Thursday, August 30, 2007

In Defense of Canadian Healthcare

R. Bobak who is purportedly a Canadian who started blogging recently on healthcare (and who seems unfamiliar with the concept of links, as he failed to link to my post) wrote a post entitled "doctor biobrain's" healthcare wise-cracks (Bobak is apparently also unfamiliar with the proper use of capitalization and quotation marks) as a response to my Healthcare for Dummies post.

But as was to be expected, my post was little more than a background prop enabling Bobak to repeat the same litany of attacks against the Canadian system, while entirely ignoring what I wrote. Even the parts that he quotes in his post were then ignored for a retread of the same old stuff. Just as with Socialized Medicine-hater Jim Campbell, what I wrote really wasn't of any importance. All they knew was they didn't like what I was getting at, and that makes me wrong; even if they can't explain why I'm wrong.

What's Wrong with Canada

And first off, just like Campbell, Bobak fails to mention a significant detail when comparing our system with Canada's: We pay about twice as much per person as they do; including a larger percentage of our GDP. And it's obvious why they can't mention this; because it undermines much of what they're saying. There's always this implied idea that Canada's system is both less efficient and more expensive than our system. Or at a minimum, as if they're getting less for the same money.

But instead, it seems as if Canada's problem is that they're just not willing to fund the system properly. Bobak seems to agree with that, but then insists that the problem is lack of competition and free-markets. But it looks to me like the problem is that they're just not willing to pay for what they need. Otherwise, their system doesn't look that different from ours; except that we pay a whole lot more.

And sure, how the healthcare is paid for is different. But whether it's being paid by taxes, or by employers, or by individuals; it all adds up to the same thing. Conservatives treat "taxes" as if they're an inherently evil thing that makes it worse than other means of money collection, but it's not. If we're paying twice as much, we're still paying twice as much; no matter how the money is collected.

Knowing the Basics

Beyond that, it seems as if Bobak doesn't understand how our system works, or his own Canadian system for that matter. Because first off, Canada doesn't have the dreaded Socialized Medicine. Their doctors don't work for the government. They have private practices, just as we do. The primary differences between their system and ours is who pays the doctors and that their system doesn't allow for people to pay for their own care (though that is slowly changing).

But otherwise, their system is just like what we do for Medicare, Medicaid, HMO's, PPO's, and other systems. I suppose there are rich people who just pay for their own expenses directly (which is far more expensive), and we do have non-HMO-style insurance with huge deductibles, which seem fairly pointless to me; but as far as I know, our system is very similar to Canada's.

And that's the thing: They don't seem to understand how our system works at all. For all their talk about "free choice" in our system, I just don't see it. I don't get to pick my insurance provider. My wife's employer does that. When she has an employer willing to pay for a good provider, we have good insurance (like right now). And if they're cheap, we get crappy insurance. So if we can't afford to buy our own insurance (which most people can't), I don't see how I have any choice in the matter.

And even within insurance providers, we have little choice. They have agreements with certain doctors for how much they'll pay for services and I'm limited to seeing the doctors they have agreements with. And then I pick one of those doctors and am stuck seeing that one doctor; as well as any specialist that one doctor sends me to, who also must have an agreement with my insurance provider. Sure, I can see other doctors, but I'd have to pay a whole bunch for it and my insurance might not cover it at all. And emergency visits are very expensive and I have to get permission before I can go there.

On top of this, I pay a $20 co-pay for every visit and have to pay a deductible for drug purchases. In the one and a half years I've had this insurance, only one person in my family has had their drug deductible paid in full; which means I've been paying full price for the few prescriptions I've had.

And for awhile, we didn't have health insurance, and so my kids got on the CHIP program here in Texas. It's government-paid healthcare just like Canada's, but let me tell you, it worked exactly like my current insurance does. We had a $20 co-pay (though poorer people had a lower one or no co-pay), as well as a drug co-pay, though we had no deductible for this (which is better than we have now). It also gave us a list of doctors to choose from, and seemed no different from my current insurance at all.

And the best part was that it didn't change just because we changed jobs; meaning that we weren't tied to our jobs just to keep the kids insured. And that's great. My wife and I rarely visit the doctor, but anyone with kids will tell you that you WILL take them to the doctor.

Healthcare Hell

And I've had much crappier insurance than CHIP or what I have now. One company kept trying to make me pay for things they were supposed to cover, kept lying to me about this, and dragged their feet for a year and a half before they finally paid them. I've had my account sent to collectors on two occasions for bills that the insurance company was supposed to pay, forcing me to pay the bill in the meantime. And when it all gets settled, I didn't get so much as an apology, and in the second case, never got reimbursed. And I've heard other horror stories much worse from this provider and others.

And how much choice do I get in this? Zero. In America, when your employer decides to get a cheaper health insurance provider, you're just screwed. If the new insurance plan doesn't have an agreement with your doctor or pediatrician, you have to find a new one (something that's happened to us on several occasions). And there's no way to evaluate a doctor beforehand, so it's just a matter of taking a blind stab at trying to find a new doctor who is good. And it was all based upon what her employer felt like paying for insurance, not on my choice.

But even the lousy insurance providers worked the same as the good ones. I've never had insurance that allowed me to see whoever I wanted. I've never been able to evaluate a doctor and pick the cheapest or best one. I like the place I go to now, but have had bad doctors in the past. And there really isn't anything you can do about it. If your company decides to change their insurance provider, you go with what they say.

In all of my adult life, I've never seen the "free-market" healthcare system that conservatives keep describing to me. Well, except for the part where if you don't have insurance, you don't see the doctor. I've seen that one a few times, and it totally sucked. I'm generally a healthy person, so health insurance is too expensive for me to pay for. But I'm always damn glad when I have it.

Fixing Canada

And to my knowledge, this is how the Canadian system works, but they've got it better. As I said, their biggest problem is that they refuse to pay as much as they should. Remember, we pay about twice as much as they do. So it's quite possible that if they paid 50% more than they do, they'd have a superior system to ours that was still cheaper. And for the millions of uninsured we have, a waiting list is still better than nothing.

But unless I'm mistaken, the conservatives who want private healthcare in Canada are the same ones who don't want to properly fund their system. Once again, it appears that conservatives are intent on proving that government doesn't work by sabotaging it. I'll admit that I'm no expert on Canadian politics, but unless someone can explain this to me otherwise, this will be my take on it. But as I said, many of the details Bobak gave match what I'm saying. The only difference is that he's got a different conclusion in mind, so he refuses to see it.

And for as much as people like Bobak complain about the Canadian system "rationing" care, that's exactly what they admire about our system. But rather than the government rationing it, they prefer it to be rationed according to wealth. The poorer you are, the less healthcare you get. They never say this explicitly, but that's exactly what they're talking about. They fear that if everyone gets insured that our services will go down because more people can see the doctor.

I find that simply disgusting. Everyone deserves good health. Not only is it good for society, but it's the right thing to do. As they say, a society should be judged by how they treat their lowest citizens; not their most powerful.

Conclusion-Based People

Bobak even took issue when I insisted that single-payer insurance should be called insurance, rather than "tax". But why? If it looks like a duck and quacks like a duck, it's a duck. And if single-payer insurance acts just like regular insurance, what's the difference? Why does it matter who pays for it, if it acts the same way? And the difference is obvious: "Taxes" are a dirty word, so if they call it that rather than "insurance," they'll think they scored a point. But I have no problem calling it Taxpayer-Funded Insurance. Again, if it acts just like insurance, it's insurance.

But conservatives have got a different way of thinking: If you don't like the duck, call it a cockroach and squish it. Same deal with why they keep saying Canada has "Socialized Medicine" when it doesn't. They don't care if it's accurate. They just want a name that sounds bad because they don't like it. And "free-market" sounds a lot better than "Every Man For Himself," which is what they really want.

But again, this is all just weird. These people don't seem to understand how our system or the Canadian system works. They've got this weird fantasy that Canadians lack choice, while we get to have whatever we want. And they refuse to acknowledge that our system has many glaring inefficiencies and is extremely expensive; or that their system is underfunded. Overall, it's like they're so hung-up on the idea that the free-market is better that they refuse to acknowledge reality at all. But this has nothing to do with the free-market, and everything to do with selfishness.

But again, there's nothing new here. This is how they treat everything. They've got their fantasies and they'll be damned if they let any facts get in the way. And if Bobak gets around to responding to this post, he'll do the same as Jim Campbell and ignore what I wrote and insist that I'm too ignorant to understand what he's saying. Jim also refused to allow my comments to be posted on his blog, including my links rebutting his posts. I guess Jim just didn't like what I had to say. We'll see if Bobak is any different.


Interrobang said...

But unless I'm mistaken, the conservatives who want private healthcare in Canada are the same ones who don't want to properly fund their system. Once again, it appears that conservatives are intent on proving that government doesn't work by sabotaging it. I'll admit that I'm no expert on Canadian politics

No, you're quite correct, unfortunately. There's a distinct lack of political will to actually fix healthcare, especially if that means spending more, despite the Romanow report preliminary research showing that most Canadians would be willing to pay more taxes to fund better healthcare.

There are complex political reasons why, mostly having to do with the unique micromanaged economy Canada has, and the peculiar set of economic beliefs the political and economic elite here has; namely that the most important priority for government is debt reduction, even when the debt is negligible as a percentage of GDP, there are governmental surpluses across the board, the economy is otherwise fairly strong, and important, wealth-generating things like healthcare and infrastructure are falling apart because of underfunding and neglect (if not outright governmental sabotage). If you think I'm making this up, I recommend the works of Linda McQuaig on the subject.

Not only that, but the right-wing Canadian position is by default to assume that whatever the US is doing is automatically better in every way than anything indigenously Canadian (whether it is or not), and should be implemented here, regardless of whether people actually want it or not. (This is actually unsurprising, given the amount of Scaife et al money that winds up here, funnelled through various binational right-wing think tanks and suchlike.) Among the brilliant ideas these folks have been pushing for years is two-tier medicine (basically where poor people use the publicly-funded system and rich people go to private, for-profit clinics, thereby destroying the publicly-funded system by draining off all the good talent to the private, for-profit system and also creating an incentive among the wealthy tax base to be anti-public healthcare); gutting our labour laws to bring in "right-to-work" legislation (or, more accurately, "right-to-fire" laws); a proposal whereby Canada should adopt the US dollar (*rolls eyes*), and a proposal to allow US law-enforcement agencies to travel across the border armed without special permission or oversight. (That last one is a little bit too much like having armed irregulars from an occupying power in one's country for my taste.)

The Conservatives here love that anti-tax, anti-government rhetoric that they all studied so carefully when they were doing their internships in Washington, as so many of them have, the noxious carpetbaggers. (Hell, in my riding alone, one of the local wingnut Christer politicians here made a point of coming back from Washington where she'd been running Republican fundraisers for Bush for the past four years. And she wanted to be my riding's Member of Parliament. *facepalm* She didn't get elected, thankfully.)

Sorry to have gone on so long; what you were surmising doesn't exactly lend itself to a two-sentence answer, and it takes me 300 words to answer the phone anyway.

Doctor Biobrain said...

Wow, thanks Interrobang. That's about how I guessed things were, but don't really know much about Canadian politics, so it's good to get some details. And to think, I always thought you guys just elected polar bears and beavers to political office. Then again, it sounds like that might not be such a bad idea...for both of our countries.