Last night we went to see ‘Sicko’ [http://www.michaelmoore.com/], the latest offering from famed documentary filmmaker Michael Moore. This is the first time, certainly in our family’s memory, that we have ever paid good money to go and see a documentary for heavens sake in a mainstream theatre – which is witness to the growing fame of Moore, who previously won awards for ‘Bowling for Columbine’ which, like ‘Sicko’, is an indictment of the sickness [no pun intended] within modern American Society today. As a British Canadian I was appalled by the abuses wrought on the poor and the sick by the monopoly of the ‘always for profit’ run HMO’s [Health Maintenance Organizations] and the careless disregard they evidently have for the welfare of patients and their families who seek any kind of medical intervention. Many of them have paid hefty premiums all their working lives in order to make sure that in the event of catastrophic illness they and their dependents will be covered for the exceptional expenses lumped upon them by privately run medical facilities in the States. Like you no doubt I knew that sick people in America were in deep trouble if they had no health insurance – but it never occurred to me before I saw the film that those who could actually afford to pay their premiums would also be sailing in the same boat.

It appears that HMO’s deny claims at the drop of a hat – deeming the most routine treatment plan or procedure to be ‘experimental’ i.e. a hysterectomy for cervical cancer, or a bone-marrow transplant for a leukemia sufferer, leaving the patient without other resources, literally, to die. Physicians and hospital administrators admit that they turn patients away if the HMO denies the claim, leaving them to find a ‘mission’ hospital or to sell everything they own to raise the cold hard cash baby – that’s the choice. And with increasing frequency the choice is to die because there is simply not enough money in the house or the car or the furniture to cover the escalating cost of medical treatment. The price of prescription drugs is excessive and can represent a crippling burden to a chronic sufferer – particularly if that sufferer is elderly and living on a pension perhaps or else is someone working three menial jobs to keep their family afloat. No wonder they often try to sneak over the Canadian or Mexican border to save a few bucks at the pharmacy or to secure treatment if they can.

A few years ago I had a series of crucial operations, without which I would probably be dead myself by now. The Canadian government sponsored Ontario Health Insurance Plan covered all of my expenses, including a lengthy [by today’s standards] hospital stay and the services of several first-rank specialists, nurses, anesthetists and surgeons. This series of treatments would have cost me well over half a million dollars had I been a United States resident at the time. And of course if I wasn’t a resident I would have had to pay for it out of my own pocket – and if I didn’t have pockets that deep well then it would have been ‘bye bye seeya’ and have a nice day – or whatever portion of the day you’ve got left that is.

The health care system here in Canada, fortunately, is not run for profit, but of course is not without its faults. There are frequently long delays and wait-lists for certain treatments, orthopedic surgery for example, and now and then we read of cancer patients being transported to treatment centres that are lengthy distances away from their homes and family. Some treatments are inexplicably deemed to be ‘cosmetic’, i.e. breast reconstruction after a mastectomy but it is at least open to argument and appeal – or if that fails you can always start shouting to the newspaper. I take it that in the case of the HMO’s ‘NO’ means ‘NO’, and that’s that – end of discussion.

There is a critical shortage of medical personnel in Ontario after the depredations of a certain politician named Mike Harris pared the health-care budget down to zip. We need more nurses and we need more doctors, particularly general practitioners, because many of us have been ‘off-list’ when it comes to having our very own family doc for many years. We make do with teaching centers that rotate their newly qualified doctors every four months, which means that you seldom encounter the same doc twice. This seriously impedes any semblance of continuity of care and any kind of personalized treatment plan. The doctor you see is the one that happens to be on call that day and to him/her you are not really much more than a number, just another patient in the crowd. S/he doesn’t know your name, s/he doesn’t know the name of your cat or the fact that you are allergic to cotton balls and she would pass by you blindly in a crowd... BUT we have some of the finest hospitals in the world – we are in the first rank when it comes to cardiac care, reconstructive surgery, pediatrics, cancer care etc. People come from all around the world to be treated at the very best facilities that you will find anywhere. And with few exceptions we don’t present you with a bill. We don’t ask to see your insurance card before we load you into the ambulance and we don’t let you die alone on the sidewalk on Yonge Street if you don’t have one. The only bill you are likely to receive from a Canadian hospital is the bill for your TV rental and your phone, and that’s about that. Well, you might have to stump up [pun intended] something towards the cost of your crutches and your cast now and again but nothing for that MRI or that X-ray or those blood tests or that 10 hour op.

When I lived in England the National Health System was amongst the best medical insurance plan in the world covering just about any treatment or procedure you could mention with the possible exception of that face lift you were forced to travel to Poland for. But apart from that as far as I remember everything else was covered – eye-glasses and dental treatments too [something which we have to pay for unless we contribute to an extended health care plan usually available through employment]. I don’t know about now because I’ve been away for 40 years and things may very well have changed. I do remember sitting on a hard bench in a crowded casualty room for hours on end waiting for my number to be called but that’s probably the same the world over. Moore’s documentary suggests that the French health care system is actually even better than the NHS [didn’t know that did you], and in fact is probably the best in the world. And compared to the United States even a poverty-stricken country like Cuba easily outstrips the States in quality of care and accessibility for all to modern facilities and treatment centers. No one is turned away and no-one dies in the street for lack of medical attention in Cuba anymore than they do in any of the ‘civilized’ countries in the West - except for the States. And if France ranks number 1, the US ranks somewhere around 38th in the world, just above Slovenia in standard and accessibility of care. This is pretty frightening. I think it’s going to be the last time I travel to Florida for that annual holiday to Disney or the winter trip to Vegas without seventeen insurance policies and a return flight ticket clutched in my shaking hands - don’t know about you...