Medicare grim realities is in the details

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As the title suggests, The American Prospect article What Medicare for All Really Looks Like claims to describe the realities of Canadian medicare to our southern neighbours. So, it is both ironic – and disappointing – that a careful reading reveals it to be remarkable only in its unwillingness to examine these realities in any meaningful way.

Instead, readers are offered a quixotic exposition on the noble ideals that undergird medicare, and these idyllic principles are then used to dismiss and/or justify the many problems in our health-care system.

For example, an in-depth discussion of wait times is integral to understanding the realities of medicare. Wait lists for specialists, medically-necessary treatment and diagnostic procedures are typically measured in months. They are also associated with increased stress, deteriorating physical and mental health, and a loss of income that can be quite substantial when wait times are excessive.

Despite the serious nature of these consequences, they are presented only as a “downside” to the system. There’s one example of a woman with vertigo who waited eight months to see a specialist and that same individual offers her insights into a shortage of child psychiatrists.

There is no thorough discussion of the negative impact on a patient’s health, although the author acknowledges that “waiting for diagnosis, treatment and relief from pain and anxiety can be frustrating.”

The author then has the temerity to suggest that the sting of waiting is lessened because “the wealthy and powerful can’t pay extra or pull strings to jump to the front of the line” and this “contributes to a sense of solidarity.”

It would also be enlightening for the author to know that some specialists deal with this problem in what some would term a very un-Canadian way: they offer quick access to motivated patients who are willing to pay a fee. That is, Canadians can – and do – pay to bypass the waiting list to see a specialist. The amount varies but it’s typically hundreds of dollars.

This uninformed author further offers: “No one wants to wait but Canadians also live without fear of medical bankruptcy, a trade-off they deeply value.”

Really?

That “value” starts to diminish rather quickly for those who have chronic health problems that require access to one or more specialists, multiple diagnostic procedures, repeated and followup care and/or medically necessary surgery (which can be anything from a troublesome gall bladder to knee/hip replacements or cataract surgery).

Over one million Canadians are on health-care wait lists where times from a visit to a general practitioner to seeing a specialist and receiving treatment vary considerably according to location (from 16 weeks in Ontario to 49.3 weeks in Prince Edward Island) and specialty (4.4 weeks for medical oncology to 39.1 weeks for orthopedic surgery). The same study showed that Canadians waited 4.8 weeks for a CT scan, 9.3 weeks for an MRI scan and 3.4 weeks for an ultrasound.

Unfortunately, none of these details are mentioned in an article that’s supposedly educating Americans about the realities of Canadian medicare.

Another example of presenting misleading realities in the Canadian system is the story of Dennis, a healthy, 28-year-old Ontario man who serves as the straw man for the author’s arguments. He apparently lives with “no fear of ever paying for [medically necessary treatment] out of pocket” because “government-funded health care, from cradle to grave, is [his] Canadian birthright.”

Yet, his entire experience with health care involves several visits to a local ER to repair broken bones that resulted from various sports injuries. He has never had to pay for health care (except through taxes and a personal health insurance policy) and, as a result, our straw man continues to play recreational sports, “free of daily financial anxiety over potential injury.”

Voila! Dennis is proof that Canadian health care is free!

But there are several issues associated with this assumption.

First, there’s no such thing as a free lunch. Governments may fund health care, but Canadians are the ones who pay the government and they pay more taxes than their American counterparts at almost every income level.

Second, the notion that government covers all health-care costs is simply false. The Canadian Institute for Health Information (CIHI) breaks down Canada’s 2018 health-care expenditures as follows: government funding covered 64.2 per cent; 15.4 per cent came directly out of patients’ pockets; 12.4 per cent was paid for by private insurance; 4.8 per cent is listed as other public sources and 3.2 per cent as other. Overall, the public/private split was 69/31 per cent.

In addition, our health-care system doesn’t include dental work, eye care or any treatments received outside of a hospital setting, such as nerve blocks for pain control, physiotherapy, mental health counselling and even some vaccines. Most general practitioners charge their patients fees for full physical examinations and providing sick notes for an employer or school.

The reality of medicare is in the details. Unfortunately, generalities, one-off examples and idyllic descriptions of the principles undergirding medicare do not fairly represent the challenging realities that are the day-to-day experiences of many Canadians.

Susan Martinuk is a research associate with the Frontier Centre for Public Policy.

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