Health Care Reform

A Canadian tells it like it is. . .

John Rawls, in Justice as Fairness says that the fair way to choose the societal structures that will serve you is to do so behind a Veil of Ignorance. Effectively, you make your choices about the society you will live in, its laws, its rules, its social safety net, without knowing who you will be in that society. You don’t know if you are male or female, if you are able bodied, or a paraplegic, smart or not, the poorest immigrant, or the most powerful person in the world. You chose on what you would want, based on knowing nothing about your life, knowing that you could need every ounce of that social safety net, or that you could spend your life paying for it, and never need it at all. This is the way, Rawls says, that we get justice as fairness.

And it seems in our world, that we should get fairness this way. Its smart to assume that you could get the worst of the cosmic dice toss, and you could be poor, disabled, not smart, not wealthy. For every opportunity to be healthy, wealthy and wise, there is an equal opportunity that you won’t be. That would be the safe assumption. Not everyone in Rawls’ society is going to be healthy, wealthy and wise. It’s the law of averages. You may all have unlimited opportunity, or at least believe you do, and that’s fine, but you won’t all succeed.

Can I just say as nicely as possible, that Americans don’t always seem to make the safe assumption? It seems like many Americans, rather than assuming they will be the poor sap, assume they will be rich and powerful. I have to confess, I’ve never met so many people who believe in the awesome power of a boot strap. Especially when all the evidence of the world seems to indicate about 10% of your population succeed by bootstraps, and the other 90% of the population languish in whatever socio-economic strata they were born into.

This is the only way I can understand the American health care system – other than to consign most of your country as selfish, thoughtless hypocrites who have no thought for their fellow man(1). I can only think that you all believe you will fall into the healthy, wealthy and wise category. I think your faith in yourselves is commendable, but perhaps not that sensible. Some of you will be poor, sick and weak, with no health care.

So, to Canadian health care. I won’t lie. We don’t have the Rolls Royce, the Porsche, the Aston Martin of health care. We have a nice, reliable Toyota. It looks ok, it gets you where you want to go, but it’s not fast, and as you drive by, no one looks at it and says “Wow!”.

When I got sick with Gabe, I had world class care, as quickly as I needed it. Care that literally saved my life. No complaints. I want to see an RE to try and get pregnant? It’s going to take 11 months to get in, and if I need an IUI, that’s $1500, including the drugs. An IVF is $9K, including drugs. Our system is not perfect. Not at all.

The reality is this: If you have gold plated health coverage, that can’t be cancelled, in the US; you don’t want a Canadian system. You get faster treatment, at nicer facilities, with more renowned specialists, than you would in the Canadian system. I get why you might be opposed to change. I really do. But, as near as I can figure, from pretty extensive reading, that’s not most of you. That’s not even a third of your population. Maybe a quarter.

What about the rest of you?

Could you please explain to me why you are not rioting in the streets about the state of your health care system?

If you have coverage with an insurer and it’s costing you $500 a month for your family? I bet your take home wage is the same as mine, with the higher taxes I pay. If your coverage can be cancelled when you lose your job, or can’t afford to pay your bills, if you aren’t covered for pre-existing conditions, well, your system is screwing you. If you’ve ever had a HMO tell you that they won’t cover you for that doctor, because they are out of network, well, the Canadian system has 1 network, Canada. If you’ve ever driven past a hospital that was closer to your house, to go to the one in your network, if you’ve ever had a doctor file an appeal to an insurance company to get the treatment they say you or your family need, would you please explain how your system is better?

Maybe it’s just me, why hold out hope for an Aston Martin system that you don’t have access to? Why not insist on the Toyota? Maybe it’s a Canadian thing, but I’d rather know that I don’t get to see an RE at the snap of my fingers, but my neighbour next door, the single mum whose barely making ends meet, gets health care coverage. And in a catastrophe? We both get treatment.

Learn something from us, would you? A reliable Toyota in your driveway is still better than an Aston Martin in some one else’s.

(1) Except not my readers. You are all nice.

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23 Responses to Health Care Reform

  1. Donna says:

    I don't have great health coverage but I don't have terrible coverage either. If everyone in the US could have that – it would be wonderful.

  2. Shinejil says:

    You're right: There is a strong delusional streak in our American makeup. And when it comes to health care, many many people with insurance are living in a dream world if they think that when something really rough strikes, like cancer, they won't be left high and dry by the company they've been forking large sums over to. Most of the folks in the US who go bankrupt because of health problems HAVE or HAD insurance!

    I'll take a Toyota, please. :)And the relief of not having to worry every single year how we're going to be insured. That's priceless to me.

    When it comes to gold-plated care, we're looking more at 10% max of the population, if not far less.

  3. Debby says:

    Mrs. Spit – I had cancer. Just as I began my chemo, my husband lost his job – the plant simply closed doors. WE HAD NO INSURANCE. Very scary indeed. I received state coverage. Welfare coverage, if you want to get right down to it.

    I have a daughter. She's got horrible teeth. She doesn't have insurance. She can't get them fixed. She's 28 years old. She's never had insurance. Huge oil companies and fast food places hold their employees to 39 hours a week so that they don't have to call them 'full time' and pay out benefits. But their stockholders still get the big pay outs on the back of the low paid, uninsured. I think it's a sin.

    But it's much, much more acceptable to simply sit back and scream 'socialism'! The vast majority of people bandying that word around don't know what it means, exactly.

    Our county is choking to death on its self centeredness, but really, thank God, it could be worse…WE MIGHT HAVE ENDED UP SOCIALISTS.

    *walks off with shorts all in a bunch, muttering about stupid people*

  4. blueeyedtawni says:

    i don't even have health coverage right now . after my divorce i was taken of ex insurance.tried to get on state insurance since im unemployed still and depending on fiance to help till i can get a job. what sucks is they turned me down due to sharing kids with ex and their on his insurance. and since i had no job they counted his income for the kids.even though we was divorced.
    pure bullshite

  5. Virginia says:

    Mrs. Spit, I completely agree with you. My husband is English, and I have lived in England w/ him, under the "socialized medicine" structure of healthcare. And it works. No one should lose their job and not be able to go to the doctor. Obama was in my town yesterday, just blocks away from my house (walked over to see if we could see motorcade, but it was pouring and we couldn't get close).

    I wish everyone in America could read your post. We don't, as a whole, understand what "socialised" medicine means. It's not scary and awful; it's effective, not perfect, but it works. One of my friends in England had breast cancer–she was in experimental trials, had a double mastectomy, multiple hospitalizations, needed wigs, reconstruction, and on and on. She never paid a dime. She had excellent care and, let me repeat: SHE NEVER PAID A DIME. (Or a pence, more accurately.)

    We pay far too much for healthcare in this nation and get far too little. I can't fathom why people don't understand that.

  6. Debra She Who Seeks says:

    Brilliant post, Mrs. Spit. You're absolutely right. This is the analysis Americans need to hear, not the TV ad of the Canadian woman bitching about our health care system.

  7. areyoukiddingme says:

    Let me first say that I agree with you that the US needs health care reform desperately.

    I think your analogy is off a little though. I would say that most Americans have a Toyota health care plan – some have the stripped down version that you can only drive on Tuesdays and Thursdays, while others have the Turbo model with satellite radio and leather seats. Some people have the Aston Martin. Then there are the people (the elderly and the extremely poor) that have to ride the city bus – you know, the one that smells of urine and has no working heat or air conditioning?

    The reason that people aren't fighting more for reform is multifaceted. First, and most importantly, most of us do not want to end up riding that city bus – and that's how we imagine government run healthcare to be. Second, the amount of people who fall through the cracks and are completely without insurance is relatively small in comparison to the Toyota drivers, the Aston Martin drivers, and the city bus riders. Adults who count in this number are usually of the age where they think they're immortal anyway. Parents will usually try to get their children into a state sponsored program. The elderly use their minimal incomes to purchase secondary insurance. Third, you have a middle class mentality that says that if you work hard to find a decent job, you will get accompanying good benefits like health care. You don't have to be smart, priveleged, connected – you just have to keep trying to get that good job. You're not shooting for that brass ring, you're just looking for a good seat on the carousel. These things, and I'm sure other factor that I haven't thought of, add up to a situation where people will make do with the status quo because they believe it is better than the alternative. I don't think it's about socialism at all.

    I do think that the ongoing economic crisis will open the door for reform. We'll find more of the middle class unable to maintain their insurance, and from that pool you will find people who will press for a better system. But you should probably also consider that there is big money in insurance, and until you can outweigh that influence, nothing will change.

  8. Bluebird says:

    Thank you for this. I hear the screams of "socialism" and feel in my heart that there's something off with that cry. . . but I don't know enough about the matter to intelligently respond (my own fault for not being more educated on the issue). I appreciate this perspective from someone who's "been there."

  9. Anita says:

    Loved this post!
    We have really good health insurance… my husband works for one of those evil (;-)) pharmaceutical companies.
    Using your bootstrap reasoning, I think another factor is that the 10% of people who pull themselves up by their bootstraps think that they did it by sheer hard work, which means that everyone else is just lazy if they don't. Forget luck, good physical health, good mental health (lack of depression, for instance).

  10. JamieD says:

    I do agree our health care system needs reform. Even more so, the insurance companies need reform. I've often wondered who the little man is at the top of the insurance chain, in the corner office, whose pockets are getting stuffed with my hard earned money.

    But as a hospital employee, I worry about government controlled healthcare. I worry about the qualiy of healthcare we will be able to provide when already they try to cram square pegs into round holes.

    As Areyoukiddingme said, the number of people completely without insurance is relativly small. And these people come to our ER, where they cannot be turned away, for rountine healthcare. Often giving fake names and social security numbers and their bills are written off.

    Americans do have a 'bootstrap' mentality. But what bothers me are the ones who want something for nothing while I made the effort to go to college, decide upon a reliable profession and work for everything I have.

    I just don't want my nice Toyota downgraded to a base model.

  11. VA Blondie says:

    Thanks for this post. I have started taking more of an interest in health insurance reform, not just for me, but for my family, as well. My father works for himself, and with my mother's health issues, they are unable to get affordable health insurance. I would love to have more flexibility in how I work, but I am held back by being afraid of losing my insurance.

    I would love to see a toyota health care system. But the almighty dollar is king over here, and insurance companies have it, and I have a hunch they are fighting this reform with all their might.

  12. Heidi says:

    I wish I had something intellegent to add to this. I don't understand either health care system. I think both need a bit of revamping, but only from the outside and looking at the big picture.

    As for me and my house, we are currently covered through the state. They won't let us get married, the least they can do is give us some health care.

  13. jess says:

    Yeah, what Anita said about bootstraps. Be careful, Mrs. Spit, you are tampering with the high holy religion of American Ingenuity here. People will defend that bootstrap mentality to the death.

    I've been paying for my own health insurance for years (it's gotten so expensive that very few employers will pay for a nanny's ins. anymore). It takes a very sizable chunk out of my paycheck and I still can't afford to pay the copay for anything that's not urgent. I fail to see how universal healthcare could NOT improve the situation significantly, in spite of the potential drawbacks.

  14. Natalie says:

    I live down here, and I am still completely confused as to why they put up with this system. My husband and I, we get IVF coverage. And we get most things covered. Usually. But you have to fight every step of the way for it. We pay a lot of money for our health care coverage, it's entirely dependent on our employment, and we have to spend hours on the phone with insurance companies (or our doctors do) to justify us getting things paid. Our doctor getting paid. It makes me very very nervous. I always wonder which one will fall into a loophole and not get paid, or what falls under a pre-existing condition. You learn to work the system, I guess. The thing most americans just can't fathom is: you shouldn't HAVE to work the system. It should work for YOU. It should BE THERE when you need it, not have you begging and writing three appeals while you hyperventilate.

    I'll take the Canadian health care system any day. And we ARE the lucky ones. My husband works for the military, has very low premiums, we have pretty much complete health care coverage, and we're not dealing with any medical crisis (other than the infertility, which, as important as it is, is not a true *crisis*).

    Yes, it's like you said…. even americans who aren't part of this privileged group believe they SHOULD BE part of this privileged group and that somehow it's their fault that they're not. That they should work harder, get a better job, and then it would all be okay. But you know what, someone will always be working at macdonalds. Someone will always be out of a job. And furthermore, I still do not see why it is the job of the employer to be providing health care…. why should my employer be the one picking out what plan I can and cannot have? Why should I have to choose my job based on insurance? It makes no sense to me, and yet that's the way it works down here. when you're job hunting it's one of the first questions asked. So a fantastic job that you love, that pays pretty decent, that will support your family and use your skills… if they're too small a company to be able to afford health care for their employees without putting themselves into backruptcy (which helps no one, of course), well too bad. now you have to choose a good job or one with health care coverage.

    Very well written, Mrs. Spit.

  15. Azaera says:

    I agree with you, I love that we have a healthcare system. On the other hand though it could be improved. I'm still paying a $250 deductible every year to be able to afford my son's life sustaining drug therapy. Which I don't understand. If he'll die without it then shouldn't healthcare cover it?

    I couldn't imagine living in the states though and having to pay $30,000 a year for Skyler's growth hormones, on top of his other drugs, especially since his condition is a condition which cannot be predicted or prevented. It's basically the luck of the draw. So glad we live in Canada!

  16. The bean-mom says:

    I'm here from a link at Scientistmother's. Your assessment of the Amercian mentality is straight on. It explains not only our current state of health care–it explains so much of what we tolerate.

    Because as one of your other commenters said… Americans think that any of us at all can be rich, and if we're not it's OUR OWN FAULT. And when disaster strikes it's somehow still our own fault.

  17. Calliope says:

    oh brilliant post!! THANK YOU for writing something so spot on about health coverage- I have been writing something in my mind for days and can't seem to get it all down.

    The truth is that I never thought a lick about health coverage until I didn't have it and couldn't get it.

    I have now seen so many failures in insurance within my family that it slays me. Just getting my Grandmother qualified to have insurance to help pay for her nursing home care took MONTHS and several social workers.


  18. Brenna says:

    What a great post to read, and I equally enjoyed some of the insightful responses! My husband and I are hoping beyond hope that the health care reform Obama is fighting for becomes a reality. I don't understand why people are afraid (other than the "it's the devil we know rather than the devil we don't know" argument) so it was helpful to read some of the other comments. We're both insured through DH's job, and if he ever lost his job we'd be able to fall back on the VA system because he was medically discharged from the military. But shouldn't EVERYONE have that health care safety net? I'd be thrilled with reliable Toyotas all around!

  19. CLC says:

    I would love to see some reform. But I just don't get how
    Obama can pay for it now on top of all of his stimulus spending. I am afraid we might get the "used" base model and while sticking future generations with an insurmountable amount of debt.

  20. loribeth says:

    I'm with you, Mrs. Spit. I have American relatives & I get to hear some of the stories. Many of my mom's cousins are well past 65 & still working, because they do not want to lose their health benefits. And my cousin recently lost his house, in part because of medical expenses. It makes me feel sick (no pun intended) when I think about it. And very, very grateful that I live where I do.

  21. Mommy (You can call me OM) says:

    I'm so absolutely confused by the entire issue of health care v. insurance. I feel that there isn't a single perspective telling the whole truth. I believe bipartisan politics is still in play and neither side is willing to listen. I'm tired of blanket statements like 'right-wing-conservative' and 'left-wing-socialist' mucking up the issues. It's as if we test the waters for liberalism or conservatism before deciding whether we agree. I just want a straight answer, issue by issue.

    My city is home to a world renowned medical facility. People from ALL over the world come here. I've met countless Canadians who come here every single year for medical care. Why? If Canada has the answer, why do any Canadians cross the border? To me, it's an enigma.

  22. Ya Chun says:

    i think most people will still have to pay for IVf in the US

    The conservatives have got a stranglehold on people that barely make enuf mony (like my parents) that the liberals are after THEIR money, when they are after the money of the uber rich, people that my parents and their like are no where near but for some reason think they are. it's some sort of crazy misconception. My dad was all upset about one of the tax things, and i just kept telling him, it was for people over $250 K. My dad doesn't even work! He doesn't have that much money! But he was sure they were after it. He trusts the folks that have run up our deficit and keep money for the likes of themselves.

    we had a looney rep out in the suburbs who wanted to cancel school lunches because it was teaching hte poor kids to rely on government handouts. she had no qualms, no compassion, no ability to put herself in someone else's shoes. it's not the kid's fault his parents don't have moeny. should he starve?

    it's the same lack of compassion we see as grieving moms.

    ok, sorry, long rant! that post pushed some buttons!

  23. Fia says:

    Excellent post, Mrs. Spits! What I never understood is the American idea that hard working and the basic right to health care are somehow related. To me, it is a basic human right, and no matter how lazy or unlucky someone is, everybody should have a given right to access to healthcare. I just cannot make the connection, like,
    "But what bothers me are the ones who want something for nothing while I made the effort to go to college, decide upon a reliable profession and work for everything I have."
    What is this? Because someone chose (could afford?) college, he/she is more entitled to be treated in case of sickness than others? Is that really what people think? And if so, isn't that very sad? To me, it is like denying people to breathe because they didn't go to college.

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