One of my friends, growing up in Los Angeles, was a boy named Walter. Our mothers were close friends, so we saw each other from time to time. We lost touch in our teens. Walter moved to Canada, has a family, a research firm, and, according to him, the world’s largest collection of slide rules.
Though Walter and I are further apart than ever, we are, oddly, closer, thanks to the Internet. He keeps track of my blog and we stay in pretty close touch
With health care being debated in the US, I was curious to know what Walter – a pretty smart guy and way better informed than most - thought of our system, vis-à-vis the Canadian. So in a series of emails I asked a number of questions. I found his answers to be interesting and informative, often sarcastic (Walter has emotional issues) and ultimately helpful. I wanted to share them with you.
The first question I asked was about the single payer system, which I believe they have there and which I think most Democrats would vote for if they thought it had a chance. I wanted to know if the single payer system precluded the existence of private insurance. Here’s his response.
Bart
Nope, we still have it, but not for basic coverage, that is 100% government run (but not expensive). I think Suzie (his wife) and I pay around C$100/month combined. We still have private things, like out-of-country insurance, dental, eyeglasses and so forth. I also have "extended coverage" for my diabetes meds and other bennies, paid by my employer, which is a private plan, though a public version also exists. The whole thing works well, with no worse access than a well run HMO at the hospital level, plus, I can use any doctor I want, whenever I want. US critics of our plan seem to suffer from a vast array of ignorance-related disorders, and the chronic inability to understand that we see keeping citizens healthy as an appropriate task of the federal government.
On the plus side, you are certainly getting the health system you deserve: cripplingly high costs for a wildly inefficient system with endless loopholes and exceptions, ghastly access, and total disenfranchisement of the poor. Angie (his American sister) and her husband and daughter pay about $1500/month for their coverage, and it doesn't seem to cover anything they really need; and if they do use it they get “rated.” US medicine is operated as a business, with little or no thought for service or health. Wahoo, for mindless capitalism. If you are down on your luck here, medical and even dental are covered by welfare, via the public system; all kids are covered automatically until they are 18. Yeah, our system clearly sucks, no question. How could anybody want this mess?
your cohort,
walter
That sounded like a little bit of paradise, but it seemed to me that something was left out. I had a couple more questions.
Dr. Smartass:
Okay, let’s assume you pay very little and get quite a lot. Aren't there some TAXES that you neglected to mention? I mean, the money, even though it's only Canadian dollars, has to come from somewhere, yes?
Bart
bart,
Yes, we do pay taxes, but so do you. We pay about 10% more, for which we get full medical coverage. Deal or no deal – you decide.
Despite rumors to the contrary, you DO have socialized medicine (medicare, medicaid, etc.) but it’s so poorly administered that even though everyone pays, few people actually benefit.
Medicine "for profit only" creates its own problems. Sometimes you just have to accept that in some areas the greater good is the key factor. The real expense of not having a national health program is that the vast majority is poorly cared for, if at all, while a tiny minority see disproportionate rewards. How does that benefit the country?
your cohort,
walter
Before I could write back, Walter added another note:
Bart,
Sorry, I was way off the mark on my medical fess. For a family of two we do not pay C$100/month, we pay C$96/month. This covers everything from flu shots to brain cancer, except some for non-listed prescription meds, and oddly, crutches. We do have extended coverage through my employer which picks up this stuff plus out-of-country fees.
But be aware, we are about to be hit with a massive price increase. Our rate for the two of us (ages 59.9 and 60) is about to skyrocket to C$102/month. Gasp!
As a family of four with two kids, we paid C$108. Why so much, you ask? Well, we are in a high income bracket, so we pay the top rate. If you are unemployed, you pay nothing, though you do have to make application for that. No one can be refused and pre-existing conditions mean nothing. Everyone is covered, but each province administers its own program as they see fit, so there is some variation across Canada. For reference, (the birth of) our two kids did cost us some money: they were C$42 and C$47 respectively, which of course covered the hospital stay, too. Emergency room visits are completely free, though you will find posters announcing an C$800 charge for foreigners. There is no free lunch in Canada ... unless you’re Canadian.
I have regularly scheduled, 90-day blood pressure, cholesterol and A1C tests for my diabetes, plus a follow up doctor's visit - all completely covered. I also went to school for diabetes, and had a follow up review a year later - also covered. Did I mention that my test strips and meter are also covered?
So, there you have it, actual data from our current bills. I can understand why US legislators and citizens think this is a bad system. It probably isn’t suitable for you because it infringes on ... something: perhaps your inalienable right to be destitute, stressed and sick.
I know a lot of people who have had everything from heart surgery to hip replacement, and while elective surgery isn't instantaneous here, neither is it in the US. People here are well cared for, healthy and, rather importantly, free from worry that any health issue can financially destroy their lives.
Admittedly, our program does not cover Viagra. It’s a stiff problem but we have learned to live with it.
your cohort,
walter
I felt there was still something missing from the equation, so I wrote back:
Dear Obe-wan
Forgive me for my dullness, but several questions suggest themselves from your answers. Our "for profit" health care system stems from our driving desire for ... profit, which most people assume is a basic human instinct. It may be or it may not, but how do you avoid it in your galaxy?
Also, the core of our insurance conundrum begins with a political conundrum: our politicians are financially supported by corporations (read: insurance industry) which makes them virtual employees. How do you get around that?
your student
dear grasshopper,
Like everything, it is simply a matter of will. It was not easy to bring this system into Canada; it was done by some very forward thinking NDP politicians from the prairie provinces who saw, decades ago, that health care was simply impossible to implement in poor agricultural areas. They fought to get the system in place, and now it is a cornerstone of our basic political structure. Few people realize what a miracle that was - we are all just used to it now.
Everything is not about money. If you or someone you love is sick, material things are simply not important. The issue here is whether you are able to do something not directly good for yourself, and to feel good about doing it. We all contribute to our health plan (taxes and fees, plus those who work in it for less than they do in the USA). People seldom need it, but when they do, it should be there, especially for kids and the disadvantaged. Not everyone buys into the concept that you cannot do well unless everyone does well, but until you get past that moral and psychological threshold, no real change is possible.
Nancy Reagan is not my hero, but her notion that the answer to drugs is to "just say no" is 100% correct. As long as there is a demand, there will always be a supply. The same is true for greed - until people let it go and take some interest in their neighbors, you will be stuck in this cycle of "I only care about what's good for me, and the hell with everybody else". The irony, of course, is that to everyone else, YOU are everyone else. Looks bad from that vantage point, doesn't it?
I believe Americans are being manipulated. They have allowed their rugged, independent, frontier, self-image to underwrite the greed and selfishness of those who are fleecing them, all the time imagining it is somehow noble. Follow the money, grasshopper, to discover true motivations.
So, there it is. Take a little less, give a little more, and learn to be happy for others. How hard can that be?
For some insight into the business and ethical problems tied up in this issue, I refer you to: http://www.sphere.bc.ca/download/business7-3.pdf
By the way, my article on oil just went to press this month in the October Avionics News, I have attached a copy for your amusement. I love the cartoon Larry did for it.
your friend,
walter
I knew we were closing in on the end, but we weren’t quite there. So I wrote again:
Dear Walter
You are a philosopher and a statesman. I disagree with you about drugs, but that's a whole other discussion.
I'm not sure if you answered my questions about how to get over greed - other than to just say no - and I didn't see any solution to the corrupt connection between politicians and big money. Any more thoughts?
Bart
bart,
You are so California - looking for a 60 second solution. Something that took decades to go so seriously wrong does not have such a solution.
Only the concerted will of citizens can fix this large-scale attitude problem, not some guy emailing you from Canada. You think corruption is the problem, but in reality those people simply reflect nation-wide attitudes and accepted norms. You have to change the way people think and what they regard as important - the rest will follow easily. You give people too little credit for their true influence - consider Ghandi or Gallileo. When people increase their knowledge and change their habits and demands, systemic change follows. You can’t just paste that change on the unwilling. Is that clear enough?
your compadre,
walter
Walter gets a little testy sometimes, so I wrote him back, saying:
Cisco,
Not really, Mr. Attitude. I wasn't asking for a quick fix; I was asking for answers to two distinct questions: A. why Canadians seem less inclined than Americans to be head-out-the-window, face-in-the-wind capitalists, and B. how your political system is able to eliminate, or at least diminish, corporate influence in politics ... assuming that it does. Is that clear enough.
Pauncho
bart,
You’d like your answer in what, two sentences? Hmm, this is really a large topic, but the answer is really contained in the question: we just don't see money and self-benefit as the only consideration – at least in many issues.
The easier it is to live, the less important other people are to you, it's just inevitable. Life is very hard in Canada; you can die just by not paying enough attention to the weather, and as conditions get harder, you are more aware of how important other people are to your continued survival.
On another level, we have a very complex government pattern with more than two parties, and so, more voices being heard and more viewpoints being aired than in your somewhat polar template. In our parliamentary system, governments can disappear overnight if they lose the confidence of the members. A moron like Bush could not survive up here. Also, we have no dreams of world conquest and no interest in making people follow our particular pattern. We are willing to help others if there is anything we can do, but would just as soon others stay the hell out of our business. You could say we are into small magic.
We have just as much corruption (I suppose) in some ways as you do, since we are just people, not saints. But it's hard to stay in power if you are a scoundrel here, and for the most part, we are just looking to live our lives as we see fit, nothing more vivid than that. The real problem in the USA, as I see it, is that there is too much drama in everything; every issue is pivotal, every decision gets too much heat and anger; nobody seems to consider the possibility that sometimes the other guy is right. Surprisingly, one can be absolutely sure and totally wrong at the same time. As I said, attitude is the key; until you change yours, systemic change is simply not possible. As the saying goes, you usually get the government you deserve.
Any help? if that doesn't do it for you, then I guess god just likes us better because we are more charming, kind and thoughtful, and you'll just have to learn to live with that.
-walter
As I said, my friend Walter has emotional issues, which sometimes lead to delusions of adequacy. He is currently under treatment. That aside, he is one smart strip of Canadian bacon and I hope you enjoyed his comments as much as I did.
