A Tale of Two Operations

The healthcare debate rages on in the United States. Since the statistics have basically made the case against the US system, those who favor US healthcare have switched to anecdotal evidence. Find someone who feels that the wait times are too long in Canada or that someone was denied care in the UK and build a case that, if you had adequate resources in cash or insurance, the US healthcare outcome would be better. People don’t like charts and graphs anyway so perhaps anecdotal medical outcomes should be a good way to evaluate the different health care systems.

I am in the unusual position of being able to compare two health care systems, the US and Canada. For most of my life I lived and worked in the US but, for personal reasons, moved to Canada in retirement. I have had two major surgeries, one in the US and one in Canada and so have first hand experience with both systems. In comparing the two systems I will have to say that the most significant feature is that in Canada if you need non life threatening care such as I did, a knee replacement, you get it. In the US I could only consider it if I had insurance and supporting resources and the insurance company agreed.

In the US I had a good HMO plan administered by my employer, a Fortune 100 company. The plan included diagnostic screening. One year showed an elevated PSA suggesting prostrate cancer. Clinical review suggested a biopsy. The biopsy showed a moderately aggressive cancer, waiting was not an option at 60. The surgeon discussed the various forms of treatment including getting a second opinion. At no time was there any restriction on the level of care and I was free to choose. This was in the late 1990’s, the surgeon and I reviewed the options and I chose surgery, which at that time seemed the best approach. The surgery was scheduled in a reasonable time frame. The actual surgery was more complex than expected because my physiology was a bit abnormal. As a result I needed 5 units of blood. In spite of the complication and the surgeon’s request for an extension the insurance company insisted that post op release be on their normal schedule.

By the time I had my first post operative exam by the surgeon my leg had swollen a lot and the muscles were hard. I was unaware of deep vein thrombosis (DVT) but the surgeon, just watching me come toward him in the exam room, had me on the table and was booking a hospital bed. He won a loud argument with the insurance company and within hours I was in the hospital getting blood thinner. I found out later the DVT can be a very dangerous side effect of surgery and at that time the treatment used blood thinners which were difficult to regulate. The result was that I was hospitalized for 5 days while the MD’s argued with the insurance company and monitored the DVT while adjusting the blood thinner dosage. I was finally released and continued a normal recovery. While I had excellent care it was clear, at least to me and the surgeon, that blindly insisting on standard release schedule had actually cost more in the long run and could have cost me my life in spite of good facilities, good medicine and staff.

About 15 years later I am now a permanent resident of Canada. Over the decade I have had a developed pain in my left knee that could not be relieved with the normal medications. As an active person who did about an hour of mixed weight training and aerobics a day the knee pain was a greater and greater source of problems. X-Ray showed arthritis in the knee and an MRI was scheduled which showed a badly degenerated knee. The surgeon I was referred to said that on a scale of 1 to 4 it was a 5. At this point the recommendation was a knee replacement. In Canada that meant that I could schedule for the operation and the issue of paying in Canada is taken care of with a plastic card that looks like a drivers license. This card is all that a Canadian needs to get medical treatment. The diagnosis was made in early November and I was planning on February in Florida so surgery would need to be quick or delayed until after February. I chose an April date and asked that if there were any early cancellations I be considered. Several days later I got a call with a surgery date of November 22. Needless to say I had to scramble to get all the per-surgery complete in time. It would mean I would be only a month out of surgery for Christmas but I could handle that given my post op period would be winter when I couldn’t do a lot, rather than spring when I would want to be out.

Surgery was normal except for difficulty inserting the catheter. (A result of scar tissue remaining from prostate surgery) and a small DVT found in the post op Doppler scan. Following surgery a urologist opened up the scar tissue area so there would be no further problems there. My release was scheduled for the third day following surgery. It turned out in the Canadian patient centred system release was not automatic but dependent on 1)final Doppler scan of the DVT, 2)urologist confirmation that there were no urinary problems, 3)physical therapy to confirm I could walk 70 steps and climb 4 steps. As it happened I passed all but the step test. I was then held in hospital for an additional day until I demonstrated I was physically ready. Once released I was visited by a physical therapist who evaluated my mobility and set me up with a local physical therapy office where I get the critical post operative therapy. Once again all I need is my health card.

While the outcomes in the US and Canada were both successful there was a clear difference in attitude. In the US the insurance companies imposed rigid hospital stay times and ignored cases that were a bit out of the norm which, in cases like mine, added cost in the long run. I don’t know the statistics of the different approaches but I do know that in my personal case where both surgeries were a bit abnormal the Canadian system left me with greater confidence that my treatment was through and complete. Rather than worry about the government interfering, in the US it was the insurance company that was trying to second guess the doctors.

The cost in Canada was covered. I presented my health card and everything happens. There are no cascades of paper from insurance companies full of obscure codes for doctors, hospital, pharmacy, anesthesiologist, etc to deal with. I have no paper at all. Many people talk about the costs and I have not done the details but, while I paid less in US taxes I was paying about $4000/year in Medicare B and company insurance premiums. The increased Canadian taxes are much less than that so if you compare real costs I am dollars ahead in Canada.

In all the interactions with the healthcare system in Canada I never had a long wait. I did go for an MRI at 11:30 PM once. They schedule the machines efficiently, but could have oped for some other time. I did ask for a cancellation that resulted in a surgery date almost too close to meet. I am sure that are individual cases of unusual delay just as I can find such in the US but I have yet to meet a real person here in Canada that had an unusually long wait for needed work. When there is a medical need as determined by the doctor it is done. In the US it could be considered ‘elective’ and not covered by insurance thereby making unavailable to most people.

Looking at the statistics I found that Canada was paying a bit over $4000 per person for healthcare for the whole population while the US was paying over $7500 per person for covering part of the population. This is twice the per-ca pita cost of French healthcare with a life expectancy of 81 years, 3 years better than the US at 78. As a sidelight there are counties in Mississippi that have a life expectancy of 68 which is slightly worse than North Korea at 69. US Healthcare may be good but it is very uneven.

When I came to Canada I was concerned about the system and I maintained my US healthcare coverage until I had a chance to see the Canadian system in action. Now I have become a ‘Canadian’ about healthcare, it’s fair, it’s easy, it works and it’s less costly.