Friday, March 4, 2016

Healthcare north of the border.

Since the goal of universal healthcare is a big one for progressives in this country, and the topic is firmly in the spotlight this political season, I wanted to share my experience with universal healthcare as an American living in Canada a decade ago.

Canada's system is similar to what we would have if we instituted Medicare for all, which is essentially what Bernie Sanders is calling for. It's a universal healthcare system paid for with taxes, with national standards administered by provincial governments (Canada has provinces, we have states), with care provided by private doctors billing on a fee-for-service basis. The overall cost is much lower than what we spend on healthcare in the US, with much better outcomes--longer life expectancy, lower infant mortality rate, etc. There are many myths surrounding the Canadian system and how it works, and I thought it would be helpful for other Americans to see a glimpse of how the system works through my personal experience. I can't find a date of publication for it, but this breakdown out of Harvard is a good summary of the details of the Canadian system.

As a bit of background, I arrived in Canada in 2006 as one of many uninsured Americans. Moving out of my parents' house at 18, I began working full-time to support myself while also going to junior college, and was soon faced with the prospect of needing to cover my own health insurance costs. Working as a nanny in a private household, I had no option for employer-provided insurance, and ended up paying out of pocket for a Kaiser HMO plan for several years until I just couldn't afford it anymore. I spent the next several years uninsured, relying on my local Planned Parenthood for basic care mostly relating to reproductive health (and never even once had an abortion--crazy, right?). By the time I arrived in Canada, I hadn't been to a dentist in eight years, and hadn't seen a doctor outside of the phenomenal staff of Planned Parenthood for 3-4 years. And I was, clearly, extremely fortunate no medical emergency arose during that time. Many Americans are tragically not as lucky.

My status in Canada was as the recognized domestic partner of a working foreigner, and with that came the same exact level of care that every other Canadian enjoys. And once I became a student at Concordia University in Montreal, most of my care was provided by the student clinic on campus. And as luck would have it, after several years of no major health issues while being uninsured, I was struck with two somewhat serious health conditions while living in Canada. I was slightly thankful to be living where I was at the time, although, to be fair, one of the conditions was exacerbated by the climate. When a California-born-and-raised girl moves to the Great Frozen North, there are bound to be some adjustments, I suppose.

So how would I characterize my experience with universal healthcare? Fucking AWESOME, that's how.

The first medical need that arose was my then-yearly Pap smear and re-up on my birth control. Now, when I first moved to Montreal, I lived in what's considered the ghetto. Literally. I lived in St-Charles, the old Irish working class neighbourhood of the city, totally cut off from the rest of the city by a canal. Prostitutes worked the corner one block over and a man was stabbed to death in the street in front of my house. The neighbourhood was in the early stages of being gentrified, so the quintessential brick row houses were being snatched up for cheap by younger, trendy counterculture types, as well as investors looking to fix up buildings and charge astronomical rents. This is, unfortunately, the situation I found myself in. My anglophone landlords found my post looking for housing on Montreal's craigslist, had just completely gutted and beautifully remodeled a two-story duplex, and because I think they liked the idea of renting to Californians (we're basically the holy grail of Americans to Canadians), they oversold the neighbourhood just a tad. Again, the neighbourhood was actually in a great location physically, close to Old Montreal, where my ex worked, not far from downtown, and the canal itself was a beautiful greenbelt for, you know, like two months a year (okay, okay...maybe three). And coming from Marin County, one of the absolute most expensive places to live in the States, the rent seemed cheap to me.

And I'm giving you a thorough description of the neighbourhood because when I first contacted health services to make an appointment for a Pap smear and birth control, I was given the name of a neighbourhood clinic literally around the corner from my house (on the same block favoured by the prostitutes). I called and was given an appointment within a few days. Not knowing what to expect in the slightest, I was pleasantly surprised by both the clinic and the care I received. It was clean without the totally sterile and impersonal feeling of so many clinics here in the States, and the whole process had a much more laid back and personal vibe in general, while still retaining a very professional level of care and interaction. Afterward, I was able to fill my prescription for birth control at the little pharmacy downstairs and that was that.

Oh, and I didn't pay for any of it.

My first full winter was when both of my other ailments cropped up. The first was an extreme exacerbation of the osteoarthritis I have in the base joint of both thumbs, combined with some tendonitis in my right hand. I am severely double-jointed and unfortunately as a child learned to use my thumbs in a way that puts the wrong kind of pressure on that joint. Before moving to Montreal, I had very occasional minor pain after doing things that overly stressed that joint, like the weird way I hold my chopsticks. But things got so bad in Montreal, my hands became almost useless as I lost strength in my thumbs. I couldn't pull up my pants without turning my hands palms out to grip the hem between my fingers and palms. I literally didn't have the strength to pull them up using my thumbs on the inside of the hem, and the pain when I tried was excruciating. I had to learn new ways to grip and use things like my toothbrush, hairbrush, and hair dryer, and was constantly dropping things, such as dishes as I attempted to hold them in one had and scrub with the other. You don't think about how much you depend on the strength of your thumbs until you don't have it anymore. And the most frustrating part was barely being able to write--and as a history major, that was a serious, serious issue.

I finally contacted Concordia's student clinic and was almost immediately given an appointment with a specialist (who just happened to currently be studying the increasing rates of young women with osteoarthritis in that joint--what the hell, right?). They thoroughly tested the strength and flexibility of my hands and ordered x-rays to pinpoint the issue. Once the problem was established, they made not one, but three braces for me, totally molded to the exact shape of my hands and wrists--one resting brace for each wrist to wear in the evenings and overnight (super, super sexy, let me tell you), and one specialized brace to wear while I wrote to stabilize that joint. I also began physical therapy. Again, I didn't wait long for appointments, I received fantastic, comprehensive care, and I didn't pay for any of it. I can't tell you how many times I just stood there at a reception counter waiting for them to tell me how much I owed and the bizarre looks I received when I finally asked about it. The habit took a while to fade, as my brain just couldn't comprehend the fact that I was getting so much for literally nothing.

The other medical issue that arose for me while living in Montreal was sudden, severe, debilitating bouts of vertigo. Again, I contacted the university's clinic, was given an appointment immediately, was thoroughly examined, including having an EKG performed, was diagnosed with labyrinthitis, an inner ear condition, was given options for treatment, and followed up with. Efficient, comprehensive, compassionate, modern care for, again, nothing.

Now, I had more comprehensive care than some Canadians, as my ex's employer provided supplemental coverage for things like prescriptions, which are not covered under Canada's health plan, and I was able to receive wonderful care through Concordia University's clinic because of my status as a student (for which, I want to add, I was able to pay resident tuition because of my status, a laughable fraction of what a similar education would have cost me at home). But overall, universal healthcare in Canada works very, very well for most everyone for far less than what we spend on partial care for only a portion of our populace. And the reactions of Canadians to how we do things here can be summarized as various levels of horrification. I once stopped at a pharmacy with a Canadian friend to refill her prescription and asked her how long the wait would be. She looked at me quizzically and said, "Ummmmm, a minute or two? However long it takes them to grab it from the back?" My surprise at hearing this led to her asking how long it would take in the States, so I told her generally nothing less than 10-20min and it was not totally uncommon to wait hours or even days depending on your coverage and issues relating to communication and disagreements between your doctor, your insurance company, and the pharmacy. I will never forget the look of utter shock, disbelief, and indignation on her face.

That was 10 years ago. What is my current healthcare situation back in the States and now married with two kids? It's a bit lower starting this year, as we now qualify for help under Covered California, but for the past two years, we have paid roughly $1300 a month just for medical care--no dental, no vision--since the options provided by The Barbarian's company are even more expensive. In addition, we pay a $30 copay to see our regular doctor, and a $50 one to see specialists. We have fairly good coverage for prescriptions, but still pay well over $100 a month on prescriptions for the four of us. It's depressing and aggravating and doesn't have to be this way. Universal healthcare is not rocket science, and is provided by every other developed nation in the world, as well as some developing countries. This is a great look at universal healthcare in general, for those interested in reading more. Seriously, people--if Rwanda can make it work, I think the US can probably get its head out of its ass long enough to figure it out, no?

So there you have it. Universal healthcare does not equal death panels and bloated government programs. It is, in fact, a far more efficient system than what we have in the US with much better outcomes. However, insurance companies aren't able to ream people for basic medical care in a system like that, and that really is the crux of the issue in this country, isn't it? Because here in the US, we worship at the altar of our most venerated and holy Capitalism, and gosh darnit, corporations are people, too.

Or evil bastions of legal, institutionalized crime.

Depends on who you ask.