for over five years she visited the ER several times a week and lived and worked pumped up full of morphine and various other drugs. I remember the Christmas eve she layed on the floor in front of the tree crying her eyes out, from the pain. I sat down and cried with her. Oh yes, THIS is universal health care, folks. Thankfully she finally saw an ER doctor that immediately referred her for emergency surgery, while her regular family doctor would not give her the referal.

By stark contrast, the health care I received in the states was nothing like this. The same doctor that delivered me 44.5 years ago, was the same doctor I went to any time I was sick, until he retired when I was in my early 30s. During my pregnancies in the states, my family doctor referred me to the OB/GYN and after the first one had retired, I saw the same doctor for all of them. The same pediatrician treated all the kids from the day they were born until the day we moved to Canada. My doctors all knew my medical history (and my family's, since he was also my mom's family doctor long before I was born), and the kid's doctor knew their medical history - which is VITAL when you're talking about quality health care. Any time I ever needed a specialist for any reason, all I had to do was get the phone book out and call one or call my doc and ask who he'd recommend. When we had health insurance we paid that way, when we didn't, we paid the bill on installments. I know, it sounds so simple, doesn't it?

I lived in WA state for 33 years and always had a doctor, and always had access to whatever kind of health care I needed. When my late husband was diagnosed with cancer (by our same family doctor who'd also treated my husband's family members for years) and had to be referred to an oncologist (and at one point had 12 different specialists treating him, one of which was our pediatrician's husband, oddly enough) he had access to the best health care available with doctors that knew his medical history, knew his family's medical history, and were dedicated medical professionals. I've lived in Canada for 11 years and still do not have a family doctor (nor do the kids, or Kev), and do not have access to any type of quality health care unless there is an emergency and I have to visit the ER. Quite often, by the time your health is in an "urgent" state that would require you to visit an ER (with the exception of accidents of course), the prognosis is not so rosy.

So, what do I think of Universal health care? I think it's an absolute disaster that simply doesn't work the way it's proposed. I know a lot of Canadians that do not have a family doctor, and I know a few who do, and wish they could find another one - but they can't. You can't just "switch" doctors if the one you do have isn't someone you want to see, or doesn't give you the treatment you know you need. In Canada, YOU are not in charge of your health care, the government is.

For some, I'm sure it's worked out wonderfully (although I almost never hear a Canadian brag about the wonders of the health care system here, I suppose they do exist?) For many others... not so much. If the stats at the Ontario Ministry of Health's own page are any indication, half of all people registering in this program to find a doctor, get nothing - and yet they still pay for universal health care via their tax dollars just as much as the people who are matched with a doctor.

I think the numbers speak for themselves, even if the very subjective personal stories (both pro and con) may not be the standard. I fully admit that my own perspective is tainted, because I was blessed to have excellent health care in the states. I realize no system is perfect, but the current system in Canada is quite dismal, in my opinion.

In fact, it's not just my opinion. One person's perspective doesn't really mean a whole lot, unless that person happens to be someone like, the incoming president of the Canadian Medical Association, Dr. Anne Doig. Dr. Doig was recently quoted in the media with this rather urgent warning:

"We all agree the system is imploding, we all agree that things are more precarious than perhaps Canadians realize. Canadians have to understand that the system that we have right now — if it keeps on going without change — is not sustainable". (source)

So, that's what I think of the health care system in Canada. Dr. Doig seems to agree with me, and she knows the system far better than I ever could.

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