A tale of two health care systems

On September 9, 2009 President Obama delivered a speech to a joint session of Congress on the need to overhaul health care in the United States.  In this speech, President Obama said that the United States’ “collective failure to meet [the challenge of health care reform] – year after year, decade after decade – has led [the country] to a breaking point.”

While President Obama was delivering this speech, I was in the Georgetown University Hospital, sitting in a hospital bed because of a significant abscess that was beginning to develop in my mouth.  I would end up spending nearly four days in the hospital, a not-so-pleasant surprise a few weeks after moving away from Canada and my parents for the first time.What was to follow from this hospital stay was literally countless hospital visits, numerous CAT scans, emergency room visits, and an invasive surgery that left me incapacitated for days.  All in all, it was a nightmare saga that would last nearly three months and result in nearly $35,000 in health care bills.

This is where my story differs significantly from what it would have been like if my treatment had occurred in Canada.  After dutifully submitting all of my insurance information, my insurance company proceeded to reject nearly all of the claims.  All of a sudden, my family owed $35,000 because of circumstances completely beyond our control.

Upon hearing this news, my family was shocked.  In Canada, where the government insures most medical procedures, such hassles are virtually unheard of.  We were left confused, not knowing the best way to move forward.

After some research, we hired a professional insurance claims appeals representative, who began assembling our case to the insurance company.  She contacted the doctor who had done the surgery that finally removed the piece of bone, and he passionately came to my defence.  Eventually after over a year of fighting with the insurance company, and thousands of dollars spent on our health care advocate, the insurance company agreed to pay for virtually all of the medical bills.

Almost two years since my surgery, American health care has been transformed.  In March 2010, President Obama signed into law the Affordable Health Care Act, which is estimated to reduce the number of people lacking health insurance by 32 million by 2014.  This law was certainly a step in the right direction, but the health care insurance system in the United States still contains many flaws.

Despite the lack of a legislative appetite to take on additional health care reforms, work remains to be done.  The insurance system remains unnecessarily complex, and many Americans continue to lack access to basic health care.  The Affordable Care Act will dramatically increase the number of Americans who will receive health care insurance.  Where the law did not go far enough was fixing the problem of unscrupulous insurance companies.

When thinking about American health care reform, one should not just assess the number of Americans who have health insurance.  It is arguably just as important to think about what kind of insurance millions of Americans are gaining access to.

The problems that I experienced in the United States were caused not because I lacked health insurance, but because my insurer acted unscrupulously.  That is why nearly 62% of Americanswho have trouble paying their medical bills are actually insured.

If I had been in Canada, the cost of my treatment for my family would have been negligible.  One of the reasons the American health care system is so expensive is because it is so inefficient.  Looking at my own experience, money was wasted on hiring a personal health care advocate, on the insurance company having to spend resources dealing with my claim appeals, and on the countless different hospital personnel who worked with my family to sort out the mess of my hospital claims.  These costs really add up, and it is estimated that American doctors waste nearly 95 billion dollars each year filling out unnecessary paperwork.

In researching this article, I interviewed Roy Romanow, the former Premier of Saskatchewan and the Chair of the 2002 Royal Commission on the Future of Health Care in Canada.  He explained that competition can be good in some industries, but in healthcare it “costs a country more and increases costs.”

Moreover, if my family had not had the resources and determination, we would most likely have had to swallow the entire health care bill.  This illustrates how the American health care system preys disproportionately on the elderly and low-income families who lack the resources to fight back against insurance companies.

Furthermore, the U.S. insurance system is needlessly byzantine.  Patients can be inundated with literally hundreds of different letters following medical procedures.  As a freshman at Georgetown, already overwhelmed by being away from home for the first time, I remember the shear shock of opening my mailbox only to see 30+ letters.

These letters were littered with incomprehensible codes, and it was not actually clear what I was being charged for.  All of this gave me a complete feeling of helplessness that the system was simply far too complex for anyone  to fight back against.  I could not imagine being an elderly individual with no family having to deal with such a barrage of information.

What is truly shocking is how many individuals living in the United States have their insurance claims rejected each year.  According to a California study, over one in five insurance claims in the state are regularly rejected.  This means that literally millions of Americans have to go through this process.   Even more striking is the fact that consumers win 40-60 percent of cases on appeal.

According to Professor William McGreevey of Georgetown University, who has worked at the World Bank and the Organization of American States, “the interests of health care providers do not necessarily line up with that of patients.”  According to such logic, the profit incentive simply makes government a more effective provider of health care, as it is solely concerned with providing high quality services.

With all of this in mind, I cannot complain about the quality of health care service that I received while in the United States. However, this care was not worth almost putting my family $35,000 in debt.  Many of these costs were completely unnecessary, which is why the United States spends significantly more per person on health care than any other country in the world.

Every year, almost half of the personal bankruptcies that occur in the United States are caused because of medical bills.  This means that countless numbers of people end up losing their life savings due to conditions far beyond their own control.  What is even more striking is that nearly three-quarters of these bankruptcies occur among people who are insured.

All of this begs the question: when will the United States have a public health insurance option?  According to former Premier Romanow, “creating a public option is essential for meaningful health care reform.”  Without a public option, many of the same problems relating to redundancy of services and unnecessary paperwork are not significantly reduced.

In Canada, the government contributes 70% of all health care expenditures.  Most of the private spending in Canadian health care occurs in dentistry and optometry, which are not covered under the Canada Health Act.  However, in Canada, the government insures all citizens for most medical procedures, meaning that the entire American health insurance bureaucracy does not really exist in Canada.

Also, contrary to popular perception, there is only a four week wait to see a specialist in Canada, and two weeks for MRI and CAT scans.  These waits can be long, but in the end all Canadians have access to health care at a cost much lower than that of the United States.

Neither Canada nor the United States has a perfect health care system.  According to a recent global assessment of health care systems by the World Health Organization (WHO), Canada ranked 30th and the United States ranked 37th.  While Canada’s system is preferable to that of the United States, France’s number one ranked government funded health care system is a potentially better model.  France has a publicly funded insurance system, which requires modest co-payments, and quite sensibly the sicker you get the less you pay.

It’s been nearly two years since my medical problems in the United States ended.  All that remains is a scar going down my jaw line.  But, dealing with these health issues was definitely the hardest thing I’ve had to go through.  The stress of having to deal with major health problems was only compounded by the financial stress of having to deal with $35,000 in health care bills.

Sometimes after achieving a victory it is easy to stop pushing one’s agenda, and to lose sight of the broader picture.  But I want to encourage people to remember that health care reform is still needed in the United States.  Many of the same problems I faced continue to persist even after the passage of comprehensive health care reform.

I am not going to pretend to be a health care policy expert.  But it does not take an expert to see that a system ranked 37th in the world is not working effectively.  All Americans should have access to well regulated and managed health insurance.  The United States should look to countries such as Canada and France as models for future health care reform.  If I had been treated in Canada instead of the United States, my family would have saved thousands of dollars, and society would have saved thousands in unnecessary paperwork.

My family was lucky, and we emerged relatively unscathed from my health problems.  Unfortunately, far too many others are not so lucky, and suffer the consequences because of circumstances completely beyond their own control.  It is time for all Americans to be treated fairly by their health insurance companies.  Americans deserve a health care system that provides high quality service to all, without the risk of bankrupting millions of people, just because they have the misfortune of falling ill.

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