By James Fife
One entirely different aspect of life in Home South and Home North that I have not touched on more than fleetingly is the state of health care in the two countries. For Americans who know nothing else about Canada, it is the one difference that they will readily be able to cite when forced to come up with something they know about the country up yonder. If Canadians, when they think ‘United States,’ think of spread-eagle attitudes, when Americans think ‘Canada’ (if they ever do), they think free health care. It’s our national stereotype of the Great White North.
Fortunately, I have had little occasion to experience either medical regime. Since an urgent surgery for appendicitis when I was a teenager, I have avoided any other major health crisis. Knock wood. So pretty much all I can say about the two ‘systems’ of health care (I use that word circumspectly regarding what we have Down South) comes from second-hand observation and general reports. I trust that does not make my comments here too skewed or inaccurate. At least, no more than any of the other ramblings that have appeared in this column.
Of course, the primary difference between health care North and South is the stage of the process where the money for it comes out of the individual’s pocket. The United States (in)famously relies (in theory) completely on each person ponying up all fees to the doctor, hospital, therapist, pharmacist, etc. for any medical services required or desired. I say, “in theory,” because, as it appears, such a system in its purest state is utterly untenable: we’d have bodies falling in the street if that were how it was really done. Instead, in fact, the American health-care regime is principally an insurance-driven machine. So, the “crisis” in health care that has been bemoaned in America for the last two decades consists in the fact that so many Americans don’t have insurance, either through their jobs or through their wallets. I reckon this demonstrates that pay-as-you-go, individual funding is unworkable, because when even part of the population depends on it, it drags the entire system down.
For this reason, the American health-care debate has centred ultimately on how to provide coverage for those not already covered. There have been two basic solutions: (1) More of the Same, or (2) Do Something Different. Seemingly, Canada has chosen the second course. When I first found out I was a citizen from birth and decided to conduct a crash course to get up to speed on the history/culture/traditions of my ‘new’ country, one subject I dived into early on was the life and times of Tommy Douglas. I had read reports that he was repeatedly cited as the most admired/respected Canadian. When I read his biography, I found out why that is. It also told me why nearly no American has ever heard his name.
To me, the national health system in Canada or the U.K. is just an extension of the ‘solution’ even the U.S. has turned to: cut costs and spread coverage by pooling resources through an insurance scheme. The only difference is, who provides the insurance. In the U.S., even Obamacare was based on the premise that private profit had to remain at the heart of any regime. In systems like Canada’s, the concept was to take the profit motive out of it, and, miraculously, the cost would drop by that much, freeing funds up to devote to other uses. That seems so basic and logical, but it is a concept largely lost in the smoke and thunder of the American debate.
Naturally, there is the theory and the practice. And I am aware that Canadians have multiple complaints about how medical services are provided in B.C. and elsewhere. Too few doctors, too long waits, inadequate coverage, etc. That, I assume, will always be the case in any joint, human endeavour: it takes constant effort and attention to perfect a thing. But I would point out one fact to my northern compatriots: when you have a complaint about how medicine is (not) dispensed in B.C., you have one place to go to belly-ache: the province. Down South, there is no single direction you can focus your efforts for improvement, because it is dispersed over every locality and entirely in the hands of separate doctors, hospitals, pharmaceutical companies, etc. There is no common pressure point that can demand a better outcome.
As I said, I have had no personal experience with Canadian health care. For me, it remains as yet a big, mysterious question-mark. But I have neighbours in Home North who do partake and have discussed their views of plusses and minuses. And, despite stray grumbles, they report glowingly about how, when one dear neighbour had a sudden need for heart surgery, he went into the Royal Jubilee at a blink of an eye and was given sterling service that he praised endlessly. It was personally comforting, but also reassuring that we are soon joining our lives to a society that values an outcome like that.
Meanwhile, Down South, while I am one of the lucky ones to have job-linked health insurance, I am constantly mystified by the waste and bureaucracy causing our ‘system’ to be the most expensive in the world. As I write this, I’m looking at a letter I received from my insurer. It was sent with the positive aspiration to inform me that I may need a potassium blood test sometime soon. But it took three separate sheets of paper and postage to inform me of that, and I know that the cost, and the mass of paperwork always sent to report the most trivial service rendered, adds a cumulative price to it all. Obviously, these incremental costs add up, but they all go to a middleman, a for-profit insurer, not to the system-operator. That is the fundamental difference: the paperwork might all be desirable and necessary, but who is paid just adds another layer of expense to the entire process.
I know I am likely preaching to the choir with these comments. But setting this rant out on paper is truly part of our transition process to Home North. It represents our shedding of umbrage about the U.S. system, while consciously noting and appreciating what the Canadian system is like. In that sense, Marilyn and I may sound like a couple of cheechakos praising Canadian medicine, when so many out there grumble about its defects. But that is exactly the benefit of hearkening to newcomers like us: we remind all Canadians of how lucky they really are, so that the grumbles should all aim at perfecting something that has already provided a very large cure to a very large social ill.