Friday, December 6, 2013

A Chat with Canadians About Universal Health Care

By E’Louise Ondash, RN

I had the good fortune to visit Beautiful British Columbia recently. They call it that without apology because it is beautiful and has everything -- the ocean, beaches, old-growth forest, mountains, glaciers, rain forests and wine country. In light of the controversy in this country about the Affordable Care Act (ACA or Obamacare), I used the opportunity to talk to random Canadian citizens about their health care, health insurance and mandatory coverage.

Full disclosure: As a nurse, I find it difficult to disagree with the goal of providing health care coverage for every citizen. It seems almost redundant to explain why: no coverage, no care. There are many ways to provide coverage for everyone in this county and that’s where many disagreements arise. No system of coverage will be perfect, but the ACA is, at least, getting us off the starting block. (Okay, the website problems have made it a bit of a rocky start, but we are on the way.)

Canadians have already been down this road. Federal law there requires that every citizen have health care insurance, and each province has the freedom to design its own rules and types of coverage. It came as somewhat of a surprise to learn that Canadians are not insured under one, giant monolithic system, even within the provinces. Canadians acquire health insurance through many avenues.

For instance, one man in his early 50s said that he is covered under his wife’s policy. She is a nurse and the terms of coverage are negotiated between the hospital and the nurses’ union. He was more than satisfied with their health plan, but acknowledged that if you need an elective procedure like a knee replacement, you will wait. A board of physicians decides your place in the queue.

Another man I spoke with was a low-income musician in his late 50s. His premiums were subsidized by taxpayers, and like others who cannot afford to pay premiums, he is enrolled in “the provincial plan.” This is a low-cost, no-frills policy, but he was glad to have it. He is not responsible for any medical charges that he incurs, and he also said that he doesn’t abuse the system. “I only go to the doctor when I have to,” he told me.

A third Canadian with whom I spoke was a single woman in her early 60s who paid for the provincial (cheapest) plan. When it comes time to pay her premiums, she said, “I don’t even think about it. It’s something we have to do and I’m glad to have the coverage.”

One last example: A low-income, single mother of two who lives in a rural area told me that she and her children are enrolled in the subsidized provincial plan. “If it weren’t for that, I don’t know what I’d do,” she said. Nevertheless, she was upset because the nearest hospital is probably going to close because of fiscal problems, and if that happens, she will have to drive at least 30 minutes for care.

All of these Canadians must buy separate policies for drug coverage and services like physical therapy, or pay for them out-of-pocket.

Shortly before we left for British Columbia, I had the bad fortune to spend six hours in outpatient surgery. The bills for this one-quarter-of-a-day in the hospital totaled about $25,000. The hospital billed the insurance company, knowing it would never see full reimbursement. In the end, my insurance paid about $9,000 and thankfully I am not responsible for the difference. With no insurance, I would’ve been responsible for the entire $25,000, and we all know what’s wrong with that logic.

I hope that someday our medical bills reflect reality, but I don’t expect it to happen soon. In the meantime, assuring that everyone has health insurance is a good thing because, in all likelihood you will get sick or injured at some point and incur large bills.

Canadian health care is not perfect, but at least no one worries about declaring bankruptcy because of medical bills.

Do you think nurses should take a stand for or against the ACA, or remain neutral?

Have you had any medical bills that threatened your financial stability?

Tell us what you think.


rn360 said...

I agree with having to change the healthcare system in the u.s !I just wish that someone first called some other countries to find out how it is done.There are many ways to implement new coverage.

Nurse Dee said...

In Ontario it's completely free - it's paid through taxes and we don't have to have additional coverage - what we have to pay for are medications and extended care such as physiotherapy - I wonder if the US put a tax of even 2% would they be able to offset the coverage that many american's cannot afford?