In Canada, residents and citizens are recipients of a socialized provincial insurance plan. Although the specific terms of what is covered might differ slightly by province, most of the major aspects remain the same. Trips to the doctor are free and do not include any type of co-pay. The cost for the healthcare is covered through our taxes.
In Ontario, the Ontario Health Insurance Plan or OHIP, covers the cost of every doctor visit, visits with specialists, admissions to the hospital, any necessary surgeries, and so on. Certain treatments are limited by their needed frequency. For example, OHIP will cover the cost of a Pap smear once every three years as that is the standard frequency recommended by Health Canada. In the event however that you test positive for HPV or have an abnormal reading, or have a family history that requires more frequent screenings, OHIP will cover the cost of those as well as they are deemed medically necessary to occur more frequently.
Similarly as someone with Crohn’s, I require frequent colonoscopies, more than might be otherwise covered, but don’t ever have to worry about paying for the procedure.
All of my surgeries and hospital admissions have been fully covered. What isn’t covered is if I decide I want a private room. Interestingly, because I’m immunosuppressed and because my symptoms are similar enough to C. Dif for offer a concern, I often get a free semi-private or private room as it is deemed necessary. This is especially convenient for me since that usually means I get my own bathroom. Again, what is covered is deemed by what is considered medically necessary.
There are major gaps in coverage however, here in Ontario in particular. Prescriptions for example, are not covered by provincial health insurance. In some provinces they are. Although it isn’t covered under OHIP, low income individuals in Ontario are eligible for provincial prescription insurance under a plan called Trillium. The coverage is determined by your total earnings, and issue you a related deductible. For example before I was on disability, I had a total of $400 deductible which was spread out across 4 quarters of the year ($100 for the first 3 months, etc. etc.). Since my Remicade costs $10000 every six weeks, I met the deductible pretty quickly. Now that I’m on disability, I have prescription insurance provided through that program, with no deductible.
Some medications, like my medical marijuana which is my only at home treatment for the chronic pain and nausea I experience, are not covered.
Another major gap is that eye care is not covered. Trips to the optometrist are out of pocket, except for one a year for children under 18, and for people who suffer from conditions that can affect their eyes such as diabetes. Dental Care is also not covered.
Wait Times
One of the most popular arguments against socialized medicine is to point to the increased wait times that can occur as a result. Many believe that that is the result of more frivolous cases coming to waste doctor’s time. While a very small percentage of cases might have that as a problem, my experience is that a bigger issue is the lack of sufficient doctors and hospitals.
Canada has been experiencing a brain drain of talented doctors going over to the US because they can make more money there. Interestingly, many doctors who have worked the two systems have said that they prefer the Canadian one. Some actually come back here to practice, unable to handle the devastation of treating patients too late because they couldn’t afford to come in sooner.
Insufficient family doctors and not enough nurses is not a cause of the socialized system but rather a lack of a socialized medical school can be said to be blamed. While a cap on earnings might discourage some, many devoted individuals cannot afford the cost of the schooling necessary. It is also caused by an aging population with not enough doctors in the area of specialty most needed by them.
Because there are not enough Family doctors, and because some people don’t know how to find one, there are cases where people are forced to turn to the ER for conditions they might otherwise have been able to treat with their own doctor.
While the wait times at hospitals can be difficult, they are in fact managed based on severity. During my own admissions and visits to the ER for example, I have averaged anywhere from a 20 minute wait to something like 8 hours before seeing the doctor. The average lately can be between 1 hour and 3 hours to see a doctor. I have, however, also received medication and xrays before seeing the doctor. It often depends on whether you have a nurse willing to bug a doctor, or enough of a report from triage to be able to speed up the process.
My total wait in the hospital might be longer, but that is usually because I am waiting on lab results, and to see if I’ve gotten better in any way in that time.
When it comes to tests like MRI’s and CT Scans, the wait times have also been listed as a concern. What a lot of people don’t realize is that the longer wait times don’t refer to emergency scenarios but rather to regular screening. Each case is designated as Life Threatening, Emergent, Urgent, or Regular. Life threatening cases get priority, and Emergent cases are immediately after that. Urgent are given higher billing over Regular screening. That doesn’t mean that regular screening always gets pushed off. The hospital sets aside a block a day each day for those cases, it just means that the actual appointment might be scheduled months in advance.
I’ve had MRI’s, Cat Scans, and other imaging tests done the same day I arrive in hospital. When it is necessary that the scans be immediate, it can happen. If a patient is scheduled for a regular or urgent screening but finds their symptoms worsening, they do have the potential to tell their doctor, who can then reclassify their case if they believe necessary.
No matter what right wing demagogues in the US might have you believe, a person in a car accident who needs an immediate CT Scan to find out where in relation to their spine a piece of debris is won’t be left waiting for days or weeks to get the scan.
Would Adding a Two-Tier system including privatising solve wait times?
No. Emphatically no. Not unless privatisation also included the building of privately funded hospitals, which is unlikely. In the case of privatisation the same resources would be shared not according to need but according to who could afford to cut the line. Essentially people with money would be given access to faster treatment regardless of whether it was necessary or not. Now in addition to dealing with the time restricted by emergent, urgent, and life threatening cases, regular cases would also have to schedule around paid for spaces. The waiting time for people who couldn’t afford it would increase. Only a small population would find their wait times reduced. We would essentially have a medical system in which people with money are given care preferentially over people without money.
Moreover, unless Canada also creates a system where more people have the option of going to medical school – by increasing class sizes so more people get accepted, and providing the cost of school so that low income individuals can also afford to become doctors – the number of doctors and time available for public patients would decrease thus increasing wait times and reducing access to necessary medical care.
What Would Solve Wait Times?
- Building more hospitals and clinics so that there are more spaces available for doctors.
- Socializing post-secondary education and increasing the number of medical schools so that more people can become doctors.
- Hire nurse practitioners as triage nurses so that when they see people come in for colds, flu, and other ailments that could be handled by a nurse practitioner, they can give them a prescription and send them home right away. Note that intake nurses already perform quick exams including checking blood pressure and temperature.
- Pay nurses better and hire more of them. Many Nurses work 12 hour days, sometimes as long as 16 hour days. They should be able to afford not to work that many hours and there should be enough nurses that they don’t have to work such long hours.
I live in Ontario as well, and from my experience Ania’s description of our system is accurate. My experience of emergency room visits is with kids, and while I have heard of or read about 8 hour waits, I don’t think that we ever waited more than 1 hour (and I live in a smaller northern city, which is generally considered underserviced).
My wife had breast cancer, and everything was covered, from initial diagnosis, through surgery, chemo, and radiation. There was one extra expensive drug that still would have been expensive even after coverage by my work prescription plan, but the company itself had a plan to cover part of the cost, so $3000 a shot became $30 (and I am not low income).
A bit of a correction – the Trillium plan is not just for low income. It is for anyone without drug coverage, and basically limits what you pay for prescriptions to 4% of your income, even if you make $100,000 per year.
I also have a bit of experience with the US system, when one daughter was in school there. She suffered 2 minor sports injuries, and was taken to the hospital where they ran all kinds of tests, including x-rays. Cost $3500 total US. Way, way overdone. In Canada they would do a physical examination, say it looks sprained and to take 2 acetaminophen, and come back the next day if it wasn’t feeling better. Same 2 visits in Canada (if we paid directly) would have cost $200.
The problem with the number of doctors and nurses is because all (most?) higher education in Canada is publicly-funded. So medical schools have a particular number of students that they can enroll as doctors. Back in the 1980s they kept those numbers too low, and the effects are still rippling through the system. They have since opened up new medical schools, including one in the north, greatly easing the shortage of doctors (here, at least). There also seems to have been a major era of building new hospitals, at least in the north (eg., Sault Ste. Marie, Sudbury, and North Bay all have brand new hospitals).
Somewhat unrelated is the abortion issue. I read with horror the US abortion clinic stories, and the pressure that those opposed are able to put on clinics. Here abortion is done in hospitals. These new hospitals are huge affairs, with large surrounding properties. Protesters are not allowed on hospital property. So what you get is a few sad-looking protesters a mile away on the nearest sidewalk, protesting in front of all the hospital traffic, having no way of identifying anyone going for an abortion. The way it should be done!
You’re right about trillium. I think part of the reason I was thinking low income because when my parent’s income was taken into consideration the deductible was so high as to be basically non existent.
And while the universities are publicly funded there are still tuition fees which can act as a barrier. Thank you for your input though. It’s very helpful.
I have another comparison of the US vs Canadian system. My American father-in-law was traveling to visit us for Christmas, and 3 hours from the border developed some severe abdominal issues (cramping?). After testing and giving his history, they said he was in danger of an immediate heart attack and should stay in the hospital over Christmas (mostly because of a lab result that he explained was normal for him). He was well insured, and I am mighty suspicious they just wanted to fill an empty bed with a well-insured patient over Christmas, because…
He decided instead to journey on to our place, and trust himself to Canadian health care. Went immediately to the hospital here, where he had to wait an hour while they called in a heart specialist (small northern city, on a weekend). This doctor agreed with him that there was nothing wrong, given his history with that lab result, and sent him home to us. He lived 20 more years (to his mid-80s), and never did have any serious heart problems during those years. Over-diagnosis much, US health system?
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Private hospitals also might not be terribly up to scratch. BC built a new hospital in Abbotsford as a public-private partnership (it happened to replace the one where I was born 🙁 ), and, well…seven years in and the copper pipes are leaking. Pipes that are supposed to last decades.
http://bc.ctvnews.ca/lengthy-renovations-ahead-after-pipes-leak-at-abbotsford-hospital-1.2687179
Also, I cannot find the article that pointed this out, but, the biggest advocate for two-tier healthcare is an asshole in BC named Dr. Brian Day, who runs a private surgery centre right across from Vancouver General Hospital. He mostly (when he’s not unsuccessfully running to be president of Doctors of BC so he can go back to moonlighting as a lobbyist like he did when he was head of the CMA) provides high-demand, low-urgency surgeries like arthroscopic knee surgery for pro athletes. Skipping the line for GRS? HAHAHA, no, he doesn’t do that. A two-tier system would also only allow patients needing certain high-demand lower-urgency (most likely athletes followed by body-modders) procedures to skip the line, not patients with lower-demand and extremely specialised surgeries like gender affirming stuff, because the high-demand low-urgency procedures create more revenue.
In the US we also have a shortage of doctors and nurses. Medical school is prohibitively expensive, so it becomes a matter of who, among those who qualify, can afford to go rather than necessarily getting the best candidates. It can also cause good doctors to choose specialties based on financial reason rather than skill, interest and need.
The wait time argument always annoys me. First, it is common for people to wait long times in the ER. Many hospitals are now working on that problem. However, it is still a major issue especially in large urban centers and underserved communities. Second, we wait for procedures also. There are waits for hip and knee replacements, cataracts surgeries, routine screenings, etc. Depending on your need level and coverage you can wait months for heart surgery. As you described for the Canadian health system, access is prioritized.
However, we are much more likely to have differences in wait times based on the quality of insurance we have and which medical centers we have access to. I live in San Francisco. I go to doctors and hospitals on the wealthier, whiter north side of town because I am more likely to get faster care. I am also more likely to be treated with dignity and respect.
Also, under US health care, we are very likely to require multiple visits prior to diagnosis since we tend to go one of two directions. ERs are likely to either decide nothing is wrong or perform every possible test. On doctor’s visits, allotted times are so short that only routine care is provided. If you’re going to go beyond your 5 minutes, you may be forced to come back. Healthcare then becomes available only to those who are able to come back again and again, taking off work, getting transportation, etc.
I’ll take the Canadian system. I will gladly pay more taxes to ensure all people have coverage.
I live in Israel and our system is similar to the Canadian one and Ania’s explanation is accurate here as well.
Where we differ (among a few other things) is that Israel does have a two-tier system. If you want you can pay extra to get the doctor you want to perform the procedure you want (we also have private, semi-private and public hospitals). Israel has only partially implemented the two-tier system (it’s a bit complicated, but at different decades different hospitals were allowed to practice it) so it acts as a natural experiment. A committee concluded (hebrew) that the two-tier system has the following drawbacks:
1. Greater inequality (no duh).
2. Greater healthcare expenses (because you’re basically paying extra for the same treatment).
3. Non-medical consideration in determining treatments.
4. Increased insurance costs.
5. Negative incentive for infrastructure repairs and renovations (since the money would be diverted to private practice).
6. Money funneling and double payments for the same procedure (government funds will go to the hospital as usual, but instead of going to the public part of the system it would be diverted to the private part and the private patients would still have to pay the same cost).
The proposed advantages were deemed:
1. Better use of hospital resource (supposedly hospitals are most busy during day hours and this system could redirect patients to night hours).
2. Reducing the fiscal deficit of hospitals.
3. Offering incentive for personnel to stay in public hospitals (if the system would be implemented in public hospitals as well).
4. Greater competition between hospitals and improved equipment.
5. Better monitoring and control (supposedly the patients would be less likely to seek medical help at home or in private clinics and so would be easier to monitor).
But remember, the system is already in place in some hospitals. Namely the Shaarei Tzedek and Hadasa hospitals in Jerusalem. So how do they fare?
Both recently went bankrupt, with Shaarei Tzedek eventually being bought out and restored to functionality. However Hadasa has such a huge debt that its barely functional.
Because of the financial troubles the medical stuff in Hadasa is often on strike or leaving the hospital all together.
When it comes to equipment there is a big difference between the two hospitals. Hadasa does have the best equipment and the largest buildings, however, due to the aforementioned troubles they are mostly unused and an entire new wing of the hospital remains vacant. Shaarei Tzedek is average regarding equipment and space, offering no benefits relative to public hospitals.
So in effect most of the supposed advantages are proven not to work, whereas the disadvantages remain.
The US healthcare system is frankly a mess. I am currently living in Germany and am continually impressed by how rapidly I can get appointments here, in a country that has had universal health care since the 19th century, as compared to the “free market driven” US.
As for the medical personnel shortage in Canada, if the US elects Trump I seriously expect you to get enough applicants to fill up every space you have available. Quickly.
It never ceases to amaze me that even now, in the year 2016, healthcare in the US continues to be a privilege rather than what it is: a right to which every human being should be entitled. I agree with Dianne; if Donald Trump wins the election, lots of Americans will be moving to Canada. He can forget his wall between the US & Mexico; he’ll have to build a wall to keep our people from slipping out.