The U.S. health-care debate and Shona Holmes

Here’s a television ad currently being aired in parts of the United States, as private interests, including physicians and health insurers, wage their war against President Barack Obama’s push to reform health care. It features Shona Holmes of Waterdown, Ont.

Holmes, 45, has become the latest poster child for Americans hoping to stave off Canadian-style “socialized medicine.” She has appeared at press conferences on Capitol Hill and been interviewed on CNN and Fox News. She has repeatedly told the story of how she was diagnosed with a brain tumour and eventually had surgery at the Mayo Clinic in Phoenix, Ariz., when it became apparent that the wait for treatment in Canada would take months. She remortgaged her home to pay the clinic’s $97,000 bill and is suing the Ontario Health Insurance Plan (OHIP) to recoup the costs.

(Holmes certainly isn’t the first media darling to be featured on U.S. networks on the issue of Canadian health care. British Columbia businessman Don Neufeldt, who went public earlier this year about lack of timely access to a cardiologist in Canada, forcing him to seek treatment in Oklahoma City, Okla., is another).

As one might expect, Holmes’s case is slightly more nuanced than powerful lobbies or ratings-driven newscasts care to reveal. In today’s Globe and Mail, columnist André Picard offers a piece that provides some background, balance and clarity. Holmes’s tumour was not malignant; it was a benign cyst that, yes, was impairing her vision, but was not life-threatening. Frightening as vision loss would be for any patient, Canadian doctors believed it to be temporary and reversible. They were doing what, in the Canadian and British systems, doctors must do: prioritize patient care.

Meanwhile, Holmes has come under personal attack by defenders of the Canadian system, including bloggers and Facebook users, who are giving the family mediator a little more grief than she’s accustomed to.

Having lived and worked under both systems, I don’t understand the overheated rhetoric deployed by both sides of the health-care debate. Each system has strengths and weaknesses. In the U.S., thanks to competition among hospitals and an abundant supply of health-care professionals, care is often more immediate, especially when specialists are involved. For those with health insurance, most trips to the doctor or operating room carry a cost in the form of a deductible or co-payment. For those without, the quality of care is less robust or comprehensive. Depending on the condition, it may even be absent. Long-term catastrophic illness, for either the insured or uninsured, can spell financial disaster.

In Canada, taxes are substantially higher to bear the massive burden of a national health-care system, but illness is seldom financially catastrophic. Everyone working in the system — from nurses to doctors to specialists — must ration and prioritize care, and that can mean long waits. (See CBC News correspondent Neil Macdonald’s open letter to Americans in the wake of the Neufeldt story.) The system is imperfect at best. Sometimes, wait times can get so long that they threaten Canadians’ right to personal security, as specified in the Canadian Charter of Rights and Freedoms. Remember the case of Chaoulli v. Quebec (Attorney General [2005] in the Supreme Court of Canada? “Delays in the public system are widespread and have serious, sometimes grave, consequences,” wrote Chief Justice Beverley McLachlin and Justice John Major, as part of a split decision. “Inevitably where patients have life-threatening conditions, some will die because of undue delay in awaiting surgery.”

Picard’s final observation is a salient one, brimming with irony: Given her medical past, Holmes is now in a position where she would find it nearly impossible to buy medical insurance in the U.S. In Canada, she will continue to be covered and will get the same access to the system as any other Canadian.

7 Replies to “The U.S. health-care debate and Shona Holmes”

  1. I think you omitted something there. Let me fill that in for you:

    “In the U.S., thanks to competition among hospitals and an abundant supply of health care professionals, and the fact that 15% of the population is uninsured, and almost double that again under-insured and thus are less prone to clogging up doctor’s waiting rooms with their pesky medical needs they know they won’t be able to afford… care is often more immediately available to someone like *a lady who comes down waving a $97,000 check*.”

    There, that’s a little more accurate. Because quite frankly it is not the “competition” that is reducing the waiting times. It’s all the excluding people FROM the lines that reduces the lines. Because see… when they’re not getting the care at all they’re not technically “waiting” any more are they? It’s a really genius tactic for dealing with the wait list problem don’t you think? I know you mentioned the “for those without health insurance” angle, but you rather downplayed it’s relevance to this part of the equation.

    The other correction is going to require total rewrite I’m afraid.

    Canadian taxes are:

    1. NOT significantly higher. I believe the last figures I saw for the average marginal tax rate in Canada was like 3% higher than the same in the US. It’s more progressively structured, so if you’re at the upper end of the income range the difference is more pronounced.

    2. The marginally higher rates Canadians pay on average are NOT because of the “massive burden” of their health care system. Canadian public sector spending on health care, as of 2005 (latest OECD data available) was 6.95% of national GDP. US? 6.85%. The difference is Canadians actually get something for that money so they then get to pay almost 3 TIMES less out of pocket on top of that than Americans have to before they’re adequately covered. And it rather obviously isn’t causing their tax rates to be any significant amount higher than Americans are. What difference that does exist between the tax rates of the two nations is primarily due to other social services available in Canada. Oh, and the fact that they were maintaining federal budget *surpluses* and paying down their national debt for the last 12 years straight before the global recession hit. Little things like that.

  2. Larry, you write: “In Canada, taxes are substantially higher to bear the massive burden of a national health-care system.” Is this true? My family is split with some living in the States and others in Canada. I never thought that living in Canada I was paying substantially higher taxes. (I worked for awhile in the States and didn’t notice a big difference. In fact, I thought my tax rate was lower in Canada.) According to The Toronto Star: “We’ve all heard that Americans pay less taxes than Canadians. But in fact, for more than half of Canadians, the grass is still greener here at home.

    In Canada, governments tax upper middle-income earners and the rich much more stiffly, and go easier on those with lower incomes. The poor, and those in the lower middle-income ranges, end up with more in their pockets in this country than they do in the States.

    For simplicity’s sake, the cutoff point comes at about the $60,000 level, slightly above the average Canadian family income.”

    Also, Grant has it right. Drop the poor off your waiting list, and the list gets quite a lot shorter. 45 million Americans are without coverage! You are comparing, as they say, apples and oranges.

    Americans are being asked to make some hard decisions. Their present system does not work. Check some of the figures – like infant mortality rates. They should be looking at what others do and doing us one better. They can improve on what we do if they only get their heads around the idea that what they have is not the best in the world. (Nor is the Canadian system the best in the world.)


    1. Hi Ken,
      In my experience, taxes in Canada are substantially higher, especially when one accounts for the massive tax writeoffs available in the U.S. for interest payments (mortgage interest, credit card interest, etc.). I don’t necessarily begrudge that — Canada has a far more robust social services network. But the health-care system Canadians support through their taxes at the provincial and federal levels is incredibly expensive. Just a few years ago, when I met regularly with Ontario cabinet ministers in editorial board meetings at the London Free Press, the Ministry of Health and Long-term Care comprised half of all government spending — equal to everything else, combined. Considering the massive trillion-dollar deficits the U.S. is running, however, they may soon be taxed at a rate closer to or above that of Canadians.

  3. What nobody seems to be able to figure out is that when Canadians pay taxes they pay their health care too. In the US the taxes are a bit lower, but then they pay $15,000 a year for health insurance. The end result is that after Americans pay taxes, health insurance, and copays, Canadians have far more disposable income after taxes (including health care).

    Regarding wait times, as a 60 year old, I’d say what wait times? I’ve had four surgeries in my life, and the so called “wait times” were 4 days, 7 days, 10 days, and 16 days, a couple were serious (not urgent) and a couple were not serious. Wait times are highly exaggerated based on my experience.

    While Canadians do not have a mortgage deduction for income tax, some portion of the $15,000 they have in their pocket, from not having to pay health insurance and copays as Americans do, is often used to pay down a mortgage, so that by the time many are 40, they own their home outright, something very few Americans could achieve by that age, or any age perhaps.

    In the US they just have Social Security. This year I’ll be receiving Canada Pension, then at 65 I’ll be receiving Old Age Security, the total of which is well above US Social Security.

    The US pays 17% of GDP to have health care for 64% of Americans. Canada uses 10.6% of GDP to cover ALL Canadians. In other words (both in US dollars), the US pays $6,714 per capita, and Canada pays $3,678. Which then is more expensive, US’s $6714 or Canada’s $3678?

  4. Oh yes, regarding Shona Holmes. She did NOT have a brain tumour. What she actually had was a non life threatening benign cyst. Her physician had made appointments for her in Hamilton based in that diagnosis, but she thought she knew more than her own physician and took off to the Mayo Clinic in Phoenix. She paid $97,000 for surgery for a non life threatening benign cyst in Phoenix that she could have had done in about the same time in Hamilton and would have cost her nothing. She eventually admitted that she would have had surgery in Hamilton in about 6 weeks instead of the 6 months she had said on that commercial.

  5. Hello just wanted to give you a quick heads up and
    let you know a few of the pictures aren’t loading properly. I’m
    not sure why but I think its a linking issue.

    I’ve tried it in two different web browsers and both show the same results.

    1. Thanks for your observation. The server was hacked a few months ago and I still haven’t been able to put all the pieces back together. I’ll look into it.

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