Two kinds of freedom: a story about the US and Canadian healthcare systems

Once upon a time, I lived in Philadelphia and worked for a fancy white-shoe law firm. I had top-drawer health insurance, including 100% UCR — if you’re not familiar, UCR stands for “Usual, Customary and Reasonable,” which means covering the standard tests, x-rays, etc. that one might reasonably expect to be necessary for a given condition or diagnosis. So, being young, I never worried too much about healthcare.

Then one night I decided to sleepwalk when I was staying over at a friend’s house, and I fell down a flight of stairs. Wow! never did that before. But I was still exhausted when I hit the floor, and decided to head back up to bed rather than take inventory, even though my arm hurt.

I woke up a few hours later from the pain. My hand was swollen — my whole arm was swollen! turns out I had dislocated my elbow by about 6 inches, and smashed up my wrist but good. Went to the hospital ER nearby and first they gave me some IV valium. Then they took an x-ray to see what was going on inside the tree trunk that was my arm. Then they repositioned the elbow. That was fun! Everything was still so swollen, and I couldn’t tell what was going on in there, so they took another x-ray to verify that my elbow was, in fact, in its correct place.

They put a cast on me (my first!) to keep my wrist somewhat immobilized while the swelling went down, and then a few days later, I was hospitalized (first time since infancy) for a four-hour reconstruction surgery that included a bone graft from my hip, and the installation of external titanium pins and a frame to keep everything perfectly still while my bones knit.

Two nights in the hospital, with morphine and lots of ice, and then I got sent home.

The bills started coming. I thought everything was covered, because I had 100% UCR, right?

Wrong! UCR only covers one x-ray per dislocated elbow, for example, so I had to pay for the other one, even though it was prescribed by the ER physician.

UCR only covers some amount of ice, I guess, because I was charged for ice in hospital.

UCR doesn’t even cover your ugly old hospital gown.

I was able to retain use of my right hand (kind of important to me!) due to the fantastic surgery and care available to me, but despite that 100% UCR coverage, and all of my care being in-network for my Blue Cross & Blue Shield, I was on the hook for $1,000.

$1,000 is still a large amount to me now, but in the early 1990s, to me at my first grown-up job, it was huge. Luckily I was able to pay it without undue trouble, but if I hadn’t been back living with my parents after university graduation, it would have been a very different story.

Fast-forward to the early 2000s. I’m living back in Canada, where I was born. Spring skiing, going rather fast, let my feet get out from under me and boom, hit the corn snow. Corn snow is hard! I’m wearing a helmet. I’m OK for a second, but then I pass out for a few minutes. Rescue comes to get me, takes me down in the basket, I’m in and out, I forget where I am and when it is in my life. Again I’m with my parents, so they look after me and make sure I’m awake every hour or whatever it is, and I stay with them a few days, and seem to be improving.

I go back home to Vancouver, and go to my doctor (free!) to get her up to speed on my latest. She does some neurological tests to see where I am, and it’s pretty clear I have a traumatic brain injury, but it doesn’t seem to be too severe. She tells me to come back if anything changes. A day or two later, I get a blinding headache, and I’m not much of a headachy person, so this worries me. I go back to the doctor (free!) and she sends me off to the ER (free!) where they can take scans (free!) if needed. I check in at the ER and hang out there for a few hours while they monitor me, and turns out things are OK, and I should just expect the odd blinding headache for a while. I also have to not do anything for the next year or so that could result in hitting my head again. So much for skiing, rollerblading…I was never very athletic, but I could scarcely walk for a while, my balance was off-kilter, and I just felt weird. My personal thermometer went nuts and I was constantly cold for years. But I was able to go to the doctor whenever I needed to, for free. If you’ve never had this freedom, I’m sorry. It’s a really great thing.

Some time later, I met my American husband, and we got married. He lived in Canada for five years or so, but then we decided to move to California for a change, where cost of living is cheaper (although take-home pay is less, surprisingly), and there’s Obamacare, and everything will be groovy.

We moved in 2016. You know what happened next.

When I heard about California State Senator Lara’s single payer initiative, I was ecstatic. I had already had the experience since moving of going to the in-network doctor ($65 co-pay) and having blood tests ($120 for a pretty ordinary battery), and of slicing open my hand with a super sharp Japanese kitchen knife, but deciding that I didn’t want to end up with a $2000 ER bill for a couple of stitches, so slapping some hardcore band-aids on there and crossing the fingers of my other hand. It turned out OK, but I really should have gotten some stitches.

So as someone who has experienced the Canadian and the US healthcare systems, I can tell you that while it has its faults, the peace of mind that comes with universal healthcare is better. Many of the arguments against single payer are simply the outliers, or grossly exaggerated. Yes, you might have to wait for treatment or non-emergency surgery. Yes, our nurses are overworked. Yes, you will probably have to try several medications before being authorized to get the super-expensive one. But no, you will not go bankrupt for not having the foresight to be born in a perfect body, or for allowing that drunk driver to t-bone you, or letting that bank robber shoot you while you were going about your business, or god forbid — getting old.

The idea that we, as citizens, care enough about our fellow citizens to all subsidize each others’ healthcare is something that Canadians can get behind, along with most other first-world countries. I really hope that the United States can, too. There is no moral superiority conferred to those with enough money to pay for insurance or with a few million in the bank to cover cancer treatment. There is likewise no moral inferiority in lacking those millions!

What is the point of a civilized society if we consign the least fortunate among us to suffer preventable illnesses and preventable deaths? What kind of freedom do we have in this country if we can’t take a step, literal or figurative, without wondering if the result might be bankruptcy or penury? I am by nature a relatively cautious person, but now I have this constant underlying anxiety about needing healthcare that informs everything I do.

How do we look in the eyes of our compatriots and say, sorry! we have treatment that can cure you, but you can’t have it. Or, yes! there are services available that could assist you or your loved one to have an independent life, but you don’t qualify because you aren’t rich enough, so we don’t actually care.

Well, I guess I am what you call a bleeding-heart liberal, and I care.

This piece is adapted from a speech made by the writer at a SB652 Single-Payer Healthcare Information Event in Yucca Valley, California on June 26, 2017.

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