... As I've posted on another thread, a major accident a few years back saw me seriously injured; I was operated on by one of the top surgeons in this speciality in Western Canada within 24 hours (he's a specialist who also treats one of the biggest Western Canadian sports teams, the Vancouver Canucks). He saved the use of my arm.

I spent a desultory amount of money, certainly less than $100 CAD in prescription painkillers, on the six-month recovery path to getting well. I never saw a bill; in Canada, you just don't. Who needs to deal with money stresses when they're recovering from major illness or injury?

No excessive waits. Ever. Not in my entire life. Family history that encompasses members' pregnancy, cancer, injury, illness... absolutely not one single solitary point of commonality between the anti-Canadian-health-system smear job I'm hearing lately and my own real life experience.

Once in a (rare) while I've run into mediocre doctors (by the time I was in my early twenties, it had become pretty obvious that our family GP was one of those, but family loyalty and comfort prevailed 'til then); when I have, I've excercised my freedom of choice as a consumer and obtained a second - or third - opinion or simply opened the Yellow Pages and chosen another doctor.

Which freedom incidentally just had a price tag placed on it. We recently privatized the handling of our medical records to an American firm. Naturally within a year afterwards they instituted a fee for transferring our medical records from one doctor to another. It was quite steep. I was in shock when I was first told that a service that had been done immediately for me several times in the past as a courtesy between doctors was now going to cost me around $150 if I wanted it done in under a week.

I'm not saying it's the same everywhere in Canada; I'm saying that my personal experience and that of all of my circle of acquaintance completely contradicts this.

( ... Link ... )

and...

The last time I was seriously injured - three years ago - the top Western Canadian specialist in the relevant field operated on me within 24 hours. I had been abroad for years and had let my BC medical lapse. I was permitted to rejoin with date effective retroactive to my accident.
I was treated very professionally, healed fully and never once saw a bill. The operation could have cost $15,000 or $90,000 - I admit I have not the faintest clue. Who cares? I paid about sixty bucks after discharge - in prescription painkillers.
I'm certain there are worse examples than my own - however, also anecdotally, I have never heard anything from any of my extended family and friends, my colleagues, students, or in fact anyone I know that has any complaints whatsoever about our provincial healthcare system that amounts to anything more systemic than the occasional mediocre doctor.

( ... Link ... )

The threads to which these comments are attached have some more anecdotes (and some disinformatsiya tracking).

There is a treasure-trove of information in your links, and now I am definitely not getting much work done for the rest of the afternoon. I'm a bit embarassed that I didn't realize that this issue had been addressed so comprehensively on Agonist in the past. Much obliged.

I am trying to understand "greater choice". I think "greater choice" is an excuse for improved insurance company profits. My son was born at a hospital of our choice in California. The hospital was close to our house but the main reason for choosing it was its membership in our medical plan; a "preferred provider"; that is, insurance would pay 85% of the cost of my son's birth beyond our low deductable. This is the story of my son's birth almost seven years ago and how one of the nations largest health care benefits providers would pay only 40% of the cost.

Everything was approved by our insurance company including my wife's Epidural anesthesia but, unbeknownst to us on the night of my son's birth, the on-duty anesthesiologist was a contractor who was not a member of our health plan; not a "preferred provider". There was "no choice" to be made even if we had known. The hospital, it turns out, could not find anyone else to staff their night shift. This little glitch would cost us an extra $5,000 USD out of pocket.

Next I caught the nurses, making mistakes with the Epidural and the electronic monitoring equipment hooked up to my wife. The bag full of anethestic went empty, they did not understand the monitor etc. Several times I had to call the nurse for a new bag of anesthetic. By far the biggest mistake was that the nurses did not call a doctor in when they should have. This was my first experience at being a father and I was trusting their judgement; my mistake was not trusting my own judgement.

I first noticed the problem when the babies heart rate started to jump. Eighteen full hours after admittance, a doctor has yet to see my wife and my son was in trouble. A doctor would not see my wife until 23 hours after admittance; she was already 5 cm dilated when she was admitted.

He was just a little too big but the nurses refused to call the doctor. Time after time his heart rate jumped. "Why didn't anyone call me", was the doctors only comment when she finally arrived. By now, 23 hours after admittance, it was too late for cesaerian. It was a birth with forceps and the doctor bracing against the end of the birth table with her feet and pulling as hard as she could finally brought the 9 lb plus baby out of the birth canal. My wife sufferred third level tearing from the forceps birth. She still suffers, seven years later, from their mistakes.

I was helpless as the seconds ticked by and still not a breath from the baby. "Come on little guy", was the comment from the revival team. Finally, after more than a minute came a little cry from my son.

My wife was sent home after spending one more night. It was all the insurer would cover. Twenty-eight hours of labor including the time before she was admitted and one night's sleep and we were on our own. I can tell you she was too tired and too badly beat up to leave the hospital. I was tired too but she was in bad shaped; but all the same, we were sent packing. She should have been in the hospital for at least another week.

Later we were notified that the insurer would only pay 40% of the birth. The hospital, though a "preferred provider" was evidently charging too much and the contractor anesthesiologist was not on a preferred list and he was charging too much as well. We were left to fight out the balance with the hospital. Three years later my son is diagnosed as autistic and we are referred to the Early Childhood Intervention program in our school system; that is the last our health care system has to say about it.

So when people say that we have "greater choice" here in the States, I am wondering for what?

we get many bad ones. That's my interpretation, anyhow.

I don't think there is any choice. You have to have something to base a choice on. There is no accountability so there is no information to support a choice. Having said that, the service we received was criminally bad. The nurses were incompetent. The Doctors too few. We ended up paying for most of the costs even though we paid as a family $750/ month for insurance.

which highlights at the threshold the importance of preserving malpractice claims (not to say that any malpractice award could ever compensate what Joaquin and his family were and have been forced to endure). Without in anyway wishing to minimize Joaquin's central points, I think he has identified a fairly universal problem insured Americans often encounter in the hospital, and that is that, for whatever reason, the cost of an anesthesiologist ends up not being covered by insurance. This would seem to be yet another hole in the "hodgepodge" system of American health care.

What I am trying to say is that its not just who pays for what. The level and quality of care will have to change; that should be just as important as access.

I didn't mean to suggest otherwise.

experience, and needless to say, thank heavens that you are with us and hopefully well.

Let me just add some personal perspective as a union lawyer in the U.S. As you might imagine, unionized workers in this country are, on average, far better off when it comes to health care as compared to their non-union counterparts. But the price is extraordinary. Health care cost containment is the dominant theme in 90 percent or more of the collective bargaining negotiations I am involved with. My principal client is party to what is called a multi-employer health plan that is administered by an equal number of union and management trustees. Most participants in this fund receive incredible health coverage while employed and also benefit from retiree health coverage, beginning at age 55, if they have more than 25 years of service in the industry (they then switch to Medicaire when they become age-eligible). The problem, of course, is the cost; most employers that contribute to the plan are paying almost ten dollars per hour for each hour worked up to forty in a week. As you might imagine, the pressure to change the plan, beginning with the retiree component, increases in every negotiation. And this is as good as it gets for American workers.

In short, the current system, even in the shrinking unionized sector, cries out for reform.

I envied my sisters who with the birth of each child, received the services of a nurse/maid/hostess/cook/housekeeper/babysitter for 10 days post delivery. This person would look after the mother, the new born, other children, the husband (not including sex, off course:-)), visitors etc. All paid for by the insurance. The monthly payments were a nominal amount.

In Canada, giving birth is free, but no post-birth services exist other than a weekly visit from a nurse.

See my comment below. We found going with a midwife was a great choice. The post-partum visits were frequent and went over 6 weeks. One of the reasons that the midwife service is so good is that, in Ontario, it was structured based on feedback to OHIP (the health insurance plan) about what mothers wanted.

Maid service would have been great, though. Fortunately I get along really well with my in-laws, whose 4 week visit was *really* welcome.

available when I had my daughter in 1960. What sticks out most in my mind is when they brought her to me for breast feeding. She would take a couple of gulps then fall asleep. Several days of her falling asleep went on before I said to the lady in the bed beside me, "My baby keeps falling asleep and does not take enough nourishment." Fortunately, she had just had her fourth child and told me to flick my fingers on the bottom of her feet to ensure she stayed awake long enough to get enough food. Had there been instruction in how to feed one's child, I would have known that.

I had spinal epidural anaesthetic which was brand new in 1960. Unfortunately, it did not take effect on my right side. After my daughter was born, it was discovered I had an ovarian cyst--the first of three operations ensued. The labour squeezed the cyst and caused the epidural to be ineffective. Because I was so young at the time, a midwife would have been of great benefit. Doctor's don't have enough time to devote to pregnancy and to the birthing process, but well-trained midwives do and their talents if there are no complications are far superior.

My daughter was born on a Saturday night and my family doctor had been wearing a tuxedo when he arrived at the hospital. I could no longer go to him because a bill for $150 for the delivery was in our mailbox when the two of us arrived home six days later. Haydn was really ticked off that our family doctor could not delay the arrival of his invoice. We did find a family physician that was interested more in my health than sending us bills.

It is very disturbing to me that women after giving birth are not kept in the hospital for a minimum of five days; especially new mothers who are in labour for more than 24 hours. New mother's bodies do not repair themselves immediately after such an intensive period of enormous stress. Having meals delivered and not having to worry about housework was of great importance to my recovery from the ordeal of birthing.