February 2019

Health System Limps, Needs Treatment

Canadians are pretty much like us, aren’t they? Well, more hockey and less NFL, then. But we share pretty much the same socio-economic levels, strong middle class, some poor, some rich. We eat almost the same, give or take a hamburger or two. Really, we both hail from European stock for the most part which should indicate a parallel health status. Granted, they have more Native American peoples. We have more descendants from slaves.

But maintaining the health status of both countries should be pretty much the same job and should cost about the same. But the truth is that the US Health System limps along compared to Canadian Health System and needs treatment

Why then, do they spend around half as much per capita as we do on health care and get better outcomes?

Could it be the 28 million people in the United States with no health insurance? That’s 9% of our population completely uncovered, either because they don’t have a job with health care benefits, or they don’t have enough money to buy it themselves. Get sick in the US, and risk bankruptcy.

Or, stave off seeking care due to fear of the gigantic expense, allow the disease to progress, present in extremis to some emergency room, run up a huge bill, and still die of a disease that’s treatable in the early stages.

On the other hand, even having “health insurance” in the US is no guarantee of one’s ability to absorb the cost of health care because the co-pays, deductibles and co-insurance could still be unaffordable. A patient could “cap-out” and still have a large bill after the insurance stops paying. This state of underinsurance plagues 85 million US citizens. For that 26%, who don’t have enough coverage, seeking care for sickness is still to risk bankruptcy.

Not so in Canada, where at birth a health card is simply issued. Every health card is honored by any doctor or any hospital. There is no denial of care from inadvertent arrival to the wrong network. There is no co-pay, co-insurance or deductible. In fact, Canadians never see a bill. They’ve already paid.

The Canadian health care system is funded by income, sales and corporate taxes. The tax payments are moderately progressive. The 20% of people in lowest economic level pay 6% of their income into the system while the top 20% pay 8%.

Canadians spend 10% of their GDP on their health care system. We spend 17.9%.

Canadians love their health care system and the social solidarity that ensues. Everybody in. Nobody out. Some studies show an 80% approval. Only about 30% in the US approve of their health care system.

The people who could fix this, our elected officials, are trying but we need to let them know what we want. They think we are fine with paying our taxes so they can get wonderful health insurance.

Yep, we pay for theirs.

They think we are fine with people dying every day as a result of lack of health insurance. I am ashamed of the health care system that allows those deaths.

Our elected officials have the power to save lives.

The Capitol Switchboard (202-224-3121) will connect you to each of your two Senators and to any of the people in the House of Representatives from our state (one of these represents your district). Their work is to do what benefits all of us. I do not think it is too annoying for our elected officials to briefly hear what we want. Pick one sentence. Call them and deliver it.

What is a representative democracy anyway?

—Lauren Florence, MD

This is a summary of her presentation to HoU on January 10. Another version was also published in the Opinion section of the Salt Lake Tribune on Sunday, February 3.