Living With Obamacare

With the passage of President Obama's health reform bill, understanding the Canadian experience with government healthcare can be timely and instructive for Americans.

With healthcare a riveting issue in the U.S. that causes heartburn to Republicans and gets resident scholars fired at the conservative American Enterprise Institute think-tank, maybe a Canadian’s experiences with Medicare would be timely, even instructive.

I’ve had more experience than most with Canada's healthcare system, and have benefited more than most, dating back to my first (triple) heart bypass surgery in 1978, followed by seven more bypasses and replacements in 1993 – all performed by Tirone David who, since first introduced to me by cardiologist Gary Webb, became recognized as one of the world’s most innovative and gifted heart surgeons.

No argument from me. Since the first bypass, I’ve not noticed decline in energy or ability to do basically whatever I’d wanted to do – which included covering crises in various parts of the world, mountain climbing, bungee-jumping, and incidents in between. As an aside, it should be noted there is no history of heart disease in my family, and I have never smoked in my life – something that was vital in my various recoveries.

I’ve recently had another brush with our healthcare system– a supposed three-day confinement in hospital for a pacemaker/defibrillator implant that stretched into nine days in Toronto’s University Health Network (UHN) that involves four hospitals: Toronto General, Western, Mt. Zion and Princess Margaret, all of which, in my experience, cannot do enough for patients. The staff is patient-oriented -- which isn’t to say I’m uncritical of our healthcare system.

For example: Canada’s universal “no choice” Medicare forbids doctors to opt out of the system which forces patients who wish to pay for treatment, to go other countries for it.

Canadian doctors are always tempted to leave for greener fields.

Who you know, or privilege, guarantees quick access to treatment. Long queues or time-lags for those awaiting all but emergency surgery result in prolonged pain and/or unknown numbers of deaths among those who wait and hope.

Shortage of MRIs results in appointments stretching into months, and sometimes scheduled at unreasonable times, like 3 a.m.

My first encounter with Canada’s national health program – Medicare, once derided in Canada as “socialized medicine” – was during a doctor’s strike in Saskatchewan in the early 1960s where it was first introduced. At the time, a fragment of chrome became imbedded in the white of my eye when I was sawing a fishing line on a car bumper to break it. A snippet of chrome catapulted into my eye. No doctor would help. They were on strike. Emergency services came to my rescue.

My next encounter was after a heart attack in 1977, followed by triple bypass surgery at Toronto General Hospital in 1978. My gratitude to cardiologist Dr.Gary Webb is everlasting for getting a young heart surgeon, Tirone David, to operate.

Three weeks after surgery on April Fool’s day I was back playing tennis and attending spring training with my newspaper’s softball team. Two months later I was whitewater rafting down the Grand Canyon. Four years after the surgery I was a member of a team that tried to climb China’s highest Himalayan mountain (Gongga).

And my medical treatment cost me the grand total of nothing – save for taxes. I noticed no adverse effects from the surgery, nor was physically inhibited. In addition, three times I went to Angola to report on the civil war; I covered the turmoil of Zimbabwe’s independence; I covered the war in Eritrea that defeated Ethiopia and established Eritrea’s independence. I also rode a bicycle through parts of China. I felt I was a wonderful advertisement for bypass heart surgery , and even for Canada’s universal “free” health system.

In 1993 I had another heart attack in Cuba that extended to Mexico and finally brought me down in Costa Rica. After a week in a Costa Rican private hospital ($1,000) as opposed to a free one, I reported to Gary Webb in Toronto. An angiogram was called for to assess damage to my heart. At the time, a big issue in Canada was the long waiting times for surgery. It is even worse today. People can die, or deteriorate, while awaiting surgery.

My wait for an angiogram was estimated at six to 10 weeks. Or, if I wished, I could pay $5,000 to go to Ohio’s Cleveland Clinic on a Monday and they would give me an angiogram on Tuesday and send me home that evening with a video of the results.

As a journalist, I chose Cleveland, and wrote about the differences. Cleveland determined I had seven blockages, but some were probably too small to be operated on. On Wednesday I gave the video to Dr. Webb, who gave it immediately to Dr. David, and it was instantly agreed that my condition was an emergency that brooked no delay.

I was in the operating room the following Monday – exactly six days after the angiogram. And I had my story: Canada provides excellent and immediate attention to emergency cases, but the delay in discovering if a condition qualifies as an emergency can be so long, that the patient can expire while waiting.

My recovery was again -  to me – miraculous. A couple of months later I was bicycling through New Zealand and bungee-jumping. A year later I was in Bosnia and Croatia with the Canadian army, and then went back to Eritrea for the beginning of the next border war with Ethiopia.

Around 2000 my heart got out of normal rhythm and I labored with shortness of breath. Again, Canadian Medicare filled the vacuum. Dr. Doug Cameron tried cardio-version – zapping the heart with electricity to shock it back into regular rhythm. Several times this worked, but didn’t last indefinitely. He recommended a combination defibrillator/pacemaker in my chest, in case I ran into trouble in countries with primitive healthcare. I worried about being hospitalized and needing a blood transfusion in AIDS-prone countries.

The implant was made in 2001, just after 9/11, with no adverse effects. The device, if it kicked in while I was out of Canada, might keep me going until I could get home, and avoid possible surgery in places like Africa.

Once again I was operational. I attended the first presidential election in Afghanistan showing no effects from the surgery – a total of 10 to 13 bypasses (counting replacement bypasses) – and again at no direct cost to me. My surgeon, Dr. David, has since acquired international renown, and the ineffable Dr. Webb has moved to the United States and been replaced by cardiologist Heather Ross whose hobby is climbing the Andes mountains with heart-transplant patients and trekking to the North Pole. I’m proud and relieved to be her patient.

The device in my chest helped, but didn’t correct the shortness of breath problem. Tennis became hopeless, and walking entailed stops and starts. I no longer ricocheted when hurtling through the newsroom, but limped. I spaced myself like an old guy. I realized I could no longer keep pace in Afghanistan or the Balkans. My wife went trekking in Bhutan, Nepal and Tibet without me. My body simply said “No.”

I was 83, and together with Dr. Cameron, Dr. Ross figured another wire from the defibrillator device – this time into the right side of the heart as well as left - would improve my breathing and energy. Instead of one ventricle getting an electrical boost, the other would also have access to battery power. It made sense to me  - and in Canada it was covered by our government health system.

Apart from annual taxes, my only contribution was time in a hospital bed, subjected to periodic blood tests and barely edible meals. In a week, I lost about 10 pounds I could ill afford. A small price to pay.

If all this sounds positive for Canada’s universal healthcare, it is. But Canada’s political fixation that individuals should not be able to pay for treatment needs revising. We like to think we have equal medical treatment, except we don’t. Celebrities, politicians, athletes, people with connections, all jump the queue.

When my wife needed a hip replacement, she was told it would be eight months before she could see a specialist, and a year after that she’d get the operation. However, by knowing certain doctors and friends of surgeons, she saw a specialist immediately and was operated on two months later.

In order to pad fees ordained by the government, some doctors charge extra for writing prescriptions, or for making phone consultations, after hours appointments, and a succession of roles unmentioned in legislation.

I suppose my various treatments that were free under Canadian Medicare (omitting a prohibitive tax rate), would have cost me $500,000 or more in the U.S. It’s fair to say I have been a beneficiary of the system, and have been treated generously and courteously every step of the way.

Even my venture to the Cleveland Clinic prompted one Canadian doctor to fret that if only I had called him, he could have had me jump the queue for an angiogram. I told him that was the point – to emphasize how unacceptable and potentially disastrous the Canadian wait-times for operations can be. If only Canada allowed choice on whether or not one paid for healthcare, it would ease the burden. But that’s not the Canadian way – which is why some rich Canadians go to the U.S. for treatment, and why many Canadian doctors leave their country to work in the freer environment of American medical practice.

With Obamacare, all that may change but I wouldn’t bet on it.