Hey America, Come Join The Civilized World!

I live in Canada. Going by the raging healthcare debate in the US, I am living in a socialist country where I have no say in how I get my healthcare. And, yet, I choose my own family physician, unlike many Americans who are restricted to those physicians approved by Kaiser or another healthcare provider. In fact, I have had three family physicians over the last 40 years, as the earlier ones stopped practicing. My medical records have traveled from one doctor to another, so there are no gaps in the records of my illnesses, medications and sundry tests that I have undergone over this 40-year period. I have had an physical check-up every year, including tests for blood, urine and even stools, if necessary. Every fall, I get vaccinated against influenza and, this year, I will also get a vaccination against H1N1 virus. When in emergency, I can walk into any of the walk-in clinics or a hospital. Whenever my family physician or I thought that I needed to see a specialist, my doctor sent me to a specialist of my choice, or someone he trusted if I had no one particular in mind.

All these above services are provided to me absolutely free of cost upon showing my Ontario Health Insurance Plan (OHIP) card. I am never asked to fill in any forms to claim my expenses; indeed, I do not even know what my medical expenses are even if I spend a long period in a hospital (of my choice, again) to be treated by a physician of my choice. Of course, I pay my taxes and, when I was employed, my employer paid a charge on his payroll for healthcare. I also pay for some of the services that the govt., on the basis of the opinion of the medical community, does not think are necessary; for example, my doctor has been routinely sending me for a PSA screening test for the past several years for which I have to pay $25 from my pocket. The same would apply to many surgeries, such as cosmetic surgery, which the medical community does not consider to be health-related; although many women have been able to obtain such surgeries on the grounds of experiencing psychological trauma. In other words, the medical services provided to me are controlled by me and my doctor, and not the government that pays for those services.

A lesser known fact of the Canadian healthcare system is that it does not force physicians to be part of the government run systems. A doctor is free to run a private practice but is not allowed to combine private and public practice so that she or he does not use the latter to promote the former. Doctors are paid for services rendered and are not on a fixed salary. However, their fees for various services are set by provincial governments after negotiating them with the provincial associations of medical doctors.

The Canadian system does not prevent insurance companies from offering medical services not covered by governments. Many employers provide a drug insurance plan which covers most of the drug expenses as well as other services, such as physiotherapy or psychological counseling, not covered by government plans. Provincial governments generally cover drug expenses only for seniors and economically disadvantaged sections of the society.

Not all Canadians are as lucky as I am. There are some who are dual citizens of both Canada and the US and who now find themselves in a forced exile from their home country. One such person is Kathleen Kelly, a Californian who met and married a Canadian and now lives in British Columbia, Canada. She discovered that her four year old son had a rare skin disease. She has been getting treatment for her son in Canada without ever knowing how much it costs her. Now, she wants to move back to California so that her son can get acquainted with her family and American roots. But she found out that her son’s treatment would cost almost $200,000 a year, which she cannot afford. No insurance company is willing to offer her insurance for her son’s pre-existing medical condition. Kathleen is not alone; nor is this plight limited to Americans living outside the country. There is no dearth of heartbreaking stories of Americans without insurance, including celebrities like Margot Kidder, who go bankrupt or go without treatment for serious illnesses because they cannot afford expensive treatment, or who are refused medical insurance, or who have run out of their lifetime limit.

Canada is not the only Western country which has a universal healthcare system, so does every other industrialized country, except the United States of America. All industrialized countries treat universal healthcare as a basic human right, just like universal public education, and not a privilege for those who can afford it. Even some underdeveloped countries, such as India and Pakistan have government run hospitals and clinics which are theoretically accessible to all citizens regardless of their ability to afford treatments. Different countries have adopted varying combinations of public and/or private healthcare systems but the universality of coverage is common to all of them. Unlike America where the paramount consideration is the cost to the taxpayer; other countries have accepted the principle of universal coverage and found a way to minimize the costs to the society of that universal coverage.

The irony is that the American system, which has failed to provide a healthcare system to all its citizens, is also the costliest among the OECD countries. In the year 2003, the US spent $6711 per capita on healthcare, as opposed to under $2300 for Canada and Japan. It also spent a higher proportion of its GDP on healthcare than any other OECD country – 16 per cent in 2003 as against 9 per cent in Canada and between 7 to 10 per cent in most OECD countries. It is also worth noting that more than a third of the US expenditure on healthcare is paid by the US taxpayer through Medicare and Medicaid; not much lower than the 7 per cent of the GDP that some countries like Ireland and Finland, who have a somewhat older population, spend on providing a universal healthcare to their citizens.

Despite a higher spending on healthcare compared to other OECD countries both in terms of per capita expenditure as well as the proportion of GDP, the United States is behind most industrialized countries in terms of life expectancy and health indicators. Its life expectancy is lower than Canada’s both at birth and when a person reaches age 60. Indeed, an average Cuban lives a longer life than an average American. In other words, the US has the least efficient system which spends most for getting the least results. So, America, come join the civilized world and save some money.