Tag Archives: Medicare

The mess that is hospital insurance in the United States

I read this over at Meg Hourihan’s blog and am still shocked that people disagree with health care reform.

I haven’t had employer-provided health care in over ten years, which means I’ve been paying for individual or small group insurance for myself and now my family every month. Every year my premiums increase by 30%, so I’ve changed providers going from crappier to crappier policies until now we’ve got the cheapest I can find. This "cheap" policy is costing over $1300 a month and is an HMO, so it only covers in-network providers. Because it’s not a very good insurance company, very few providers take it. For my OB/GYN I just pay out-of-pocket for my appointments.

Two things now: my pediatrician referred my son to an ear-nose-throat specialist to check his hearing. None of his referrals take our insurance, so I called the company, used their website to pick a random doctor, called the doctor and was told they didn’t take it, was transferred to another doctor, was transferred again and finally ended up with a fax line picking up my call after fifteen minutes on the phone. After two hours calling various people, I gave up and am now going to pay out-of-pocket for the referred doctor for Ollie tomorrow.

Some time last week I think I stepped on a piece of glass. There’s something in my heel and I’ve soaked it and squeezed and tweezed but whatever it is, I can’t get it. It’s been throbbing for a week. My primary care physician can’t see me for two weeks. Their urgent care center takes my insurance but I have to make them my PCP to have the visit covered. Another local urgent care facility doesn’t take my insurance. So basically if I want to address this before May 24 and not pay out-of-pocket, I need to go to the ER and it’s a $50 copay.

This is after paying $1300/month.  I have written about Canadian medicare before and while it’s not perfect, it’s a lot better than what Meg describes.

Canadian Medicare Does Work

I have watched with bemusement seeing Republicans denouncing Canada’s socialist Medicare system and how it doesn’t work.  While the system isn’t perfect, it does work.  Since Saskatchewan is the birthplace of Medicare, I thought I would offer up some thoughts.

Former Saskatchewan Premier Hon. Tommy Douglas

The positives

It’s free.  I have had two shoulder surgeries over the the years.  Resetting the separated shoulder, seeing doctors, seeing specialists, getting a surgery, reinjuring it, getting it reset, getting it reset again, seeing more doctors, seeing a different surgeon, having a nurse pass out while pulling out the drainage tube, having a friend of mine play with the morphine injecting thing, having to explain to the nurses that I was fine, it was someone else who pushed the button, all of the rotten hospital food… it’s all free.

The only thing I paid for with Mark and Oliver being born was parking and food for myself (and Mark).  Wendy had some serious complications with the birth of Oliver and for days she had a 24 hour nurse in her room.  Outside the Starbucks I would get for the nurse, none of that cost me a sense.  The total priority was on Wendy’s health.  Not just my focus but the focus of Royal University Hospital.  After Ollie was born, this included 22 days for Ollie in the Neo-Natal Intensive Care Unit.  All of it was free.

(What’s funny is that one night someone came by to tell me that if the cost of coming up to see Wendy was too expensive, maybe the Salvation Army could help out – we had a good laugh when she found out what I did for a living but the Government of Saskatchewan does even have resources to help out with food at the hospital)

With Oliver being premature, he was given $10,000 in booster shots to help his immune system his first year.  Unless you could teething as an ailment (I don’t but I am sure he does), he has been remarkably healthy.

There is no government death squads in Saskatchewan.  No HMO to decide what resources Wendy or Oliver received.  There was just the knowledge that when you go into the hospital, ALL of the resources you need are at your disposal and we will deal with it all later (apparently the Minister of Health has a big check book).

It’s fast in an emergency.  When my mom was diagnosed with brain cancer, the surgery was within a couple of days and the radiation treatment started soon after that.  When I had heart pains a couple of years ago, I was into an angiogram within hours.

My mother was sick before she got cancer.  There was numerous surgeries on her foot and a lot of complications.  When that didn’t work, my mom had her leg amputated when I was 16, she was given amazing quality of care from the Sask Abilities Council.  She would go over there almost weekly and was always coming home with a new foot or ankle that would help just a little bit.  Sometimes they worked great, other times not so great, and one time her leg snapped while walking across the lawn.  She wasn’t hurt but it must have been quite a site for anyone driving by to see a women’s leg snap off as she watered the grass – when I found her, she was both yelling for me to help her and laughing at her situation.  We never paid for any of the work Sask. Abilities Council did.  Part of it was they were aggressive because my mom worked hard at rehabilitation but that goes both ways, she worked hard because she knew that the Abilities Council was so supportive and aggressive on her behalf.  I remember getting phone messages from her worker Stan, who would tell me to tell mom to come by for a new ankle or something.  These were not revolutionary upgrades, they were incremental upgrades (like Snow Leopard for your leg) which makes it even cooler.  All of the effort and resources were there for her, despite when what she had was doing okay already.

The negatives

We don’t have enough family doctors and really hard to find a good one.  When I define a good one, I mean one that you can trust and develop a comfort level with.  One doctor reminded me that not all doctors graduate at the top of their class and I think some coast but that’s probably a universal issue rather than a Canadian one.

Elective surgeries can take a long time and I think it’s fair to say that we have a pretty broad definition of elective here.  If you need surgery to fix anything that isn’t ruptured, having an attack, or developed a tumor, you are going to wait.  Actually waiting is a part of the Canadian health care system.  Wendy is struggling with her depression again.  Her medication isn’t working and when we called her doctor, the first appointment available was September 16th.  When you know your depression medication isn’t working, waiting three weeks for an appointment is pretty tough (that being said, he left a message for her doctor and she made an appointment today for Monday morning early).

My personal opinion is that we underfund essential services at times.  When I hear the RUH Foundation say that we need to fundraise for a new emergency room, I can’t figure out why the government isn’t paying for that.  When we were pastoring in Spiritwood, the expectation is that the town needed to build a new hospital (I know it was renovated and added on to but for all intents and purposes it was new).  They had to fundraise for years to pay for it, that isn’t right.  That isn’t a shot at either the NDP or the Sask. Party, it’s a criticism at both of them.  When Wendy was in the hospital with Oliver, they had a big reception to celebrate a gift from the RUH Foundation, the purpose of the gift was new hospital beds.  Again, I wonder why the government is not paying for that.  We should not need golf tournaments, home lotteries, or other fundraisers to pay for essential hospital services.

The poor still receive very poor medical care.  Part of it is they don’t have good family doctors but part of it is that I don’t think the system works well with those with limited mental capacity or mental health issues.  It’s a complex problem but if you are living at the shelter, the level of primary care you will get is not as good as I get.  This may be the biggest frustration I find at work. Of course this is connected to lack of family doctors (an emergency room is not designed to provide effective long term care) and lack of inner city doctors (the amazing Westside Clinic is an exception)

This isn’t the problem of Canadian healthcare but Canadian politics but any attempt of privatization is considered too American.  Now my doctor’s office is privately owned, my blood work is done at a private clinic but when someone wants to open a MRI clinic and bill the government, that is two tier American style health care (please explain that to me).  What I am saying is that in Saskatchewan and parts of Canada, we haven’t learn how to have a health care debate yet and I think that hurts the system.  Again, that isn’t a Canadian thing, Americans are also having a problem with having a good debate on the topic.

My ways to improve it

Charge a service fee when I go and visit my doctor.  Make it $10.  My doctor’s office charges $10 for a sick note but waived it when I needed it because I was incredibly sick.  Do the same thing if someone comes with something really serious or if they can’t afford it (a supplemental health card type of thing if your household income is below a certain rate).  If you are coming in with a runny nose… $10 may encourage you to wait it out.  If you come in again with the same runny nose, the fee goes up.

A box of Metformin As a diabetic, I felt an old doctor was milking the system by demanding the amount of visits he did.  Every time there would be a battery of blood tests (and my veins are so hard to find, they are rumored to be under the witness protection program).  When I changed my doctor, the need for non-stop blood work and visits to have a prescription refilled stop (I take a small about of Glyburide and some Metformin twice a day).  I know it is hard to prove given the personal nature and differing styles different family doctors have but over the years I have often wondered if I was only being summoned in for more tests because someone had a car payment to make.  One one hand I keep hearing in the media that over usage is hurting Medicare while on the other hand part of me wonders if this is at least partially the fault of some doctors.

Waive ambulance fees in an emergency.  At work I see a lot of people abusing 911 because they don’t have to pay for it.  It drives me crazy but yet when a co-worker has something seriously go wrong, they get a massive bill from MD Ambulance.  If you sprain you ankle, pay the bill.  If you appendix burst or you have a heart attack, maybe that bill could get waived.  I am sure common sense could be the determining factor.

See health care as only part of the solution.  If health spending crowds out investments in education, childhood development, housing, environment and other measures that improve living conditions, then health status suffers.  Of course we don’t do that here.

"If you look internationally, and you look at what you’re getting for health-care spending, beyond about $600 or $700 US per person per year, there is literally no correlation between life expectancy, infant mortality, and how much you’re spending," the University of Saskatchewan’s Janice McKinnon said. "So countries that spend $800 to $1,000 Cdn have pretty much the same health care indicators as we do. And we’re spending four times as much."

Related: CBC has more.  So does the Toronto Star.  If you still doubt medicare works in Canada, there are other examples to look at: Britain, France, Denmark, Germany, Sweden, Japan, Belgium, Iceland, the Netherlands, Australia, Canada, Ireland, Norway, New Zealand, Spain and Switzerland, where medicine is not regarded primarily as a business but as a fundamental human right.