Canada, Oh, Canada!

Last weekend my husband was the scholar-in-residence for a Jewish Sabbath event in Vancouver, BC, hosted by a large synagogue.  We left Seattle about 6 am in the rainy darkness (sunup was about 8 am).  The only exciting part of our trek to the north was a freeway mishap in which we were snagged by a large, random piece of metal lying in our lane that drilled onto our front bumper, caught in its own hole, and dragged alongside us, etching the side doors, until we could exit the freeway and extricate it (thousands of dollars' bodywork).  The good news is that there was no line at the border crossing; with our passports and a couple of perfunctory questions, we were off.

The couple who invited us were congenial and intelligent, and as soon as we arrived, the husband presented us each with a red Remembrance Day poppy pin, worn the week before November 11, a national holiday honoring the country's war dead and military sacrifices.

Poppy in lapel, I went with the wife on a little tour of Granville Island, while my husband worked.  Toting her 6-month-old in a pouch, we explored the market stalls and quaint shops, and she told me about her life in Canada.  She was born in Vancouver, met her husband while at McGill University, completed law school and a year's practicum--and suffered plenty of frustrations and challenges living in a half-socialistic state.

Later, after services, I was seated next to a different young couple for the traditional Sabbath dinner.  The husband represented the third generation in his family's local business, though his wife had grown up in San Diego.  An upbeat and appealing pair, but they, too lapsed into a litany of difficulties with the system.

And the next day, we were delighted to be invited for lunch to the home of the congregation's assistant rabbi, with the head rabbi and his wife and many friends also in attendance.  On our walk from synagogue to our meal, as the food was assembled, and during our repast, we engaged in wide-ranging discussion--that somehow always returned to the vagaries of the Canadian experience.

We heard variants of these three complaints:  1) The health care system is tough to navigate, insensitive to individual needs, and even dangerous, given long waits for surgeries and selectivity about who's entitled to care.  2) Taxes are astronomical, with taxes on top of taxes, leaving people little left with which to enjoy life.  3) Compared with the United States, Canada offers less variety of all sorts of goods, and an insouciance about customer service that drives our new friends to make frequent trips to the US to shop.

Here are some of their stories.  One woman's brother, 21 years old, has a digestive problem causing constant discomfort and daily vomiting.  It took him three months to get an appointment with a doctor, another three for a specialist, and now he's waiting six more months for his needed surgery.  Another person I spoke with told me that while private, directly paid health care was recently approved, not everyone can afford such care on top of the taxes for basic services--the case for the 21-year-old brother, who suffers constantly. I found an interesting article describing a current court case where a for-profit hospital is claiming the Canadian law forbidding private docs from charging more than they'd charge the national health care system is unconstitutional, impinging on patients' rights to freedom of care.

A new mom told me of the rule that each obstetric patient must bring her own birth companion--because hospitals don't have the staff to watch over women in labor.

View from Granville Island

Taxes upon taxes.  The "Harmonized Sales Tax" went into effect July 1, shifting around sales taxes a bit, but resulting in a pretty-much-the-same 12% tax on Canadian goods.  Touted as a money-saver since certain low income earners can apply to get some of it refunded, and because it simplifies the taxes that previously kicked in at each step of manufacture (and pushed up the cost of goods), it's got a big thumbs up from the government.  But if you go to its website, you'll see a daunting list of what wage-earners must pay--consumer taxes (that Harmonized Sales Tax, Provincial Sales Tax, Hotel Room Tax, Tobacco Tax, Motor Fuel Tax / Carbon Tax, Tobacco Tax), Income taxes, (Personal Income Tax, Insurance Premium Tax, Logging Tax), Property Tax, and Natural Resources Tax (Forest Revenue, Mineral Tax, and Mineral Land Tax).

I saw the effect of taxing each stage of production when I ran into a market to grab some snacks for my toiling hubby.  A little pack of trail mix was $7.  A small box of Kashi crackers was $5.  Two large apples were $4. By the way, the exchange rate is now about 1:1.

Meanwhile, salaries in Canada are not too far from US wages. One of the big grouses I heard is that nearly every type of job is unionized, which means business is stuck paying what unions demand.  (In 2007, a third of all workers were unionized; government workers comprise the largest union in the country).  The new mother I spoke to said the shortage of obstetric nurses was due to the high wages they command, forcing hospitals to minimize staff. 

Housing, according to our host, who kindly drove us through the neighborhoods where he lives and grew up, seems at least as expensive as in our Seattle area.  The average price for a Vancouver residence as of September, 2010 is $679,000.  I consider that steep.

The final complaint, that retail shopping is limited and not that pleasant, links to the unions and governmental entitlement mentality, my dinner companion explained.  "Sales staff don't want to help you; they don't smile, or offer to get you anything," she noted, "because they think everything's taken care of by somebody else; they don't have to make an effort."  So she treks south to shop, her Nexus border pass smoothing her crossings.

She did recount the recent tale of her sister, who frequently visits from Seattle using her own Nexus membership.  The sister had made a Vancouver Costco run, bringing groceries back home to her sis as a favor.  However, she'd inadvertently stuck a pack of toilet tissue in her trunk with her things--it's strictly forbidden to buy anything Canadian and take it across to the US without paying duty on it.  She flashed her Nexus to cross the border, and somehow the patrol found the undeclared toilet paper.  She was detained two hours, while the officers decided whether or not to charge her--ultimately, her sister said, "they let her go with a slap on the wrist, and a stern warning that should she try to pass contraband, she would be jailed!"

Several of our lunch-mates said they make regular visits to Seattle to shop, especially for kosher food, of which there's far less in Canada.  I overheard them discussing the merits of one kosher-specializing Seattle market over another.  Most travel south for supplies at least monthly.  One lady said she prefers shopping in the US because Canadian stores are shabbier--even when they're the same chain.  "For instance, there's a world of difference shopping in WalMart in Canada versus WalMart in the US," she insisted.  "In Canada there's a lot less selection, and the store's dirty and dingy."  She too notices a difference in the way salesclerks treat customers.  A native of Vancouver, she scowled that if it weren't for her family, "I don't think I'd stay."

The reason I write about this is that I was completely surprised to hear so much spontaneous complaining about the Canadian system. The Economist this year ranks Vancouver as the most livable city on the entire globe, while Forbes lists it as the fourth-best city in the world.  The beautiful setting and quaint-plus-new combo gives it an urban rush with a charming British twist.  Certainly the people I met there were top-notch--affable, interested, opinionated, yes, but warm-as-toast.  And sincere. Quite sincere.

A two-day adventure, but after listening to our new friends describe their worlds, I was certainly glad to come home. ...Even though we idled for 45 minutes in line at the border at 10 pm on a Saturday night to do it.  When finally at the front of the slowly snaking queue of cars, two questions, show our passports...and we're on good old American soil, back in what even our new northern friends agree is the greatest nation on God's green earth.

ObamaCare and the Return to Marcus Welby

Obama's urgent need to confiscate tax money to cover everybody's health care is an indicator of how far medicine has come since I was a kid.  His pressing insistence has a basis in the same technology that brings you this blog, and the apps on your iphone, and your music and photos and games and Kindle--and there's no way we'll ever retreat.

Way back in the far reaches of my memory was chicken pox.  It was a disease your mom made sure you got, by sending you to play with some spotted friend, because you needed to "get it over with" lest it strike with greater force once you became an adult.  Kids don't get chicken pox any more. They get MMRV shots as babies, ending the social delight of intentionally exposing youngsters to "childhood diseases" that are no more.

But when my siblings and I were in the midst of "getting it over with," the pediatrician, as part of his normal duties, showed up at our front door.  I vividly remember him--a stranger to me, really--coming into the bedroom I shared with my similarly-stricken sister, his leather black "doctor's bag" in hand; his cold stethoscope on my chest.  They used to call those visits "house calls."  They didn't cost extra.

In those days, families paid for just about everything outright.  You got a bill from the doctor; if you couldn't pay it all at once, you worked out a payment plan. Yes, there was insurance, but it was private (Blue Cross), not very expensive, usually only for really catastrophic situations, and most people didn't have it.  Certainly no employers paid for it.

Until the 60s, when governments and unions used coverage for bargaining and as perks for employees.

Then, in 1965, President Lyndon Johnson, in a fit of liberal largesse, sought to provide retirees with government-sponsored health coverage.  At that time, most people retired at age 65 and looked forward to rapid decline, surviving at most another decade, as US life expectancy was only 70 years.  Medical care was just starting to get technical; pharmaceuticals were becoming more sophisticated and proprietary.

Without universal retirement plans, a new class of oldsters who weren't being taken care of by newly mobile children got attention in Johnson's "War on Poverty" after exposes about their subsisting on dog food.  Medicare filled in where Social Security left off, followed by Medicaid, the national program for non-elderly poor. But the key there is that it's not federally-managed--each state controls its administration locally. 

Really, it's only been in the last 20 years that HMOs and employer-subsidized health plans became de rigueur, severing all direct connections to local doctors and inserting middlemen at faraway desks, insulated from customers by powerless phone personnel.  Ask a kid what a doctor's bag looks like--he'll shrug.

Do we customers like dealing with huge corporations who determine our premiums, our co-pays, our deductibles?  Do health care providers like that their fees are negotiated and set by the same corporations?  Ever get an "EOB" (explanation of benefits) from a health insurance company that lists a doctor's charge, and then the "adjustment" he makes because the insurance company decided his fee was more than they've decided to pay?  What is this game?

It's the stuff of consumer backlash.  Because if taxpayers know one thing, it's that adding layer upon layer of government bureaucracy onto a system that's already rife enough with regulations, strategies and middlemen isn't going to streamline anything. Instead, it will complicate and worse, cost much more.

By the way, I'm incredulous that thousands of American citizens die each year due to inability to afford health insurance.  Emergency rooms do not turn away indigents.  Medicare, Medicaid and local governmental programs do exist. And private charitable institutions do a tireless job. College and university students have campus resources. And 1,200 free clinics, staffed by generous physicians, exist in every metropolitan area.

Can we ever go back to the friendly Dr. Welby of the olden days? Of course not. We now demand medical science provide magic pills and room-size equipment that hardly fits in the traditional physician's bag.  We seek specialists for second opinions, and form our own analyses by scouring the internet, sometimes spurring expensive lawsuits, served by eager lawyers.  Health care is increasingly complicated, and we now expect to live a lot longer than before. Into our 90's, actually. 

The US spends 16% of its GDP on health care; more than any other modern country.  It's not going to drop--either with feds controlling potential profit or with the status quo, because free enterprise is already so tamped down by government regulations and laws that shape the structure of the insurance industry. What's the answer? I'm not in a position to speculate, but getting back to catastrophic insurance coverage, with individual management of relationships with doctors would be much better than the interminable phone waits and impersonal rulings on payments that we all now face--which would be much, much worse controlled by the biggest bureaucracy of all, the federal government.

Keep Your Health Plan? Not Likely, Pres. Obama

The question was posed by a caller to my fave radio talk show: Why does Obama want everyone to be part of a massive national health care plan?

The query came as the result of the host's explanation of the dishonesty in the way Obama is presenting his complete restructuring of health insurance and care in America.

Obama says that no one will be forced to drop his health plan. But 60% of Americans, according to 2008 census data, have coverage provided by an employer. Under Obama's proposal, employers who want to continue to provide it can--costing them typically several thousand dollars per year per employee. That's why health care is considered such a great perk.

On the other hand, if they choose NOT to insure their employees, employers with annual payrolls of more than $400,000 pay a "penalty" of 8% of wages to the government under the House plan, or just $750 per worker under the Senate plan. What would an employer rather do--pay several thousand for a health package, or a fee of just $750?

Businesses who now offer their employees health care would surely dump the hassling with insurance carriers, and substantially lower their expenses by ending the insurance perk, funneling their workers into the government plan (perhaps kicking and screaming).

And this is exactly what Pres. Obama wants. In fact he needs those millions of formerly employer-covered workers to enter his vast national plan to lower costs! The larger the pool, the wider the risk is spread, the less the whole enterprise costs. And productive employees--presumably the most healthy among us--are the ones footing the bill for the disabled and those with pre-existing conditions that Obama wants taxpayers to cover. Corralling as many healthy wage-earners as possible into the system expands its base, getting the government bigger discounts from its providers of everything from medicines to nursing.

And when independent, for-profit insurers fold, as they eventually must when they can't survive against taxpayer-subsidized competitors, then the government can set prices just the way it wants to. After all, Medicare now sets prices for all sorts of services and procedures. Are they fair? You'd have to ask health care providers. I've heard that docs who still accept Medicare have to make up for losses by charging higher fees to others. One thing I do know, however, is that the huge bureaucracy created by Medicare is just a smidgen of the paperwork and frustration that would face everyone if the government took over health services for every citizen across the country.

My point is that Pres. Obama's mantra that his plan keeps "government out of health care decisions, giving you the option to keep your insurance if you're happy with it," is intentionally sneaky and wrong. With the underlying philosophy that government should not only grow, but federalize functions that have always been local and personal (education, health care), Obama does not want you to "keep your insurance if you're happy with it," and is doing everything possible to force employers who offer insurance to their workers to shift them to his national plan.

If you've got your insurance through work, and suddenly, your boss says it's not available due to government penalties or Obamacare forcing the provider out of business--what happens to your "option to keep your insurance"? And so everyone quietly enters the nationalized network, or pays extravagantly for "concierge care" from the maverick docs who buck the system.

Once nationalized programs are in place, what will young collegians do: choose careers in medicine, where their entrepreneurial zeal will be squelched by set government limits, or head into business? Ahh, but then there's that nifty "surcharge" successful go-getters will pay, as high as an extra 5.4% beyond the elevated taxes on the horizon.

Margaritaville doesn't sound so bad. Given the agenda of present leadership to federally provide everything we need, we won't have to wait too long for the government to replace our lost shaker of salt.