Tuesday, January 15, 2008


I recently watched Michael Moore's health care documentary SiCKO. Alliance Atlantis provided free admission to the movie for nurses across Canada during one week in July 2007 and my daughter who is a nurse saw it at that time. Mr. Moore is not certainly not boring and all his documentaries have been somewhat controversial.

One of the biggest criticisms of SiCKO is that while bashing the American health care system which is less than ideal, Moore white-washed the Canadian, British, French and Cuban health care systems.

We have had universal health care in Canada since 1966 and I have been employed in the system for over thirty years. Many changes have occurred in this time as more expensive equipment, tests, drugs and treatments have forced hospitals and governments to save money by cutting other services. There is a lot more scrutiny of outcomes and best practice. In the 1970's and 80's, patients stayed in hospital for two weeks after joint replacements while today the target is five days. In some larger hospitals there are efforts to reduce the inpatient stays to three days or less.

While there are some variations from province to province, approximately 70% of our health care costs are publicly funded in Canada. Dental care, prescription drugs outside the hospital, and optometry are not covered in most cases. Home Care professional services are covered but there have been significant cut backs recently in personal care support. Some areas still have long wait lists for special tests and elective surgery, but this is improving. My father-in-law waited almost a year and died before his coronary bypass surgery in 1987 but this procedure is now available in our city in a timely fashion.

We continue to lose about 10% of Canadian trained physicians and nurses to other countries, mainly the USA where higher health care salaries are available. Thousands of people in our region do not have a family physician and have to visit clinics or emergency departments for primary care. But on the whole, good health care is available to everyone and urgent conditions are generally treated promptly. There are those who would like to have the choice of paying to be treated at a privately run centre, but it is illegal to operate a facility that provides the same health care as our publicly funded centres.

The average person I see at the rehabilitation hospital where I work may have had surgery for a fracture, or have been treated in ICU or a medical/surgical unit for some acute illness. Their rehab stay averages about three months and they only pay for optional telephone and cable TV services and personal laundry if their family cannot do it. The patient wearing those hot pink casts above was in hospital for just under a year. I do think it would be a good idea if patients were presented with an invoice itemizing their cost to the system, even though they are not billed. The doctors I work with are tops! Patients get good assessments and thorough investigations whether they are a six digit wager earner or on welfare.

Today I had a physical exam by my family physician. The examination and tests were covered but I had to pay $45.00 to have a small skin lesion removed from my forehead. (If it turns out to be malignant, I will be reimbursed) Our dog had an exacerbation of his chronic liver problem last week and his examination, labs and medication cost $250.00.

It is possible to opt out of our health care system and many Old Order Mennonites do not subscribe to the government plan. As a community, they support those in physical and financial need and really operate their own health care program. I have seen OOMs receiving ICU care for acute illness or injury and they are billed for service. But our health care costs are much less than those charged in America. My mom has no health coverage in Canada. She had to visit our doctor when she was here over Christmas and her office visit and antibiotic cost less than $50.00.

The stories told in SiCKO are horrendous and I would hope that most Americans do not have to worry about their health insurer paying for their medical treatment. And it is clear that more effort needs to go into preventative health care in both United States and Canada. I think the most memorable interview in the documentary was with British politician Tony Benn. In one part he described how the National Health System in Britain came into being after World War 2. The rationale was, “If we can find money to kill people, we can find money to help people.”

Our Canadian health care system is not perfect, but I am thankful that we have it and that I can provide care within its framework.

(photo of Mennonite buggy and sleeping children taken by my father)


  1. For quite a while in my career, I worked in health care--for our state medical society, then for our state department of health. My specialty was health policy.
    I was always bemused when people would say--oh, we don't want a Canadian system of health insurance. We wouldn't want to ration health care.
    To which I would reply--well, we in the US ration health care--we just do it by denying care to people without insurance.
    Usually ended the conversation.

  2. I am forever grateful for our health care system. I just add that I wish it were possible to receive more than 4 hours per week of home care! And I haven't been able to set that up yet:)

  3. As you know I spend a lot of time in the US and I see first hand the panic my friends have when faced with a major health issue. Just this week my house-sitter's husband was faced with lay-off from his 6 figure job and their biggest fear was "no health coverage". (He has a major medical problem with his back and hip.) GIVE ME CANADA ANY DAY!

  4. Great post, Ruth. A good eye-opener. You are very fortunate.

  5. Anonymous7:40 pm GMT-5

    I want to say first of all, I have a VERY deeply colored view of the American health care system.

    I watched my best friend's mother waste away to nothing and die last year. She was denied care for several months because she lacked insurance, we did not know what was wrong. She was looked 9 months pregnant but she had had a hysterectomy years before, so that was impossible. One hospital even told her she was making it up.

    Finally, after several months she was diagnosed had 4th stage ovarian cancer (I guess they don't remove those when you have a hysterectomy?) The government, after much paperwork and stalling, gave her the most basic "care" and she died in pain, unmedicated, because she did not have the insurance.

    Sorry, I am ranting...

    Michael has great insurance through his work. For my pregnancy, they are paying everything, except 20% of my final hospital stay (labor) and I have to pay part of my prescriptions. Even with what is considered excellent insurance for this area, I still am baffled by some things they don't cover. Things my doctor considers necessary. I had bacterial bronchitis last year and the doctor tested my oxygen levels with some little blue light device. It only took 5 second to do. My insurance wouldn't cover it because they deemed it unnecessary, (I suppose oxygen isn't important?) and billed me $70 for that "treatment".

    Now I worry about every simple test they give me at the doctor. I worry most at the thought of being uninsured though. In the US, that kills.

    I'll stop ranting now...

  6. KGMom- People in the USA sometimes misunderstand the Canadian health care system. I would say things may be prioritized not rationed. For instance, hip fracture will get surgery time before an elective hip replacement.

    Jean- Home Care services are not covered in the Canada Health Act, but the provinces have picked up the tab for many years. The pressure on Home Care has increased as people are discharged earlier from hospital. People often choose to have palliative nursing care at home. So the homemaking/respite services get cut further.

    OmaLois- I was hoping that the documentary was exaggerated, but perhaps it wasn't. Several of our eldest daughter's nursing classmates wanted to work in the USA (there are plenty of recruitment job fairs!) But "B" said she could never work in the US system.

    Mary- We are fortunate, yet we still complain at times.

    Jaspenelle- Your comment scares me! How much is 20% of your hospital stay? When I think of your cousins, our premature twins, I shudder to think of the cost we would have had to pay for even a portion of their first few months of care. Plus I was hospitalized during the pregnancy. If a simple oximetry reading is $70!! what does hospitalization cost? Anyway, you can rant, and I will pray that everything goes smoothly for you and the baby.

  7. Anonymous8:54 pm GMT-5

    The hospital stay will probably cost us $600, assuming all goes well and we are estimating correctly. It could be up to $1000 though. I am planning on having an unmedicated birth, so that may cut down on part of that costs.

    Is it sad when you fear your insurance company more then death? It is a very sad truth for most people I know, no wonder assisted suicide has such a following here.

    Anyhow, our bundle of joy will still be worth the expense. Though I have to admit I often imagine how much baby stuff I could buy for $600.... But dwelling on such things is a pipe dream.

  8. Our system has its problems, but I wouldn't trade it. I'll bet the two hours that I spent getting an echo cardiogram and a similar examination of the carotids would have cost the best part of a thousand dollars. I didn't have to wait all that long, and I'm sure that it would have been done even sooner had it been necessary. No, I'll take this system with all of its warts.

  9. Thanks for sharing your view on it Ruth. The cost has just simply skyrocketed here and something HAS to change. I am not sure how to fix the system, but it is a sick system and if no solutions are forthcoming, it will eventually collapse I fear.

  10. Anonymous9:19 pm GMT-5

    My chief complaints about our current health care system in Canada: wait lists and not enough doctors. It seems to differ from province to province. In Ontario, I believe the average waiting time for an MRI is about 31 days, while here in B.C. it's 84 days. I can't understand it. This was the topic on last night's news. One man who needs an operation for a heart problem is going to Bellingham to have the procedure done because he doesn't want to wait any longer. It will cost him $31,000.

  11. AC- I agree with you...the system with its warts is better than no system at all.

    Jayne- As a nurse you must see first hand the difficulties in your health care system. I don't understand the political resistance to change.

    April- In Ontario there are wait list strategies to reduce times in five areas: Cardiac surgery, joint replacements, eye surgery, cancer treatment, and CT/MRI
    I often see people get an MRI in 2 days or less for an acute condition, while others may wait months for a non-urgent condition. So the averages may seem high, but they do not really tell the whole story. As far as the person going elsewhere for cardiac surgery...it would be interesting to know how urgent the need for surgery really is and how long the wait would be in Canada. I do think the media tend to exploit the extreme cases and there may be another side to the story. There is no doubt we need more doctors outside the big cities.


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