Healthcare IT & Transformation

Healthcare for Everyone

As a Canadian living in the U.S. as a permanent resident for many years now, I’m always frustrated at the primary characterization of the Canadian healthcare system as one where patients have to wait for care.

Please understand I’m not upholding the Canadian system as the be all and end all. I could write a variety of other posts on opportunities for improvement in Canada but if you asked me to choose between what I have for care in the U.S. versus what I had in Canada I would choose the Canadian system for healthcare every time. Without pause! Why?

Having done a lot of consulting work for insurance companies in the past I can tell you they have one focus as a business…. to make money. How does an insurance company make money? It’s almost like gambling although they like to call it actuarial science. They apply mathematical and statistical methods to assess the risk of insuring someone. They base your insurance rates and whether they will cover you on this risk. And when it comes to paying out…. their motivation is not your good health! Their primary goal is to pay out as little as possible to cover their obligations to you so that more money is kept for their profit.

And what about pre-existing conditions? Why should it matter if I had a health problem previously? My doctor wants to treat it regardless of when I started to experience the symptoms and got the diagnosis. How ridiculous would it be if doctors wouldn’t treat something that was diagnosed by another doctor? This is exactly what insurance companies do because they want to pay as little as possible and we accept this as OK! It is not ok.

I can’t for the life of me understand why Americans are afraid of socialized medicine. I think it is ludicrous that a country as rich and powerful as the United States lets our very health be managed by insurance companies! It seems that every American must experience the stress of trying to extract coverage when they are critically ill to get this. Really? Do you need to cut off your own leg to “get” that losing a limb would be traumatic?

I HOPE that President Obama will be able to resolve this. Every person has a right to good healthcare. Now… what is good healthcare?

The Canadian system is always characterized as a system where patients have to wait. But what about appropriate wait? Let me give you an example.

In CANADA

An 80 year old man in Canada has one cardiovascular test that indicates he needs triple bypass surgery. It is determined based on his medical results (not surgeon or hospital availability) that he will need this surgery in approximately 6 months. He is put on a list to have the triple bypass in 6 months. In the meantime he is monitored to make sure his condition doesn’t escalate and he is given further tests to validate the original findings. In these additional tests it is discovered that he doesn’t really need a triple bypass and instead he would do well with two stents on the viable arteries with the 3^rd less critical one left alone. They schedule him for the far more minor stent surgery and he recovers before his original 6 month timeline was reached.

In USA

An 80 year old man in the U.S. has one cardiovascular test that indicates he needs triple bypass surgery. Once it is determined he has the appropriate insurance coverage he is scheduled for the triple bypass as soon as the surgeon has an open slot. He has a very hard time recovering from this major surgery and 6+ months later he is still not back to his old self.

The questions to ask yourself are:

     
• Did the American need a triple bypass?

 

• Would he have recovered better with just as good results with a lesser surgery?

 

• Did the fact that the surgeon would make much more money doing the bypass operation play a role?

 

• Did the fact that his insurance coverage would pay for the bypass play a role?

 

• What if a procedure not recognized by the insurance companies was the best medical procedure for this man according to his doctors? Do you think his coverage would have paid for that?

What about the uninsured in the U.S.? What happens to them? They get healthcare… yes even illegal immigrants get healthcare. But they get healthcare in a way that just drives the crazy cost of healthcare up higher. Having worked in a location with a high population of illegal immigrants I can tell you how. The uninsured don’t go to a primary care doctor because that doctor has no obligation to see the patient for no charge. They also don’t go to private urgent care centers for the same reason. They end up at hospital emergency rooms where there is an obligation to see patients regardless of ability to pay. And another fact about hospital emergency rooms? Of the three (doctors office, urgent care and er) it is by far the most expensive route to care. The average cost of an emergency room visit is nearly five times the cost of an office visit with a primary care doctor.

President Obama…. please make sure your healthcare reform team keeps their eye on the ball. Insurance companies and physicians can have their input but they both have vested financial interests in the outcome. They shouldn’t be leading the charge! Healthcare should be provided for the greater good of a nation’s people! Isn’t that what government is for? Call me if you need someone to herd the cats….

2 Responses to “Healthcare for Everyone”

1. Bob Macdonald Says:
   June 18th, 2009 at 4:47 pm

   Hello Susan,
   Thank you for your insightful comments on an issue that is so often fraught with misinformation intended to protect the status quo/vested interests. Playing to a long standing bias against anything labeled ’socialist’ and hijacking people emotionally by suggesting that they and/or their loved ones will have to endure unreasonable wait times for critical care is, as you have pointed out, an inaccurate characterization of the Canadian healthcare system.

   I’ve worked in the Canadian healthcare system now for the past few years and wholeheartedly agree that there’s plenty of room for improvement but I have yet to meet anyone that would prefer the US system.

   Lets hope that President Obama will utilize his considerable communication prowess to bring about some rationale debate on the is issue.

   Thanks again for comments,

   Bob Macdonald
   Managing Director
   Bridge Learning Technologies Inc.
   Vancouver, BC

2. Maguire Says:
   November 17th, 2009 at 4:23 pm

   I’ll agree with in regards to not understanding why so many of my fellow Americans are terrified of social health care. Many have demonized it to the best of their abilities, including people who could benefit from social health care but are too blinded by all of the lies they’ve been spoon fed to see it. Insurance companies have been running without accountability for too long and it would be nice to see a plan that gives us a public option, but also regulates the private companies as well.
   America is too far down the list in health care at this point in history, with all the money and technology, why don’t we use it for our own people and the future generations of America. There is a statistic by the World Health Organization that puts the United States as #37 in health care. http://www.who.int/whr/2000/media_centre/press_release/en/index.html
   That should make more of an impact than it has. We need to create a system that really focuses on prevention. Help this country get back on track, eat better, live better, and with a plan that would allow more freedom, people may no longer have need to be bound by jobs they dislike simply to guarantee they have health coverage.

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