^{Posted on February 13, 2001}

Privatised health care: U.S. system not the way to go

By Miguel Aguayo
The Toronto Star

Talk of privatizing the health-care system in Canada began to emerge shortly before my immigration from the United States.

Its proponents spoke positively, even enviously, of the speed with which medical treatment was received south of the border. No lining up in queues and more choices in treatments were offered as evidence that a private system is better than Canada's universal health coverage. These testimonials, however appealing, are not the complete story.

In my youth, becoming ill and going to the hospital was expensive. When someone in the family needed medical attention, the cost of health care was paid either out of pocket or through health insurance.

Even those who were lucky enough to have health insurance did not walk away without debt. The insurance policies usually required a co-payment of 20 per cent. This payment structure encouraged people from the working class (or lower) to delay seeking treatment in the hope that the symptoms would subside. If not, it usually meant a trip to the emergency room because the disease or injury had progressed to the point that the trip became necessary.

This was a gamble that my father once played and lost.

Instead of rushing me to the hospital when I became stricken with meningitis, my parents waited almost three days before we made the trip. Consequently, I became deafened for life. At first glance, this may seem like a case of bad parenting, but in context, this delay in seeking medical attention is somewhat understandable.

Over the years before my illness, my siblings and I experienced a series of illnesses. My sister's birth had a few serious complications. I had an appendectomy. My bother had abdominal surgery.

These successive hospitalizations kept my parents from getting ahead financially. So it is not surprising to me that my father would try to avoid another hospital bill. Accruing a large hospital bill has led many to, consciously or subconsciously, delay seeking treatment for illnesses.

Americans are more likely to buy over-the-counter medications than seek medical help. This is true even when a fever is present, which is the medical ``red flag'' that something is wrong. Pop a couple of acetaminophen tablets, cross the fingers, and hope for the best. An expensive trip to the emergency room was made only if the illness persisted.

Eventually, insurance companies developed the managed care concept to control the spiralling cost of medical treatment that resulted from this practice. Under managed care, Americans could seek treatment without being stuck with a bill afterward. Unfortunately, the price they paid was costly insurance premiums and a rigid set of rules to follow. If a rule was broken, the patient got stuck with the bill.
My experience with managed care was not better than the old insurance system. My share of the premiums, after my employer's contribution, was an annual $4,000 for a family of three. Worse yet, some of the rules that patients had to follow were simply unrealistic. For instance, unless it's a life-threatening condition, you are supposed to call the hospital before seeking treatment.

I once got stuck with a bill that amounted to several hundred dollars when an anxiety attack put me in a hospital without contacting my primary care centre in advance. Never mind that I thought I was having a heart attack or that deaf people rarely have an accessible phone handy while in public places. The important issue was the call was not made.

Although these stories are worst case scenarios, they provide a contrast to the picture that proponents of privatization wish to paint. What they would like Canadians to believe is that allowing the medical system to chase dual goals of providing optimum care and realizing a profit will not hurt the system.

They seem to believe that allowing private medicine into our system will somehow improve services and reduce costs. After living under the American system, accessing medical treatment here is liberating. When I feel ill, I call my doctor and get help.

I don't have to worry about the cost. I don't have to worry about special rules that can place the full cost of service on my shoulders. Sure, there are problems in the Canadian health-care system, but opening it up to privatization, to me, is simply not the way to go.