I recently had an acute medical event, took myself off to a local emergency room, received excellent immediate attention. After about 8 hours of care, an expensive drug that I had never heard of before, multiple disposables and several high tech investigations, I was able to go home. I got back home in the early hours of Canada Day, the 150th anniversary of the convention that created Canada. Two days later I was seen by a specialist, and had further expensive high tech tests.

When I got home from that, I thought I had better figure out my bill to make sure I could afford it all:

Taxi to hospital $14, taxi home from hospital $14, outpatient prescription drugs $1.84 (outpatient drugs are not completely covered for most people), parking for the specialist appointment $12.

Total cost $41.84

That’s it.

Everything else was covered by the provinical healthcare system, paid for by taxes.

Tommy Douglas was a former professional boxer, who was also a baptist minister, and is the father of Canadian Medicare. He was from the Canadian Prairies, has been referred to as the ‘greatest Canadian of all time’ and worked tirelessly to start a Canadian Health Care system which provides care to all, regardless of ability to pay. It is an interesting contrast to me, the attitude of someone like Tommy Douglas, a committed baptist who believed in creating a just and equal society where all are cared for when they are in need, to some of the attitudes of some christian groups in the USA today.

Our system (actually systems, there are significant differences between provinces that are responsible for administering health care) is far from perfect, acute and emergency care tends to be favoured, so neonatal care, for example, is in a privileged position. Central management makes regionalization quite effective, so we have almost no avoidable deliveries of very preterm babies in non-tertiary hospitals. Central management also creates problems, with the size of medical school intakes oscillating as the government tries to decide if we have too many physicians or too few, and keeps changing its mind.

Chronic care, and domiciliary care are the big losers in our system, as it is politically easier to cut budgets when the adverse effects are slowly cumulative rather than acutely visible. Non-urgent surgery is another place where our system does relatively poorly, so a hip replacement might be quite delayed, with consequent avoidable pain and disability. Although, in fact, some type of waiting list is an important way of containing costs, if everyone can get a hip replacement within a few days of qualifying for one, there has to be a great deal of redundancy in the system.

One interesting comparison with the US system was made a few years ago by John Ralston Saul. The cost of US Medicare and Medicaid, divided by the entire US population, (even though they only cover a smallish part of the US population) was substantially greater than the cost  of Canadian Medicare, divided by the entire Canadian Population; but the Canadian system covers everybody. A system with a layer of administration dedicated to making a profit has to be more costly.

I am certainly grateful for the Canadian health care system, both as a patient and as a part of the system, no-one find themselves in debt because of medical costs, those who pay taxes pay for the medical care of those who pay little or no taxes. In a relatively just society, that is how it should be.

Happy belated 150th Canada Day!