Fear: Why is it working?
As a rational Canadian watching the completely irrational American ‘debate’ on health care these past few months, I would almost find it almost humourous if it weren’t so infuriating.
Here are some of the lies that the anti-reformers are telling about proposed health care reform: You won’t get to choose your doctor. There will be a government bureaucrat standing between you and your doctor. Grandma will be euthanized if she gets sick. Health care will be rationed. Everyone will be forced to pay for abortions, sex-change operations, and health care for illegal aliens. “Death panels”?!?!
But people are believing it. Anti-reformers have launched a campaign of outright lies and absurdities, and a lot of people are believing it. Why?
Why are the fear tactics quashing rational debate about health care? Because appeals to emotion generally trump appeals to logic. (It’s the bane of a rationalist’s existence.) And the most powerfully motivating emotion is fear. Fear is our most primal emotion; survival is linked to it.
I don’t know about all world cultures, but certainly most western cultures are uncomfortable with death. We don’t like to discuss it, and we don’t know how to handle it when we (or someone we care about) are confronted with it.
There has long been a campaign in the American federal government to encourage Americans to make living wills and have end-of-life-care discussions with their doctors. It’s not new. The Bush administration advocated it. It’s a good idea. It’s a smart idea. It’s an important idea. People should have all of their wishes honoured when their inevitable end comes, and those wishes cannot be honoured if they’re not known. Therefore, they should have a living will. And they should be able to make informed decisions about what measures they would like taken (or not taken) at the end of their life. Therefore, they should talk to their doctors about it.
This idea of having living wills and end-of-life-care discussions with doctors was included in ‘Obamacare’ because it’s a good idea and a smart idea. It is, by no means a new idea. In ‘Obamacare,’ as it has been proposed, no American will have to pay for this out of pocket—it will be covered by the government.
When the American public learned of this, compounded by the scare tactics of the anti-reformers (“death panels”), they freaked out. Suddenly they were being forced to confront the idea of their own mortality. That’s scary. Even after millions of years of brain evolution, existential fear trumps logic and reason.
Fear is also contagious. This is another mechanism of evolutionary biology. Survival of a species requires signalling danger to others and being receptive to danger signals, even subtle ones like dilating pupils.
So fear of death is one culprit. Others include fear of change and losing the things they have, fear of diminished freedom of choice, and fear of government. I understand that people don’t trust the government, but it’s selective. Americans currently trust the government to fight its wars, to keep traffic moving, to catch and prosecute criminals, to educate their children, to help them when they need it (social assistance, food stamps, employment counselling), and so on.
There are very good examples of the American government providing health care, and all work very well (although not without problems): Medicare for seniors, Medicaid for the very poor, the Veterans’ Association for veterans, the Department of Defense for soldiers, and the federal government for all members of congress provide the best health care in America. Anti-reformers know that people like and trust these systems of health care, so they are including them in their scare tactics, telling people that health care reform will take away Medicare or veterans’ health care.
While people are chanting “no government in health care” they are simultaneously chanting “hands off my Medicare!” using selective ignorance to deny that Medicare is government-run health care.
The truth about U.S. health care
Again, as an outsider, I see the ‘debate’ about health care in the U.S. as patently ridiculous. I know enough about the current American system to know that most of what anti-reformers are yelling about are railing against already exist in their current system.
“I don’t want some bureaucrat standing between me and my doctor!” or “I won’t be able to choose my doctor!” are two that come to mind. Insurance company executives currently stand in the way of Americans and their doctors, and their choices are already limited.
If an American is lucky enough to be able to afford a health care plan, or have a job that provides one, and if she goes to a doctor or hospital not on her insurance company’s ‘in-network provider’ list, then she’ll likely be paying for it herself. An in-network provider is one contracted by the insurer for agreed-upon rates. An out-of-network provider is one not contracted with the insurer. If Americans go to a doctor or hospital that is ‘in-network’ then they will pay less than if they go to an out-of-network doctor or hospital. In some cases they will have to foot the entire bill because the insurance company may refuse to pay for out-of network services. So if you’re an American who is unconscious and being rushed to the hospital, you’d better regain consciousness long enough to tell people which insurance company-approved hospital to take you to.
People in the current American health care system can be denied coverage by their insurers for pre-existing conditions, or denied reimbursement of drugs not approved by their insurer. Doctors and nurses spend a good part of their day on the phone with insurance companies to make sure that certain treatments and drugs are covered by their patient’s health care plan (often they are not). Sick people are often turned away by a hospital and told to go to another one because that hospital isn’t on their insurance provider’s pre-approved list. And yet some believe that they currently have free choice, that no one is standing between them and their doctor?
We keep hearing that America has the best health care system in the world. It’s true that the U.S. spends more (by all measures) than every other country. In fact, it is the most expensive in the world. But that doesn’t mean that they’ve bought themselves the best system. In fact, the World Health Organization ranks France, Switzerland, Britain, Canada, and Japan higher than the U.S. in health care. The U.S. ranks 37th. Forty-six million Americans can’t afford health care. Seventy-five percent of those who file for bankruptcy because of medical costs had insurance when they got sick and went bankrupt anyway. The system is run by huge health insurance corporations that make enormous profits off of denying care to patients.
And this is the system that anti-reformers are fighting, fighting, to keep.
The truth about Canadian health care
I live in Canada and I am appalled (and a little naïvely surprised) at the lies being bandied about regarding the Canadian health care system. In Canada we have universal, single-payer, non-profit health care called Medicare. It is a single-payer system: The government pays the medical bills, but doctors and hospitals are private and independent. The provincial governments and the federal government are responsible for providing non-profit health insurance to all citizens—they pay for it, they don’t run it. And citizens pay no deductibles or co-payments in most cases (some medications and treatments are not covered or are only partially covered).
As a Canadian, if I get sick I go to my doctor (any doctor of my choosing!), I get diagnosed, I get prescribed some medication or treatment, and I (hopefully) get better. Oh yeah, I almost forgot: I don’t have to pay for it. If I have an accident while biking to work, I am taken to the emergency room, I get emergency treatment or surgery, and I (hopefully) get better. Oh, and I don’t have to pay for it. (Actually, I may have to pay for some of the prescription drugs and for the ambulance, which is dumb, but it’s never thousands or even hundreds of dollars.)
Canadians do not have to fight with insurance companies (or the government) for reimbursement. We are not denied reimbursement so that insurance companies can increase their profit margin. We do not go bankrupt from medical bills. We are not denied care because of pre-existing conditions (or for any reason). We do not have to suffer from illnesses or injuries because we cannot afford medical care. Canadian doctors and administrators do not have to waste precious time fighting with insurance companies, or turn patients away because they are not ‘in-network.’ Drug prices are negotiated by the government with the pharmaceutical companies, which keeps costs down. Doctors are reimbursed monthly by the government, which means no time-consuming paperwork for thousands of different insurance companies. (In the U.S. which has between 1,000 and 1,500 different insurance companies, about 30% of health care costs are purely administrative—dealing with all the paperwork for insurance company reimbursements.)
Why is it that Canada pays less for a better system? In Canada, medical care is a basic human right; it is not for profit. Health care is not a market. Therefore, it is not motivated by companies trying to make as much money as they can. We don’t have bloated administrative costs, high-paid insurance company executives, ridiculous bonuses, and millions of dollars spent on marketing. It is a not-for-profit system.
Franklin Delano Roosevelt said, “We have always known that heedless self-interest was bad morals. We know now that it is bad economics.”
Canada pays for more hospital days and doctor visits per capita than the U.S., but spends 40% less. We pay medical personnel less, our equipment and services cost less, the government negotiates drug prices with pharmaceutical companies, and the government is responsible for financing health care through its budget so therefore must keep its costs down.
In Canada, general health insurance is not tied to employment, so you’re free to quit your job and change jobs without having to fear, “What if I get sick or hurt?” And health care is not age- or prior condition-based. My grandma died in December. She was 86 years old. When she was 78 years old she fell and broke her hip. She had hip-replacement surgery immediately and recovered nicely. When she was 86 years old she fell and broke her hip again. She was rushed to the hospital and had hip-replacement surgery the next day. Mortality rates from hip-replacement surgery increase exponentially the older you get, and my gramma remained in the hospital due to complications. She was treated with the utmost care and concern. She had many tests, many treatments, many drugs. She got well enough to be moved to the rehabilitation ward and we thought she’d be coming home soon, but she took a turn for the worse and ended up in palliative care. Gramma died in the hospital after just over a month, but never was she denied care. The doctors and nurses always did everything they could to heal her, make her better and, at the end, to make sure she was comfortable. The only thing we had to pay for was her phone.
Canada’s health care system is not perfect by any means. It is sadly true that there are wait times in the Canadian system. But it is a problem that has improved exponentially over the years due to better administration and management. If you require surgery and waiting a while is not life-threatening (for example, cataract surgery), then yes you may have to wait a couple of months. But if you require essential, life-saving surgery, then you won’t have to wait at all.
There is a Canadian woman (from my aunt’s town, no less!) making the rounds on American talk shows condemning the Canadian system because she required brain surgery and went to the States for it. This woman has been thoroughly debunked (see here, and here, and here, among other places).
Shona Holmes claims that she was diagnosed with brain cancer and needed emergency surgery, but was forced onto a waiting list so she went the States for her life-saving surgery. The truth is that Shona Holmes did not have cancer, she had a benign cyst, which is not life threatening. She probably would have had to wait two or three months in the Canadian system. But instead she went to the U.S., mortgaged her house, and paid $100,000 out of pocket. Had her non-life-threatening benign cyst been a life-threatening malignant cancerous tumour, the Canadian health care system would have provided Shona Holmes with surgery immediately, and she wouldn’t have had to pay one red cent. But because it was a non-life-threatening benign cyst, she was put on a short waiting list, freaked out, went to the States, and mortgaged her future.
Yes there are wait times in Canada, but nobody waits for emergency surgery.
The ways in which our health care system has deteriorated over the years are ways in which it is being made more like the American system. Things that used to be covered (eye doctor, physiotherapy) are not covered any longer. So if you don’t have benefits from your job and you don’t have money, then you cannot afford the kind of health care that someone with money and/or benefits can afford. It’s turning into a two-tier system that can cause disparities between classes. And Canadians abhor it.
Not every person can be privately wealthy—the world economy wouldn’t be able to support that—so we need services like public transportation, education, and health care. Countries like Canada and the United States are supposed to be meritocracies; that is, people’s worth is supposed to be derived from their abilities and not their wealth or lineage. A system wherein only the wealthy can afford education and health care breeds a classist society with an underclass that is treated as such because the people in it don’t come from money and have jobs that aren’t valued as much as those in the upper class.
But I digress.
Despite its imperfections, inadequacies, and increasing classist structure, Canadian Medicare is still a universal health care system that ensures no Canadian will ever go bankrupt, lose their house, go into debt, become homeless, or die because they have an accident or get sick.
Not too long ago Tommy Douglas was voted “The Greatest Canadian” by a national poll. Tommy Douglas is Keifer Sutherland’s grandfather. But this isn’t why he was voted the greatest Canadian. He was voted the greatest Canadian because he is the man who ushered in our universal health care system.
A friend of mine once said that if anything were to ever cause a revolution in Canada, it would be the government trying to take away our universal health care. I think he was right.
- This is a great article: “A Canadian doctor diagnoses U.S. healthcare.”
- This is a no-holds-barred article by Matt Taibbi in Rolling Stone. Here are the first two paragraphs:
Let’s start with the obvious: America has not only the worst but the dumbest health care system in the developed world. It’s become a black leprosy eating away at the American experiment — a bureaucracy so insipid and mean and illogical that even our darkest criminal minds wouldn’t be equal to dreaming it up on purpose.
The system doesn’t work for anyone. It cheats patients and leaves them to die, denies insurance to 47 million Americans, forces hospitals to spend billions haggling over claims, and systematically bleeds and harasses doctors with the specter of catastrophic litigation. Even as a mechanism for delivering bonuses to insurance-company fat cats, it’s a miserable failure: Greedy insurance bosses who spent a generation denying preventive care to patients now see their profits sapped by millions of customers who enter the system only when they’re sick with incurably expensive illnesses.
- Here is a more detailed primer on the Shona Holmes story.