A nurse recently told me that we could no longer afford our current health care system. I was just starting to think about her point when we were sidetracked by other people and other conversations. I wanted to ask her, though, what exactly she thought the solution was. She's a nurse. She sees first-hand the health care system in action.
Our health care system here in Ontario, and in Canada, is a publicly-funded, universal, regulated system. Every citizen of Canada is covered, automatically, for all necessary health care, except for prescriptions, and experimental or unapproved treatments. That part is great. You get sick, you go to your doctor and she recommends treatments and books you into the hospital and, if you're lucky, you get cured and get home. All without having to reach for anything in your wallet except your OHIP card.
For certain procedures, like MRI scans, you might have to wait a few weeks or months, because the system is a little over-loaded.
Some people really hype the issue of waiting periods. I personally feel we should be concerned about them, and we should try to do better, but in most cases people do receive decent treatment on time. I believe the advantages of our publicly funded system far outweigh the disadvantages of the U.S. system, which is more efficient-- if you have money-- but leaves about 50 million people with no coverage at all. For one thing, it seems logical that people who visit doctors regularly (because it's free) will be healthier than people who don't, and therefore, less costly over-all to the system. Pre-natal care in the U.S. is ridiculously inadequate for a "developed" country. They pay sooner or later, with the higher costs of premature births and complications.
But in the U.S., you wouldn't have to wait for certain treatments. You could have your hip-replacement or MRI or triple-bypass immediately.
But if you got cancer, for example, your private insurance company could discontinue your coverage and you could be forced to sell your car and your home and then declare personal bankruptcy. That might sound like a harshly exaggerated scenario, but, in fact, it's not. The largest cause of personal bankruptcies in the U.S. is catastrophic health problems. It's not an exaggeration. It's not.
I thought about the comment, "we can no longer afford our health care system". What exactly is the alternative?
Think about it. Our system is expensive, and it has it's shortcomings. But right now it provides decent care for the vast majority of people. We absolutely can afford it because right now we absolutely are affording it, and paying for it. It works.
What my friend meant was that costs are escalating so much that soon we will not have enough money to pay for all the treatments available for all the possible diseases or injuries we could ever have.
So think about this: when you get really old and your organs start failing you and your hips need replacements and your eyes are filled with cataracts and your bones are brittle and you can't process food and you need dialysis and a respirator, and so on and so on, and nobody but nobody has the courage to "pull the plug" and we decide to keep you alive forever-- then yes, it's going to get very, very expensive. I recommend the movie "Coma" for an interesting discussion of the issue.
It is possible to spend an infinite amount of money on health care.
A very large percentage of the U.S. health care dollar is spent on people who are in the last few months of their lives. I forget the portion-- was it 30%?
I think she's right in this sense. We will have to learn, as a society, that there is a time to let go. And so far, in the entire world, it appears that the Dutch are the only people to have faced this problem squarely.
At it's heart, our system relies on a very simple concept. Most health care problems are the result of chance or accident or diseases over which we have little control. As citizens, we band together and pool our resources and agree that if any of us becomes seriously ill, we will all contribute to the costs of making him or her better.
Since the total cost of providing health care for everyone is theoretically the same no matter how the system is paid for, the Canadian system makes a lot of sense. It makes even more sense when you realize that the government has a lot more control over costs in the Canadian system, because it can regulate doctors' fees, and it can choose to not fund treatments that have no proven medical benefits.
The only obvious alternative-- if we really can't "afford" our system, is to drop people off the map. In other words, poor people will no longer receive health care. That has a cheeky kind of appeal to some people, but it's never going to happen.
Or.... or you start charging people who can afford it for the health care they receive. But since these are the same people that would pay most of the taxes for a publicly funded system, I fail to see how that changes anything-- except this: if you are reasonably well-to-do and you get cancer and require very expensive treatments, you are going to be impoverished. If you are really poor, you will probably be covered by some government plan. And if you are really rich, you will be able to afford extended private insurance coverage.
But if you are in the middle, you will be screwed.