I just spent a week in Canada. Most days were spent enjoying the glory that is a Manitoba summer on the sandy shores of lake Winnipeg, the kids playing in the water and building sandcastles while the parents chatted.

As often happens, when people find out that I’m a doctor, the conversation turns to medicine. I don’t think this is because I’m special somehow, but since everyone requires health care and almost always has a friend or family member struggling with some health issue it’s a common ground. People are eager for insider information. Unfortunately, most of the times people recount horror stories, although I suspect if I were a pilot conversation would veer to the travel industry and we’d all talk about the longest time we sat on the tarmac or the worst flight we ever endured.

I heard a story about a young woman, age 42, who felt she had to bully her doctor into an annual mammogram instead of every two years. She had no specific risk factors for breast cancer, but wanted a yearly screen. She was successful, and at her yearly mammogram a cancer was diagnosed (fortunately stage 1). Unfortunately, she was going to need chemo and radiation, but thankful it was caught and that she had advocated for herself. I have heard very similar stories south of the border as well.

I heard a story about an elderly father with a severe gastrointestinal bleed while he was in the hospital. How the bed filled with blood in front of the family. How the brand new Intern muffed explaining the DNR and the agony of deciding whether or not to surgically intervene in this situation. This too is familiar territory.

I heard about transfers to hospitals because more acute care was needed.

I heard about post-operative infections.

And I shared my own mother’s issues, a hip replacement in December where the fracture was missed on the post operative x-ray. A few days after coming home the fracture grew and her femur shattered. She was taken by ambulance to the hospital and needed both a second hip replacement and the fracture required an intricate system of pins and wire. I spoke about how she spent 6 weeks in an inpatient hospital getting intense rehabilitation and eight months later was still getting physical therapy.

I heard nothing about co-pays, nothing about fighting with an insurance company to get a drug or procedure approved, and nothing about limits to the allowed number of physical therapy visits a year.

Money was startling absent from every conversation about health care.

I got back to the cottage and poured a glass of wine from the $9 bottle that cost me $16 at the Liquor Commission in Winnipeg and reflected on the conversation at the beach.

I’d rather pay more for my wine and not worry about affording health care than the other way around.

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  1. Amen to all above with one addition from an American disgusted with the result of thrity years of fools calling for less government either not understanding or not caring what their really calling for is an end to protections (while not including much needed healthcare) were put in place to end abuses that with their return have wrecked our economy and are rapidly destroying our environment to the point that ground water is increasingly poisioned to the point the tap and river water can be lit on fire due to gas and unknown chemicals (chemicals with names protected by law from the public affected by their dangers). American capitalism has totally run amuck with “public servants” claiming to be devout Christians for votes while, in fact, committed to the “philosophy” of Ayn Rand whose “philosophy” of “objectivism” promotes nothing as fiercely as her concept that “greed is good,” making it in direct contradiction with Christian values. She preached, “If any civilization is to survive, it is the morality of altruism that men have to reject.”

    Thus it’s no surprise they support, and are supported by, health insurance companies that make millions for no real service. All they do is stand between doctor and patient, denying care whenever possible. I lost a healthy kidney due to an HMOs refusal to allow an MRI that would have allowed doctors to know for sure what was being seen on ultrasound as a bleeding cyst and on catscan as a tumor. My husband complained to his employer about the insurance and after a call from the employer the insurance company gave me the option of surgery. My doctor warned he would have to take the whole kidney if he couldn’t tell for sure the mass was benign and feared I’d be upset if I lost a kidney over a benign condition. With the only other plan being quarterly catscans to watch for growth that would signify cancer and having a grandmother who died from kidney cancer – I saw no reason to wait for confirmation of cancer they clearly believed would result in time and assured my doctor he needed worry about my being upset to loose the kidney due to a benign condition. What happened took everyone by suprise and while I didn’t blame my doctors – the insurance, which could not be held liable – cost me a healthy kidney with neither a cyst or tumor. After removal it was sliced and diced in the hunt for a mass that was not to be found. In hindsight, I recall having a significant amount of blood in my urine the night before so I believe it was a bloodclot that passed before surgery that would have been seen beforehand if i’d had the MRI – an MRI which would have saved my kidney and cost the HMO significantly less than my surgery.

    I always maintained insurance and, gratefully, never had problems like above again – until having left my job due to disability, the time came when my cobra eligibility expired. I was offered a conversion plan for $1,600 a month -more than half my monthly disability – and with multiple pre-existing conditions the only policy I could get without a waiting period turned out to be a “limited liability policy.” I was told, when purchasing, it would cover 12 office visits a year with a $30 co-pay when, in fact, it only covered 5 office visits a year and 2 labs (the discrepency was due to mine being individual vs family coverage). My costs for daily medication needs jumped from $250 to $700 a month. They did promise to pay for hospitalization and limited amounts for surgery that can only be described as a joke. As horrible as it was, I paid the $400 a month until doctors ordered much needed tests for which the insurance refused to pay – forcing me to see the folly of paying premiums with money I needed to put directly toward care.

    Just when it seemed I had no hope of handling the increasing cost of my medical problems, with disability income too low to pay for care and too high to qualify for my area’s excellent healthcare system for the poor, I was blessed to finally be approved for social security disability and with it – enrollment in medicare. All this leads to my now having “government” healthcare and the peace of mind that comes with it as I know my needs will be covered – assuming President Obama can achieve a second term and, more importantly, adapt a stronger stance in dealing with congress and the senate.

    While he rightfully boasts being the first president to pass meaningful healthcare reform. True universal healthcare could not even be debated in the halls of congress with republican claims that it would result in government coming between doctor and patient when the truth is it would end that very practice by private insurance companies, with in-network and referral requirements and/or limitations or exclusion of benefits as profits, not people, are their main concern. The much hyped idea that universal care would lead to “death panels” actually came from a provision to allow medicare to pay doctors for what, at times, seems the greatest service they provide: help with critical end of life decisions all families must make. I will always be grateful to my mother’s doctor for helping us understand the reality of her condition near the end and honoring the spirit of her living will as while she’d made her wishes known to us, her legal document was lacking in clarity. As I understand it, the propagandist won in the battle to cover end of life consultations leaving families to hope doctors will provide this vital service without compensation.

    Of course, what can you expect when, during the healthcare debate, Fox news (aka the republican propaganda network) had seniors so misinformed, they took to the streets with signs insisting government keeps its hands off their Medicare – evidently not understanding their Medicare is government health insurance and most importantly – not realizing the extent to which republicans are determined to end medicare and social security. These politicians love to claim our healthcare is second to none. Nevermind we rank 34th in Infant mortality (according to the UN), 49th (according to our own CIA) and in life expectancy we rank 38th (according to the UN). As a true patriotic American I find it obscene when politicians and their blind followers insist this is the greatest country on earth. A great country doesn’t allow the health, the life and death, of its citizens to be determined by the size of their bank accounts.

  2. I totally agree with you. It is horrible that in America people who are among the working poor have very little chance if they get sick. Not having affordable healthcare means not having the option of healthcare at all. It is frightening but people are literally dying because they cannot pay hundreds each month for healthcare coverage and it seems that so many in our country are content to continue to allow them to die so that they can wrap the argument in rhetoric and politics. It would be laughable if it wasn’t so frightening and frustrating.

  3. It’s no wonder that America is so soaked in religion. When your country sentences you to death and calls you a failure if you cannot afford medical care, what else do you have left other than desperate prayer when illness comes?

  4. You are so right. When I was recovering with complications from a burst appendix, I (fairly typically) got onto internet forums and blogs to see what others who had suffered this,did to aid their recovery. It was shocking, for me, to see how money and insurance was at the forefront of US contributors. Some of the stories I read were so sad. I remember reading a post from one panicking mother, who was posting while her child was in surgery, asking for advice on how much it would cost and stating her fears about not being able to afford it. Heartbreaking stuff.

    it was different for me. When i collapsed last year, I remember lots of fears and worries. Whats wrong with me? Will I die? If so who will look after my family? When wll the pain end, and what does the future hold for me? But – as a UK taxpayer who therefore benefits from our NHS, i can honestly say that when I collapsed, and was rushed to hospital for treatment, and when I needed lots of specialist aftercare at home for a horribly infected wound, NOT ONCE did I worry about paying for treatment, or limited access to what I needed.

    I am constantly amazed at the US political debate around inproving healthcare. For me, even though I pay greatly for it through higher taxation, universal healthcare free at the point of delivery is a no-brainer. I hope one day that we will see these principles spread far and wide across the world.

    1. Same here. I’m disabled and chronically ill, and can’t work now.

      In February I started vomiting faecal matter and was rushed to hospital. I was there for ten days, had a colonoscopy and endos,copy, CT scans, x-rays, ultrasounds, drugs upon drugs upon drugs, a trip to a different hospital to see a specialist, then back to my admitting hospital on the same day for, yes, more tests. At one point I was having three ultrasounds a night to see if my bladder was filling.

      It was a scary, horrible time and I’m still ill. But all the times I cried, all the pain and indignity I suffered, were. paired with nothing more financially worrying than the extra petrol my partner was using, and the outrageous parking charges at the hospital.

      We still have. a roof over our heads, food in our bellies, and our miniscule “fun fund”.

      My partner likes watching ‘Extreme Makeover – Home Edition’, and virtually every episode features some family who are homeless, or living in a squalid shack, because their child was born prematurely, or has cancer, or died in an accident, leaving enormous expenses.

      The taxes we pay are more than worth it, to live in a place where children aren’t punished for being terminally ill.

  5. Hear hear!
    My father died recently (Ontario) and as one goes through all the paperwork that is required of death, I was so glad that I knew I wouldn’t have to worry about a hospital bill. And for any decisions we made with regard to his care prior to death, we didn’t have to consider them from a financial perspective.

  6. Not long ago I went hiking with a fellow who’d been a doctor in Canada, but moved down to my area (the Blue Ridge Mountains of Virginia) because he loved the mountains. He was still working part-time as a doctor here, but spent most of the discussion venting a huge amount of frustration about insurance companies and an even bigger amount of heartbreak at patients who wouldn’t come in because they either didn’t have insurance or still couldn’t pay medical costs even with it. He shook his head a lot with befuddlement about why this system is still in place.

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