What Does Universal Healthcare Mean? A Canadian Physician’s Experience of the Current Healthcare System in America

I am near the end of another busy shift in a major Canadian emergency department.  The nurse in charge asks me to see two women in the minor care area – a daughter and her elderly mother.  Both of them are in tears and pale with fear.  I go into the room that they are in and immediately observe the elderly mother is holding her acutely swollen wrist.  I am not surprised that she is crying; however, her daughter’s tears take me aback.  The first words out of her daughter’s mouth are that they are American and do not have insurance.  They were visiting our city and her mother slipped on the water front pier, badly injuring her wrist. 

In Canada, we have the “Canada Health Act” which requires that all residents of a province or territory [Canada] be accepted for health coverage.  This means that every Canadian, regardless of the amount of money they have, receives quality healthcare that is within their financial means.  Everyone is covered.  If someone genuinely cannot afford healthcare, they are covered by the province’s social assistance program.

Not fully grasping the extent of what not having health insurance in America means, I begin assessing the mother.  Immediately, I offer her something for pain before she heads off for an x-ray.  Her response again puzzles me: “How much will that cost”?

I have no idea.  I just show up for work and do that best job that I can.  I, like many of my colleagues, are oblivious to the costs because cost is not an issue for Canadian patients.  Before the patient allows me to do anything, she insists that I find out what she will be charged.  In this particular emergency department, foreign patients who visit the hospital are charged up front.  In this case, I manage to wave all costs because the thought of contributing to someone’s financial ruin in the name of compassionate healthcare is too disturbing for me to comprehend.

I assured the injured mother that our priority in the emergency department is to take care of her – not get paid for rendering emergency care.  After accepting medication for pain, I review the x-ray.  Fortunately, all this patient will require is a cast.  There is no need for surgery or bone setting.  Recognizing that the supplies for taking care of her cast and medication are out of financial reach, I provide her with everything that she needs, free of charge.  The two women leave the department extremely relieved.  When I go home that night, I still feel nauseated by what I observed.
America, “the land of the free”, has millions more people similar to the two that I took care of.  I remember when I was training in the U.S. during a couple of months of elective time, I witnessed events that continue to disturb me to this day.  I witnessed critically ill patients being seen by someone from the hospital’s administration before being assessed by a nurse or physician.  If the patient did not have the “correct” insurance plan, they would be shipped over to the “community hospital” before receiving any medical care. 

I witnessed patients who were too sick to be transferred denied surgery or advanced care because the hospital would not get reimbursed.  In another major U.S. hospital, I saw first hand how the administration makes up for patients who cannot pay.  If a homeless person gets shot, they are well taken care of.  Then, when someone with a sizable insurance plan comes to the hospital, they are over charged in an effort to compensate for the loss of earnings from the previous patient.  I was told that sometimes the insurance company pays everything asked of them, while other times they question the extra costs and the bill is subsequently adjusted.

Our healthcare system in Canada is not perfect either.  Emergency department over crowding is a major issue.  There are waiting lists in several parts of Canada for what are termed “elective” surgeries.  Such procedures include hip replacements, knee replacements, back surgery, and certain cancer related surgeries.  Having money does not bump anyone to the front of the line.  However, people who do have money often opt to go to the U.S., or elsewhere, to have their procedure.  Our system is getting better due to Canadians demanding, en mass, for improvements.  Emergency department overcrowding was a major national issue during the last national elections. 
This begs the question:  Why aren’t Americans demanding affordable and compassionate quality healthcare for everyone?

The only candidate in the 2008 Presidential Election who has significant experience and expertise in reforming America’s healthcare system is Senator Hillary Clinton.  Keep in mind that I am a Canadian physician.  I have nothing to gain by endorsing anyone.  I am writing this letter because I never want to see a patient like the elderly woman who broke her wrist in tears because of fear, and not pain, again.  No one should be denied quality healthcare.  Becoming ill or injured should not become a point of financial sacrifice or ruin. 

Instead of advocating for amending the Constitution of the United States to conform to “God’s standards” (whatever that means), Americans and their government should demand to amend their Constitution to conform to human rights standards.  The only candidate who has shown an ability to do this, again, is Senator Clinton.  She has already demonstrated the ability to pass legislation, which provides free healthcare to anyone who became ill or injured as a result of helping at Ground Zero of the World Trade Center, following the September 11th, 2001, terrorist attacks.

Her critics fault her for not making significant gains in reforming the healthcare system during the 1990’s.  However, every major system over haul, every great invention, takes trial and error.  Thomas Edison did not achieve light with his very first prototype.  However, thank goodness he did not stop trying.  Senator Clinton is a fighter and will not stop either – that we can all be certain of.
In conclusion, Americans must ask themselves what their priority issues are.  Nebulous concepts such as “change” or “unity” don’t pay the healthcare bills.  However, a well laid out healthcare plan, which covers everyone, will!