Two Tier or not Two Tier, That is the Question

Just to warn you right off the bat, this blog entry will be filed under the “rant” category.

Is two tier healthcare better than universal healthcare or is the American system better than ours? Do we in Canada already have a two tier system? What does two tier actually mean? These are basic questions that Canadians face on a daily basis, often with a one sided explanation. I will answer these questions (from an unbiased position using real examples of what is actually going on) and give some solutions to help our good but not perfect system. We will explore more healthcare issues in upcoming entries and I welcome your feedback, comments, hate mail and future topic suggestions.

I will answer the questions in reverse order.

Question #1. What does two tier actually mean?

Answer – A two tier system is a model that allows citizens to pay directly for their healthcare. The most obvious example is the USA. Citizens have the choice of paying expensive insurance premiums (which gives them health coverage) or paying the doctor/institution directly. This means that they usually have timely access to their doctor, get very quick diagnostics done and then receive the best treatment with the best equipment. Sounds great right? What if you can’t afford insurance premiums that can cost upwards of $1000 a month? What if you go with the “out of pocket” option hoping you won’t get sick – and then you do? Would you have $200,000.00 laying around for that heart surgery? Just like any system that tries to cover the entire spectrum of the population, there are some pros and cons. I’ll leave it to you to dissect all of the tiny details but the short answer is: if you make lots of money two tier is good and if you don’t make a lot of money two tier is bad. All of the people who fall outside these parameters (disabled, elderly, unemployed etc.) get there healthcare funded by something called Medicaid or Medicare which the government pays for. Sounds almost like the Canadian system eh?

Question #2. Does Canada already have a two tier system?

Answer – YES! Anyone who thinks different is a politician or a fool. I realize that we technically have a universal system, but if you look closely you will realize that we only have a universal system when it comes to acute care, doctor’s visits or prescription drugs. What happens if you have the crazy idea that you would like to try to walk again after having a stroke? Better hope you recover 100% while you are an in-patient which normally lasts 2-3 months. After that you will eventually have to dip into your pocket to reach your goal. Next time you see a stroke survivor who has regained the ability to walk, ask them two things: How long it took them and did they spend any money out of their pocket? Everyone (unless you are smart enough to evade the CRA) pays taxes into this mismanaged pool of money (insert any health scandal you wish) that is supposed to cover ALL of our healthcare, not just SOME of our needs. I understand that this is not an easy task – having to split up all that money across this great big land, try to account for every health condition imaginable, fund research, pay administrators, buy new and fix old equipment blah, blah, blah. The list would go on for pages. I get it, this is a hard job with many things to consider. The bottom line is still that people ARE PAYING out of their own pocket, or through insurance plans or “loophole clubs” or “associations”, but not to see their doctor, get some pills or to receive surgery. I am not out to bash our system, I just want to see it work better. I also don’t want to fool myself into thinking I have something only to realize I actually don’t once it’s too late. Short answer is: people pay for all kinds of healthcare services in Canada that are not provided for free (or government subsidized) to people who can’t afford the service. Sounds kind of two tier to me.

Question #3. Is two tier healthcare better than universal healthcare?

Answer – Yes and No. I’ll explain. Two tier is obviously better for those who can afford it. For those who can’t it’s horrible. It’s a misguided question though. The real question we should be asking is “How do we take the best of each system and incorporate them together to create a new system?” Canadians are fortunate to have some of the best doctors, researchers and clinicians in the world at our disposal. The only problem is we can’t get to see them because there are so many sick and injured people and so few doctors. The fact is we get scared as soon as we hear the term “Two Tier” and instantly shut down. We either think of less than wealthy Americans dying on the street because they couldn’t afford a surgery that is free in Canada; or people pick this moment to become the most patriotic Canadians on the planet and say things like “this is a Canadian institution, our heritage. We’ll never be like those horrible Americans”. We need to wake up and realize that both systems can work beautifully together and that America and Canada already use each others system to some degree. We just need to come out and admit it publicly so we can move on and make the system better. Canadians travel to the US and all over the world regularly for medical services. Why are we letting this money leave our country? Are we worried that people will begin paying for services in Canada and sooner than later not be able to afford healthcare? Or that there will be no doctors left in the public sector? Or that we will turn into the US?

So how do we keep the money in Canada without becoming a two tier system as we currently know it to be? Short answer: Rich people pay for services (which they already do) at private hospitals that are operated by the government where the doctors are all still paid by OHIP. This will shorten the line across the road at the public hospital. The funds generated through the “private” hospitals will cover their own operating expenses as well as create a new revenue stream for our ailing public system. Two line-ups, less people waiting, same doctors treating and everyone is getting paid the same. Best of both worlds! I could go on and on but the point I am trying to make is let’s make our money work for us and trust that we have smart enough people to figure out how to make that happen. Worst case, I’ll do it (for free!).

One response

  1. I live in Canada, your facts are not all up to date or correct. If someone has a stroke, and are sent home still needing rehabilitation, then we have community services that are covered by each province. People get publicly funded home assessments by nurses, physiotherapists through CCAC – community care access centre. They also receive the care needed afterwards through the same avenue. This is also true for all mental health conditions and rural healthcare is a priority. If they are needing services for rehab or chemotherapy, and they are able to get to the hospital then those services are covered for them. I have never seen an elderly patient left wanting. They even have services to drive seniors and disabled people to healthcare centres for testing and treatment. I have been a visiting nurse here for 15 years and in California for ten. The difference is astounding. In California, I was discharging those that most needed care after several visits because they were on medicaid or medicare. While those that could go to a lab to get their blood work done for an INR were kept on service….forever..because they had insurance. The disparity and the inequality of healthcare was almost criminal in my view. I just go back from working for VNA in California two years ago. So I know the differences. No, those that need care here get it. Those that don’t don’t.. There is little wastage . This is an issue for me and I get upset when I read such naive statements. In Canada, we have what is called a government funded program called Trillium Drug Coverage. When we do our taxes we are assessed for coverage according to our income. If people are below a certain income they get a drug card. If they can afford to pay for some – then they pay a yearly deductible and then all medications are covered.

    You NEED universal healthcare. Its about what is at the core of your value system regarding healthcare. Are human beings and quality of life for all or is it the almighty dollar. In 2009 U.S. government statistics showed that most of the health care cost yearly was due to profit making businesses – hospitals and doctors. Then we have the pharmaceutical and insurance companies down there pretty much controlling the economy. Its almost a syndicate.

    We have a lot to still tackle up here but please know that it is still the better place to live if you are sick or raise children. It is a security that we have. We will not loose our homes or our businesses because of cancer or a stroke. That is where the rubber meets the road.

Leave a Reply

Fill in your details below or click an icon to log in: Logo

You are commenting using your account. Log Out /  Change )

Google+ photo

You are commenting using your Google+ account. Log Out /  Change )

Twitter picture

You are commenting using your Twitter account. Log Out /  Change )

Facebook photo

You are commenting using your Facebook account. Log Out /  Change )


Connecting to %s