Shona Holmes, a 45-year-old Canadian who paid for her own cancer treatment at the Mayo Clinic, presents for opponents of health care reform the kind of prohibitive tale necessary to blunt any drive necessary to cover those 44 million uninsured Americans. Suffering headaches and vision loss, Ms Holmes was put on a six-month waiting list to see specialists in Canada; she chose, instead, to go to Arizona, where she was diagnosed with a growth on her pituitary gland and returned home with a recommendation for immediate surgical intervention ignored by our public health care system. In the end, Ms Holmes spent nearly six figures back in the U.S. to have what proved to be a benign cyst removed.
In the face of heavy government spending, there seems little traction in arguing the cost of Mr. Obama's health care plans. Billions and trillions scare no one anymore: we might as well, like Dr. Evil, put our pinkies in the corner of our mouths when we discuss these numbers. But the idea that Americans might have to wait for their health care gets some attention. Now, I have no time for the scaremongering used to bring Ms Holmes' case to the American public, but I am concerned -- as are some Canadian doctors -- to hear that, in the face of undiagnosed vision loss, she could not get a referral within a week. Something here does not add up, and that something should worry all Canadians.
The New York Review of Books held a recent forum on health care, and John Dean from Kent, England wrote in praise of the British medical system. "The U.K. National Health Service deals with the majority of U.K. citizens," he affirmed, "but everyone has the right to opt out of the system and seek private medical advice and treatment for which, of course, they will pay." When I lived in England, I had two relatively minor experiences with the NHS. (We should remember that I was a foreign student, and I was using gratis the system for which British citizens paid through tax.) I once spent fourteen hours vomiting on a cot in a hospital corridor, suffering from a kidney stone, begging nurse after nurse to believe that I was not a fraudulent drug seeker. After a doctor finally relieved my pain, I was released and pointed towards the bus stop. I missed it, in my prescription-addled confusion, and I staggered home on foot only by the most circuitous route. On another occasion, I had a medical test far more advanced than that offered in Canada, and my general practitioner assured me that she would be in touch if the results warranted treatment. When I next sought advice for a severe shaving rash, a year later, I was asked why I had not returned for my other treatment. My test had come back positive. (On the rash, I was advised to grow a beard.)
So, the long and the short is that I got pretty much what I paid for in England: that is to say, nothing. I have always had the uneasy feeling that the same kind of thing happens in Canada, and so I have been more proactive in seeking my own treatment. I try to stay healthy, and I visit my doctor regularly (though not obsessively), hoping that any problem I encounter will thus be properly contextualized. ("Honestly, I am not a crank. Look, I have had eight previous uneventful checkups!") But as my classmates at Oxford were either well-bred enough to "go private" already, or looked forward to a day when they could afford to do so, they did not worry about getting put at the back of a hopelessly long queue when push came to shove. The objection of some Americans to Mr. Obama's plan is that they fear being forced into a public system where they will lose the right to fight with their ghoulish and heartless Health Maintenance Organizations for timely care. As Michael Moore's excellent Sicko (2007) demonstrates, however, such advocacy is likely fruitless while HMOs are private and profit-driven. But what is also clear is that advocating your case to a government bureaucracy is no less promising.
Whatever happens in the United States, there will always be a system there for those willing and able to pay. Of that, Americans can be sure. For Canadians, this option exists for the most part only with our neighbors to the south, where we are free only to line the coffers of American hospitals, improving facilities for their regular customers. Should Mr. Obama's initiative not open debate here in Canada for more innovation for Canadians?
I was once supportive of a parallel, private system in Canada, but I have been convinced that this system would, initially at least, draw resources from our public system, and that is too heavy a risk. But that is not to say that some system by which people who wish to spend their discretionary income on health care could not somehow be devised. I am not rich, and unlike those old Oxford colleagues I do not come from a privileged background. But I also do not have a large recreational vehicle or fly extensively all over the world. If, instead of spending what money I have saved on these pursuits, I would like quick access to discretionary treatment, why would the government not at least help me to do so? It is not as if the roads on which my neighbors drive those RVs or the subsidized aircraft on which they vacation do not have taxpayer sanction. I am not certain that government health dollars could not match private dollars for parallel treatment. At least that additional private money would be staying in the country, and any public contribution could be accurately tracked and measured against the level of support of the public system. How about a private insurance scheme? With the cooperation of my employer, I am currently insured for dental work I will never need, exercise equipment I could never house, and enough pharmaceuticals for the rest of my life. Is there not a way to use insurance companies to buy a little peace-of-mind time? Could we not insure ourselves against catastrophe, and expect to pay higher premiums or get struck off (as with our automobiles) if we have to use it. Unlike Americans, currently, we would at least have the public system on which to rely as a baseline.
Make no mistake, I have every confidence in Mr. Obama to reach out and provide something adequate to all Americans, just as there is something adequate now for all Canadians. But we should let his great leap forward allow us here the opportunity to talk about improving what we have. It is not about having one system for the rich and one system for the poor. Rather, it is about acknowledging that health care should be more important to all of us than the silly commercial goods with which we fill our lives.
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