Universal Health Care: My Experience
by Timothy Niedermann
It is inevitable, I hope, that after the current pandemic has run its course, the US will have a renewed national discussion on universal health care. For current and future Silver Sagers, this will be critical as, like the COVID-19 virus, future epidemics and pandemics will most likely put us at greater risk of illness and death than other age groups.
Despite all of the back-and-forth about the pros and cons of “Medicare for All” during the Democratic primaries, most Americans still don’t have a clear picture of how a system of universal health care would work for them on a personal level. But as someone who has lived (and been hospitalized) in two countries that have universal health care, let me give you my perspective.
When I was in college, I spent a year abroad studying in Germany. While I was there, I came down with hepatitis (which I caught, I believe, from eating a raw clam and oyster appetizer in a seaside restaurant in northern Spain). After a few days of sleeping 16 hours a night, I finally went to a local doctor, who essentially ordered me to go to the hospital immediately. I had to plead with him to first go home to get a change of clothes. I had a mild case, but this still required a month in the hospital and a liver biopsy. As a registered student at a German university, however, I paid nothing. Repeat: Nothing.
Germany as it happens, was the first country to have a universal health-care system. It was created by none other than Otto von Bismarck, the Chancellor of Germany, in 1883. Bismarck was no Socialist, but a hard-nosed Prussian empire builder. He wanted to provide medical care for low-income workers, in the interest of ensuring their health and thus uninterrupted growth and efficiency of Germany’s expanding industrial sector. The system later came to include everyone. Germany’s system is multi-payer, meaning it uses private insurers, but those insurers are required to be non-profit companies.
In 1999, I moved to Canada and lived there for 13 years. As a legal resident I was given a Medicare (yes, that’s what it’s called) card, as were my wife and three small children. This was essential because the companies I worked for were start-ups and so were not in the position to offer medical insurance of any kind. Without Canadian Medicare, I wouldn’t have been able to afford health insurance. With Medicare, we went to our doctor’s appointments, presented our cards, and got treated. No muss, no fuss. And no dealing with the arcane requirements of private insurance.
The Canadian health care system is the brainchild of Tommy Douglas, a one-time Member of Parliament and Premier of Saskatchewan—who, in contrast to Bismarck, was definitely a Leftie, and, incidentally, the maternal grandfather of actor Kiefer Sutherland. Douglas advocated for years to get universal health care established in Saskatchewan, against the sort of opposition one is hearing in the US today. Nevertheless, starting with Saskatchewan, his idea was adopted province by province until, in 1966, the whole of Canada had universal health care. The Canadian health-care system is now a source of national pride for Canadians, up there with their men’s and women’s Olympic hockey teams.
In the end, both my wife and I had to spend time in the hospital in Canada—me for a broken elbow, she for a chronic condition—but the real clincher was how the system handled one of our daughters. An athlete all during school, she had had occasional, though not extreme, pain in her neck and back. After university, during her first job working all day in an office, the pain got worse. She finally saw a neurological specialist in Montreal. The diagnosis was Chiari’s malformation, which is when the brain is sitting lower in the skull, blocking the flow of fluid to the spine. Chiari’s leads to increasing pain, numbness, difficulty maintaining balance, weakness in the arms and legs, and more if not treated through surgery. Since my daughter had had no serious head injuries, it’s clear that the condition was congenital—a pre-existing condition. Had she been in the US, no insurance would have covered her, certainly. Luckily she was still a legal resident of Canada. A month after the diagnosis she had the surgery. Brain surgery. They cut away part of her skull and added tissue to the membrane around her brain to relief the pressure. The surgery and recovery went “perfectly,” in the words of the surgeon. The bill? My daughter’s insurance covered everything except the fee for five days in a hospital bed, which I gladly paid. It was $250.00 (Canadian)! That’s it. In the US, how many hundreds of thousands of dollars (US) would the operation and hospital stay have cost? God only knows.
The Canadian system is a fairly pure example of a single-payer medical insurance system, although there are variations from province to province. The government is the insurer, but doctors and hospitals are private. In general, visits and care, including hospitalization, are covered. Some prescription drugs are not. And there is still debate on how to improve the system. Everyone has essentially the same plan, again with some provincial variation. One critical difference between Canada’s system and the patchwork that passes for a system in the US is that the burden for choosing the best way to deliver medical services is put on elected officials and the medical community, not on individuals, businesses, and insurance companies.
The chief advantage of single-payer medical insurance for the individual is simplicity. There are no differing plans to try to compare, no fine print to read, no deductibles to worry about, no pre-existing-condition exceptions. If you go to a hospital or see a doctor, you present your card and the system kicks in. You are covered. You don’t have to deal with an insurance company and endure the wait to be sure something is covered. There is also an added level of social comfort: not only do you know you are covered, you know that everyone you meet is too. And so are their children.
Single-payer insurance also means that your employer doesn’t have to spend time and money administering a plan and thus can spend its resources on running its business.
And lastly, on a collective level, single-payer insurance is cheaper. Canada’s per capita medical costs are just half of the US’s, even though a greater percentage of the population is covered. In Western Europe, which has a variety of government run or administered medical insurance systems, per capita costs are greater than Canada’s but still lower than in the US. And in both Europe and Canada, life expectancy is higher. In the US, it has actually gone down in recent years.
There is something odd about the data I cite in the last paragraph. In the US, we pride ourselves on finding free-market solutions to most of our problems, because we believe this to be the cheapest and most efficient way to gets things done. We distrust government involvement in our lives. But this clearly is not happening with US health care. And the reason is simply that there are some things that the market does not do well. Over the past two centuries we have seen government take responsibility for a number of things in our lives that we now not just take for granted but wouldn’t have any other way. Standing armies, police and fire departments, public schools. The common element is that these address issues of what can generally be called public security. Even education, because our work force is required to have certain minimum skills and the market is not going to supply education efficiently. The same has to be said for health. We do not choose to get sick. It is simply not a market transaction. That’s why government-administered health-care systems work better.
It is truly unfortunate that it took a self-described “democratic socialist” to champion the idea of universal health care in this country, because, as the pandemic has so brutally exposed, our so-called health-care system is inadequate, outmoded, and overpriced. Fixing it should have nothing to do with politics and everything to do with ensuring the health of our citizens—all of them!
Timothy Niedermann is a professional editor, who over his career has dealt with a wide variety of subject matter—including international law and public policy as well as general fiction and non-fiction. He has also taught writing at Yale and McGill. A native of the state of Connecticut, Niedermann moved to Montreal in 1999. He reviews books for the Montreal Review of Books and the Ottawa Review of Books. A graduate of Kenyon College, Mr. Niedermann also attended the University of Freiburg in Germany and holds a J.D. from Case Western Reserve University Law School. He recently published his first novel, Wall of Dust, with Deux Voiliers Publishing.