One day after school in Grade 4, we received a call from my big sister, attending college in Massachusetts, that she was very ill and had to see a doctor, as a Canadian citizen in the United States. With a child’s imagination and informed only by the horror stories we Canadians tell each other about American health care, I was sick with terror that my sister would die in some clammy Massachusetts hospital, with cold-faced and cross-armed American doctors in white coats sitting and watching as she crumpled onto the floor and gasped her final breaths, a victim of the American health care system. Of course, my sister was just fine.
And American health care is hardly the cruel, scary system I had been led to imagine.
All Americans over 65, and disabled Americans under 65, are provided health care under a federal government program called Medicare. Low-income Americans, especially those with children or disabilities, receive health care through a state and federal program called Medicaid. Uninsured American children, Americans considered “medically needy”, and American women who are pregnant or have female cancer, all have their health care covered by Medicaid. State and federal government employees, including military personnel, and their families receive taxpayer-funded health coverage. Even non-U.S. citizens over 65 who have lived in the country for at least five years receive partial Medicare coverage.
And regardless of coverage or even citizenship, American hospitals are required by stringent federal law to provide necessary medical attention to anyone who requests it, without consideration to payment. The law goes so far in erring on the side of ensuring treatment that it has become the subject of massive abuse by Mexicans who “heal and run”, crossing the border and appearing at American hospitals, receiving care and then disappearing back into Mexico. One small, 14-bed hospital in an Arizona bordertown lost $450,000 last year treating Mexicans who are using the Federal Emergency Medical Treatment Act as a free health care program.
These are not the programs and laws of a nation that does not care for the health of the needy and vulnerable.
Americans between 21 and 65, in good health, and able to provide for their own health care coverage are responsible for insuring themselves, and even those Americans are eligible for billions in tax deductions.
The American health care system does not remotely resemble the uncompassionate, “you get what you pay for” caricature of it drawn by so many Canadians. American health care is a blind spot in Canadian thinking. The reality is that health care in the United States has been largely socialized since the mid-1960s, as in Canada; The difference is that Canadian health care is universally socialized and uniformly governmental, where in the American system socialized coverage is for those who need it and health care is not a government monopoly.
Contrary to popular opinion on both sides of the border, the United States actually devotes more public spending to health care than Canada. U.S. federal, state, and local health care spending this year will total about $891.3 billion U.S., or $2,993 U.S. for every man, woman, and child in America (about $1 trillion Canadian, $3,500 Canadian per person), compared with Canada’s total public health care expenditure this year of $91.4 billion, or $2,832 per person. We could accuse the United States of inefficiency in its public health care spending, but we can hardly accuse it of stinginess with its health care tax dollars when it outspends even us.
The figure of “40 million uninsured Americans” is often cited as an indictment of American health care, but uninsured does not necessarily mean untreated. Under the Federal Emergency Medical Treatment Act, health care is provided to millions without coverage, public or private. A recent Kaiser Foundation study estimated that uninsured Americans received $40.7 billion U.S. in free health care in 2004, and that federal, state, and local governments assumed $34.6 billion – about 85 percent -- of that cost. As the Kaiser Foundation argues, American governments might consider tacking a few extra billion dollars onto that 34.6 and calling it a new taxpayer-funded program to cover the uninsured.
American health care is not what we think it is. We may prefer our system, but we cannot claim a monopoly on compassion in health care in North America.
Andrew W. Smith, Cape Sable Island, Nova Scotia and Tulsa, Oklahoma
Published in The Chronicle-Herald, Halifax, Nova Scotia
And American health care is hardly the cruel, scary system I had been led to imagine.
All Americans over 65, and disabled Americans under 65, are provided health care under a federal government program called Medicare. Low-income Americans, especially those with children or disabilities, receive health care through a state and federal program called Medicaid. Uninsured American children, Americans considered “medically needy”, and American women who are pregnant or have female cancer, all have their health care covered by Medicaid. State and federal government employees, including military personnel, and their families receive taxpayer-funded health coverage. Even non-U.S. citizens over 65 who have lived in the country for at least five years receive partial Medicare coverage.
And regardless of coverage or even citizenship, American hospitals are required by stringent federal law to provide necessary medical attention to anyone who requests it, without consideration to payment. The law goes so far in erring on the side of ensuring treatment that it has become the subject of massive abuse by Mexicans who “heal and run”, crossing the border and appearing at American hospitals, receiving care and then disappearing back into Mexico. One small, 14-bed hospital in an Arizona bordertown lost $450,000 last year treating Mexicans who are using the Federal Emergency Medical Treatment Act as a free health care program.
These are not the programs and laws of a nation that does not care for the health of the needy and vulnerable.
Americans between 21 and 65, in good health, and able to provide for their own health care coverage are responsible for insuring themselves, and even those Americans are eligible for billions in tax deductions.
The American health care system does not remotely resemble the uncompassionate, “you get what you pay for” caricature of it drawn by so many Canadians. American health care is a blind spot in Canadian thinking. The reality is that health care in the United States has been largely socialized since the mid-1960s, as in Canada; The difference is that Canadian health care is universally socialized and uniformly governmental, where in the American system socialized coverage is for those who need it and health care is not a government monopoly.
Contrary to popular opinion on both sides of the border, the United States actually devotes more public spending to health care than Canada. U.S. federal, state, and local health care spending this year will total about $891.3 billion U.S., or $2,993 U.S. for every man, woman, and child in America (about $1 trillion Canadian, $3,500 Canadian per person), compared with Canada’s total public health care expenditure this year of $91.4 billion, or $2,832 per person. We could accuse the United States of inefficiency in its public health care spending, but we can hardly accuse it of stinginess with its health care tax dollars when it outspends even us.
The figure of “40 million uninsured Americans” is often cited as an indictment of American health care, but uninsured does not necessarily mean untreated. Under the Federal Emergency Medical Treatment Act, health care is provided to millions without coverage, public or private. A recent Kaiser Foundation study estimated that uninsured Americans received $40.7 billion U.S. in free health care in 2004, and that federal, state, and local governments assumed $34.6 billion – about 85 percent -- of that cost. As the Kaiser Foundation argues, American governments might consider tacking a few extra billion dollars onto that 34.6 and calling it a new taxpayer-funded program to cover the uninsured.
American health care is not what we think it is. We may prefer our system, but we cannot claim a monopoly on compassion in health care in North America.
Andrew W. Smith, Cape Sable Island, Nova Scotia and Tulsa, Oklahoma
Published in The Chronicle-Herald, Halifax, Nova Scotia
