Doctor’s prognosis: American-style health care a nightmare

By Inge De Becker, M.D.
The Chronicle Herald (Halifax, Nova Scotia), Aug. 26, 2014

As a Canadian physician who now lives south of the 49th parallel, I’m alarmed that Canada’s publicly financed national health-care system is once again under attack

Nine years ago, we witnessed Dr. Jacques Chaoulli’s legal attack on medicare in Quebec. Then we saw the Harper government’s failure to renegotiate a new Canada Health Accord this past March. And now Dr. Brian Day, owner of the for-profit Cambie Surgery Centre in Vancouver, is unleashing his drive to “profitize” health care in British Columbia.

On Sept. 8, a trial to hear a constitutional challenge to B.C.’s health system that Dr. Day launched in 2008 will begin in Vancouver. Day wants to strike down provincial legislation that limits private payments for medically needed services by claiming that these laws violate the Canadian Charter of Rights and Freedoms.

Should he win, the door will open for an American-style health-care system (consistently ranked lowest in performance among wealthy nations — and the most expensive) with its profit-driven insurance companies, bloated administrative costs, and inequitable access.

Let me tell you about my experience with the U.S. health-care system. I am a pediatric ophthalmologist by training and, like all of us, I am occasionally also a patient. In 2008, for personal reasons — not for a better job — I chose to move across the border from my home in Nova Scotia to Minnesota.

I knew that the health-care system in both countries would be different. But I did not grasp what that meant until I lived the difference.

My learning curve as a patient in the U.S. was brutal: even as a “well-insured” patient, I suddenly was dealing with pre-authorizations, in-network/out-of-network issues, co-pays, co-insurance, deductibles, health savings accounts, and EOBs (Explanation of Benefits) which look like bills but aren’t.

The accounting department of my HMO (Health Maintenance Organization) overbilled me by thousands of dollars. I stalled with the payment.

On a bright Saturday morning, I received an intimidating call from a collection agency for unpaid medical bills. Never mind how that affected my credit rating.

In Canada, I paid taxes, had a Nova Scotia health card that guaranteed access to medically needed care anywhere in the country, used the health-care system if I needed it, got to choose my doctor, and did not have to worry about bills. With private insurance in the U.S., I learned not to take the Canadian experience for granted anymore.

In Canada, I benefited from superb oncology care. In Canada, my son was in a catastrophic car crash. He spent seven days in a state-of-the-art neuro-intensive care unit. Not one bill, not one phone call to or from an insurance company disrupted emotionally charged times.

My learning curve as a physician practising in the U.S. was equally unpleasant. For the first time in my professional life, I had to deal with the intrusion of third parties — health insurance companies — between the patient and me.

I had to keep in mind that a patient’s insurance may not cover the tests and treatments needed, that common procedures needed to be pre-authorized by an insurance clerk, that certain things needed to be done before the insurance ran out, or that some treatments had to be delayed to the next “benefit year.”

I have been an unknowing accomplice in causing great anxiety and financial harm to a patient and his family: a $24,000 bill for services that were not covered because the patient had gone “out-of-network.”

The U.S. is the world’s richest democracy, yet it has decided that health care is a commodity for the privileged who can pay. Its health-care system is an opaque and complex patchwork of competing multiple payers, causing mammoth administrative costs (12 per cent for U.S. private multi-payer insurance overhead vs. 2.1 per cent for Canadian public single payer insurance — i.e. medicare).

Each year, up to 45,000 people die from a treatable condition because they lacked coverage and could not access care. Medical bills cause 56 million adult Americans, more than 20 per cent of adults between the ages of 19 and 64, to struggle financially, and about 650,000 to go bankrupt annually, affecting 2,608,119 individuals.

Other rich and civilized democracies have made the fundamental moral decision that access to health care is a human right and have figured out a way to make it happen. Canada is one of them.

Rather than sliding down the slippery slope toward a U.S.-style system, I ask you to stand on guard for Canadian medicare. Please reject Dr. Day’s bid to undermine it.

Dr. Inge De Becker practised in Nova Scotia for 20 years. She now resides in St. Paul, Minnesota.