Thursday, October 14, 2004
Colon cancer; two oncologists; ten days in the hospital attended by a battery of technicians and nurses and "the same doctor who would treat the prime minister." Total cost to patient: $85.00 (for the TV and phone in his room). As you have surely guessed, the scenario we have just described did not take place in the U.S. of A.:
Although delays and other problems have caused support to dip slightly, Canadians still overwhelmingly back their universal health program. They think of their health care system as a mark of their national identity, something that separates them from Americans.
Meanwhile, a recent ABC News poll showed that while Americans value the quality of U.S. health care, 62 percent think the nation should shift to a universal health insurance program like Canada's . . . .
The United States has more hospital beds per person than Canada because most American hospitals are private, while almost all Canadian hospitals are publicly funded. As a result, American hospitals compete for patients, while Canadian hospitals "don't fund excess capacity," said Sharon Sholzberg-Gray, chief executive of the Canadian Healthcare Association.
By many measures, Canadians are healthier than Americans, with a longer lifespan and lower infant mortality, even though they spend much less on medical care. Canadians devote about 10 percent of their gross domestic product, the total of a nation's goods and services, to provide full health coverage for all citizens. American health costs account for about 14 percent of GDP, yet 45 million Americans have no health insurance and many more have limited coverage.
One of the main culprits pushing up the cost of care in the United States is the expense of administering a plethora of complicated health plans. It has been estimated that any large health insurer in a midsize U.S. state spends more on administration than is spent on health administration in all Canada.
Dr. Catherine Kurosu is a gynecologist at two San Diego hospitals. A Canadian, she said the biggest differences between the two systems are that poorer Americans won't seek medical care until their problems have become serious. In addition, she said, American insurers often play games to avoid paying bills.
In San Diego, a lot of pregnant women -- especially illegal immigrants -- show up with problems that could have been avoided with prenatal care, she said. The idea that they can't get this kind of care "still seems foreign to me," she said.
When it comes to billing, the Canadian system is a simple matter of sending an invoice to the Ministry of Health, which pays on a fee-for-service basis, she explained. In the United States, there are so many insurance companies, each with its own rules covering not only the patient but also the doctor -- as Kurosu learned when she had to wait months for an insurance company to approve her.
U.S. health insurers nickel and dime doctors by always sending bills back and questioning everything, she said. "It's like a game to see how long they can forestall payment."