Friday, August 15, 2008

Insurance



Lisa from Brass and Ivory posed a question in her comments section to me about my experiences with health care and insurance in Canada. Because we have universal health care in this country we often don't think about what an illness can do to families financially. This is much more evident in the US but it does affect Canadians as well.

My mother was quite ill when she was pregnant with me. I wasn't a very good guest apparently. As a result of not being able to keep anything down and the threat of miscarriage a few times, when mom went into labour, the specialists were called in to help with the delivery and to care for what they thought was to be a tiny baby. The minute I was born, they wheeled the incubator out of the room and the specialists all started to leave. Mom asked where everyone was going. She was told they weren't needed as I was big and healthy (and screaming), at 7 pounds, 14 ounces.

My father is fond of reminding me it took them 3 years to pay for my birth because of the precautions needed and the specialists required to be there. I never understood that statement until I was a teenager and learned about our health care system. Canada has only had universal health care since the mid '60s (I was born in '63). Yes, they had insurance, but that only covers so much. My parents have been adamant over the years that I have insurance for everything, and I do.

I have been a consumer of health care since before I was born. All the usual childhood diseases, tonsils came out at 10, occasional trips to emergency for sprains, stitches, etc., regular doctor visits (they now call them "well woman" visits instead of paps), irregular doctor visits for severe colds or flus, MS onset and diagnosis and most recently my surgery for ovarian cysts (I can't imagine the costs associated with that whole experience).

If I added the costs of my health care together, I'm sure I'd be at the million dollar mark by now. But it has basically only cost me parking. And the occasional over the counter medicine.

When the MS diagnosis came along, I signed up for the Avonex drug study. For the duration of the study, the drug company, Avonex was going to cover the costs associated with the study: MRIs, blood work, etc. That was for almost two years. Then after the study, my insurance at work covered the prescription. But it would only do so for two years. This was in the midst of lobbying the various provincial governments to cover the enormous expense of the DMDs. Nova Scotia came on board with the plan around that time along with New Brunswick a few years later and eventually Newfoundland and Labrador. The rest of the country had already covered the drugs.

I get my prescription for Avonex filled every three months. I call the hospital pharmacy, give them my ID number and go pick it up the next day. They send me a bill for $9.54 for "dispensing fees" or some such thing and that's it. So for about $40 a year and parking I get Avonex. In September it will be 9 years that I've been on this drug. Since diagnosis I haven't missed any work because of MS. I have worked full time for the past 8 years (I was part time for several years before that), volunteered, and in general contributed to society (and to the government coffers).

A lot of folks complain about the government's take of income tax. I understand their frustration as I used to be one of them. But not now. I know why I pay taxes and my health is to show for it. I also sock away as much money as I can for retirement because I know that my retirement may one day be forced on me because of the MS.

I have repeatedly said over the years that I am one lucky duck. Not everyone can say that. Some folks may not be working full time or have full health coverage for other prescriptions or they may not be working at all. They may not be living where they want because of financial strains. Maybe they were the sole breadwinner before disability and can now no longer afford to look after their families the way they had been. Whatever the case, even in Canada, getting sick can cause great financial hardship, though it may not be because of the cost of the actual health care.

The Wookie moved to Canada from southern California when he was a teenager. His father (now semi retired) became a professor at one of the universities here. A few years after they had moved here, the Wookie's youngest brother was diagnosed with testicular cancer. Sadly, it was discovered too late and he passed away, but not before undergoing surgery and treatment. Both parents were working professionals but admitted that if they had still been in the US, the brother's medical care would have bankrupted them.

We have wonderful care in this country, wonderful doctors, and wonderful facilities. We also have problems with our medical system that we're trying to work out. The biggest complaint people have is wait times for tests or to see specialists. If your condition is emergent you will be seen and assessed quickly. If it turns out that you don't need emergent treatment, well, you'll wait...

Over the past several years I have watched walk-in medical clinics open up to help ease the strain on emergency departments. There is a shortage of family doctors and as a result, longer waits to see one even if you have one. That's part of what was driving folks to the EDs. The other part is that many people aren't proactive enough with their health, engaging in risky behaviour, not following doctors' advice , that sort of thing. The government and our doctors are not responsible for our health. We are. And we have to educate ourselves about...ourselves. We must become more knowledgeable about our health, we must lead healthier lives, and we must not take for granted the great things we already have.

S.

PS:Lisa, I guess I could have contributed to the Carnival this week after all. Hope that answers some of what you were wondering about.

9 comments:

LISA EMRICH said...

Shauna, thank you so much. This is a fantastic post!!

When I was born my parents were just graduated from high school and very young. They were proactive enough to sign-up for a program which, if they pre-paid half the cost of the delivery, discounted the hospital costs greatly. I came EARLY, but good thing that my parents had paid already.

This is the only social assistance my parents ever received. My mom says that when they got married, she had $40 to her name. That's it. They even lived with my grandmother for the first few months until they found a house.

People here in the U.S. whine about the "evils" of "socialized medicine." If I were to calculate the percentage of what money I earn which goes to medical care, and if I could demand that all CEOs had to do the same, there would be some serious changes in our health financing system.

I certainly would much rather we went to a taxing system which spread the burden over many more people. It's enough to be concerned with the other financial aspects of living with illness than to add enormous debt on top of it.

If I had a different living situation going on, I'd be screwed (to put it delicately). Basically, I'm in a position to NEVER be financially independent. That doesn't feel good to someone about to turn 40. (ok enough of that for now.)

Thank you for writing this!!!!!

Shauna said...

The other thing that happens to people is that if they change jobs or get laid off, insurance coverage ends when the job does. It is vital that you get yourself some separate insurance, pay the premiums, and continue paying them because if something medical happens when you are unemployed then you're really up the creek.

I was laid off for a few months several years ago and maintained my insurance premiums as well as continued to make contributions to my retirement fund becasue if you stop, all heck is bound to break out.

As responsible adults, we have car and home insurance or tenants' insurance if we're renting. I suspect chances are greater that we'd have a major health episode before we have a home-destroying fire.

Lisa, I understand the frustration of knowing you will never be financially independent. That is my greatest fear and what drives me to try and save for the future.

S.

Jen said...

Hi Shauna---

I became interested in socialized medicine a few years back when I saw some "Dateline" type of show investigate the healthcare coverage in, I think, Denmark or Finland. The country in question had about 50% of their income taxed, but their basic needs were met and no one had more than anyone else. Everyone was relatively comfortable. Okay, maybe this is bordering on communism (not sure...)

Another incident happened when I was younger, when my mom went to England and during her trip, she had to see a doctor for strained chest muscles (too much luggage.) She was delighted that the visit cost her about 5 American dollars, whereas in the US, I imagine visitors pray that they don't need to see a doctor or land in the hospital during their trip.

I really enjoyed Michael Moore's "Sicko" movie, and he mentioned Canada's universal plan, but his opinion might have been a little skewed, because you and others have mentioned the long wait for non-emergent care. France is supposed to have an outstanding system, but I would like to hear personally from someone on this.

So I guess we all have yet to find a universal system that doesn't have kinks in it. I hope Obama get elected here in the US and actually works toward this goal, as he has mentioned. I guess I get my liberal roots from my parents, both retired school teachers. My dad is a real hoot at 77. He suscribes to a newsletter specifically targeted to the issue of the separation of church and state. Who knew such a newsletter existed?! Haha....sorry this comment is an autobiography.

Anyway, very interesting post about the Canadian system.

Sincerely,

Jen

Denver Refashionista said...

I wish I could become a Canadian but it's harder than it sounds...
Thanks for this fantastic post. it really clears up many questions I had about universal health care. I think that we need to move in the direction that Canada has taken.

Shauna said...

Jen,

Sadly, when something is free people want to have it whether or not they need it. Just watch people at the supermarket on sampling day.

This kind of happens when health care is "free". You get people clogging up the EDs of hospitals when they would be better served by a walk in clinic or a visit to the family doctor. You also get people making frequent trips to their family doctor for the most mundane of things that will get better on their own or can easily be treated by an OTC medicine.

The idea of a small "fee" per doctor visit has been floated around many times (and I really am in favour of this) but it meets so much resistance from the voting public, it has never been enacted. And this idea is not without its own problems, too (increased cost to an already ill population:ie an asthmatic child needing much more frequent supervision by a doctor than one who goes yearly for a check up).

I have been extremely lucky with all of my experiences with our health care system. 20 years ago I had a rather unpleasant family doctor for 3 years. I was finally able to get another doctor, but I was looking for a couple of years. I did not want to be without one for fear of really needing one at some point, but at the first opportunity I switched. And that was just before the so-called family doctor crisis.

I feel badly for those who aren't in tune enough with their bodies to know the difference between an emergency and a regular doctor visit. And I get p###ed off when people tell me they went to the ED and had to wait 7 hours before seeing a doctor. It couldn't have been much of an emergency if it took that long for a doc to see you (granted, there have been the infrequent events where triage wasn't done correctly and innocent people have suffered the consequences) but those events happen in both the US and Canada so it can't be blamed on one system or the other.

First aid responders learn the ABCs of treatment. Why is it so difficult to teach the general public that unless your Airway is obstructed, you can't Breathe, or your Circulation is compromised, or those components are threatened, it's not an emergency?

So now this response is even longer than my original post, but you get the idea. thanks for visiting Jen.

S.

Diane J Standiford said...

I loved your post and the comments. These stories need to be told.

BRAINCHEESE said...

When I defect, I'm coming to your house! How I DO love O' Canada...

Linda D. in Seattle

Shauna said...

DR,
Come on up!

Diane,
thank you. and I agree.

Linda,
I've got extra pillows and blankets. And I always have good coffee.

s.

Blinders Off said...

Outside insurance is definitely the key. I always believed a person should not depend on the insurance they receive from their job because when your job is gone, to keep your insurance through COBRA was too expensive for an individual to pay.

The trend in how insurance with your job changed during the 1980's when HMO's came on the scene. It looked promising in the beginning, several years later CEO, and executives of the insurance industry and pharmaceutical companies made it a profitable business them at the expense of employees.