March 08, 2007

Health Check Out

In British Columbia (my home province), the local government has been having a series of public and professional forums (fora? Forii? Hm) on health care. Now, if you're not from Canada, and especially if you're American, you've probably heard us bragging (in our modest, self-effacing way, of course) about the single-payer system we enjoy.

Much as we'd like to think otherwise, it is hardly perfect. There are waiting times for non-critical surgeries, an aging population, and a disparity between the provinces.

Add the movement of that aging population to B.C. for retirement, while much of the youth goes elsewhere for work and FAR cheaper housing (and paying taxes in those areas), and you have a numbers crunch.

Improved technology has helped many people with their quality-of-life, while at the same time increasing their lifespans, also increasing the amount of time people have to fall ill in.

Then when you include lifestyle choices that many people unfortunately make, such as becoming obese, lousy diets, and simple lack of exercise, you have more heart attacks, diabetes, and knee and joint injuries that are also taking their toll on the system.

As such, the politically right-wing party in power here have been looking for a way to get out of paying for it. That, plus it doesn't meet with the ideals of free enterprise, so there must be something better, right?

Like, say, private clinics. As everyone knows, private industry is far more efficient than any government could possibly be, right? Sure, there would be some administrative costs with government overview, but the efficiency would more than make up for it! Especially if we say "efficient" a lot!


Okay, so maybe not. This has come around as an issue in the United States as well, but from the other direction: the question being asked there is "Why is private health care so lousy?" This was spurred on as a side note to the horrible circumstances at Walter Reed (and pre-privatization, just two years ago) military hospital, but has been simmering since former president Clinton tried proposing a universal health care plan when he was in office. It failed, but the idea was brough to the attention of the entire nation for a short time, and once that's done, the idea is easier to revisit in the future.

The biggest problem of private medicine, as I've mentioned before, is the cost. Not so much the cost to the government, but the cost to the individual. When you know a trip to the hospital is going to cost you money, even for a simple check-up or to look at a suspicious lump or (in my case) a sore wrist, when do you decide to go?

How will you know when "too late" happens?

The answer, of course, is that you don't. Would you, for instance, go to the hospital for a cut finger if you knew it would cost you $150? Sure, it includes a tetnus shot, but if that's a full days' pay (that's a lot more than I make), you'll think twice. Then if it develops into something more serious, and you end up having to go to the hospital, the cost will skyrocket.

And if $150 is more than a full days' pay for you, then the odds of having medical coverage are slim, even if you can find a provider. Most people who are close to the edge in thier finances have let their coverage slip, or decided they couldn't afford it and are taking that risk.

And guess who ends up in bankruptcy? This Health Affairs study from 2005 found over 50% of claimants filed because of medical circumstances (the statistics are a compilation of 2001 numbers). The medical emergency bankruptcy claimants were less likely to say they had any money problems up until that point; and of all the people who declared bankruptcy, equal numbers of medical claimants and other claimants lacked coverage. Meaning when people are poor, medical coverage is one of the things that they give up on.

Maybe they should put it on thier credit cards? Yeah. That should help.

Even when the medical costs are covered, don't forget, there is still a loss of employment for the injured and for anyone who has to take care of them.

Frankly, this population wave isn't going to last. Yes, we're going to have more retirees in British Columbia that paid their taxes elsewhere, so there will always be some financial strain; but it really will pass. And what we have is simply too valuable to toss aside because we're too cowardly to ride out a single generation, even when the nation itself is financially flush.

I've seen the argument for private insurance that includes the "freedom for people to choose for themselves". After considering how unlikely is is that you can choose anything in a medical emergency, I remain unconvinced. This is medicine, not a shoe store. Treating helath as just another commodity doesn't strike me as either just or sensible.

But then, finding sense in politics, especially where some people (like 27% of them) might be too much to ask.


posted by Thursday at 9:33 pm


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