Opinion

Joan Wickersham

Health care in the US is an expensive mess. How does Canada do it?

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My friends — let’s call them Tim and Richard — live in Toronto. In their wallets they carry cards issued by the government, entitling them to health care.

Last April, Tim, who is 58, got a bad cold. Because he has asthma, developing pneumonia could be dangerous. He went to a neighborhood walk-in clinic, above a supermarket right near his house. He didn’t need a referral. He showed the card, waited an hour, and saw a doctor who prescribed prednisone.

He showed the card again in July when he was taken by ambulance to the emergency room. He’d been feeling dizzy, and had suddenly vomited blood and become too weak to stand. The doctor suspected a Cameron ulcer, a relatively rare condition in which the lower esophagus gets tangled with the upper stomach. An endoscopy confirmed this diagnosis. Tim was given a blood transfusion and admitted to the hospital. After three nights, he wanted to go home; by then his blood count was in a low-to-normal range and they reluctantly agreed to discharge him with some ulcer medication and a prescription for more. They also scheduled a follow-up appointment for him with a gastroenterologist.

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Meanwhile, his husband, Richard, 59, was preparing for double hip replacement surgery in August. The surgeon was skilled in a relatively new procedure that went in from the front, rather than the back, eliminating the need to cut through muscle and speeding recovery time. All through the surgery, Tim was getting texts from Richard’s surgical team updating him on how things were going. The nurses and physical therapists had Richard walking that same afternoon. By the next morning, he was climbing a few stairs and that afternoon he went home.

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Tim opted to cancel the appointment with the gastroenterologist because his yearly physical with his internist was scheduled for October. At that check-up the doctor ran a battery of tests. The ulcer medication was working, but a new concern surfaced: Tim had an elevated level of prostate-specific antigen. The doctor scheduled a follow-up test in three months.

A month later, Tim used his card again in the emergency room, where he’d gone with severe abdominal pain, which he assumed was related to the ulcer. The surgeon in the ER believed it might be his gall bladder, a diagnosis confirmed by ultrasound the following morning. Tim was told he could have surgery in the next few days, but he was about to sing in a concert so the operation was scheduled for three weeks later. It was done in a different hospital — one dedicated to ambulatory surgery — by the same surgeon whom Tim had seen in the ER, and who remembered him and spoke reassuringly to him before the procedure. “I had a snarky anesthesiologist,” Tim told me. “That stood out: the one person in this entire year of medical stuff who was anything other than nice.”

He told me this on the phone. I had called and asked him what health care was like in Canada — not in general policy terms, but how it felt to use the system. I had said, “Tell me about every time you and Richard have seen a doctor in the past year.”

He admitted that the year had been atypically intense for them; they’d seen doctors a lot. Each time, they showed their health care cards, and that was it. He felt the care had been excellent. I asked how much it had cost them. He said that outside of Richard’s crutches and some $10 charges for prescription drugs, it hadn’t cost them anything.

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We both knew that what we were really talking about was US politics.

“I like knowing that every person I see when I walk down the street in Toronto will be taken care of, and it doesn’t matter what’s wrong with them or how much money they have,” Tim told me. “If you need help, you get it.”

Jan Wickersham’s column appears regularly in the Globe.