Monday, March 17, 2008

The Canadian Safety Valve is the US

John LaPlante at recounts another story of a young man's experiences with both the Canadian and American health systems:
The Best Part of Living in Canada? Being Close to the U.S.
The safety valve for long waits for medical treatment

It's been said that Canada's single-payer systems "works" to the extent that it does because the U.S. serves as a safety valve. Since most of the population lives within a short drive, it can, if need be, get around rationing queues by crossing the border.

This morning I came across an anecdote in that same vein. It's from a sports-related blog, maintained by two guys in Toronto who love to cycle and go snowboarding.

Adam, the snowboarder, suffered a knee injury while playing basketball. On March 25, 2006, he wrote about his first trip to a medical facility. The people there were friendly and knowledgeable, but further treatment would expose him to the long queues of Canadian health care. "It’s really, really tempting," he said, "to go to Buffalo, Montreal or somewhere else to get an MRI sooner, so I can get on the road to recovery sooner. Is recouping my summer worth shelling out $500 to $1000?"

Rather than wait 55 days—the projected queue in Ontario—he must have come up with the money, since on April 22—28 days later—he had an MRI done in Buffalo, New York.

Would the doctor in Canada object on the grounds that Adam was subverting socialized medicine, that quality that (aside from "not being the United States") seems to define the country? Nope. "The [Canadian] company rep I spoke to said they had very few issues with doctors protesting, because the end result was that you were making the waiting list in Ontario shorter."

Once Adam placed the call to the U.S., he could have gotten his appointment with the New York clinic in a New York minute—they offered a screening that evening.

"To say I was impressed was an understatement," he wrote. "My overall impression: so worth the money. I'm now four months ahead of where I would be using the Ontario system."

But it took him over a month for an appointment in Canada to review the results. They weren't good: a scope on his knee, and possibly more, was called for. And "this being Ontario and all, when will I get the surgery? Six to eight months from now." [Emphasis in the original.]

The schedule must have loosened up a bit. (Maybe more Canadians decided to have their surgery in the U.S., too.) Adam decided to delay on scheduling his operation, so as to make better use of the winter. When he called in November 2006 for a date, he was told he would have a ...five month wait, which was in fact the truth.

At least three lessons come from this story: Time and money are interchangeable. A "right" to health care is a right to a queue. And if you need to see a doctor in a government-financed system, take a number.