I'm following the health care debate with fascination from up north.
This diary on words you will not hear in Canadian health care is spot on. There are supply issues at times and we do pay more taxes, but the system is by and large efficient, effective and simple - the last being very important given that you interact with the system at times of signficant personal stress.
I've also had some interesting discussions with a Republican American friend of mine. Not a deather - I don't hang out with insane people - but earnestly skeptical of the ability and capacity of a government single payer system.
He had two major concerns: 1) that single payer leads to a tragedy of the commons situation, where people abuse a free resource; and 2) that covering every and all procedure is prohibitively expensive.
Strangely, I found myself using everyone's favorite crazy mother of 14 to answer his concerns.
So, this is what the OctoMom could expect in our system.
- Delivery - Covered in full, even given the fact she shouldn't be having kids at all. Stories such as these in Andrew Sullivan's recurring series of Tales from the Sickbed are simply foreign to us. The last thing you need to be worrying about in pregnancy - and certain in delivery - is whether or not X test or Y procedure will be covered, if so, to what level, and how much any of the component pieces may cost. Co-pays, deductibles, procedure shopping, opaque pricing structures, insurance battles - all this does not happen here. The focus is on your well-being - where it should be.
- Fertility treatment - A common misconception of our public insurance system is that it covers everything. Not true - some procedures are offered partially or solely as private care.
Fertility treatment is one such procedure. If a woman has fully blocked fallopian tubes, Ontario's insurance program will cover many - but not all - costs of IVF. Otherwise, fertility treatments are entirely a private transaction. One set of costs in both insured and non-insured cases can be found here.
So, in OctoMom's case, she'd pay for her insanity. Alas, because it remains a private transaction, I'm not at all sure she would have be refused treatment, but one would hope that reputable clinics would show restraint. As the case of Michael Jackson's doctor shows, though, in private practice, you can always find someone greedy enough to indulge your insanity.
- Abortion - If she changed her mind after the bother and expense of IVF and chose to terminate her pregnancy, her abortion would be covered by Ontario insurance.
My friend was not at all OK with this. I'm personally not comfortable with it myself - and I'm not only pro-choice, but have paid for the procedure 20 years ago for an ex-girlfriend, at a time when the constitutionality of our abortion laws was being challenged so it was certainly not covered.
Apart from the moral objections others may have of covering abortions on the taxpayer dime, most abortions are elective procedures. In instances of sexual assault or when pregnancy is a serious health complication for the mother, by all means cover the procedure. Otherwise, freedom of choice rather implies responsibility for one's choices - including the mistakes made that directly led to you needing the abortion. It was a big financial hit for me at 17 years old, but paying that bill certainly made me think more about the consequences of my actions.
- Cosmetic surgery - Sorry, but I'm not paying for anyone to transform themselves into Angelina Jolie. Cosmetic surgery is largely uncovered, unless part of a larger basic medical care concern. So, if you're a woman with breast cancer by all means some attention will be spent to reconstructing the breast after surgery. Breast protheses are also partially covered and co-covered under many supplementary private insurance plans. But if you're healthy and just looking for a boob job, you pay for it entirely out of pocket.
On the tragedy of the commons issue, a personal example of cosmetic surgery. Five years ago, I had a cyst on my neck that seemed to be growing. So, I went to my doctor - who happened to be my pediatrician. With all this access to free care, I hadn't been to a doctor in 18 years.
Apparently free care doesn't turn everyone into a hypochrondriac. Most people, after all, aren't exactly super eager to go to the doctor. It's just nice to know you can with your health card, not your credit card.
He referred me to a cosmetic surgeon. This is where it gets a bit complicated, since this cyst was in the gray area of coverage. If cancerous, removal would be covered. If not, removal would be an aesthetic procedure not covered by government or private insurance. Either way, the biopsy was covered, and given it was kind of ugly and the cost was reasonable ($300) I had it lopped off. It was benign, thank God. Interestingly, if it wasn't, I'd have received a refund on the procedure.
Overall, our system controls cost to the taxpayer with private options (including many things that we'd probably like to cover with more money, such as dental, vision and drug coverage...), but is generally efficient, certainly more cost-effective, infinitely less confusing, and really doesn't lead to freeloader abuse.
I hope you find your way to something similar in your national debate. The horror stories I read here and elsewhere are, to many non-American readers, bizarre at best, sociopathic at worst.