Wednesday, March 07, 2012

The Gem in Canada's Crown

One of the best things Canadians have ever done, was to follow the lead of a former 'commie' preacher from the west and set-up a national medicare system. Tommy Douglas was the leader of the Canadian Commonwealth Federation - a cover for 'the communists' - during the 50's and 60's.  He had the notion that one of the things every Canadian should be able to afford was to look after their health. For a long time that wasn't the case, doctors and medicine were private enterprises to which those who could afford subscribed and the rest borrowed when it was absolutely necessary. Doctors 'built' their own patient lists and sold their practices to new-comers as sort of a retirement gratuity. Doctor Fred Banting, the discoverer of insulin, failed in business as a GP and was only saved from a different career by a lab assistant's job at the University of Toronto. Doctors and their patients, both had it rough.

The Government of Canada passed legislation to set up the national medicare plan in the early sixties. But the government left the administration of the plan to each province. Each province set up its own bureaucracy to administer the plan. Hospitals were socialized.  Doctors joined the plan as private corporations contracted  at fixed rates for service, or opted out, as they wished. Each individual was registered with the plan and issued a membership card and could be assigned a doctor if they didn't have one. Individuals paid for the plan at one of two rates, through their employers. Those unable to pay were registered for free. As time passed, many employers subsumed all, or part of the insurance costs  as fringe benefits. Provincial governments allocated other funds to healthcare as well. There were disparities between some provinces, but essentially most common medical and surgical services were 'covered'. Dentists, and some specialists like specialized clinics and opthalmologists exempted themselves and required private arrangements.

As time went on, drug benefit plans were added to insurance coverage paid by individuals, or as fringe benefits. Public coverage of some medications was extended to the unemployed, aged and needy. Some drug abuse treatment and mental health programs became part of the medical establishment. Hospitals and clinics were built in many areas where there had previously been none. Doctors were educated, or imported, often at public expense, to meet needs. Canada has perhaps one of the most wide-spread medical care in the world.  Regional Health Centres to address high-tech treatments, or unique services e.g. oncology, were developed in the 80's  and 'families' of hospitals refer patients for specialized or intensive treatment. Costs were beginning to be concerning in the 80's and 90's and cost savings, as well as increased payments, were instituted.  Some aspects became payable e.g. testing, disposable materials, prosthetics and appliances, private rooms, and there were cutbacks in others e.g. nursing staff reductions. Multi-doctor clinics and nurse-practitioners are becoming more common, to ease pressure on  medical facilities and deal with trivial complaints. Prescription by pharmacists is also being considered to ease the cost of doctor visits.

So where does this leave us all to-day? We're still in good shape.

If you become ill and call an ambulance, there is a paid public service that will have EMS personnel pick you up, treat you as necessary and transport you to an ER. You will be seen by a nurse and physician in order depending on the severity of your problem,  eg chest pains are seen at once and monitoring started. Should you require emergency surgery, that will be done within 24 hours either 'on site' or, if necessary, after transfer to a regional center by land or air ambulance. Other surgery will be done within 26 to 48 hours if required, non-essential procedures will be scheduled at anything from two weeks to three months. Such might involve screening, or evaluatory visits to specialists. Stays in hospital are covered at 'ward rates', private rooms are available at an extra daily cost. All meals and most in hospital treaments, drugs and materials are covered. You will be released when full body function is restored, provided there is safe care for you. Some people are placed in nursing facilities for recovery, at their own cost. Some visiting nurse activity can be arranged at low or no cost. What we only rarely find out in all this is the cost of such treatment. From time to time the plan auditors will send out reports of treatments received and costs involved for corroboration by patients. It is at that time Canadians can appreciate what a gift we have in our healthcare system. For whatever the cost, it could only be increased if there were somebody's 'profit margin'. A payment out of pocket, for a visit to a top-rate opthalmologist, say, is a real 'eye opener', when one gets a glimpse of what 'quality private care' costs.

When  somebody says most Americans are one disease away from bankruptcy,  that's not hard to believe.

I was hospitalized for 5 days due to an aneurism. It was my first real trip to 'the shop'. I signed in, under my own steam, after a day spent with the lab people, the anaesthiologist, heart eval. monitor, x ray, Cat Scan, etc. I was tagged and gowned and swabbed for C Diff. etc. I walked up the hall to the surgical suite, was checked, taken into a theatre, introduced to the 'gang'  present, greeted by my doctors - the surgeon and my GP, there to assist. I was sedated and awoke some 3 hours later in the ICU where I spent the next two full days as there was no room for me on the ward. I had been given a spinal analgesic,  had my abdomen opened and my aorta opened and patched with dacron, the incision had been stapled closed and dressed.

The spinal analgesia was miraculous until I displaced the shunt flopping around in bed. I had the 'trots' due to a preexisting condition that caused almost-constant use of the bedpan and, later, the commode. My nurses deserve a service medal for putting up with my foul output.

Hospital food is crap. I think it a total waste of time and money. Most of it, I would bet, goes into the garbage. That is an area of potential cost saving. Either make a deal with a mass-manufacturer for something like TV dinners, or leave it for the family to provide. Nobody is in hospital long enough to get sick, or well,  from the food. Nutrition should not be a problem, or a hospital department, unless someone is starving.

I noticed that the folks who had come in with me - for some equally-serious surgery - and who had been placed in a ward  (4 to 6 beds) were discharged a full day before I was from my 'private ' room. I found out later that my insurance didn't cover a private room. That was when I got the bill for $600.00. I had a few squawks about that private room, as, the first day I was there, they put somebody in the next room to die. They 'closed' my side of the bathroom door with a paper notice saying that I couldn't use it. Whatever he had required biohazard dress from the staff, one of whom stayed with him every night. She coughed constantly and I could hear her through my side of the common bathroom to which she kept her door open. He also seemed to be visited by members of the staff, with their  kids, well after visiting hours. I know tough times are often lightened by levity, but at one point I had to ask them to take their 'laffs' down the hall to the lounge rather than outside my door. That was close to midnight.  The moribund chap was still in residence when I left.

When I called the hospital business office about my tab, I was told I was getting a "one-time amnesty" on the bill and my insurance coverage was being changed to note 'no private coverage'.

On some floors there are no wards, in that case there is no charge for a private room. Likewise if you get 'bumped up'.  I have feeling, however, that,  if you have insurance coverage, your insurer gets billed. A little 'money-maker' for the hospital, like the parking lot.

 Since then,  it's been back to see the surgeon once, to have the staples out. To see my GP on a number of occasions related to the surgery. All at no cost to dear old retired me. Except for a medicare surcharge on my annual taxable income ($400) . Since I turned 65, my prescriptions cost me $6.88 each, in co-payments, covered by my  family medical insurance.

 Canadian medicare is great.

 Changes may be in the wind but I'd bet Canadians would give up their military and politicians before they'll give up 'socialized' medicine.


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