Heavy, Heavy Stuff

(I tried to post something light the other day but the video wasn’t embedding so I said a bad word and gave up. Now you get something HEAVY.)

The US healthcare reform is heavy on people’s minds this week, and I thought it might be interesting to compare theirs and ours, as kids are wont to do while playing doctor.

This is a reply, kind of, to the Musings of a Distractible Mind’s very, very interesting two-part series on What if Life Were Like Healthcare (pre-reform). He writes from the perspective of an American doctor, so he is both a healthcare producer and consumer. I unfortunately can only speak from the consumer side, and my version will be nowhere near as accurate or witty, but I thought it would be a fun thought experiment.

Please read the original first! There are, of course, a lot of similarities between any Western healthcare system, so he’s really done a lot of the work for me. I’ll just focus on the differences as I perceive them in the systems. Some of the similarities are:

- How easily we are all swayed by experts as well as charlatans, family, friends, and majority opinion on a subject we’re reasonably familiar with: the bodies we’ve had all our lives
- How people so readily accept health care ‘anecdata’
- How many hoops healthcare providers have to jump through in order to complete the paperwork necessary to be reimbursed by insurance companies, private clients, or the province/state
- How many tests are probably unnecessary but done because they are recommended by specialists who get reimbursed more for these tests
- How resistant all hospitals and other healthcare facilities are to publishing the costs of their care
- How the perception is that people who get free healthcare abuse the system by going to a doctor or the ER much more often than everybody else
- The system focuses more on cures than prevention
- People are ejected from hospitals generally far faster than is healthy for them, and they are not always provided with help when they are back home because they make too much money to be helped by the province/state and their insurance will not cover the level of care they need

“The grocer can’t post prices because all customers have different negotiated prices.”
Fortunately this is (as far as I know) not the case in Canada. Here in our grocery stores, there are even fewer brands to choose from – and fewer items on the shelves, due to our lower and often very dispersed population – but within a province, the groceries all cost roughly the same. You do not, of course, know what the cost is till you get to the till.

“You go to the cash register to pay. The total is $380, but the cashier informs you that your negotiated price is only $150. A poor person behind you has not had the chance to negotiate a price and so must pay full price for everything.”
This is partly true in Canada. I will pay $150 for my basket, while the guy behind me may pay $450, but after my employer pays me back for my groceries it might have turned out that I paid $100 of my own money and he paid $35. However, the poor woman behind me doesn’t pay full price – she will have her groceries paid for by the government, so she doesn’t even bring money to the store, just her shopper’s club card. She has to buy a lot of groceries because she has seven children, and the poor-quality goods on the shelves don’t feed them for long, so they always need more groceries. The other shoppers resent her for never having to pay anything and mutter constantly about her wasting the family’s food instead of saving it for when they really need it.

“Finally driving to work, you notice the following:
· Rich people have very nice cars.
· Poor people all have cars. They are not real nice, but all gas and maintenance is free.
· Many middle class people don’t have cars; those who do have to pay enormous amounts for ones that are worse than the poor people get.
· The elderly get free cars, but can’t afford to put gas in them.”

In Canada, we all take the bus. It’s secretly acknowledged that rich people get the nice new buses, or if they take buses with regular joes they always get the good seats by the door, but we all have bus passes and the government pays for the transit system. There are limo services too, which can sometimes be seen from the windows of our public buses, but they aren’t advertised as limos because if they say they will drive you along the same routes as the public buses, they will get in trouble with the government. They have to take you to very specific tourist spots, nowhere else. Despite their limited route and the fact that you pay for them yourself, many people use limos to get to these spots because the government buses don’t go there. Cars are supposedly not permitted, but you often see sports stars, politicians, or celebrities zipping along the back alleys in very nice cars. Sometimes the cars are even partially paid for by the government.

The busdrivers, though paid by the government, often think about leaving and starting their own limousine company, especially after they or their loved ones have to take the bus in a blizzard or on really hot days. A lot of kids graduating from busdriver academies are opting to become limo drivers because the pay is better and they get less flak from the riders. This makes the older busdrivers unhappy, because they are retiring in droves and with fewer buses, each one is getting more and more crowded and making fewer and fewer stops. If a bus doesn’t stop where you need it to, you are forced to get off one stop early and walk, even if you are in poor health or have limited mobility. Ironically, while you are walking you may be heckled by the other riders for needing to do this. They are proud of themselves for usually getting off at stops in good neighbourhoods where they don’t have to walk. Stops are eliminated every year, but the limos will take you to some of these stops if you can afford it. Most of them are too inaccessible to reach on foot.

Most of us hate it on the bus, but we either don’t need to get places that the limos go or we can’t afford to hire a limo. We wish we could buy cars, but the government won’t let us and insists we should all be happy that they are providing these buses, even though they are smelly, old, take forever to get anywhere, and are becoming increasingly crowded and objectionable. Worse yet, some of us are pretty sure that there are people riding the bus to places they could easily walk, but we don’t want to say anything because everything is supposed to be equal on the bus.

Anyway, there’s my Canadian take on things. Which probably was a dumb thing to do since I think 99.999% of SodaCraze readers are Canucks. Did I leave anything out? Was I totally off base? Let me know in the comments!