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A Canadian Observation of US Health Care System during Presidential Primaries

By Babs Ajayi

The US presidential primaries are front and centre in the United States as I visit from Ottawa, Ontario, Canada.  With kin interest in the political process and the involvement of citizens in the voting process, I was very impressed with how Americans participate and engage the presidential candidates in one of the world’s best democracies, its recent influence by big money and billionaires notwithstanding.  For the very first time, I am privileged to observe the activities of the presidential candidates, their supporters, and their meetings cum robust contacts with the public – in search of votes as they sell their ideas and deliver their bags full of promises to members of both political parties.  Lots of promises have been delivered, and this range from changing the way Wall Street interact with the Main Street, national security, illegal immigration, job creation and the way America deal with its neighbours, particularly Mexico, and other nations such as Iran, North Korea and Russia.  Mr. Donald Trump, the Republican frontrunner, promised the other day that he will order the Mexican President to build and pay for a wall that will finally separate the US and Mexico.  He will also deal with Mr. Putin decisively and ask China to get rid of the North Korean dictator.  There have been lots of talks and promises but not much around health care, beside the promise of Hillary Clinton and Bernie Sanders to enhance and improve on Obamacare.  On their part, the Republican Presidential candidates promised to kill Obamacare on day one if elected.  The keep or kill of Obamacare is the only thing close to policy around the health and wellbeing of the American people, and that got me worried.

I do not know much about the health care system in America but wish to learn more.  Though I followed the battle over Obamacare and the battle to keep or kill it, which went as far as the Supreme Court.  I expect and was hopeful that the Republican and the Democratic Parties must have the interests of the American people at heart as they fight to keep or kill Obamacare.  However, my current visit is proving to be an eye-opener.  My host took ill suddenly.  Stomach pain was the problem and for nearly three weeks she did nothing – resulting instead to pain killers.   I had to intervene on the fourth week by encouraging a visit to the family physician.  With so much reluctance, we set out for a visit to the doctor’s office.  Everywhere we went the wait time was on average about two hours.  I was restless at the clinic and wondered aloud why we had to wait that long to see a doctor.  I told her I do not wait more than 30 minutes to see my family doctor in Ottawa, Canada.  But the first shock for me was the $25 co-pay demanded by the medical assistant.

“Why do you have to pay $25 before you can see a doctor?”

“It is the co-pay.”

“What is co-pay?  I’ve never heard that word before.”

“It is my share of the consultation fee.  That is how it is here in America,” she added.

“Your share of the fee? Who is paying the other share?” I asked with a frown.

“My health insurance company,” she replied.

“You have health insurance and they only pay a fraction of a visit to a doctor?” I was not amused.

“Yes, they pay a fraction and I have to pay the rest.”

“And you pay insurance premiums regularly?” I probed further.

“I pay about $300 every monthly.  It’s taken from my salary, and my employer, the state government pay its own share.”

“And you still have to pay $25 each time you visit your family doctor?  America, their America!” I managed to whisper.

“Yes, I have to pay every time I visit my family doctor.”

“You co-pay $25 and still have to suffer a wait time of 2 hours!  This won’t happen in Canada.”

“I have no choice.”

“You should have a choice.  I have a family physician back home in Canada and I do not pay a cent when I visit her clinic, and I do not have to wait more than 30 minutes each time I went there.”  I was shocked that Americans go through a medical system that has no human face.  Surely, the two political parties must have some kind of solution that will provide universal healthcare for all Americans.

As we compare our two divergent experiences and the truth about American health system hit me, I began to worry – genuinely concerned that millions of people will not be able to access health care when they need.  This is happening in America?  The next day, we visited a gastroenterology specialist along the Southwest Freeway in Houston, Texas to examine the stomach and determine where the pain was coming from – even as the pain became worse within the week, and it has taken persistent pressure from me to force my host to seek medical help.  I was beginning to understand why she has been very reluctant despite excruciating pain from seeking medical help – it was the fear of co-pay and the possibility of bankruptcy.  I found out that medical care problem is one of the major reasons many go bankrupt in America.  I started minding other patients’ problems and asking questions.  Co-pay and random bills are the bane of visits to hospitals in America.  For the medical examination alone my host was hit with a co-pay of $65.  The wait time was almost two hours.  The specialist came in without a word of apology despite keeping her waiting for almost two hours.  She spent less than 20 minutes with the patient and said she would need to undergo an endoscopy, but first she must call my host’s insurance company to find out if they will cover the endoscopy.  No date for the endoscopy can be fixed until she hears from the insurance company and determine her co-pay.  I was amazed that co-pay raises its ugly, unwelcome head everywhere we went and that co-pay is a big part of the health care system in the United States.  When I asked around, so many people told me about several co-pay bills they have outstanding in their medical files.

Pre-procedure instruction document that was handed to my host screamed out loud that there may be random bills on the way and the patient should prepare to receive these bills in the mail later.  In part, the document listed facility fee, professional fee, anesthesia fee, and pathology fee, all of which might be sent by mail.  The clinic accepts no responsibility for anything – not even for the wellbeing of the patients it treats!  Though the pre-procedure instructions advised patients to arrive early, the doctor/specialist do not have to attend to patients at the time specified.  The endoscopy procedure was scheduled for 7:00 am.  We arrived at the clinic around 5:00 am but the gastroenterology specialist did not show up for the procedure until well after 8:00 am.  I wonder if the American Medical Association does anything to ensure that members treat patients with decency, respect and compassion. The nonchalant attitude of the gastroenterology specialist was very shocking.  My mind flashed back to Dr. Nelson King and his associates who diagnosed, operated and treated me for colon cancer at the William Osler Health System – Etobicoke General Hospital in Toronto, Ontario, Canada in April 2005.  Now I know I have a lot of reasons to be grateful for the amazing care they provided, the high quality of the care, the nearly zero wait time for the tests and surgery, and a care that did not cost me a cent despite a three-week stay at the hospital.  How do you charge someone so much and yet render a pedestrian, take-it-or-leave-it service?  I am very proud to be a Canadian, I thought loudly.  Though my nation is not as wealthy as the United States, my country care for the health and wellbeing of its people and we have a true and tested tradition of caring for all.

When the message finally came that my host’s insurance company, United Health will cover the endoscopy procedure, her co-pay was about $250.  I was alarmed.  I was alarmed because I have undergone endoscopy at least twice and I have never paid a penny for the procedure.  All I had to do was provide the hospital or the diagnostic centre in Canada with my health card, which they will swipe and get paid by the government.  I told my guest that I underwent tests, examinations and treatment for colon cancer and I did not have to pay a cent.  I have undergone eight (8) colonoscopy procedures in 15 years and all I have provided has been my health card.

“You had colon cancer and it did not cost you a cent to treat it?”

“It did not cost me anything.  On hindsight now, I remember my cousins living in the US then kept asking me how I plan to pay for my treatment.”

“It would have pushed you into bankruptcy here in the States.”

“I can see why you were reluctant going to the hospital.”

“Yeah, you have to think about all the fees, the co-pay here and there and the endless wait.”

“I can’t believe this.  I would have said it was not true if someone had relayed all these to me.”

Is it possible many of the Republican Party presidential candidates are promising to make America great again and they plan to do this without providing universal health care to the American people?  And the voters are not demanding better access to health care?  What kind of greatness will Trump, Rubio, or Cruz delivers that will not include access to health care for all?  How can any presidential candidate in the right frame of mind promise nothing better than Obamacare and he wants to kill Obamacare?  I now understand why Americans cross the border regularly to visit Vancouver, Toronto, Montreal, and several other Canadian border cities to buy cheaper drugs.  Many of them will ride as a team clutching their American prescriptions which they will replace with a Canadian prescription at a doctor’s clinic before proceeding to buy their cancer and related medications at Canadian pharmacies for the fraction those drugs cost in the United States.  Many Americans nowadays buy their drugs online from Canadian Pharmacies to avoid exorbitant prices.  The drugs are cheaper in Canada because the Canadian government negotiate the prices of drugs with drug manufacturers.  Price control is a reason drug prices are reasonable in Canada as the Patented Medicine Prices Review Board see to it that the prices of medicine do not get out of control.  Price-gouging is in practice in America as recently demonstrated by the drug executive who raised a drug’s price in thousand folds.  Who protect the patients in America?  Of course, not the lobbyists from the pharmaceutical, health insurance, and medical groups who have enough cash in their hands to make Congress do nothing while access to healthcare is taken from the reach of the majority of Americans.   Copaxone, a drug used in the treatment of multiple sclerosis cost an average of $11,000 per year in New York but a 28-week supply cost just $1,200 from an online Canadian pharmacy.  The same supply will set a patient back by as much as $4,500 in the US.

Is this not the time the American electorate step up demand for a decent healthcare system that will not cost them an arm and a leg every time they go to the hospital?  I do not think the average American can get any medical care close to what the top politicians, senators, and congressmen receive from Walter Reed National Military Medical Centre, but at least something fair and decent.  When I called Walter Reed a female voice reiterated what a male operator had earlier told me: you must be a top politician, congressman, or military man to get medical care from that special hospital.  Shouldn’t Americans be asking their presidential candidates what policy they hope to pursue to make drugs cheaper and affordable?  Is this not the time to ask the Republican Presidential candidates the alternative they have to Obamacare?  The wellbeing of the American people should take the centre stage during the process of nominating presidential candidates.  Health is wealth, they say, but that does not seem to hold true here in America; cash is the wealth here and dollar is the king.  In the meantime, my host is scheduled to undergo a laparoscopic cholecystectomy (a fancy name for gallbladder removal and treatment) as we wait to see what her co-pay fee will be.

Babs Ajayi






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