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US health care vs Canada/Europe
July 6, 2007 5:30 AM   Subscribe

SiCKO follow up: US health care vs Canada/Europe... what are your experiences?

Like many people I just saw the film SiCKO.. and it floored me (and all the people I went with). I have personally have had more than a few negative experience with my insurance companies over the past few years so it didn't take a lot for me to win me over.

After the movie I went on to 'the internets' so see other people reaction but I didn't see people who have experienced BOTH the US brand of health care and a single payer system compare and contrast the two.

Can anyone share their experiences?

Would anyone 'give up their NHS card for a HMO card?'

Thanks!
posted by cowmix to Health & Fitness (40 answers total) 18 users marked this as a favorite
 
Silly cowmix! You didn't need to search the whole of the internets - just this tiny little corner of it.
posted by googly at 5:42 AM on July 6, 2007


How the heck did I miss THAT thread?!

Sorry folks!
posted by cowmix at 5:45 AM on July 6, 2007


Can't speak to SICKO... It's not out in Australia yet! But I grew up in America, and my experience with the health care system was thankfully minimal. I don't remember ever having a proper doctor with yearly checkups growing up. In high school and college I remember going to the emergency room a few times for things (horrendous sinus infection, stomach problems) because it was too expensive or too late to go anywhere else. Luckily no one in my family had any major health scares, but I always remember an older woman at work whose diabetic husband passed out and had to be taken to the hospital in an ambulance. They had no insurance. I remember her telling me that she was sending the hospital $50 a week, because that was all she could afford. They had threatened to sue, but "it's not like you can get blood from a stone." I remember thinking she would be paying that off for a loooong time.

Then after college I moved to England for two years. I had a hell of a time actually getting a GP (everyplace near my flat in Hammersmith seemed to be full and "not taking new patients"), but when I finally did get in, it was AMAZING not to have to pay through the nose to see a doctor. I was also astounded the first time I got a prescription and only paid six pounds for it. I still miss that. (Not to mention the fact that every time I visited the women's health clinic at Hammersmith Hospital, they'd insist on sending me out with an entire bag full of free birth control pills and condoms.)

Now I'm in Australia... which seems to be heading towards the American system, and away from the British one. It's still possible to see the doctor here without paying any money. There's still a safety net for families that spend a lot on prescription drugs. The government wants people to go on private health insurance though, and we eventually caved (mostly because they penalize you if you don't get it by the time you're thirty). I still don't pay nearly what my family in the US does, and I have the luxury of knowing that if I did have a major health issue, there are still public hospitals here that would take me without question. (I remember nearly falling over on my last visit to the US when my Mom told me that not only is Zyrtec - which I take regularly for allergies - only available by prescription in the US, but it costs double or triple what I pay for it here. That's nuts.)

Needless to say, I feel a lot more confident about my health care options outside the US.
posted by web-goddess at 6:01 AM on July 6, 2007 [1 favorite]


Well.. I read through the above mentioned thread.. and I think the conversation evolved into a theoretical debate.. and away from detailing concrete experiences..

So.. if people don't mind.. post them here.

thanks!
posted by cowmix at 6:15 AM on July 6, 2007


Here's my anecdote:

A couple of years ago, my sister and I both had our gall bladders removed with laproscoptic surgery. I, with my USian PPO, had to wait approximately 2.5 weeks to get my surgery scheduled and done. She, an American permanent resident of Canada, had to wait about 9 months due to paperwork regarding her immigration status, and then another 2 months to get the surgery scheduled and done. I think I got the better deal there.

On the other hand, both my sister and her husband work part-time jobs and spend the rest of their time pursuing other interests. I'm tethered to a boring desk job because I can't afford to be without insurance. She wins.
posted by donajo at 6:17 AM on July 6, 2007


I'm sure it's in something like a postwar mess now still, but even in my former (and relatively poor by European standards) country of Bosnia, the healthcare was generally superior, at least in terms of cost (basically free), accessibility (never had to wait long to see any medical professional) and general sense of security. The American health care system is rather sad, I feel - expensive and not much better than Bosnia's (a little maybe, but certainly not worth the added expense, the hassles of getting appointments and so on.)

I'm in Hungary now, and I made a friend here yesterday from America who is here to get his teeth fixed. Hungary is famous for its fogorvosok" ("dentists," but more literally "tooth doctors.") He reckons it will cost him about 20% of what it would in America; he doesn't have American dental insurance. It's interesting that Moore did not touch on the popular "medical tourism" issue. But many Americans come here for dental work.

Back to Bosnia - I wouldn't trade the health care I got there for the American equivalent (though I can't comment on the situation now), except perhaps if I had some crazy rare form of cancer or something like that. And Bosnia is poorer than Hungary, where the average person makes less than $500 per month - but still, they've got "free," high-quality healthcare. The US system is messed up!
posted by Dee Xtrovert at 6:22 AM on July 6, 2007 [1 favorite]


I'll just note some actual history: prior to the introduction of universal healthcare in Canada, Canadians were fairly skeptical of the idea. Today, they LOVE it. (Polling data, before and after.) The politician in Saskatchewan that passed the very first province-wide universal healthcare plan is revered as a sort of demi-god -- he died 20 years ago and was recently voted the greatest Canadian of all time.

I cannot promise that results in the U.S. would be the same. If the Republicans were running it, they'd do their best to screw it up. Universal healthcare is something good and tangible that the government does, and it helps poor people more than rich people, so Republicans would be strongly against it and they'd try to sabotage it at every turn. Probably you'd need a decade-long stretch of non-Republican government in the U.S. to get everything started on the right foot. Once it was going, you might have to guard it from Republicans in power or you might not - in Canada, slashing healthcare budgets is much more of a political live wire than cutting Social Security would be in the U.S., so even the conservatives in Canada are pro-healthcare. But if you got it going well.... Americans would love the results. The political party that diligently and without trying to sabotage the results implemented a universal healthcare system would be the favorite at the polls for the next 50 years.

(Although I have not seen Sicko, I expect that it is a largely accurate comparison of the systems involved, with a focus on the worst of the U.S. system that is slightly unrepresentative, and I wish that Michael Moore would hire someone else to narrate his movies, as his smarmy voiceovers tend to ruin what could have been good movies.)
posted by jellicle at 6:25 AM on July 6, 2007 [2 favorites]


Just for Canada, our health care system seems to be in a state of crisis right now. Regular surgeries such as knee and hip replacements are scheduled six or nine months out. MRI? Four to six months. Once you are in, you will find that doctors and nurses are overworked and have little or no time. Some small towns (pop'n around 5 000) don't have doctors because physicians can make more money elsewhere (like the US) and aren't interested in working for a standard fee. Many doctors will make an appointment to change a bandage simply because they can charge for a visit.

Critical care however remains as good as one could expect, and this is a tribute to the dedication of the doctors and nurses in the IC units.

The idea is that we have a flat system, where everyone participates and receives equally. The ironic thing is that sports figures, politicians and well known Canadians tend to go to the front of the line for care but the rest of us can wait. Those politicians who would argue the loudest for equality are also those tend who jump to the front.

If Canadians could wake up to a systemic secondary pay for care system, it would take a lot of strain off the public care system. Don't get me wrong, Canada has done a lot of things right - but with aging boomers who have a little more disposable income and who don't want to wait "pay for care" could be a viable option.

Lots of Canadians are travelling outside of Canada to get elective surgery done. Dental work in Mexico(admittedly not part of the medicare system), knee replacements and MRI's done in the US, and these are people I personally know.

I haven't seen Mr. Moore's film, but things aren't all roses in Canada. We have a lot of problems with our health care because of the false idol of universality, and its getting worse instead of better.
posted by fox_terrier_guy at 6:38 AM on July 6, 2007 [1 favorite]


A few years ago, I, a U.S. citizen resident in Sweden, had surgery to remove part of my thyroid. I had to wait 9 months from the original checkup (for work) where the doctor noticed that the thyroid was enlarged until the surgery. About the first half of that was spent being sent from the first doctor to another GP at my local health care center, then from her to doctors at the hospital for enough testing to establish that I needed the surgery. After that the official waiting period for the surgery was 3 months, and I think it ended up taking a little longer. Along the way there was some kind of snafu where the local health care center dropped some of my paperwork and I had to call and find out what was going on a few times. The total charge for all of these visits and tests was about $20.

I went in for surgery early one morning. I spent that night in the hospital and went home the next afternoon. I wasn't given any painkillers after the surgery--I didn't have that much pain and it didn't occur to me to ask for them. I got a bill in the mail after a few weeks for about $15.

When I told my doctor before the surgery that the thing I was most apprehensive about was having to take hormone replacement medication for the rest of my life, he said that I could try not taking them and see how I felt. I would continue to have yearly checkups and if the bloodwork was all right and I felt fine, there was no need for me to take the medicine. That has been the case.

There were, again, problems with the local health care centers not calling me to arrange the checkups. This time, the hospital hadn't sent along the paperwork in a timely manner. Almost a year after the surgery, I got a letter from my local center saying they had just received a letter from my surgeon directing that I have regular checkups. In the meantime I had taken the initiative to call them myself. The situation was probably complicated by the fact that I had moved in the interim, meaning I was now a patient at a different center.

My mother had the same surgery about 20 years ago in the U.S. She was about 5 years older than I was. She is a U.S. citizen and had health insurance. She told me the surgery was performed within a few weeks of the diagnosis. She was given some kind of pain medication in an IV after the surgery--she woke up with it alread started--and spent at least one more day in the hospital than I did. Her doctor told her that medication would be necessary, and she has been taking it ever since. I don't know what the total cost was for her. Obviously it was many thousands of dollars.

The quality of health care in Sweden is exemplary. The hard part is getting access to it. You start off the process by calling to make an appointment at your local health care center. Depending on where you live and how overworked the center is, this can be easy or almost impossible. Different centers have different systems. Sometimes there is a central number to call where a nurse answers. Typical telephone hours are 8.30-9.30 a.m, anywere from 2 to 5 days a week, with perhaps another hour in the afternoon. I also lived in one place where you had to call one of the doctors at the center (your choice of six) directly. They all had different telephone numbers and different hours when they answered the telephone, again typically for one hour in the morning, two or three days a week. Almost always, no matter when or who you call, the line is busy. I have frequently spent 8.30-9.30 dialing and redialing uninterruptedly and getting only busy signals. At exactly 9.30 the recorded message stating the telephone hours comes on again. This kind of situation is very, very common here, especially in the cities, and very, very frustrating. People frequently turn to the emergency rooms for non-urgent complains because they simply can't get through to their health care center. This puts a strain on the emergency rooms and waiting times can be very, very long.

The few times that I've had to go to the doctor during visits to the U.S., I've called the doctor's office, any time of day, spoken immediately with a secretary, and gotten an appointment the same day or the next day.
posted by bluebird at 6:54 AM on July 6, 2007 [1 favorite]


Indeed, while I am supporter of universal health care in Canada, the waiting lists are becoming an increasing problem... last year the Supreme Court addressed the issue, and found that a ban on private health insurance in conjunction with a public healthcare system that was, in effect, insufficiently funded, was a violation of the Canadian Charter of Rights (Chaoulli v. Quebec).

It remains to be seen what the fallout of this case will be. It is unlikely to shake the bedrock principle of free universal healthcare for all those who need/want it, but it may have some impact upon the delivery of that healthcare.

The great conundrum in all universal health care systems is how to combine market advantages (efficiency) in delivery, while maintaining health care's "free" status to the recipient.

Canada's govt has two choices -- either dramatically ramp up the funding of the universal health care system so that wait times drop, or attempt to embrace a more market oriented approach that will drop wait times, but still maintain universality. Both options are frought with political danger, and explain why Canadian healthcare has been ideologically "stuck", despite its evident flaws.
posted by modernnomad at 6:57 AM on July 6, 2007 [1 favorite]


My anecdotal experience is that hospital experiences in the US vary greatly depending on the neighborhood. I've waited hours in downtown Washington DC hospitals for some procedures, but whisked right through the doors and straight to a doctor for others, without stopping for paperwork along the way.

In suburban hospitals in PA, MD, and VA, my experience is that there is no wait either in the ER or to schedule an appointment with a specialist.

So while I have no experience with the Canadian system, I don't think you can generalize hospital experience in the US. Public hospitals are usually run by cities, and some cities are better run than others. Many hospitals are university run, many are private or religiously affiliated, and they all are run differently, some more efficiently and effectively than others.
posted by Pastabagel at 7:02 AM on July 6, 2007


Things aren't all roses in Canada, to be sure. There are wait-time problems and certain access issues. But most of these can be solved, and slowly but surely they are being solved IMO.

There's a deep paradox, though, that is evident when comparing the centrally controlled Canadian system (systems, really, each province has its own) and the supposedly "free" US system (not free as in $$ of course). In the US, it is my understanding that access to physicians is much more tightly controlled than in Canada. One's insurance company tells people which physicians they can and cannot see, and getting around that is a big issue (and we have seen that here in Ask MeFi for years).

In Canada, you are free to see any physician who will give you an appointment, period. There are shortages, and many if not most specialists will require a referral from a GP, but there's no central organization that vets your choice of physician in any way or tells you that you must see one from a certain list. Such lists, I understand, are the norm in the US.

So in a way, it has always seemed to me that the US system actually does restrict access to physicians much more than the so-called socialist Canadian system does.
posted by mikel at 7:07 AM on July 6, 2007


Don't believe the hype about the NHS (British National Health System). It's a damned good system, but it's very far from perfect.

It's free at the point of use. All working British people pay National Insurance, which is deducted from our wage automatically. Effectively we're paying for health insurance. We just don't do it privately. It's currently around 7% of earnings, I think. And employers also pay a contribution on your behalf, which I think is about 3%. So if I earn £1000 (US$2000) a month, £70 (US$140) is deducted for National Insurance. And that's before tax, which averages around 20% for most ordinary workers. Don't forget the 3% the employer pays for you too, behind the scenes.

Incidentally, even NI payments don't pay for the NHS. More money has to come from tax. The NHS eats money. It's the UK's biggest employer.

Don't think we Brits can walk into hospitals for treatment, or that the hospitals are top class. There are "waiting lists" for all kinds of popular operations. My mother badly needs a knee replacement. She can barely walk and is in constant pain when she does. She has to wait six months for an operation. There are many, many horror stories like that. People die while waiting for operations.

Hospitals aren't top-class either. They're notoriously dirty and there have been several outbreaks of nasty life-threatening bacteria recently. You'll be wise to know which hospitals are good, and which are bad. My sister won't go near a particular hospital in her locality. I've been told not to attend one near me, and ensure the doctor sends me to another a little further away.

We are unable to find staff in the UK population, so we steal a lot of doctors and nurses from overseas, particularly Africa and the east. We've been doing this for many years. Yes, in many cases those doctors are needed in their own countries, where medical professionals are rare, but the salaries we offer mean they would be foolish not to come over here.

Prescription charges are always rising but, yes, an ordinary person can get any doctor-prescribed medication -- even that costing thousands of pounds -- for a simple charge that's under £10 (US$20). I remember my teacher at school some years ago receiving an experimental migraine medication that cost something like £500 (US$1000) a tablet. All for the cost of a monthly prescription fee.

That said, most long-term and elderly people are exempted from prescription charges, so they get their medication free. Very few people actually pay the prescription charge, or so the government tell us when they keep bumping-up the charge.

ALL THAT SAID... I'm glad we have the NHS in Britain, simply because the alternatives sound horrifically worse. Because it's state funded, we can always rely on the NHS. If I chop my finger off while preparing vegetables, I know I can go to the nearest hospital and get treated very quickly. Ambulances always attend and don't care who you are, or what insurance you have. Generally speaking, you can get to see a doctor (GP) within a week, and sooner if it's something urgent.

That said, if I could afford it, I would pay for private medical care, which is still available in the UK in the form of Bupa. But comprehensive private medical insurance is expensive because so few people have it.
posted by humblepigeon at 7:13 AM on July 6, 2007 [4 favorites]


In the US, when my gynecologist decided I needed an ultrasound, it was done ten minutes later in another room down the hall. I needed one here and I was put in for an appointment, got a letter in the mail about two months later telling me when it was scheduled--which was another month out. This for a procedure that is non-invasive, can be done without removing your clothing if you are wearing hipster jeans, and took less than 5 minutes start to finish.

In the US, I needed a referral to a specialist. After getting the referral, I was given permission to choose the specialist from their approved list. I had to phone each one, find out whether they were accepting new patients, and make the appointment. When I arrived at the first appointment, I was told that they no longer accepted my insurance. I phoned the insurance company, and they told me that the doctor did. I finally broke down crying on the phone and said I was very sick and couldn't handle all of this work, would they PLEASE just tell me where to go. One of the insurance company's customer service people took pity on me and did that, but I don't think she was supposed to. In the UK, when I got a referral to a specialist, I just waited for the letter to show up in the mail (just like the ultrasound above). It took a bit longer to get in to a specialist, but it was nice not to have to deal with it myself! Also, the specialist writes to my GP, so all of my medical records are in one place.

The hospitals and doctors office in the US are new and shiny. In the UK they are very old. My doctor's office is in an old converted house. These structures are more difficult to keep sanitized than modern purpose built structures, so there is a big problem with antibiotic resistant infections in the hospitals.

In both countries there is the same problem with getting approval for the care you want if it's very expensive, it's just that the Horrible Mean Evil person who turns down your care is the local trust instead of the insurance company. The problem, of course, is that the cost of treating one very sick person with a costly treatment that has a small chance of success will pay for a lot of moderately sick people who need standard treatments. But if the very sick person is you or your loved one, then you want to take even that small chance of success.

Private care is available if you want to pay, and private medical insurance is available. I can actually get it free through work, but would have to pay income tax on the value of the insurance. I was astounded to find that the cost of the insurance was more than my employer in the US was paying for my health insurance, and it covered a LOT less. Ultimately, I turned it down because it covered so little and the taxes would be so high.

I can't tell you which is better. From the perspective of a patient, this system is certainly easier, but I believe I got more advanced care in the US.

On preview: Some people have trouble getting a GP to take them on in the UK. I was able to get right in as a patient of my husband's GP, but was led to believe that they weren't taking new patients who weren't family of existing patients. I'm not sure how difficult it would be to get a new doctor if we moved to a different part of the country.
posted by happyturtle at 7:15 AM on July 6, 2007 [2 favorites]


One thing I forgot to mention: We have a terrible phrase in Britain, which is, "go private".

This means that you get so tired of waiting for an operation on the aforementioned waiting list -- or you're in so much pain -- that you pay for the operation yourself. You pay for private medical treatment. This is usually in the range of thousands of pounds (so if it's £3000, that's US$6000). Doctors will mention this possibility during the initial consultations.

"Going private" is become more and more common.
posted by humblepigeon at 7:16 AM on July 6, 2007


I think the problems in Canada are two-fold. A good portion of it is being abused. Universality IMO opens the floodgates for healthcare services being used unnecessarily (for instance, the last time I needed some pharmaceuticals, instead of giving me the prescribed amount the pharmacist saw fit to throw in a few extra vials "just in case". These were $80 a piece.).

Either that is simply through frustration with such a rigid system, or the supposed "free-ness" of it all means that those services lose their intrisic value which costs us all. Sadly, people are increasingly holding value only to those items that cost them more and more cash.

Second, the system is flush with cash. Healthcare spending has increased each year (perhaps not as much as it should, but it has increased) but the increasing layers of bureaucracy have also increased. I believe that if you were to evaluate the costs of treating one patient today (from top-to-bottom) it would be a lot more expensive today then 20 years ago even after inflation adjustment. For instance, the insurance companies are the primary beneficiary of the Canadian healthcare system.).

If you increased the awareness and respect for the institution by highlighting the cost per visit or drug dispensed and then relating it to individual tax burden you could possibly solve that problem. If someone was to really tear open the n-th level bureacracy surrounding the healthcare system (particularly the insurance end) you would probably find billions in wasted dollars that could be better spent elsewhere.
posted by purephase at 7:19 AM on July 6, 2007


Personal experience: Ex-wife had a myriad of health problems, both physical and mental. (Hypochondria among these.) There was never a problem getting health care, and my insurance (Blue Cross) was fine other than a normal amount of bureaucracy. (Occassional requests to fill out another form, etc.) Most visits were covered by $15 co-pay, and most prescriptions cost very little out-of-pocket. A few prescriptions, usually newer meds, could be expensive. Few complaints, really, but I attribute this to having good insurance, and nearly every provider in my city is part of the Blue Cross "Preferred Provider" network.

Gall bladder surgery, and a couple others required a phone call to pre-approve, but I never had the "that's not covered" nightmare that many talk about. The cost of my insurance is about $300 per month to cover myself and family; my employer pays the rest of the premium. (I think the total is $600 a month, as part of a large group.)

I have never had medical care outside of the US. My only 2 Canada-related anecdotes:

A friend from Canada had to come to the US for surgery because there was not a qualified specialist for her condition in Canada.

Also: A Canadian couple I know always says: "Don't believe Canadian health care is free: we DO pay for it in taxes!" They also come to the US for a lot of their care, because they can afford it, and they say that other Canadians they know who can afford to do the same.

I have needed very little personal health care, but any time I have, or my daughter has, it has been good. My regular physician is excellent.

My latest issue did have a problem, however. I went to hospital walk-in care for chronic elbow pain. I was x-rayed, then diagnosed by a Physician's assistant, who looked at the x-rays and said I had early onset arthritis, and there was not much I could do about it. The pain persisted, and my regular doc referred me to an orthopedic doc. One look at the x-ray and he shook his head in disbelief at the arthritis diagnosis. He showed me the x-ray as well, and there was absolutely no sign of arthritis. The PA had earlier mistaken some minor, normal calicification, nowhere near the joint, as arthritis. Actual diagnosis: severe tennis elbow in both elbows. He gave me some stretching routines to do, and those have worked incredibly well. My pain is now 10% of what it was, after only a couple months. That was a $15 co-pay well-spent. Punchline: I had to fill out paperwork for my insurance company for the walk-in visit to confirm it was not an injury caused by work or some other responsible party.
posted by The Deej at 7:25 AM on July 6, 2007


I'm a very healthy 30 year old woman who has had good, decent-paying jobs in big cities since I left college. So that colours my responses.

I lived in the States (NYC) for seven or so years and had absolutely excellent care. Great choice of local doctors, getting GP or specialist appointments whenever I needed them (day or night), great quality of care/follow up/willingness to talk about general health and prevention during visits, etc. The constantly changing benefits - ever-higher contributions from my paycheque, higher co-pays, my employers switching around plans every year or so - was a huge pain in the neck, from a personal administrative point of view, and friends with kids seemed to have this worse. But no issues at all with the excellent care or nightmare insurance stories, either from my or my husband's point of view.

I've live in Canada (Toronto) for the last couple of years, and can't find a doctor accepting regular patients, which really sucks. I aso have issues with some of the hours the doctors and clinics I've tried are available, and have felt very rushed in and out on visits, like I'm holding them up. It seems to us that doctors aren't interested in discussing general health or preventive care. Just, problem, brief advice, NEXT! Again no nightmare stories and friends rave about the care they've had while pregnant. I hope like hell I age healthily and don't need any of those waiting-list tests.

I'm from Ireland, and have had limited need to see doctors there, but am appalled by the bed shortage in such a rich country, the way the profession holds up an increase in doctors (similar to Canada, of course!) and the care given to elderly parents of a couple of friends. My parents have had really good care in the private system there, and think the nurses particularly in both the public and private hospitals are outstanding.

(BTW, the dental care I've had in Canada is light years ahead of that I had in either NY or Ireland, but that may be the luck of the draw).
posted by jamesonandwater at 7:39 AM on July 6, 2007


I don't have any anecdotes to share, but I have been following the response to Sicko on numerous websites. What I think is telling is that there are tons of Canadian and British letters-to-the-editor where they bitch and moan about waiting lists and problems with their systems.... and then they all conclude that they wouldn't trade it for our system any day of the week.
posted by bradbane at 7:48 AM on July 6, 2007


I aso have issues with some of the hours the doctors and clinics I've tried are available, and have felt very rushed in and out on visits, like I'm holding them up.

I think this depends on your doctor, not on the system. My doctor explains everything thoroughly, with charts and anecdotes, and often goes off onto tangents about maladys similar to one's own. I'm in Toronto.
posted by dobbs at 8:05 AM on July 6, 2007


To those of you pointing out the obvious that universal healthcare doesn't magically grow on trees and in fact is funded by taxpayers it might be worth noting that per capita spending on healthcare in the US is much higher than in any other developed nation.

This Commonwealth Institute comparison of Australia, Canada, Germany, New Zealand, the Uk and the US might also be of interest:

http://www.commonwealthfund.org/publications/publications_show.htm?doc_id=482678

It compares quality of care, access, efficiency, equity and healthy lives.
posted by ninebelow at 8:05 AM on July 6, 2007


I grew up in the US and moved to the UK five years ago.

In my experience, the UK is top-notch for two kinds of medical problems:
1. Problems that do not require specialized expertise or equipment. If I have (say) an ear infection, I can walk into my GP's office and get it treated the same day.
2. Problems that must be solved immediately or you will die. If you are hit by a car and rushed to the hospital, you'll get exactly the same quality of care here you would in the US.

The problem comes in a third category: things that require specialized expertise or equipment, and that are not life threatening in the short term. For example, mammograms. For any individual woman, having to wait an extra day for a mammogram is unlikely to be the difference between life and death--but spread that probability over an entire population, and keep adding extra days onto the waiting time, and it is virtually certain that women will die because their breast cancer was discovered a little bit too late. Obviously this is a deeply chilling thought.

This points to the big dilemma of a government-funded healthcare system. Government health budgets are finite. If you have to choose between funding one treatment that will save 1000 people from blindness, or another that will save 10,000 from death by heart attacks, obviously you spend it on saving those 10,000 lives. But if you are one of the 1000 people who go blind as a result of that decision, it seems terribly callous. Of course, those 1,000 people always have the option of "going private" and paying for the treatment themselves--but not all of them will be able to afford it, and then you're facing the inequalities that a socialized health system was meant to prevent.

I really don't have any easy answer. I don't think the socialized medicine is the magical, fix-everything solution that some Americans might hope, but nor is it the terrifying, health-destroying blight that some Americans fear.

Just to bring it back to the practical experiences you were asking for: I guess I would say that, on balance, my experience in the UK has been more frustrating than when I had a really good private health plan in the US... but much less frustrating than when I had an HMO in the US.
posted by yankeefog at 8:08 AM on July 6, 2007 [1 favorite]


(Canadian who lived in the US for a few years)

(in Canada) many if not most specialists will require a referral from a GP

This is true, but there's a notable exception in obstetricians. If I don't like mine , I'm free to cherry-pick to my heart's content. Certainly I haven't encountered any waiting lists among obstetricians (midwives here are a different story, but they are at least covered), or any hassle in switching among them a couple of times.

Same with hospitals; living in the US, I'd have been driving to Insurer-Approved Hospital X for anything that came up, or dealing with non-trivial hassles to be seen elsewhere. Certainly I would not now be hospital-shopping for the nicest maternity ward if still in the States.

Anecdotes:

I had a couple of inexplicable seizures a few years ago, in Canada. I had a CAT scan done a few hours after the fact.

I was sent for an MRI once here; the waiting list was horrifying. I paid to have one done the next day in a quasi-legal private Québec MRI clinic.

I had a cystoscopies done in the US and in Canada. US: in-office procedure with local anaesthetic, sent wobbling into the parking lot immediately afterwards. Canada: general anaesthetic, hospital procedure (this is getting very anecdotal, but: when recoverd and nicely doped up, wheeled all the way to friend's waiting car). A D&C apropos of a miscarriage in Canada was also a hospital thing with general anaesthetic and an overnight stay (Mr Kmennie spent the night in an easy chair in my room; no charge); I understand that's not the norm in the US. I do like me my general anaesthesia...

I wouldn't go back to what I had in the US, which I was given to understand was fairly good as it goes there. I could never figure out how most people could afford health care there. Asthma -- mild asthma that's never, ever caused a problem -- meant a ridiculous premium in what I paid every month; I shudder to think of what that would've been if I was actually sick. And the "pick a doctor from this list" crap was ridiculous; ditto being forced to use some really awful chain pharmacies to get drugs covered.

(I grant that drugs are not covered here in Ontario. But I don't know many people with jobs -- even lousy jobs, or whose parent or spouse has a job, who don't have drug coverage. There are programs to pick up the cost for the poor and retired/unemployed/uninsured. I have American in-laws, not young folk, and prescription costs are a huge part of their budget. And worry.)

On preview: yankeefog makes an excellent point. That said, what the cystoscopies were looking for went undiagnosed and 'treated' with some unpleasant drugs in the US. Here, I saw one specialist, got the feeling she wasn't any better than the US guy, quickly found another, and, problem solved. The US guy was supposed to be "good," too. I'm sure he had a very nice car... Some of the US specialists I saw were clearly a bit too money-oriented. I was and remain thoroughly skeeved out by how many doctors' offices had things being sold in them in the US -- vitamins, skin care stuff, etc. No doctor here has ever tried to sell me anything.
posted by kmennie at 8:46 AM on July 6, 2007


My only anecdote of health care in another country is years old: in my early 20s, travelling in Ireland, I got a bad sinus infection. Went into a local GPs office in a small village, was seen immediately and given antibiotics. Total cost: about 5 pounds or roughly $15 in those days. I could not believe it. In the States I had to keep going back and back for tests and more tests until they finally decided I had a bad sinus infection conjoined with mono and gave me antibiotics and told me to stay in bed for a while. My parents paid for that - I have no idea how much it cost. Thousands, probably.

I've had plenty of horrific run ins with the US system and I must say I'm completely amazed at all the commenters above who have no trouble or wait getting in to see a US doctor. Yankeefog says that routine mammograms take forever to get in the UK? The last time I went to the gyno here in NC for a checkup (which was incidentally the first time I'd been in three years because for those years I didn't have insurance and I also didn't have the $200 an office visit that my gyno charges) they scheduled a routine mammogram for me: in 3 months. Which was the first available appointment. And I had to cancel it when something else came up and the next one available was another 3 months down the road. Judging from my friends' experiences, that's totally normal here.

I assume that if I call my gyno, who's the equivalent of my GP, that it will take a minimum of 3 weeks for me to get in to see her. I've broken down sobbing on the phone before to her office begging to be allowed to pee in a cup to be treated for a UTI. They finally did let me come in but I didn't get to see an actual doctor; although she did phone in a prescription. Eventually.

This is not uncommon. Maybe Asheville, with a huge percentage of retirees, has longer wait times than other cities but I doubt it - my experiences in Baltimore were similar.

Here in Asheville, it took months to get my elderly mother diagnosed with colon cancer last spring - appointments were so difficult to come by and then there was fuckup after fuckup after fuckup, compounded by the fact that the (expensive) clinic she goes to, which is the only one approved by her retirement community, changes doctors every couple hours and so there was absolutely no continuity. Sure, when they finally figured out that she was really sick - which coincided with me screaming loudly enough, you have have have to have an advocate in today's US medical system - she got surgery quickly. But let's not even talk about what wasn't covered by Blue Cross and Medicare, because it's so depressing.

And my son needed a plate put in his arm when he broke it two years ago. After Blue Cross kicked in their share for the surgery and one night in the hospital, they still wanted about 5 grand from me, which was a major contributing factor to my bankruptcy. Last week I got another bill from the hospital for that, out of the blue: $600. That will take me at least a year to pay off. And this was when I was having $300 a month taken out of my paycheck to cover us both.

Nowadays he isn't covered - I can't possibly afford it. I can hardly afford my own portion of insurance but if I don't have it they'll discontinue my company, since we're so small we only get insurance if every worker agrees to take it. That would put one of my coworkers, who has a heart condition, out on the street in deep, deep shit. So I pay. I hate the American system passionately. I don't even need to see Sicko to know that.
posted by mygothlaundry at 8:58 AM on July 6, 2007


having grown up in germany, I was somewhat surprised to go to the dentist in america and have the doc pull out a pocket calculator mid-session, type something into it and say "that'll be $450 - that ok?"

I had chosen the best insurance option my employer offered at the time - a premier PPO plan without referrals and with a comprehensive dental and vision coverage. it took a load out of my paycheck but the dental apparently was capped at $1500 per year. who would have thought.

someone I know had the same insurance when he was slammed by a wave onto a rock while surfing. he ended up paralyzed and flown across the country to a rehab facility on the east coast (kessler, I believe), where he died from an infection roughly six weeks later. this dude was making six figures and was in is early thirties, yet his mom ended up declaring bankruptcy over the cost. that something like this could happen to a well-to-do and insured person came as a complete shock to me.
posted by krautland at 9:06 AM on July 6, 2007


Just to add another anecdotal data point - I'm a US citizen who is temporarily living in Canada, and I vastly prefer this system. I've only had routine care and it has been top-notch - better than my HMO in the States was - and I've never had a significant wait.
posted by Staggering Jack at 10:19 AM on July 6, 2007


I have free private health insurance through my employers. What this means is that I have a GP who is NHS, but he can refer me if I have insurance (or want to pay) to a private hospital. I also pay National Insurance to the NHS, deducted direct from my pre-tax pay.

A few years ago I needed an operation. Nothing life-threatening, but something that was affecting my daily life to an increasing extent. My doctor gave me an appointment to see a surgeon at the local NHS hospital. It was several months before I got the initial appointment.

I saw the surgeon who agreed that yes, I did need the operation. On the NHS the wait would be around two years. But if I could go private ...

So I went private through my employer's insurance and had the operation within weeks, in a beautiful private hospital, where I had my own room and private bathroom, delicious food, and the patient/nurse ratio was about 4:1.

Had I had it done on the NHS, it would have been at my local hospital, which is an ancient Victorian edifice. I'd have been in a mixed (yes, you heard right, mixed) ward of around 30 beds, sharing 5 toilets.

I remember being shocked to the core the first time I ever visited someone in that hospital. I thought that a mixed ward meant, well, all the men at one end, then a nurse's station, then all the woman at the other end. But no, men and women were mixed side by side, many of the beds had no curtains (or they were ripped and holey) so there was no privacy or dignity for many patients. The only bathroom had two baths side by side that were meant to be used by two patients at a time with one nurse supervising. It seemed as if the patient/nurse ratio was at least 15:1, with no more than three nurses on a ward.

Those patients who were ambulatory were expected to take other patients to the toilet, and to help serve food. I remember thinking that I would rather crawl away dying from that hospital than ever choose to have treatment there.

But if I was in an accident, it's that hospital to which I'd be taken. There are, as far as I'm aware, no emergency care private hospitals in the UK. All emergency care begins at the NHS.

I am one of the lucky ones who has a choice. And by going private on my employer's insurance, I freed up a space for an NHS patient. I couldn't afford my own private health insurance, but more and more employers see it as a necessary expense because they can't have ill staff waiting months or years for treatment.

As it turns out, the decision I took to go private was completely the right one. The pathology on the organ that was removed showed pre-cancerous cells that no scans or tests would have detected and that would have metastasised within months. Had I waited two years on the NHS, I'd be dead by now.
posted by essexjan at 10:31 AM on July 6, 2007 [1 favorite]


Just for Canada, our health care system seems to be in a state of crisis right now.

It's been my understanding that primary problem with the health care system in Canada is the health care system in the States. Doctors are leaving Canada to "make it rich" in America, which is what's resulting in the long waits and such in Canada. Were the US to implement a sorely needed socialized health care system, the Canadian system would "bounce back" since there'd be no benefit for doctors to leave the system.

That being said, don't let 'em fool you. We already have socialized health care in the state, it's just not easily acknowledged. You can get emergency care at any hospital, and it's illegal for them to refuse you service due to lack of insurance. Then, just don't pay. Those with health care carry the cost for you, they just don't do it through taxes like other countries. :)
posted by Spoonman at 10:33 AM on July 6, 2007


Just another data point -- this is purely my personal experience and it may not be representative of anything:

I'm American, currently in the process of gaining permanent resident status in Canada. I had no problems at all with my American health insurance. I had a great, thorough doctor who was always able to see me, who gave referrals to great specialists, and who had a clean, modern office. The most my co-pay ever was under any plan was $15; though it was usually $5 (and was lowered to $0 around the time I moved). I have been to the emergency room twice as a kid (once when I put my hand through a window and severed a couple arteries, once for a very badly broken arm), and although I don't know how much it cost my parents, they definitely weren't struggling under the weight of the bills. Both times I was seen immediately and well cared for. All of the prescriptions I've needed have been covered by my insurance, costing between $5 and $7 per fill (which was usually a month's supply). I once needed an MRI for something -- I don't remember what -- and all I had to do was go down the street and get it done the same day my doctor requested it. Same thing for blood work, x-rays, or any other diagnostics.

My limited experience with the care available in the part of Ontario in which I now live has not been as favourable, however. I do not have a high opinion at all of my husband's GP. My husband will go in with relatively complex problems (he's had chronic undiagnosed back and knee problems for years now) and come out literally five minutes later with a prescription for painkillers and nothing else -- no tests run, no plan for follow-up, no diagnosis, no explanation. My husband reports that his GP barely asks him any questions before writing the prescription, and has actually declined to refer him to a specialist (no reason - just "no, you don't need one"). The one time we have been in an emergency room here was a terrible experience: my husband hurt his back somehow and it was so bad he couldn't walk, so we brought him to the emergency room. There was not one other person in the waiting room, and from what I could see most of the ER rooms were empty as well. It was dead quiet and yet it was over two hours before we were seen. My husband kept passing out from the pain and when I asked the triage nurse if there was anything that could be done she curtly told me to just wait (and returned to standing around and chatting with another staff member). When we were finally seen, he was just given painkillers, told to rest, and released. In general, I've also noticed that the hospital and doctor's offices I've been to have older equipment and are more run-down looking than what I'm used to in the States. The office where I had to go for my x-ray for my immigration exam was actually dingy and I'm not sure I'd like to have anything done there that involves anything internal (blood work, etc.) because it really did seem a little grimy. I do not, however, have OHIP yet, so that is the sum total of my experience with Canadian health care.

Some things to consider along with my observations:

I am from a middle class family in the States. I lived in a mid-sized city with a pretty good university medical school in it as well as a highly respected cancer research hospital (which I'm sure had an effect on the quality of doctors in the area). I think our health care plan was pretty standard for a salaried professional's benefits package -- not unusually good, but definitely not bad. My parents are both in the medical profession, though (Dad is a biomedical engineer and Mom is a nurse) so they may be able to advocate for better medical care within their plan than someone without specialized knowledge.

I have no experience with severe illness (cancer, etc.) while under US health care. I do not know to what extent these things are covered by my parents' health care plan.

My husband and I live in a small city in southern Ontario; there are much better hospitals (and I would assume doctor's offices as well) in Toronto and other big cities although I have no personal experience with them.

If I had to choose based strictly on my experiences, I'd take my old health care in a heartbeat. As it is, we are looking to re-locate to the Toronto area and the quality of health care is a big factor for me.

Finally, I don't think that the flaws of the Canadian system are an indication that socialized health care is bad or not a viable option for the US -- I just think that it shows how important it is to adequately fund and staff such a system. I think these problems should be learned from, rather than held up as an example of why socialized medicine doesn't work.
posted by AV at 10:53 AM on July 6, 2007


Spoonman: Yeah.. if you have NO insurance.. it sorta works the way you say ie. you can get 'free' healthcare. but if you are insured... a hospital can refuse you and MAKE you go to your 'in network' hospital if on is 'near'.
posted by cowmix at 10:55 AM on July 6, 2007


as a Canadian who is currently living and working in the US, I can't provide a lot of measurable anecdotes as I've been blessed with good health. however, I can confirm from my parent's experience (they live in Vancouver) that complaints about long waits for specialized care are common. however, the brain drain of doctors to the States is a bit of an exaggeration.

I've had a couple of high school classmates who went on to become doctors with the possible idea of moving to the States, thinking that it would have been the best of both worlds -- cheap, socialized Canadian education with grand American salaries. Turns out, of course, that in order to practice medicine in the States, you still need to be licensed and complete a medical residency requirement first -- and that to begin a medical residency, you need to have a green card which, short of marriage, is tough.

where the brain drain could be really hitting Canada hard, though, is with nurses. With the TN visa established by NAFTA, Canadian nurses have free pass to work in the States indefinitely; and I suspect that a lot of the staffing bottlenecks that one sees in the Canadian healthcare system is partially related to a shortage of skill nurses on staff.

With that said, I would love to see the US move to a socialized model both to even out the brain drain inequality, and also to remove all of the stupid distortions that workplace healthcare benefits adds to my compensation.

I may not pay as much in American taxes or in payroll deductions for my Blue Cross/Blue Shield plan, but that's only because I don't know how much money my employer is giving to BC/BS that would instead be going into my paycheck.
posted by bl1nk at 11:25 AM on July 6, 2007


Just my personal (recent) experience as a Canadian: Recently, I've been in the ER for both chest pain and what they suspected was a stroke. ie - big scary things. In both cases, I was in and getting an EKG within 20 minutes; they move when they think they need to. Once I was in and it was apparent I wasn't going to die on them, however, the waiting began. Both visits turned into 6-7 hour affairs, waiting for different doctors, test results, yadda yadda. As it turned out, I'm relatively fine; the chest pain turned out to be inflammation of the ribs, and the 'stroke' was actually a TIA and got me a office visit within a week with the neuro who saw me in the ER.. The same visit would have taken 3 months to get if originated as a referral from my GP.

Given my neuro concerns (docs still worried I might stroke out, and wondering why...) several MRIs were in order. I had one in the ER, and the rest were within 2 weeks. Following that, I got in for extra CT scans, a lumbar puncture and an angiogram within 2-3 weeks of each of these being requested by my neuro.

Now that everybody's sure I'm ok and satisified I'm not going to drop dead tomorrow, however, things are different. I'm almost doing waiting 2.5 months to see another, more specialized neuro.

The short version: Canadians don't have to wait if it's an emergency. They do if the docs determine it's not life threatening.

Through all this, I'd be out of pocket approx $200 for some prescriptions, if i didn't have coverage. I can't complain in the slightest, and frankly, am really, really glad I'm not American. The MRIs alone would have cost me thousands if i had to pay for them. OTOH, not everyone I know looks so kindly onto the Canadian system, and just about everybody has a horror story or two.
posted by cgg at 11:42 AM on July 6, 2007


British, living in the US.

Is the NHS underfunded? Sure. Does it encourage a certain kind of 'doctor knows best' passivity? Yeah. But I think about my overnight emergency stay in hospital seven years ago (hooked up to IV antibiotics) or my mother's cancer treatment in the context of the system I've encountered in the US (a PPO), and shudder.

What strikes me most about the American experience is the culture of self-diagnosis and self-medication, because of the deductible structure and the fear of pre-existing conditions going on your record. That's all in the context of DTC drug advertising and the shilling of dubious supplements on television.

Doctors are much quicker to send you to the MRI machine, but that's $1,000 a pop and you usually pay for at least the first one. I can't help but see it as a nice little earner, and as part a tendency to trust the magic machines over old-fashioned doctoring.

I personally resent the American system from top to toe. I hate the way it turns every health decision into a complex set of choices, and turns so many of those decisions into bureaucratic wrangles over billing and access to records. I resent the clipboard-thrusting billing offices, and the repetitious filling out of personal information. Most of all, I hate the worry it engenders, because that's the last thing you need when you're already sick or injured.

It brings out the stubborn bastard in me: I'd sooner bleed to death in a ditch than give a penny to perpetuate this system.
posted by holgate at 11:50 AM on July 6, 2007


What strikes me most about the American experience is the culture of self-diagnosis and self-medication, because of the deductible structure and the fear of pre-existing conditions going on your record.

Totally!

I'm an American living in Canada, and my husband wants to go back to the US. I don't really want to, and a big part of it is the health care system.

I've had a great doctor here, and it's really upsetting to think about going back to health insurance hell, having to choose my doctor from a few on a list, being charged co-pays, and then having to worry about having the dreaded "pre-existing condition" on my permanent record, so that it's almost impossible to get private insurance. Then you are stuck in your job or with your partner, however you get insurance.

When my husband lost his job in the US, we had to pay huge amounts for coverage. What a great system. Get laid off and you get a huge additional monthly expense.

I'm not a particularly sick person, I don't go to the doctor much, but the stress of dealing with the insurance system of the US makes me really sick.
posted by Melsky at 12:19 PM on July 6, 2007


I'm Canadian, just outside the GTA and I haven't had too many dealings with OHIP (free medicare) but those I have had are pretty positive. When I brought my daughter to ER for a minor problem she was seen by a doctor within minutes, even before asking for her HealthCard; this also happened when I brought her with a (thought to be) major problem. My mummy fell in a pothole in a parking lot around 3 pm and broke her hip and had a new one put in at 8 pm, my dad had double (triple?) bypass surgery a few weeks after his heart attack. When my second pregnancy went horribly wrong in the last month I had numerous tests and specialists and extensive hospital care that I am sure would have cost thousands of dollars. I am so glad that during that stressful experience I didn't also have to worry about how I would pay for it. My hospital care has always been in a private room in a clean, modern building. For my third pregnancy I had genetic counselling, specialists, and tests that again would have been so expensive I would have chosen to have an abortion if I had had to pay for the special treatment. My midwives have always been fantastic, spending at least an hour with me for each appointment and available 24 hours a day. Both my husband and I choose to work in jobs we love part-time to spend more time with our children; without free healthcare one of us would have to suck it up and work just for the benefits, although with my husband's health history and my pregancy history, we would probably be uneligble for insurance at any cost. My sister owns her own business; she would never have started it up if she had to cover the costs of private healthcare for her family.
posted by saucysault at 1:54 PM on July 6, 2007


Well this brief note about my experience is going to be lost in the heap of enthusiastic responses to this popular topic, but oh well: I think there are a lot of problems with socialized medicine in Canada but they are caused by the lack of conversion of immigrant medical professionals into practicing medical professionals. This is extremely bad idea for inner cities in Canada because we have had a large influx of immigrants brought in with the hope that they will help us handle the aging and shrinking workforce... these immigrants are all stuck scrambling for general practitioners and specialists who can't take any more patients or can only do so many operations a year. I know people personally in Vancouver and Toronto who have waited so long for operations that they ended up dying of cancer and other diseases. So, on the one hand bravo to SiCKO for high-lighting the problems of private health care, but also do please look at the greener patch of grass with a healthy dose of skeptism.
posted by iheartcanada at 2:35 PM on July 6, 2007


This also hits close to home: premium offerings by medical practitioners and specialists are more often then not completely outside the coverage. OHIP only paying for hygienes when you'll temporarily need four a year to nurse your gums back to health. But then some of these premium offerings aren't sure to help (I am not pointing out hygiene appointments or anything, I am saying in general) your health along. It really depends on a whole lotta factors. In Canada we don't have laws that say you cannot over-worked for decades in a stressful environment, never eating right, and neglecting sleep and diet. You can do that. But if you do that, OHIP isn't going to be able to rescue you.

Your best bet, IMHO, is to place living ahead of money-making. If you want $$$, become an american.
posted by iheartcanada at 2:41 PM on July 6, 2007


Addenda to my earlier comment, to be complete.

My visit to the orthopedic doctor, as well as for my daughter, entailed a wait of 2-3 weeks, agreeing with other statements that specialized care for non-life-threatening issues can entail a wait.

My visit to the orthopedic was excellent, and the doctor absolutely did not push for unnecessary procedures or tests. Both the otho's PA and the ortho himself accurately diagnosed my issue within a minute, and as I said earlier, the treatment plan has been very successful

My daughter's ortho appointment was with the same group, but a different doctor. Her appointment was about 3 weeks out from the first call. She got x-rays in the office, and the doctor seemed very knowledgeable, and again, there was no rush to start unnecessary treatments or procedures. She was given a treatment plan to follow before they wanted to do any further tests.

If I were an anxious type, who wanted to know NOW what was going on, the wait for an appointment could be distressing.
posted by The Deej at 2:53 PM on July 6, 2007


By the way, if you'd like an introductory-level discussion of the theoretical flaws and benefits of various kinds of government health policy, I recommend The Undercover Economist. He points out that the UK government spends less per-capita to give everybody health insurance than the US currently does to insure just some, and that, when polled, UK citizens generally express more happiness with their system than do US citizens.

He also discusses the flaws of both systems, and makes the case that a Singapore-style system is the best of all worlds.

I find that, in the interests of clarity and accessibility, he sometimes simplifies his arguments so much they become less convincing, but it's an excellent starting point.
posted by yankeefog at 3:32 AM on July 7, 2007


Anecdotal evidence is tricky, of course. I lived in America for a year as a teenager, and had several visits to a GP for various minor ailments. That GP is the only one I've ever had who was sexually inappropriate with me... I do not however conclude anything about the state of American general practice from that.

Perhaps more tellingly, a few year ago I was diagnosed with endometriosis. It took 7 months from the first moment of "holy hell, what is that pain???" to the surgical diagnosis and treatment, partially because I kept putting off my ultrasound in hopes that it would just fix itself (unlike someone above, in Ontario, the doctor gives you a requisition for an ultrasound, and you go to a medical lab and have it done whenever you want). According to the American Endometriosis Association, the average American woman waits 7 years for a diagnosis, mainly because of doctors not taking the pain seriously and actually requisitioning the appropriate tests. This has been my American cousin's experience.

While my experience in Canada was obviously better than the average American experience, I don't know if such fast diagnosis and treatment is typical or atypical for Canadian women: my GP didn't think it was endo, but he said I could see a specialist if I wanted. I said yes, and that's why everything happened so quickly.
posted by carmen at 8:34 AM on July 9, 2007


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