I just had my first encounter with the Canadian medical system, a “get acquainted” visit with our new primary care physician.
From what my Canadian wife tells me, I demonstrated my ignorance of the Canadian political system when I attempted to explain it in a previous blog entry. So I will risk doing so again trying to explain the health care system.
The primary care physician, a GP or family care doctor, serves much the same function his counterpart in the US does, dealing with general issues and making referrals to specialists as needed. There is a shortage of general practitioners in Canada, so sometimes it is difficult or impossible to find a primary care physician willing to take on a new patient.
In Canada, not having a doctor is not as critical as it would be in the US because you can still get treated at walk-in clinics or directly at a hospital; just show your health care card and you get what you need. The problem is that you don’t have a doctor familiar with your medical history and a general overview of your health care needs. But still, no one goes untreated for lack of insurance or money. Everyone is covered by the health care system.
Fortunately Faye and I had no problem finding a doctor who would take us. We became eligible for coverage on August 1. Faye made a couple of calls and got us an appointment with our new doctor yesterday.
In the US we have become accustomed to luxurious waiting rooms and offices, and a busy front office staff who make sure your insurance is current and hand you forms to fill out while you are waiting for the doctor. In fact, I think most of the office staff is there to deal with the health insurance companies. Once you get past them there is usually just a doctor and an assistant, or maybe more if it is a group practice.
The doctor’s office we went to yesterday was similar except the staff to deal with insurance was missing, since there is no health insurance here. There was just the doctor and two assistants.
OK, that wasn’t the only difference. For one thing the “office” wasn’t luxurious, it was a converted house, and still looked like a normal house from the outside. There wasn’t even a sign to indicate it was a doctor’s office. The living room had become the waiting room, and I think the former dining room was where the desk and patient records were kept. And the bedrooms had become the examining rooms.
There was something familiar and cozy about the whole thing. The two women, the assistants, were probably both close to 70 (the doctor wasn’t much younger). There wasn’t a computer in sight, just a typewriter. I realized it reminded me of the doctors offices of my childhood (which is quite a ways back).
There were no insurance forms to fill out, of course. All we did was hand over our health care cards. Later, the doctor will submit a bill (probably a standardized amount for a given procedure) and will be paid about two weeks later. No negotiations or complications; they send in the bill, they get paid. What a concept!
The doctor called us in together within a few minutes of the time of our appointment. He reminded me of the doctors of my childhood as well, a kindly man with white hair who seemed genuinely interested in our health needs, and was in no particular hurry. Fortunately we don’t have any serious problems; he asked us about our health, took some notes, renewed some prescriptions we had from the US, referred us to a lab for some routine blood work, and referred me to a dermatologist to have him look as some sun damage I have on my face. We’ll have to pay for the prescriptions, but the doctors visit, the lab work and my upcoming visit to the dermatologist won’t cost us anything above our premiums–$93 a month for the both of us.
It will be a little over two months before I can see the dermatologist. “Ah ha,” I thought, “that’s the long wait time everybody talks about.” But Faye tells me it took longer than that for her to get an appointment with a dermatologist in the US. My primary care physician in the US didn’t bother to refer me to a dermatologist at all. As I wrote some time back he hit one spot with some liquid nitrogen, and charged me $250, which came out of my pocket since it was under my deductable.
Ironically I’ve already talked to the dermatologist I will be seeing here, at a sand sculpture contest on the beach last weekend. He was offering free consultations as part of a sun exposure awareness team. I got more attention from him standing there on the beach (under a shaded canopy, of course) than I did from my doctor in the US. He told me how he’ll treat my sun damage, so it is just a matter of waiting to get in to see him. And it won’t cost me a thing. The Canadian system will take some getting used to.
So far I am favorably impressed. If I need a hip replacement or brain surgery I may not be, but for the health problems I am 95% likely to have I think it will be fine. I will document any future encounters with the health care system–good, bad or indifferent–and try to make objective comparisons with the US system as much as possible.
There can be no doubt that the US system is seriously flawed. The insurance industry is a parasite; I think there are people even within the industry who realize that such a greedy parasite can kill the host, and that is what is happening. People live in fear of needing medical treatment and have become numb to the expense of insurance. The insurance and medical industries both realize people will pay whatever they have to treat their health problems–in a crisis. And both industries excel not so much in health care, but health crisis management. That’s where the money is. Keeping people healthy, keeping small problems from becoming big problems is penny ante–not worth it from a business perspective.
Health care should not be a business any more than education, good roads, fire and police protection, etc. are. These are things that make a civilized society. (Of course teachers, road workers, firemen and policemen–and doctors–are worth a good wage; that is not the issue.) For those who insist on viewing it from a fiscal perspective it can be seen as resource management. A healthy populace is more productive.
With the upcoming election the US is at a fork in the road. I don’t think the system will change fast enough in my lifetime to allow me to return to the US, but I hope a new government will take steps in the right direction for the sake of those to come.