I have not seen Michael Moore's Sicko and I may not. I get tired of that style of "gotcha" "journalism."
Still, living as I now do in the land of socialized medicine, I'm supposed to have an opinion about the Canadian system vs. the U.S. system. So here goes.
Both have positive and negative sides. In theory, socialized medicine provides coverage for everyone. In practice, it's not that easy. I don't have a family physician, partly because I'm healthy as a horse and haven't insisted. But they're in short supply. Wait lists for routine procedures like colonoscopies are very long. The population in Thunder Bay is aging (as is the population across most of Canada, like that of the U.S.), but the local hospital (a regional "health sciences center") is just now getting approval for equipment to conduct some basic heart diagnostic procedures. The wait lists for hip and knee replacements are also quite long.
On the up side, my soon-to-be-stepdaughter can take her three children to urgent care clinics or the hospital's ER and know they will receive care. She doesn't have to worry about how she'll pay for their care.
The primary drawback of the U.S. system is that it demands that consumers be alert, educated, and proactive in seeking care. The system itself doesn't help patients meet those demands. Many physicians are simply unable to communicate medical information in a way that nonspecialists can understand, even though it's nonspecialists' bodies at risk. Some physicians I've seen have been dismissive or disdainful about patients who research their conditions and ask questions. Physicians also rarely make the time to be truly available for patients and families, who may be struggling to comprehend shocking information, intuit long-term consequences, and rearrange their lives to fit those new circumstances.
Still, during my father's last illness in Tucson in March, I was very grateful that he was in the U.S. healthcare system. For one thing, it was somewhat familiar. My sister and my oldest brother are both experienced in dealing with physicians and hospitals, and I'm not afraid of medical information, so the three of us could operate pretty well in that environment.
But mostly, I was grateful for another reason. My father was 90 years old with a congenital heart murmur and an advanced case of chronic obstructive lung disorder. In the U.S., Medicare requires that patients be given treatment until they function at pre-illness levels, or at levels as close to pre-illness as possible. That meant that my father received rehabilitation therapy with the goal that he would be physically ready to return to his home in Oklahoma, where he lived alone without supplemental oxygen. That was the goal: it wasn't necessarily practical, even before his situation got complicated.
My father would have received excellent care in Canada, too, no doubt. But I don't know how physicians make decisions about care here. At some point, socialized systems rely on statistics to determine what care is available to whom--with the lack of heart diagnostic and surgical options in Thunder Bay a case in point. If my father had been treated up here, I would have wondered if his physicians were thinking, "Hey, he made it to 90. He really can't expect more." I wanted my father to decide when his time would come. Would healthcare workers here have been fiercely intent on taking him off the ventilator and monitoring his blood glucose so that he would have the best possible chance of recovery? I don't know. There's no way to know. But my family is very satisfied with the care my father received during his illness. His life ended well.
I am not casting aspersions on physicians in either system. Individual healthcare workers always aim to make people well. But they also operate in a system, and systems fail. The two healthcare systems support different kinds of patients. They both have gaping holes.
Which brings me back to Michael Moore. It's very easy to point out problems. It's not as easy to find solutions--real solutions, not just "isn't healthcare great in Canada and Cuba?" Let Michael Moore turn his attention to solutions, and I might go see another of his movies.
