ObamaCare, Is There a Fix?

The HWN Team with guest journalist Diana Rodriguez | Heads or Tails
ObamaCare, Is There a Fix?

image by: Daniel Borman

It’s not defunding ObamaCare or granting everyone the current ‘federal worker option’ or even socialized medicine. Just ask our neighbors, the Canadians

For the lack of a better term could it be a SinglePayerPlan? In the United States, where many families struggle to pay medical bills and more than 60 percent of bankruptcies in 2007 were due to medical costs, people dream of going to the doctor or hospital without worrying about how to pay for their healthcare. But that dream is a reality for Canadian citizens. They don’t have to choose between feeding their families or getting medical care. And no one loses their health coverage when they lose their job. 1, 2

Canada’s universal healthcare system is not socialized medicine. It is a single-payer system like U.S. Medicare meaning that the federal government collects a portion of income taxes and uses it to subsidize medical expenses for all Canadian citizens. Access to a doctor or hospital is guaranteed. Canadians do not pay out of pocket for doctor visits or hospital stays. 3, 4  No bills, no insurance companies to deal with and no out-of-network charges unlike Obamacare which in most offerings is convoluted with various plans containing various prices, copays and deductibles. 5

Even if Canadians don’t get a bill from their doctors, they’re still paying for their healthcare. The total cost of healthcare in Canada is about $125 billion dollars annually, which works out to $3,663 per person. Of course, higher earners pay much more toward healthcare costs than lower-income individuals and families because all funds come from income taxes. If Canadians want more and better healthcare, they’ll pay for it through their taxes. Additionally each province has slightly different coverage, formularies, and costs. Some provinces, for example, charge a small fee for health coverage. In BC it’s around $64/ month. 6

However there is a catch...everything is not covered such as routine prescriptions as well as certain drugs, procedures, and various other health services including dental coverage. As a result private health insurance is also offered in addition to the government healthcare system. These are typically offered through employers or through third-party insurance. Private insurance, if citizens choose to purchase it, covers additional health services such as naturopathic medicine, nutritional counseling, therapeutic massage, dental care, and chiropractic treatment. 7, 8

“The majority of people in Canada will have private insurance through a private insurance plan, and the majority will cover up to a certain amount each year,” says Benjamin Snider, ND, a naturopathic doctor in private practice in Kitchener-Waterloo, Ontario. “Every province allows citizens to have private insurance, usually through their employer. And the premiums are affordable,” says Dr. Snider. 9

But, does access to healthcare translate to better health?

In terms of life expectancy, that appears to be true. The average life expectancy of Canadians at birth is 81 years; for Americans, it’s 79. And in terms of overall efficiency of healthcare, Canada is ranked 30 out of 191 countries, while the United States ranks 37th. 10-12

When it comes to common health problems, Canadians seem to be reaping the benefits of the system. Fewer than 70,000 people die from heart disease annually in Canada. In the United States, the number is more than eight times that, with nearly 600,000 people dying of heart disease each year. While 8 percent of Americans have diabetes, it affects only 6.8 percent of Canadians. Canadians also fare better when it comes to obesity. For instance, between 2007 and 2009, 24.1 percent of Canadians were considered obese, compared to 34.4 in the United States. 13-17

And the system seems to work for doctors, too. One survey found that 75 percent of Canadian physicians were satisfied professionally, compared to only 64 percent of their U.S. counterparts. 18

Although Canadians praise their healthcare system overall and literally protect it as a national treasure, some see the current system as unsustainable and insufficient to care for a country, which, like many, has an aging baby boomer population.

The length of wait times is the most common criticism. Because of the budgetary restrictions of a publicly funded healthcare system, there simply aren’t enough doctors and machines to go around. For emergencies there is no problem just like the United States but when it comes to routine medical care, specialists and elective procedures like hip replacements you have to wait your turn. The experience varies greatly based on province and the resources available, for example, the number of doctors and the availability of diagnostic equipment as well as the type of private insurance offered in a particular province. 19-22

The ratio of physicians to patients ranked 26th out of 28 countries with universal healthcare, and the shortage is expected to worsen. Almost 7 percent of Canadians said they could not find a family physician to care for them. Some even say that the shortage of physicians may be partially manufactured by the doctors themselves. 23 

When it comes to your health, the wait time to see a doctor or have a procedure can be significant – and costly. Shona Holmes of Ontario came to the United States for an operation to remove a brain tumor that, left untreated, would have caused her to go blind. The surgery cost her nearly $100,000 in 2005, and she had to take out a second mortgage on her house to pay for it.

But she felt she had no choice because she was unable to get the surgery in Canada in time to spare her eyesight. “Because we have a health insurance card we have this false sense of security that whatever we need is there. You can have the card and you can have insurance but that doesn’t mean that you will get what you need,” says Holmes. 24

“Right now Canadians are paying for one of the most expensive universal healthcare [systems] in the world. But what we’re getting in return are long waits and healthcare that is barely standard or subpar,” says Chris Schafer, an attorney and executive director of the Canadian Constitution Foundation (CCF). (The CCF is handling Holmes’s case against the Canadian government to seek reimbursement for her medical costs.) 25

But Holmes seems to be one of the few in Canada who feel that the system failed her.

Tony McEwan, 72, of British Columbia, was diagnosed with rheumatoid arthritis (RA) in 2004. His treatment injections cost more than $20,000 per year, says his wife, Liz. But their portion is just $4,680 per year, broken into an annual payment of $1200 and monthly installments of $290 – an amount calculated based on their income. It’s very affordable for them, and there’s never a question of not getting the medication he needs to control his RA. “I’ve got free orthotics and free transportation on the ferry for myself and my car to get to see the specialist,” says McEwan. And he has no complaints about wait times, either, noting that he sees his rheumatologist twice each year and could easily get in quickly if he had an emergency.

Wait times can be an issue, but Dr. Snider feels that many claims are exaggerated. “I would say that the perception of wait times, it’s generally over emphasized,” he says. “In my experience with patients, they generally are waiting anywhere from three to six weeks for nonessential or non-urgent treatment. It’s well within reason to wait for four to five weeks, or even six weeks, for a hip or knee replacement.” For a specialist like a dermatologist, a person may need to wait 12 to 18 months to see the doctor for a non-urgent issue like a skin reaction. But there are other options for care, such as naturopathic doctors or a family physician.

In some provinces, Dr. Snider says patients may wait months to get an MRI for non-urgent issues. Life-threatening issues are always prioritized, and those visits can be made within a week. The burden of a subsidized healthcare system weighs on those wait times. “It’s absolutely about economics,” says Dr. Snider. “If Kitchener-Waterloo had three MRI [machines], the wait list would be half as long. It’s about balancing the budget in each province.”

Even in publicly funded health clinics, there may be ways to circumvent those wait times and get the care that you need in nontraditional ways. “As far as the system is concerned, capacity is still a problem in the sense that there are still parts of our country where sometimes patients have difficulty with access because there may not be enough family practitioners or other healthcare providers,” says Francine Lemire, MD, and executive director of The College of Family Physicians of Canada. “I can’t say that in over 30 years of practice that I have felt limited by the system in the strictest sense,” she says.

On very busy days with many patients to see or when seeing a patient with several health conditions to manage, a 15- to 20-minute appointment may not be sufficient. But she and many other physicians often follow up with patients by phone or email to address other questions and give more detailed advice.

To circumvent a long wait for a diagnostic test or to see a specialist, Dr. Lemire says that doctors can also make phone calls to move up more urgent patients and make sure they get the care they need. And if a patient needs a medication that isn’t on a particular province’s formulary, they can still get the most effective and appropriate medication by making a request to cover the medication.

There may also be a tendency among Canadians to be less invested in their health – to focus less on staying healthy and rely more on the system to take care of them.

They may be hesitant to look for and use other resources within their own system, and the wait times may force them to the United States for healthcare instead.“Canadians are overwhelmingly well cared for, but in terms of prevention it’s a really underlooked focus for people,” says Dr. Snider. “The government is not pushing well education in terms of lifestyle diseases, cardiovascular disease and diabetes. The government doesn’t do a great job of prioritizing the prevention of those. If there was one major criticism, it would be there,” adds Snider. One study found that because cancer screenings were done more routinely in the United States, the ratio of mortality rate to incidence rate for certain types of cancer was lower. 19

The Bottom Line

The Canadian healthcare system, like that of many countries, continues to evolve. While it’s not perfect, there is an enormous benefit in having access to healthcare that is not prohibitive by cost. But there are criticisms in terms of wait times, access to doctors and testing, and educating Canadians to focus on preventive care and a healthy lifestyle.

Can it work in the United States? You be the judge.

Diana K. Rodriguez  is a freelance writer based in Louisville, Kentucky and has written extensively for HealthDay. Her work has appeared on many popular websites including Everyday Health, Real Age, MSN and Yahoo. Diana has a B.A. in journalism and French from Miami University and has been freelancing since 2006. Prior to becoming a freelancer, Diana worked in the health insurance industry in member communications.

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