Medical Marvel

I spent a good portion of my early life in Canada, and so I have a decent understanding of the culture and history of the place. One of the things that was already beginning to fail, long before I left Canada to return to America, was the Canadian medical system. Let’s talk.

Let me start with a BLUF: American health care is great. American health insurance is fucking ridiculous. Canadian healthcare AND insurance is just whackadoodle.

I don’t currently have insurance. The hows and whys are not up for discussion, but the fact is I’ve paid much less for health care in the last 20 years than my family has through their insurance (either via what they pay off their paycheck alone, or what insurance pays… works for both). I get a “discount” when I see the doctor, get medication, have labs and scans done, etc. because I am uninsured. The quotes are there because the payment I make is frankly what everyone should be making, or rather it’s slightly higher than it ought to be but I can live with it.

American insurance causes people to overcharge on a regular basis, because if they don’t, then they could lose out on insurance payments altogether. I don’t even really understand it. It’s fekking complex. It’s the only industry in the world where MY broken leg and YOUR broken leg, despite being exactly the same, could have vastly different costs. Even when all other things are equal, a doctor’s office, surgeon, or anyone else in the medical factory cannot give you a price until after the work is done, and then they still can’t give you a price because Reasons.

Today, I had to go in and see my GP about my shoulder. I injured it several years ago, and lately it’s been giving me a lot of grief. It is time, even though I’m terrified of the bill for the MRI I’m about to get (anyone want to buy a cookbook? *sigh*). I went in and immediately she bundled together the visit I’d come in for with some other upcoming visits that I can now skip. Hooray, no paying for extra office visits! Win number one.

She looked at my shoulder, hemmed and hawed for a minute, and then started in. “Well, first we should probably send you to physical therapy…”

I stopped her. “I am self-pay, remember. What is going to be the best use of my money?”

“Oh! I forgot! Well, then we should go straight to the MRI. It’s possible they’ll refer you to therapy, but more than likely you’d have gone through weeks of expensive therapy only to be referred to get an MRI and have a different path forward. I’ll make out that paperwork right now.” And off she went. I came home with my papers for getting an MRI on my shoulder, and now I can shop around to find the cheapest place to get that MRI done.

If Chris were to go in for his knee, he would first have to endure six to ten weeks of therapy. Even though we know what’s wrong with his knee (he left part of it on a mountain after a motorcycle accident and it just needs updating, IE surgery), and we know that therapy won’t fix any of it and might actually cause him harm, he has to do that. Because that’s what his insurance says has to happen.

Once the therapy fails, he’ll be sent for xrays. Those probably won’t show anything, or they’ll only show a partial picture. So at that point he might be sent for an ultrasound, or they might go to an MRI, which is where they eventually will end up. MRI is required to look at any soft tissue damage, which is much of what’s holding a knee in place.

If he is really lucky, he’ll be referred to a surgeon. But he probably won’t be lucky (been through this with friends with similar problems). Instead, he’ll probably be sent for more therapy. When that fails, they’ll suggest cortisone shots. When those fail, he’ll probably finally be sent for surgery.

Of course, when they finally get in there, the damage will be much worse than if he’d gone straight in upon talking to his doctor about it. It will also have cost the insurance company three times as much, as well as costing Chris (because of co-pays). The surgery will take longer, cost more, have a higher chance of failure, and cause more pain and longer recovery time.

All of the above is what EVERY medical problem gets in Canada. There are no options. You can’t just pay for an MRI and go around it. You can’t check into another doctor, because there aren’t any other doctors. Every doctor in Canada is working balls to the wall, every day, getting paid considerably less than what American docs are making. On average, Canadian doctors make about $190,000 a year (Dr. Bill), but that’s Canadian dollars. That comes out to less than $150,000 a year in good American bucks. While I’m sure Canadian docs are golfing now and again, they’re definitely not doing it as often as their American counterparts. If you think they’re overworked here, you should check out Canadian waiting times for even simple things (Fraser Institute).

I am going to have to pay for my shoulder to be fixed. It’s going to hurt, both financially and physically. But we’ll get it done. It probably won’t be 9 months of waiting time, either, unless we opt to wait that long. I don’t have to go through pointless therapy. If I need therapy, that will be decided when the doctor sees my scans, and they KNOW what is wrong. It will be a decision between myself and my doctor, not a decision between my government and myself or between me and an insurance agent who I have to coddle. And for that, I’m grateful.