What it Really Means to have Free Healthcare

We have friends in the USA but we also have family in Europe. Which means we know that our healthcare system is very much middle of the road worldwide. As Canadians our heart breaks for our American friends who find themselves sick or with sick family. I actually started this post long before the current outbreak when a friend in the USA had a sick relative. We were getting daily updates at the time and saying to each other that it just shouldn’t be this hard for our friend. I think it’s even more relevant now but let’s leave the specifics of the outbreak aside because this is important now but it is every other day too. If you have better health care than Canadians this might be stuff you’ve never thought of that could change your world view. If you live in a country that doesn’t offer basic health care to all, whether you have care or not, it definitely will. I can’t overstate how much every Canadian values the system we have as imperfect as it can be. We will often say to someone with a health care crisis something like “stay strong and count your blessings imagine if you lived in the USA” and this is why.

Canada’s Healthcare system

Volumes of books and many scientific articles have been written on the Canadian health care system actually our supreme court has even ruled on the minutia of the parts of it that are in our constitution (we call it a charter). So we’re not doing a full deep dive here but rather painting a simple picture with broad strokes. Essentially anything that happens in a hospital is totally covered. The government doesn’t cover dental or prescriptions (for most) though that last part is like changing soon but it’s too soon to know how that program will look. That’s also what makes us lag behind most of Europe. Anything that is medically necessary that happens in a doctors office is covered too. There is no fee to see a doctor to see if everything is okay but other things like ear wax removal, transfer of medical records and removal of warts or skin tags somehow known not to be cancerous do carry a small fee (usually a lot less than $100). That’s pretty much it. After care you need is covered too.

Canadians need an MSI card or equivalent to access the system which is only based on having an address. However if you are homeless you can still access the system you might just need the help of the hospital social worker. I personally have had an outdated card for years, it’s not a problem. Your care is covered in other provinces and in most provinces you don’t ever have to pay even if you are traveling. Worst case scenario you have to fill out a form and get reimbursed when you get home. However if you don’t have the Visa room they will totally treat your issue you a bill and your home province will eventually pay it. If you’re having a problem you can get it diagnosed and treated in the most appropriate way for free. Healthcare is a provincial responsibility so it does vary a bit but less than you’d think. The federal government funds a large portion of it and sets national guidelines. Our healthcare system is something all Canadians value and no matter who you are usually opt into even when they have the choice. Very few, very wealthy people do travel for care but they don’t often admit it if they do. Some of our customers are crazy wealthy like as close to Kylie Jenner and Kanye West are to being billionaires and they participate in the Canadian system too. Now isn’t that food for thought!

No shopping around

Our friend in the USA was really overwhelmed traveling from place to place and getting different advice from all of the consultations with his sick family member. Who was right? Who was best and what should he do? I imagine for many cost is a factor in that decision too. We simply don’t have that. You get referred to the relevant care team and a doctor within that team. If your case is straight forward then you get that treatment but you can be as involved as you like to bet in those choices. If your case is more complicated than the doctors on that team can all be involved in your case and come together to discuss what’s best for you. I think that Americans see the voices and the stress that goes with that as a selling feature of their system but I would argue its not. The choices that are made here are made by expert specialists based on up to date current research. 

Think about it though we have medical generalists that deal with day to day stuff and direct you to specialists when need be. Each person within the system and each part of the system is only asked to perform one role. That extends to treatment centers and hospitals too. Every ‘family doctor’ (aka GP) can deal with the run of the mill stuff but they refer you out for things outside their wheel house like dermatology, urology, cardiology, genetic counseling, and oncology you see the closest team of people who specialize in only that. If that team can’t handle your concerns then they refer you to people that can. There is no incentive for any of those people to keep you as a patient so you go to the best person for your specific needs. Afterwards your family doctor in your town handles the care that they can and there is no need for travel or the cost of a specialist if you can be seen in your home town. If someone needs to come change your dressings then that happens too. If your care is especially complicated you will get a case manager assigned to your case to help.

No selling or compromising 

Our system isn’t prefect and yeah there are specific examples where it does fall down. We don’t have to think about a doctor’s motives when they recommend something. In the hospital the doctor makes the same whether anyone shows up or not. In the office it makes almost no difference either. They are busy enough that their calendars are always full. There are no unholy alliances between doctors and anyone else. That means when we go into an appointment we can be sure that the doctor really is giving us the best treatment available for that specific person. Doctors are happy to recommend cost effective medications. It makes no difference to them if they prescribe you a brand name or generic. They’ll often ask if you have drug coverage and ask if you want a generic even! All they really get from drug companies is free samples in one dose packs. If you don’t like it you’re totally entitled to a second opinion which is covered too. However you might have to cue again if it’s not a serious problem.

Needs based

Our system isn’t prefect and so if you need certain procedures like a knee replacement or potentially a bypass you may have to wait. However it’s always needs based so if you need one right now you’ll get it right now. That also means that if some homeless guy and you the CEO of a multi billion dollar corporation, need the same thing you’re in the same line. If you need super specialized treatment like a transplant that’s only available in Toronto then that’s where you’re going. Lots of things are covered that you might not think of as medically necessary though. Things like reconstruction, anything experimental and all preventative medicine. However if someone comes in with stage 4 cancer and requires an OR right now you may be bumped for those things. It also means you don’t really get to choose your doctor or specialists but you can request a change if there is a conflict. No matter who you are if you have a medical need, even an urgent one, it’s covered in exactly the same way. 

This has a democratizing effect on how we view human life up here. No matter who you are if you walk into a hospital nobody is treated any differently. That means it’s baked right into our system, and our minds that all human lives have value and that that is the exact same value for everyone. One Friday night in the middle of the night over a long weekend I was waiting in the ER for treatment for something that turned out to be minor. But a lady was there from overseas who needed help. The flustered clerk checking them in explained that they did have to pay but she wasn’t sure how to make a bill. That she would be treated no problem, same as everyone else but she couldn’t ask someone until Tuesday. It might not seem crazy to us but in the biggest hospital in 4 providences serving over a million people and no one there knew how to collect money for 4 days? She took the address and told her not to worry about getting on her flight the next day. That sort of idea totally permeates our system.

Duplication vs travel

As much as we seem like the great white north over 70% of us live within an hour of an urban center. That means that we are often pretty close to multiple hospitals. I have 3 full service hospitals within an hour of me and we’re considered sorta rural. I’m like most of the Canadians out there too. This means that hospitals can and do specialize to a certain extent. There are 27 hospitals my province there are all of which are equipped to handle any sort of emergency situation but… for some things you may be transferred to another hospital by ambulance or air, by the way that’s covered too. For a few things you will have to come to the capital sometimes at your own expense. That can be really inconvenient but it allows for a pretty efficient and world class system overall. There are quite a number of charities that can help with the cost of travel if that’s a problem for some. During the outbreak only 4 hospitals are admitting pandemic patients in an effort to limit the spread in a medical setting. However all are set up to get patients to those hospitals just in case.

Why is that even important though? Every hospital does not even try to do everything because not a single one is trying to capture a larger part of the market. There simply isn’t a market to capture. There is no wondering if you are at the best hospital for a certain treatment. If you aren’t you are sent there. Since there is no insurance you don’t have to even think about ‘in network’ or ‘out of network’ concerns. There’s just one here and it’s all connected. Since every doctor in ever hospital works for the same system if a patient walks into one where there is not expertise for that condition the staff there will immediately tele-conference to the hospital that does and prepare the patient for transfer. So if you walk into a rural Cape Breton hospital with bad burns the doctor there will connect with the full time staff at the dedicated specialist burn unit in Halifax. The nearest air ambulance will be dispatched to pick you up and the staff will know how to treat you and prepare you for transfer. That’s all covered too.

In countries where hospitals are in competition for dollars patients become a business. This is the real reason health care on the USA is the most expensive system in the world because patients are dollars. If a condition is common enough then the hospital has incentive to treat it. If it’s very uncommon none of them do. Which is to say we at least aim to have a pretty efficient and specialized system. In a for profit system that burn victim has a huge price tag on them so the hospital has an incentive to keep them there. Even if they have a burn unit (which is an expensive duplication of service) by definition not every one can be the best in the state.

However our courts have ruled that patients can only be expected to travel so far for treatment at their own expense no matter where you live. If you do have to travel further your provincial government is obliged to cover the expenses for that. Sometimes people have to be sent to another province, the USA or overseas for the best treatment available and that is covered too! However if you live in the far north your access to available treatment is very limited. Almost everything requires an air ambulance and even pregnant woman are often sent south before their delivery dates. The vastness of our country does have healthcare implications but overall we are a more urban country than most people think. 

Honey getting his hardware removed. The surgeon took his work into account and when it was his turn if it wasn’t a good time to take it easy he could always get back in line. PS he’s a little stoned in this picture!!!

I hope that I struck the cord that I was trying to with this post. If I could sum it up I would say that if we get sick or injured the quality of the care we get, the choices we have to make and almost entirely the cost of that care isn’t something we have to consider. When my dad was told he needed a quadruple bypass operation the hardest thing to hear was his case was stable and he’d have to wait a few weeks. We never even considered that the average cost of a bypass is well over $100 000 USD and he had some pretty major complications after. Even though my parents were very well off and very responsible I think that sort of cost would have made us sell our home or even worse. When my mom was diagnosed with breast cancer my sister were teenagers and there was no complicated set of decisions and choices to be navigated. She was presented with two treatment plans based on the surgery she wanted at the nearest hospital and that was it. When she was ready her cutting edge reconstruction surgery was covered too. Though she did wait well over a year for it. When honey had a huge car accident as a young dad and his skull had to be reconstructed the only thing he had to think about was his family and missed work which is bad enough. He paid for generic pain meds and employment insurance covered 70% of his income while he was healing. When my brother was diagnosed with a brain tumor on Thursday an he was recovering from surgery on Monday.

Our system isn’t perfect for everyone but it comes down to a whole lot more than just being free. Well we all pay via the tax system but you know what I mean. Beyond just cost and the equality, the fact that it’s needs based, streamlined and based entirely on best current practices makes it totally different then the system in the USA. That means that the worst moments in your life are complicated by outside factors as little as possible. In combination with our social programs very, very few people will pay for anything besides prescriptions out of pocket and most people do have insurance for that too but our government is working on that as well. What’s crazy is that we all know exactly how important and life changing that sort of coverage is and we don’t understand why people that don’t have it don’t demand it as a human right. If a politician even mentions limiting access people across the country pretty much explode! I guess we really like it the way it is!

I know our system is simultaneously held up as a utopia and a socialist nightmare in the USA. What have you mostly heard about healthcare in Canada? What aspect do you think would be the most life changing for you and why? Leave it in the comments below!

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