One afternoon last summer I found myself in a conversation with a retired couple who were in Maine for a visit. The conversation turned to health care. They were unalterably opposed to the “government coming between the patient and the doctor, like it is in Canada and England,” she said. Health care is a failure in those countries, he stated emphatically. People die while waiting for care, they both said.
So I said that I am an American, who for the past several years has been a hospital director in Quebec, and that what they have been told and sold — the products of scare-tactic fearmongering on the part of the American insurance industry and complicit government folks — is just propaganda and nonsense.
I tried to explain to them what I know is true about health care in Quebec.
First, Canadian health care works. It is universal. There is no public option choice — the only choice is public. Physicians are paid by the government, and there is a basic, very high level of government-funded care that may be supplemented by private insurance, depending on the employer. I pay about $80 per month for family coverage (two adults, two children) for this supplemental plan.
Your ability to pay does not get between you and your doctor. There is no co-payment or billing of the patient for tests or procedures performed in the clinic or hospital, but there are occasional modest co-payments for some specialized tests performed on the outside.
If one is acutely ill — with a heart attack, stroke, trauma or a myriad of other serious conditions — care is immediate, detailed and attentive. You do not wait. With a diagnosis of a usually slow-growing prostate cancer, and should surgery be indicated, you would be given a surgical appointment within weeks of diagnosis. What about a potentially rapidly lethal brain tumor or vascular aneurysm? You will receive immediate surgical care — a few days after diagnosis, if possible. Preoperative tests such as MRI, CT scan, X-rays are all covered. And the surgery, your hospital stay and in-hospital medications will all be covered. No bills go to you, the patient.
Canadians keep their houses, keep their cars and farms, and still get terrific health care. Health care is a part of your rights in Canada, not a privilege.
I know all this firsthand, not only because of my role as the director of a hospital that receives 40,000 government-funded patient visits per year, but also because since arriving in Quebec, my family has received medical care that, if billed in the U.S., would have far exceeded $100,000 (biopsies, tests, three surgeries). Out of this total amount, we paid exactly $47.96 in prescription drug co-payments. And there was no deductible for any treatment.
My attempts at convincing the couple sitting next to me that Quebec health care works failed dismally. They looked at me in stony silence, eternal disbelievers. I asked if they had coverage. Turns out that they both had comprehensive health care from the hospital at which the wife worked as a laboratory technician. But they had a $5,000 deductible and many disallowed services in their plan.
Unfortunately, this couple was not alone in their negative opinion about public health care in Canada. All last summer I talked about Quebec health care to Mainers, summer people, people from away, whoever expressed curiosity about how the problem is dealt with up North. I think they expected from me a condemnation of Canadian health care, and when I stated the opposite, I was almost always met with that same stony, disbelieving silence.
Is the Quebec system a perfect one? No. Wait lists exist for many ailments that are not deemed acute or life- threatening — replacing a knee or hip in the public system can require a lengthy wait. Preventive medicine is not a priority yet. And there are not enough physicians in the system, for several reasons, the most important of which is that Canada, like Maine, has failed to attract, train and retain enough primary care physicians to care for the population. Canadians are also heavily taxed, but really, not that much more than Americans.
Can America adopt a similarly effective system? Of course. But it will require an immense, well-organized grass-roots movement to dislodge the real barrier between the patient and the doctor — the for-profit insurance companies.
As my new acquaintances left to continue their Down East tour, I gazed after them, truly bewildered. How could they be so hermetically sealed against the “public option”? Clearly, the insurance companies, who stand to lose huge profits if the Canadian paradigm for health care were to be adopted here, are poised to win yet another round.
David R. Colman, a summer resident of Deer Isle, is a professor of neuroscience at McGill University and the director of the Montreal Neurological Institute and Hospital.