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While films such as Michael Moore’s Sicko and Capitalism: A Love Story, and shorts produced by Robert Greenwald’s Brave New Films, do much spotlight the problem in bold face terms, the need to change the health care delivery and payment system in the US is essentially the collected nightmare stories of millions of individuals and families.

My sister was one of them.

It’s time for a truth-and-reality check on conservative crazies in Congress, on Fox and loose in the country who keep using the Canadian national health system as their example of why they object to making major reforms to America’s medico-insurance complex.

I’ve experienced health care on both sides of the 49th parallel and can tell you that, compared to what happens when you get sick in the US, Canada is utopia.

While films such as Michael Moore’s Sicko and Capitalism: A Love Story, and shorts produced by Robert Greenwald’s Brave New Films, do much spotlight the problem in bold face terms, the need to change the health care delivery and payment system in the US is essentially the collected nightmare stories of millions of individuals and families.

My sister was one of them.


When my sister and only sibling was diagnosed with cancer in 1999, she and her husband had major battles with their insurance company in Minnesota which fought tooth-and-nail to cancel coverage and deny care at sight of the first claim form.


Because in her original application – roughly 10 or 11 years earlier – the insurer discovered that she forgot to note that, at age eight, she had two sessions with a child psychologist after our family dog died. She had real trouble coping: Tarzan taught her to walk when she was an infant, letting her hang onto his back as he walked her slowly around the house. As a pre-schooler, she’d dress him in outfits for tea parties – the kind little girls have, not Glenn Beck’s monstrosities. When Tarzan died, it was her first experience with losing a loved one and she couldn’t stop crying, even a week later at school.

To the insurance company, which went rummaging through Janice’s past after collecting more than $60,000 in premiums over the years she was a policyholder, that oversight meant she was a scamming liar trying to defraud them. It relented only after being confronted by a series of insistent phone calls from her oncologist and increasingly strong letters from the family lawyer. Nevertheless, the fight took weeks, causing Janice and Steve enormous grief and worry – on top of worrying about Jan’s cancer.

But it didn’t end there.

After being told she was terminal, Janice wanted to die at home in familiar surroundings with her three cats on the bed and her husband of 17-years sitting in the room. Nope, the insurance company ruled. They’d pay for her to stay in a hospital wired to machines and tubes at roughly $2,000 a day or more but the $150 or so it’d cost to have a nurse come each morning to check Jan’s vitals and a health care worker every afternoon to stay while Steve ran errands, bought food and have a few minutes away from his gruesome death watch was verboten.

A Supreme Irony

How ironic.

At first, the company wasn’t willing to pay anything yet when given a chance to reduce its expenses to less than 10% of what they were running, they balked. A bizarre-o world example of what’s wrong with health insurance in the US.

So, there ensued another series of letters between their lawyer and the insurer and, this time, also her employer, threatening legal action and public exposure. Reluctantly, the insurance company backed down. To its credit, the senior vice president of human resources at the large corporation where Janice worked before getting sick phoned immediately to say that he was appalled at the treatment she was receiving and assured Steve that if the insurance company didn’t pay for home care, the employer would.

In a way, Janice and Steve were "lucky."

Besides having a caring employer, they had the resources and toughness to summon a lawyer to go toe-to-toe with the insurer. And, in the end, her care was covered. But, like Barack Obama’s mother, Jan and Steve spend much of the 11 weeks leading to the end of her life fighting with an enormous insurance company bureaucracy and its "medical advisors" who never clapped eyes on Janice before trying to deny what she’d been paying years to have. Happy to take money from her pay check every month for her share of the premium, the insurance company fought desperately when it was time to meet its end of the deal.

The best system in the world? Only people who never had the misfortune of dealing with it would say so.

Meanwhile, Up North

Walk across the road where Minnesota meets Ontario and enter an entirely different world of health care.

I’ve lived in Toronto since 1991, during which time my out-of-pocket costs for health care have been zero. Nothing. Nada. Zip. This includes more than a year seeing a psychiatrist for depression and grief after my sister died; she passed away six months after mother and three years following our dad’s death, and I was overwhelmed. It also includes two separate hospitalizations for heart problems, one very minor and one more serious. And I’ve been fighting colon cancer with chemo, radiation and surgery for four-plus years.

None of my care has cost me anything. I never waited to see a specialist, or to have tests or treatment. When surgery was prescribed, I saw another doctor for a second option and was still on an operating table within two weeks.

Before the right goes all batty and begins yelling I pay for coverage through income tax, I’ll admit that I do. But – and this is a big but, much larger than the butts on the back ends of many of the 9/12-er’s waddling around Washington last weekend – I did the math and my total cost of taxes plus insurance is less than in America.

Yes, my federal and provincial taxes are higher than if I lived in the US. But what I pay includes the cost of government health insurance. So, when I looked at US and Minnesota tax tables – Minnesota being my last state of residence in America before moving here – and added in the average of what friends back home tell me they pay annually in health insurance premiums, I pay about 9% less in Canada than if I lived in the States.

Nine percent less.

Never Cancelled

My coverage never can be cancelled or denied. I pay no deductible. There’s no such thing as a pre-existing condition. I had coverage the first day I arrived in Toronto after filling out a short form. I never heard the words "Not in our network" when seeing a physician or specialist. No one mentioned going before a death panel.

When I was ill, no one went scrounging through my past to find a reason to deny coverage. When I am discharged from hospital, the only thing I receive is a warm handshake and a sincere, "We’re glad you’re doing so well."

I did have some out-of-pocket costs. I paid for cable television in my room, a morning newspaper, a vegetarian pizza from a place near the hospital and a few Chinese food deliveries after being taken off the restricted diet list. If I’d had high speed internet in my room, I would have paid for it myself; national health doesn’t cover surfing the net.


Utopia? No, not really. Only when compared to the US health system nightmare. And there are problems with the Canadian system.

For example, Ontario and other provinces are short of doctors. It’s not because of a brain drain. In some cases, it's hard to attract physicians and surgeons to some provinces such as Newfoundland/Laborador, the Northern Prairies, the Yukon. Mostly, though, it is because The College of Physicians and Surgeons, the licensing board in each of the provinces, for many years made it nearly impossible for immigrating doctors to practice here, a kind of closed shop protectionism.

The rationale – often justified – was that foreign trained physicians and surgeons don’t meet Ontario standards. Fair enough. But the College required people to start med school all over again, as if they’d never treated a patient.

Most of these physicians readily admit they need additional training when arriving in Canada. But why force them to start a 10 year process of med school, internship and residency all over again other than to hold down the number of doctors practicing? I suspect that human anatomy is the same at a university in, oh, Kenya, India or Jamaica as it is at the University of Toronto.

Fortunately, the government stepped in to apply pressure on the Colleges. Now, additional training is handled much more swiftly and the doctor shortage is starting to ease.

Constant Claptrap

Trial lawyers joke that when the facts are against you, argue the law; when the law is against you, argue the facts; and when the law and the facts are against you, then pound the table.

The anti-change artists in the health care debate are left pounding the table because everything is against them. But there’s no talking with most of them because they react like small children: Lacking a genuine rationale, instead they cover their ears, scream loudly to drown out what’s being said and stamp their feet.

The arguments against making major changes to the medico-insurance complex are about as accurate as Glenn Beck’s crowd count. I’m not sure it will do any good but we have to keep trying. For one thing, since I’m uninsurable in the US until I’m eligible for Medicare, I can’t come home until there’s a rational plan in place.

Originally posted to Charley James on Thu Sep 17, 2009 at 12:15 PM PDT.


Will there be a meaningful health and insurance reform bill from Congress this year?

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Comment Preferences

    •  As a fellow Torontonian (8+ / 0-)

      It's nice to hear some truths about our healthcare system.  The lies and distortions about 'socialized medicine' coming out of the RWNM have been driving me absolutely insane.  

      I've had a few health problems over the years, and I've never been disatisfied with my coverage (except I had to pay for a PSA! wtf?).

      Thanks for your story Charley, and I hope that you will be relying on OHIP a little less in the future.

      "Soon the super karate monkey death car would park in my space. But Jimmy has fancy plans... and pants to match."

      by Dave Brown on Thu Sep 17, 2009 at 12:23:34 PM PDT

      [ Parent ]

      •  About that noise (2+ / 0-)
        Recommended by:
        Dave Brown, Charley James

        They've been pounding the table about tort reform and socialized medicine for years. The alarming contradiction between these positions is obvious to anyone who takes a look at the nature of malpractise suits in countries where medical costs are guaranteed by the government. Here's an excerpt from the above CodeBlue article on malpractise suits in Canada:

        Canada’s malpractice system is similar to the UK and the US, except there are far fewer claims filed and more money is paid out in compensation on average that in the US.  One reason there are fewer claims filed in Canada can be attributed to the increasing use of alternative, informal interventions that address patient concerns more quickly the formal system.  In Canada, most doctors receive malpractice protection from the Canadian Medical Protective Association.

        •  Not Exactly (1+ / 0-)
          Recommended by:

          I'd like details on the "alternative, informal interventions that address...".

          That's not what makes the difference. Here's the biggies.

          The Supreme Court of Canada has for many years capped a dollar amount maximum for pain and suffering. It's currently about $300,000. And there's very rarely the American jackpot of punitive damages.

          Most importantly, about 95% of Canada's doctor belong to the CPMA. I just learned that the various provinces pay their doctors much of the cost of their malpractice coverage with CPMA.  In Ontario, it is about 83%.

          I think there was a time when the CPMA had a policy of never settling a case.

          Things are better these days, but the CPMA will never settle a case because it's cheaper than going to court.

          To get a flavour of how it works, here's a malpractive lawyers perspective, the view of the US library of Congress and a 2003 CBC story.

    •  if I could pick (4+ / 0-)

      if I could just pick up and move my family and friends to Canada, I would in a heart beat.

      (regarding the bank mess) They want to cure the patient but not deal with the disease.

      by dark daze on Thu Sep 17, 2009 at 12:27:46 PM PDT

      [ Parent ]

    •  Glad you're here (2+ / 0-)
      Recommended by:
      sfgb, Light Emitting Pickle

      This is such a wonderfully written post.  I have been reading this site for years and it's the first time I've commented in a very long time.  Here's hoping the treatments work and you get back to good health soon.

      Where are we going? And what I am doing in this handbasket?

      by Mouse on Thu Sep 17, 2009 at 08:42:54 PM PDT

      [ Parent ]

      •  Good to see a lurker comment (1+ / 0-)
        Recommended by:

        Not that I'm much of a commenter lately, but it's good to see lurkers (esp old-timers) comment. Of course, one might say that you've been a church mouse!

        ::hangs head in shame::

        "For we know that our patchwork heritage is a strength, not a weakness. We are nation of Christians and Muslims, Jews and Hindus and non-believers." Pres. Obama

        by Light Emitting Pickle on Thu Sep 17, 2009 at 09:43:26 PM PDT

        [ Parent ]

        •  Well, that made me chuckle... (0+ / 0-)

          Yes, I've been vewy, vewy qwiet.

          I'll be frank: it's completely baffling to me that the level of discourse in the U.S. has reached the point where news networks are actually reporting on the questions of death panels and killing grandma, when there are so many other, real stories of people dying for lack of health care.  

          More of than not, I refrain from posting because there's a part of me that just wants to yell: What is wrong with this country?!

          And then I remember all that is right with it, and how we all felt when President Obama was elected; he may not be my president, but he is such a powerful symbol of how far the story of a nation may progress over time.  And so I stay quiet and listen to others' voices here and am comforted.

          Where are we going? And what I am doing in this handbasket?

          by Mouse on Fri Sep 18, 2009 at 01:05:36 PM PDT

          [ Parent ]

  •  another problem (0+ / 0-)

    this is an honest diary, so i'll mention another issue there.

    there is a de facto annual cap on the income of some providers, and some of them reach the cap well before the end of the year. most spend the rest of the year on vacation. this can affect their patients. my sister-in-law's father-in-law is adversely affected by this.

  •  Are you willing to name names? (2+ / 0-)
    Recommended by:
    sfgb, raster44

    Which insurance company tried to deny your sister care?  (Just so when I have all these choices in 2013 I can choose not to use them.)

    A society grows great when old men plant trees in whose shade they know they shall never sit. -Greek proverb

    by marleycat on Thu Sep 17, 2009 at 12:21:30 PM PDT

  •  This needs to be on the Rec List. (8+ / 0-)

    A very cogent and stark exposure of the differences. Why again does everyone run around saying the USA is #1 in health care??

    You may not be able to change the world, but at least you can embarrass the guilty.
    - Jessica Mitford

    by Swampfoot on Thu Sep 17, 2009 at 12:24:34 PM PDT

  •  part of the problem in the public debate ... (5+ / 0-)
    Recommended by:
    sfgb, danmac, midwesterner, sfbob, LoCo Liberal

    on health care is that our highly compromised senators have been crafting corporately compromised bills that by design can't solve the problem.  The problem is the insurance companies.  They essentially vampires that serve no real purpose except to stand between health care providers and patients, blocking action and skiming money.

    The idea that we're supposed to NOT create a public system that delivers health care more cheaply than the existing system flies against every free-market myth I've heard in my 45 years.  The free market due to competition and innovation and passion is supposed always be cheaper and more effective than government.  That myth is behind every effort to privatize government services and used to be behind this mess too.  

    They can't even pretend that private health insurance is more effective than the Government.  So instead they scare us with death panels and lies and illegal aliens, and instead of the magic of the invisible hand of the market being superior were told we just have to make sure we don't put them out of business.  Ou politicians have chosen to be in a co-dependent relationship with health insurance companies.  

    And for what?  Campaign donations?  Isn't that Rahm's big scam?  To get big pharma and big health insurance to give to dems instead of republicans.  I'm so sick of my party gaining power just to whore themselves out-- and our votes and our electoral energy-- to the same institutions that the republicans represent.  At best it is like a teenage girl stuffing her bra to attract the kind of guys that only care about cleavage.  It is beneath us, our party and our politicians.  

    OPEN QUESTION TO THE DEMS THAT THINK COURTING REPUBLICSN VOTES IS "WORTH IT": why the fuck should liberal and progressive and even radical dems keep supporting you?

    Single payer is the only system that will fix the problem and allow us to focus on health care instead of health insurance.  Will it be expensive?  It will be as expensive as it should be to have a health and productive and happy population in the richest country in the world.  

    Sorry for ranting in your well written diary.

    My political compass: Economic: -7.38 Social: -5.79

    by musicalhair on Thu Sep 17, 2009 at 12:36:09 PM PDT

  •  Excelent comparison (5+ / 0-)

    I get so frustrated when people act as if Canada and Britain have a health care system that provides no services and that everybody hates.  Sure, the system is not perfect, but at least people can concentrate on getting better rather then on fighting the insurance companies.

  •  Love your point on taxes... (12+ / 0-)

    ...When we first went to Europe and I got my first paycheck, the first thing I thought after seeing the 48% cut off the top was "I made a huge mistake coming here."  

    Then, I settled down and did a little math.  

    That 48% covers:

    ~Taxes for military, police, justice system.
    ~Heath Insurance
    ~Unemployment (80% of your paycheck)
    ~Long and short term disability (100% of your paycheck)
    ~The worlds best public school system
    ~paid for university education all the way up to PhD level, at any school you get accepted to, even ones abroad like Harvard or Cambridge if you get accepted there. (plus a $20,000 per year living stipend while you're a student)  
    ~Paid for preschool and daycare (where all the preschool workers must have a Master's in Early Childhood Development and pass a strict background check, and be subject to government regulations and surprise inspections)
    ~ Strong workplace regulations regarding fair pay, hours, vacations (one month paid, every year, for everyone), job security, safety, etc.

    Here in the US, once you add up Federal Income Tax, State income tax, Property tax (we didn't have that over there), Health/dental/vision insurance, long ans short term disability, workers comp, unemployment, Social Security, Medicare/Medicaid...


    ~$150-200 a week or more for quality daycare, per kid
    ~$10,000 -$15,000 per year, per kid for a private school in the US which are closer in quality to, but still not as good as the public ones over there
    ~300,000 per kid for college (unless you want to take out second or third mortgages or let the kid graduate college in crushing debt)

    Then, take into account the fact that you have no rights to fair pay, no rights to vacation, and what few workplace regulations there are are watered down and ineffectively enforced (IE: you have to hire a private lawyer to get anything done), and the fact that we work way, way harder and get a smaller slice of what we contribute....

    Well, add all that up, and I spend way more than 48% on "taxes" here in the US, and most, of not all of the services I receive for it are far inferior.        

  •  Canadians really don't understand (4+ / 0-)
    Recommended by:
    catdevotee, fiddlingnero, sfbob, Spekkio

    why Americans think their system is better.  It's mystifying to us.  It's just not affordable for people.

    I listened to a local talk show in Vancouver on Tuesday.  The local host, Bill Good at CKNW, known  to be right wing, had as his guest a talk show host from Seattle (Dori Monson - Kiro Radio). He was mystified.  The callers the same.  We just don't get it.  This in a country (Canada) that has never elected a socialist government.  

    If I can find the link to this show I'll post it.

    "you can lock up a mouse or a man but you can't lock up an idea"....Tommy Douglas

    by marigold on Thu Sep 17, 2009 at 01:17:25 PM PDT

    •  Because we're #37! (1+ / 0-)
      Recommended by:

      No Public Option, No Re-Election. It's not complicated.

      by mrobinson on Thu Sep 17, 2009 at 01:30:37 PM PDT

      [ Parent ]

      •  I'm weird, I care more about accuracy (0+ / 0-)

        It's a nice video.  Much as I'd like to use it bash idiots, I don't think it is fair. And while it isn't the strategy du jour, I think accuracy is very important.

        First, what ever in measures, it's out of date, the last go around was in 2000.

        More importantly, its calculation that the US has the 37th best health care system isn't fair for the way that Americans think about health care.  It is more about well being through a health care system. It measure health care systems more the way that Europeans think about it. The best way to understand this is to read this  long summary.

    •  Answer: American exceptionalism! (1+ / 0-)
      Recommended by:

      It's great that people love the country they live in, but there are 2 very different kinds of love for the US.

      On the right you have the obsessive, desperate, stalker kind of love; driven by jingoism and blind loyalty.  On the left you have a more honest, open and healthy kind of love: one that supports what's good in the US while still identifying what needs to be improved.

      The blind so-called patriots on the right can't deal with even the suggestion that the US might not be perfect.  They'd rather ignore imperfections than admit to them and try to fix them.

      BTW, I survived several socialist governments while living in B.C. for 8 years... But, yes, the federal government has never been socialist - unless you're a hard core Conservative who thinks the Liberals are all socialists.

      •  I live in B.C. too (0+ / 0-)

        and have most of my life.  If you're referring to the New Democrats as socialist, I would respectfully disagree.  Progressive, lefties, liberals ( I am all 3) yes but not socialist, even though the right wingers in town refer to them as such.  Just my opinion.

        "you can lock up a mouse or a man but you can't lock up an idea"....Tommy Douglas

        by marigold on Thu Sep 17, 2009 at 09:29:18 PM PDT

        [ Parent ]

  •  I found a link (1+ / 0-)
    Recommended by:

    to the talk show with the Canadian and American right winger that I mentioned above.  If you care to listen to it it starts at 7:50 and goes to 30:00 with callers.

    "you can lock up a mouse or a man but you can't lock up an idea"....Tommy Douglas

    by marigold on Thu Sep 17, 2009 at 08:54:27 PM PDT

  •  Fantastic diary (2+ / 0-)
    Recommended by:
    catdevotee, Spekkio

    and comments.  Thanks for sharing in such detail your personal experiences.  The contrast between your sister's US experience and your Canadian one is a remarkable indictment of the US health care system.

  •  thank you for this look (2+ / 0-)
    Recommended by:
    catdevotee, Spekkio

    at healthcare in Canada.

    I am so sorry to hear of your losses and your on-going health issues. Sending my hugs and best wishes to you.

    Build a man a fire, and he'll be warm for a day. Set a man on fire, and he'll be warm for the rest of his life. - Terry Pratchett

    by cherryXXX69 on Thu Sep 17, 2009 at 09:34:36 PM PDT

  •  What happens in Canada stays in Canada... (0+ / 0-)

    This Canadian says:

    America will never have a sane, rational, social medicine policy. Way too many Americans are incapable of seeing themselves as part of a civil society. Too many Americans are "Freedom," "Liberty," and Ronald Reagan's "The Government is the Enemy" nutjobs. Think about it, just today on the "Doctors" a TV show about health they stated that "OVER 50% of Americans EAT OUT (or order in) EVERY DAY!" Madness - insanity. Add that fact to the fact that well over 50% of Americans don't believe in Evolution and think the world is less than 6,000 years old and you CLEARLY have a SIZABLE share of your population who are bat shit ignorant - AND PROUD OF IT!

    I can't see a working majority of Americans even existing on any socially relevant progressive policies of any kind.

    Seriously - IF you think a far too large number of your fellow Americans are just too ignorant for their own good - or yours - why not immigrate to Canada? We can use a few more good men - and women. Come on up - eh.    

    •  Don't roll out the welcome mat just yet.... (0+ / 0-)

      I don't think you'd want a lot of American progressive refugees coming into Canada. It sounds nice in theory, but in practice...not so much.

      Also, I've read that some folk are barred from immigrating into Canada if they have pre-existing medical conditions - particularly autism-spectrum disorders. And further, I've read that people on the autism spectrum have to pay out of pocket for treatment and experience quite a bit of other trouble besides. (See Michelle Dawson's website, No Autistics Allowed and her blog, The Autism Crisis. Ms. Dawson is Canadian and autistic.)

    •  If I can find a job there (0+ / 0-)

      I'll be happy to move across the border.

  •  30% of Costs Aren't Paid by Gov't (0+ / 0-)

    The Canadian system is a single-payer with mostly fee for service doctors (although governments are offering more money if they move to capitation).  Hospitals are funded by government but administered by local foundations and sometimes by religious orders.

    It's estimated that government covers about 70% of the cost of the medical health care system.  A large part of the other is Rx drugs.  Employers at decent companies cover the cost of drugs. Similarly, they cover dental costs but there is often a co-pay of 10% or they use an older fee schedule so the employee effectively has a co-pay.

    If you don't work for a decent company or are self-employed, you'll pay for your own dental care and your own drugs.  You can get some of your costs back through the income tax system.

    There's also a maximum you can end up paying for drugs through programs that pay what's over about 4% of the cost of drugs.

  •  HCR opponents just can't handle the truth, and (0+ / 0-)

    you lay it out so beautifully and poignantly here.  Thank you.

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