“…our challenge is twofold: We have to find a way to cover all our people; and we have to figure out how to get better value for the US$2 trillion we currently spend on healthcare.”
— David M. Cutler, Otto Eckstein Professor of Applied Economics at Harvard University and Member of the Institute of Medicine -commenting on the US healthcare system.
Last month I was invited to speak for a week for The International Certificate Programme in Dual Diagnosis associated with Brock University under the guidance of Dr. Dorothy Griffiths & Dr. Frances Owen. Work I’ve developed over the past several years on psychotherapy for people with intellectual disabilities has been implemented in the States and most of the countries with socialized medicine. The Canadians have a real flair and passion for this work, and I savor the opportunity to travel there to teach and train.
The night before I began I treated myself to a day on the Canadian side of Niagara Falls. Although my diet is mainly vegetarian, I often supplement with fish entrees when I travel. A restaurant with herb-crusted salmon special and organically grown vegetables caught my eye. The dinner was delicious.
But around 2 a.m. my stomach heated up and soon I was revisiting the herb-crusted delight. Naturally I thought it was a bad piece of fish, and vowed to mend my ways back toward vegetarianism.
I was better — but not well.
Two hours later the scene repeated itself, but this time with an intensity that reminded me of the only time I had food poisoning. The pain increased with a burning in my lower stomach. The involuntary nature of this was overwhelming.
After a few more sleepless hours the pain in my lower right abdomen was getting worse. As the day progressed I started thinking about getting some post-food poisoning medicine and had the hotel direct me to a walk-in clinic/pharmacy about a mile from the hotel. By the time I mobilized myself the pain had doubled.
At the clinic I explained I was an American without a national healthcare card. The receptionist said there was a flat fee of $75 and a few minutes’ wait. I wanted a professional opinion so I paid the money, and the receptionist explained that I could submit it to my healthcare provider for the possibility of reimbursement.
So far, not much different than the U.S.
The doctor saw me within five minutes. I explained my tale of woe, and he had me lie down on the examination table. You know the drill:
- Does this hurt?
No.
Does this hurt?
No.
Does this hurt?
No.
Does this….
I let out a scream that emptied his waiting room.
Does it hurt more when I press in or out?
Both.
“You are not going to be lecturing at the university this week my friend,” he said.
“Oh?”
“You have acute appendicitis. You need to go to the hospital NOW.   How did you get here?”
“I drove.”
“The hospital is about two miles straight down the road. I think you can make it, but if you want I will call an ambulance.”
An ambulance? For salmon?
I drove, and within 15 minutes of seeing the walk-in physician I was in front of the triage nurse at St. Catharines General Hospital in St. Catharines, Ontario.
He was reading the note from the walk-in doctor.
“So, appendicitis,” said the nurse. “Let’s get you set.”
Within ten minutes they had arranged for me to be admitted to the emergency room for observation and testing. They handed me some paperwork and told me to give it the emergency room registration receptionist.
“May I see your healthcare card?” She asked.
“I’m an American.”
“Ok, we’ll take care of that later on. When you’re done we can figure all that out.”
“Fine,” I said. But I was surprised that they didn’t want a credit card, a debit card, my bank account number, or a wheelbarrow filled with cash.
I was ushered into an examination with curtains for privacy. Within a half hour a nurse saw me for vitals and information, then a physician ordered blood work. Dr. Owen and Dr. Griffiths came to see me. I was embarrassed. The fact that I couldn’t rise above this to do this work was almost incomprehensible. But the volcano in my lower right side of my stomach wouldn’t see it any other way.
Instead of focusing on the embarrassment, though, I shifted to thinking about having a profound gratitude for being in the right place at the right time.  The clinic physician told me had my appendix burst on the airplane I most likely would have died.  Gratitude seemed a better way to go. Dr. Owen and Dr. Griffiths rescheduled my training for the end of the summer–another reason to be grateful. For more information on the power of Gratitude Interventions Project and other gratitude work check here.
The surgeon, Dr. Sawula, was on call. Each nurse, each physician, each orderly, sang his praises. “My, you are lucky,” they would say, “he is one of the best.”
They were right.
The nurse put in an IV line and asked what my level of pain was from 0-10, 10 being the highest.
137.
Then nurse laughed. Then it sounds like time for morphine, ever have morphine?
Nope.
OMG.
After 10 minutes they could have come back in and announced that they were removing my ears and nose as part of the procedure.
Fine.
And your skull and knees.
Good with me.
We might have to take your tongue and spine as well.
Whatever.
The next time I treat someone with an addiction to narcotics I will have much more sympathy.
The surgeon gave me his thoughts and approach and his best guess about my condition. Yes, it looked like appendicitis. Yes, my white count confirms it. Yes the CAT scan confirms it. And there is a good chance we can remove it laparoscopically with an incision about an inch long. There will be three cuts — one on the left side of the abdomen to inflate your belly, one above the navel for the camera, and the incision below the navel to remove the appendix.
Camera?
“If it is still intact I can tie it off and take it out,” said the good doctor.
Let’s do it.
While I was being prepped, there was an accident. The two people in it were badly hurt, and were rotated ahead of me for surgery. After the first person was cared for, Dr. Sawula told me he had to wait to do the second person, that I was his intermission.
“I’m not anticipating any problem with this,” he said, “so let’s get it out of there.”
“Sounds good to me,” I said through my morphine haze.
Soon I was in the operating room. A Dr. Rose and Dr, Maximous assisted in the operation; it was about 11 p.m. when someone put a mask over my mouth.
“Daniel, Daniel Daniel Daniel!”
My eyes shot open. I’d never had an operation or general anesthesia.
“You did fine, it’s over, they got it out, and you’re in the recovery room. Everything went well.”
My stomach was like a basketball. The surgeon explained that afterward I would feel bloated, and that I might have gas. He was right about both. Toward the end of my two-day stay I asked if I could call Guinness to find out if I had just broken the world’s record of continuous flatulence.
Back home in New Jersey I went to my regular, trusted physician, Dr. Jeff Felzenberg. I explained that I had gratitude for the responsiveness of the healthcare system in Canada. They treated me as a person first and foremost, and responded according to my needs. Money was never an issue. The level of care was based on my need. When I was the most needy I was first, when I wasn’t I was repositioned.
He checked me out, admired the work of the surgeon and gave me the usual annual physical. We talked about the differences between the two countries and their approach to healthcare. Â He stuck a tongue depressor in my mouth, asked me to say Ahhhh, and then took a good look inside.
“Well you’re in great shape, you seem just fine after the operation. And you have a new tattoo on the roof of your mouth,” he said as he tossed the tongue depressor in the waste can.
“A what?”
A new tattoo. It says “Compliments of the Canadian government.”
Thank you, Dr. Sawula.  Thank you, Dr. Rose.  Thank you Dr. Maximous. Thank you, Dr. Griffiths & Dr. Owen. Thank you, Canada.
To learn more about the healthcare system in Canada click here. To learn more about the healthcare system in the U.S. click here.
Postscript: A special thanks to my Canadian friend Barea for helping me recover until I could fly back to New Jersey.
About a week after I got home I contacted the hospital and paid the full bill for their services. I say anyone who saves your life deserves to be paid. I’ve submitted the forms to my insurance company. I’ll let you know what they say.
14 comments
If only grateful patients up here would speak out, we might have a chance to save our healthcare system from the vultures of big business. I have felt like you, and appreciate the quality of care and treatment in our institutions. Thank you for publishing this. I have shared it on Facebook, for my Canadian friends, too many of whom have no clue how lucky they are.
Although our health care system is far from perfect – I wouldn’t trade it for anything in the world. Without it my oldest daughter might have died from a ruptured appendix when she was 10. Because I didn’t have private insurance – I probably would have taken her to the hospital too late. I thought she had the flu. They whisked her in and within 2 hrs she was on the table – her appendix fell apart in the surgeon’s hands. She was in the hospital for 7 days and it didn’t cost us a penny. Do we pay higher taxes in Canada – probably, but is my daughter’s life worth it, or the life of anyone worth it? Absolutely, a million times.
I am glad that they were able to help you and that you were in good hands – we have many, many, many excellent health care professionals here. Can’t thank them enough.
Thank-you for this wonderful piece. I’m glad you were well taken care of. Our system has its problems, but I’m unendingly grateful. When my 92 year grandmother collapsed of heart related problems, we had to call 911, the paramedics were on strike (ie still working but wearing T-shirts indicating their grievances), we couldn’t find her healthcard. It didn’t matter. They arrived within minutes (first the fire department, then the ambulance), she was taken into emergency, she was treated promptly and well. Health comes first, issues of payments, at least second. Also, for Canadians at least we can’t be denied healthcare, even if you haven’t paid your premiums (they can send a collection agency after you but they can’t deny you service).
For the few years when I lived overseas, wasn’t insured at home and had a foreign service plan I had to call ahead so they could look up the costs, and bring exact change and insist on paying – they couldn’t do credit cards, had no change and were utterly unused to handling cash (this was at a GPs). It warmed my heart.
Hmmn,
I am from Canada. We do have a better health care system than the U.S in terms of up front cost, but the costs do get taken out of taxes we give to the federal gov’t. We also tend to have long wait times, & have been privatizing things more now. It is interesting to watch because some Americans want a health care system more like ours & some Canadians want a health care system more like America’s. On the other hand, @ least our system doesn’t discriminate as much against the poor.
I’m very glad that you had a good experience with the Canadian system, but please be aware that socialised medicine has it’s own problems.
The one I have had the most problem with in the UK with the NHS is the lack of patient autonomy and overall accountability within the system. I think that most advanced medical systems can manage an emergency fairly well, but beware of going this route and placing all your faith in a utopian socialised scheme for continuous care.
People are the same no matter where you go and the same motivations apply. No one does their job with strictly altruistic aims, and I would much rather be treated in a medical system where choice and accountability are still able to exist via market competition.
I speak as someone who has been treated both in the US and the UK. I also know someone who has experienced the darker side of the Canadian system. People like to complain about healthcare in the US, but it only takes a little experience of a lesser system to realise how good we actually have it.
My earlier comment seems to have not been recorded.
What it essentially said is that Americans should be grateful for the very high level of care that we receive as well as the patient autonomy and better accountability within the system due to competitive Market forces.
No system is perfect and emergencies do tend to bring out the best in any one of them, but for ongoing monitoring and preventative healthcare I would choose the US hands down every time.
I have lived in the UK for six years and I have had my fair share of let downs from the NHS, some of them serious, others just annoying. When things have gone right, it has honestly felt like a happy accident. The care is not joined up, there is a cynical attitude generally with staff and there is zero accountability. I actually feel sorry for the good clinicians I have seen, because they are truly fighting an uphill battle.
Free is great when it works, but if the care is not good it really doesn’t matter if you haven’t been billed for it.
Free does work and it is good in Canada and no one is denied health care regardless of their financial status or age. It’s not perfect – no system is, it’s run by humans and humans make mistakes. But we are under the same privacy laws as the US, we have accountability and we have family health teams which work well together. Sometimes you have to speak up and make sure you don’t fall through the cracks of any system. When you take into consideration the millions of people our system services it works pretty well – again, not perfect, but I have no serious complaints and I have used our system for pretty much everything – including mental health and I have ALWAYS received the treatment that I have needed. My family is health and any concerns we have we simply make an appointment with our doctor – we don’t have to think about insurance coverage or pre-existing conditions. Still – wouldn’t trade it for the world.
I object to our system being described as “lesser.” It’s not perfect, no Canadian would ever claim that, but it’s a good system with well qualified people that is simply structured differently than the US system. You will get care in Canada, I’ve never heard of anyone being denied care. It may not be in a fancy facility, and you may have to wait, but you will get care.
Free does work – just the priorities are structured by need not ability to pay. So, if you have knee surgery scheduled and there is an emergency you will get bumped by that more urgent surgery if there isn’t capacity to do both. Obviously the ideal is endless resources, but in the absence of that dealing with things in order of severity makes sense.
I’m not sure quite what you mean by autonomy and choice. As patient (and a psychiatric patient) I feel I have autonomy and have been treated with respect, and my input about my care is taken seriously. I’m also low income – so currently I pay no premiums (those on the highest incomes in my province pay around 60 dollars a month), and my prescriptions are now 68 cents each but the pharmacy doesn’t charge for anything under a dollar.
If by autonomy you mean being able to choose your doctor – yes, there are limitations, you can choose your GP (if logistics and availability allow – ie if there is more than 1 available), and theoretically if you knew who the specialists were you could request a specific one (usually you are just assigned geographically or based on availability, or you can pick male or female). You can’t go straight to a specialist (you need a referral from a GP for everything), and you can’t choose which diagnostic tests to have (that’s your doctor’s decision). I don’t consider these issues to be unreasonable or encroaching on my autonomy. Also, I think the bottom line of any healthcare system is – how do we make sure everyone is covered, that everyone has what they need? We’re all human we all need healthcare, no one has a greater right to it than anyone else. Making more money or having better insurance doesn’t make your health (or life) more valuable than anyone else.
Glad you had such a positive experience in my country, and hope you’re feeling better now.
My psychiatrist has told me that she sees Americans who need emergency psychiatric care for free. That’s her personal choice, as she could bill people who aren’t covered by our system. She’s one of those noble doctors who believes that patient care comes before money, and if people can’t afford treatment but she can offer it, she does.
A couple of times I’ve been in America and needed psych meds adjusted and paid cash to see a doctor. I felt very lucky not to need hospitalization.
Even if you pay the full bill, it will be a fraction of what you would pay in the US. I fell down some stairs in Toronto and was taken by ambulance to an ER where they did two sets of x-rays (I was in so much pain, they couldn’t beleive I hadn’t broken anything), saw me very quickly, released me (I just bruised my lower back very badly) and asked my husband for a credit card, on which they billed $375. This would have cost thousands in a US ER.
It’s true – you can look up the costs here (there is simply a list of costs and procedures) and they are significantly lower.
When we travel there are actually two types of travel health insurance now (the province covers up to the cost at home, but it’s good to have extra) – global coverage, and global except for the US (which is cheaper). The US has the highest per capita healthcare costs in the world – INCLUDING all the people who are uninsured.
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I think it is amusing what some people (who are probably /almost certainly conservative in political orientation) wrote who have complaints about socialized healthcare. There are a LOT of assumptions inherent in those complaints/claims. Here are the assumptions and the realities:
– In the US you can go to any doctor you want (autonomy) if you dont like your doctor
Reality 1: many health insurances restrict the physicians groups you can go to, most have some restrictions and others have severe restrictions. Reality 2: What is more, in some categories the shortage of physicians or practitioners, especially in parts of the country, can be acute and your ‘choice’ might be one person – if you are lucky, or it might be that you have to drive hours to have a choice. Of particular note are GPs and Mental Health care practitioners, and Pediatricians.
Reality 3: If you are above the extreme (and it really is extreme, below subsistence in many areas) poverty level, particularly if you are a single man, your ‘choice’ consists solely of this: if you need health care, you may go to an emergency room which is required by law to treat you. You may wait 4 to 8 hours. You will receive a full bill, which will be sent to collections and can follow you for seven years. Depending upon the treatment you received, which may require way more expensive and dramatic treatment if like most people without health insurance you waited quite a while for care, your bill may run into the thousands or tens of thousands. Furthermore they are only required to offer you immediately needed treatment. If you have cancer, you will die if you cannot raise the costs of your own chemotherapy and radiation treatment, up front. You have choice: you can die. Fabulous choice. If you have any illness that requires medications and they are required to live, you will die unless you can afford them up front.
The ‘autonmy’ and ‘choice’ that some in the UK and Canada believe we have in the US is ONLY available for those who are lucky enough to have health insurance or who qualify for government care which is very restricted. Over 45 MILLION people do not have care, and millions die every year who do not have care. So what you are saying is, it is is better for those who are well off and lucky to live in the US system, not that it is objectively better.
What I understand is that in Canada and the UK there ARE supplemental insurance systems available to the well off. So if you want to pay for it you can have ‘the best’ or ‘most choice filled’ care just like the well off have in the US. If you dont wish to pay for it that is frankly your problem. If you ‘can’t afford’ to pay for it then you would probably be sadly dissapointed in the costs of health insurance in the US. Sure much of it is employer subsidized. But as many people are finding out, jobs are dicey in this time. Thousands who loose their job lose their healthcare as well, because while unemployed they can barely (if at all) keep up their utility and housing payments, not to mention adding a typical $800 to $1200 per month bill for insurance for a family plan and they can get MUCH higher if you actually have anyone with an illness in your family, $2700 a month is not at all uncommon. What’s more any sequence of circumstances can see you refused the ability to buy insurance AT ANY COST, and can even see your insurance company you have been paying, often for years, refuse necessary coverage.
Yes, lots and lots and lots of choice.
Thank you for posting this. I get so discouraged when I read people trashing the Canadian healthcare system when they are basing their opinions on stories they have heard rather than personal experience.
Is our system perfect? Far from it. But I would not trade it for one where care is based on how good your insurance plan is. I am a nurse and have seen our system from inside and as a patient. It works more than it doesn’t.
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