A Tale of 3 Health Care Systems

I have had experience as both a patient and provider in three different locations: Canada, the USandA, and Belize in Central America.
As a provider in Canada for many years the single payer universal coverage system had distinct advantages as far as simplicity of billing goes. Furthermore nobody depleted their savings or went belly up or were denied care. Most Canadians have no issue with paying for a poor single mother at the other end of the country to get quality care for her child’s ear infection. (though they might gripe about it). It’s the price of a civilized and just society.
Americans die all the time because they can’t afford the care they need. If a person has diabetes, they have to pay money to stay alive. If insurance companies decide it’s too costly to pay for your healthcare, they let you die. Having said that when I lived in Belize I had issues with my right eye-retinal detachment- an emergent condition .
I arranged speedy care at the Imperial Point Medical Center in Ft Lauderdale Florida….
For 5000$ cash I received efficient and luxurious care for one day with morning surgery in an OR designed by Gene Roddenberry. There was one nurse in recovery for every two patents. Terrific gourmet food. I wasn’t interested in being discharged anytime soon.
My only involvement as a patient in Canada was in 1986 when I broke my wrist planting watermelon (long story). The care was quick, efficient and free. A single payer health-care (in which the government pays for universal coverage, typically through taxes) helps keep costs down for two reasons: It means that the government can regulate and negotiate the price of drugs and medical services, and it eliminates the need for a vast private health-insurance bureaucracy and removes profit-making from the equation.
Currently, the US spends two to three times as much per capita on health care as most industrialized countries. Canadians live longer and the child and infant mortality rate is lower.
The US health care system is the best for capitalism . To move to a socialist type of health care system would fly in the face of everything the US stands for: greed, exploitation, and an egocentric “don’t tread on me” philosophy- “why should my taxes subsidize lazy unmotivated druggies and welfare bums” and so on.
Canadians (or Norwegians, Germans and just about every other industrialized nation) however are much too smart to willingly lower the quality of healthcare so capitalists can get rich killing us.
When I practiced in Kansas I did not enjoy dealing with the austere rules of dozens of insurance companies or explaining to managed care companies why my patient needed an extra few days and these particular tests. I did not appreciate the hospital CEO telling me there was a quota on Medicaid referrals and so I ignored him. It was not an official policy in any case.
In Belize there is a two tier system: public and private. As expected the former which is free is crowded and inefficient. Supplies are limited, equipment is uninspected, and the physicians trained in Cuba. Cuba only makes good cigars. The public hospitals look like they came off the set of a civil war film….
The two private hospitals are a bit better but lack sub-specialists and trauma units. I came to the conclusion (private sector notwithstanding) that there was really no hospital in Belize that provided quality medical care. If you needed emergent, trauma or advanced care you had to cross over to Mexico or Guatemala. In Belize you came to accept death as a natural experience and live with the fact that non basic medical care there can in no way “save” you from a negative outcome – in fact, they are more likely to hasten the journey.
Having said that, primary care in private offices was first rate, better I think than Canada or the USA. You never waited more than a day for an appointment, and you were never rushed and the MD’s were empathic, well-trained and educated. This was also true when I visited a GP in Mexico City for some antibiotics. Total office visit cost in Belize was 25$ US. In Mexico 1/2 that. I enjoyed working in Belize and my experiences are described here.
Above is an office I shared in Belize. On the chair is a cooler bag with wine in lieu of cash payments left by the last patient. I never felt comfortable with money preferring instead services or commodities which was culturally acceptable and somewhat more compatible with my socialist leanings.
In conclusion: For primary care Belize (and Latin America in general),  is superior and cheap. The same applies to dental and veterinary services. In Canada and to a lesser extent in the US it is less so and more hurried. Also in Canada you can only have “ one issue per visit” as if people are simply disjointed body parts.
If you have a bottomless bank account or generous insurance then the US is preferred for advanced high-tech care.  However for general medical services for the vast majority of people, countries with universal coverage are the most egalitarian and just. Another way to look at this is if I had a rare brain tumour and a full wallet I would want it treated in the US. If I had a severe throat infection I would rather be in Belize. For everything in between Canada is just fine.
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3 Responses to “A Tale of 3 Health Care Systems”

  1. kristina nadreau says:

    2 comments:
    first, veterinary care in Belize is hampered by the unavailability of the most common drugs, anesthetics and sutures. Vets trained in Cuba, like the physicians trained in Cuba, do not have the knowledge or experience of many pharmaceutical treatments or diagnostic procedures so they lack both the skills and the tools to do the best work. They practice according to 1955 standards. Yes, they are have a lovely concerned bedside manner. Personally, I chose efficacy over charm.

    The compensation practices in the USA have created impenetrable barriers to health care for many. Currently a patient usually can not self-refer. the encounter with the primary care physician is noteworthy only for the stunning stupidity of the practitioners of bell curve diagnosis and treatment plus treatment according to “guidelines, standards of care”.

    I recently saw a physician who could not comprehend the concept of chronic pain secondary to a hip implant. Effective pain relievers were withheld because as one in my age bracket, I might fall while under the influence of the efficacious medication. I have never fallen which she would have discovered, had she bothered to ask. This incompetent idiot was incapable of seeing an actual patient and could only see the statistic of my numerical age and then only 1 of 3 existing conditions. In her mind, my statistical age of 79 automatically indicated that I was stupid, ignorant plus incompetent to decide what I needed or wanted regarding health care.

    I do have chronic pain and I do not believe it is in my best interests to suffer when the means to alleviate the pain are readily available. If I were to become addicted, while consuming the recommended dosage, this should be an acceptable side effect.

    I also have high blood pressure concerns. The beta blocker I take is inadequate. My creatinine runs 1.2 which is a matter for consideration. Plus I do have a 7.2 cm abdominal aortic aneurysm that I have elected not to treat. I am not interested in the opinions of a demonstrably incompetent general practitioner regarding my choice to allow the aneurysm to continue on its fatal course.

    In belize I can go on the black market and obtain efficacious pain relievers.

  2. Carole Kocian says:

    I can relate to the difficulty of ageism in the US care standards but only because of a 77-year-old friend who has suffered months of a bad shingles episode. The lingering nerve pain could not be addressed by the PCP because of a reticent attitude about prescribing the best oral drug that was recommended for the condition, the “pain” specialist who did nerve blocks that did not work, then the PCP again because he would not allow a continued scrip for a sleep aid which allowed my friend to actually sleep comfortably. The shingles pain went on for 3-4 months and my friend still uses ice packs to her back rib cage even though the doc finally agreed to prescribe Lyrica taken 3 times a day which works to a certain extent to alleviate the pain and a reduced dose of the sleep aid. While acknowledging that the shingles nerve issues may not respond to any treatment because of the nature of the ailment, all that pain and distress for all that time only added to the problem by causing emotional overload.

    We have concluded between us that the changes are a result of primary care practitioners becoming part of a corporate practice from which the consensus for treatment of a particular patient problem is one-size-fits-all. One cannot find a solo practitioner anymore with the reigning confusion at the government level where specific codes for treatment dictate the treatment allowed for a condition such that gov’t programs will pay the doctors at a fixed price. A solo practitioner cannot afford not to be a member of a corporate group. Supplemental insurance policies will pay for the gap in cost if there is a gap. The coding system has to be carefully chosen for patient care by the pencil pushers or claims for reimbursement get kicked back unpaid. I could go on with new details about hospitalization but it’s too lengthy.

    It does become tempting to wish for a system such as that which exists in Mexico where a patient sees a doctor who either treats or refers to specialists with diagnostic tools immediately available by just walking into the shop where they are provided. Pay (much less expensive than in US) for service is given by the patient at each step if the IMSSS does not apply. No external insurance coverage involved.

    The only defense is not to get so ill as to cause the need to be overwhelmed by our medical establishment. If one is only in need of preventive care, no problem. All paid for by our “socialized” Medicare insurance with the exception of primary vision and dental treatment which must be paid for by patients.

    As for medical treatment as a non-citizen in a foreign country you’re literally on your own where payment is required, sometimes in advance of being seen by a doctor or in admission to emergency care, you’re on your own and you’d better be prepared in some way with deep pockets and/or high credit card limits even if armed with travel medical insurance taken out in advance of travel. Pre-existing conditions will come into question during treatment and claiming for reimbursement.

  3. Ben says:

    All power to the egalitarian Canadian public health care system – where (to most) – its viewed and available as a “right” and not “privilege”.

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