A Night in a Canadian Emergency Room

by James Channing Shaw, MD*

Key words: Single-payer, Canadian Healthcare, Medicare-for-All, U.S. Healthcare, Medicare, 2020

After practicing medicine in the United States for over twenty years, I moved to Toronto for professional reasons. One summer evening two years after our arrival in Canada, I developed chest pain, and being an experienced doctor, I ignored my own symptoms, thinking that certainly I was too young to be having heart disease. By 1:00 a.m. the pain had worsened and was travelling down my left arm so I figured it would be unwise to delay any longer.

At 2:00 a.m. my wife and I arrived at a modern emergency department in the center of Lindsay, Ontario, a quiet cottage-country town of 17,000. I handed my green Ontario health card to the triage nurse and mentioned the buzz-words ‘chest pain’. The nurse whisked me off to the examination room and connected me to an electrocardiogram. Within minutes, the doctor came in: “The ECG looks okay but you’re going to be here a while.”

Sparing the details, the visit included X-Rays, IVs, oxygen, blood tests, a CT scan, pain medications, observation, and follow-up blood tests. After ten hours, the doctor felt confident that my pain was not cardiac in origin and recommended follow-up with my family doctor.

We gathered up our belongings and started for the door, fully expecting some sort of check-out process, co-payment, a signature at least. Instead, the nurses looked over their shoulders at us with a wave of hands good-bye. Once in the car, we shook our heads in amazement over how simple, thorough and efficient the visit had been.

Why the amazement? I knew how free-market medicine, Medicare, HMOs, and the VA had functioned in the United States. I’d practiced most of my career in the states. It was a pleasant surprise, however, to realize that I preferred practicing medicine in Canada’s single-payer system. I welcomed the simplifications in patient care, social services, and administration. In essence, I identified the important distinction: Healthcare in Canada is primarily a moral enterprise, not a business venture from which to profit.

So, as a patient, what was so great about my Canadian ER visit?

First and foremost was my eligibility for coverage. My health card had given me complete access to all hospital care, doctor visits, in-hospital drugs, and diagnostic tests. There is no such thing as pre-existing disease as a determinant of care in Canada.

Second, in Canada, the insurer-patient relationship is one of service and not the least adversarial. Doctors and nurses don’t require authorization for treatments and tests. It is assumed that physicians’ orders are in the best interest of patients. In the U.S., it is common for doctors’ orders to be rejected by third party insurance on the basis of cost alone.

Third, I received no bill. Hospitals do not charge patients, and doctors in Ontario bill the insurer (Ontario Health Insurance Program) directly. They get paid promptly with a fraction of the red tape that occurs in the U.S., where payments to hospitals and physicians are routinely an administrative nightmare of hundreds of individual third-party payers, each with different rules and long delays.

Last, my visit cost me nothing out-of-pocket. OHIP insurance is funded through combined federal and provincial tax revenues. My employer, the University of Toronto, paid nothing. I paid nothing.

Many American families and businesses struggle with the huge financial burden of free-market medicine. Canadians occasionally complain about paying higher income and sales taxes than Americans do, but the majority find it liberating to know that they will be covered if they get sick, and proud that healthcare insurance provides for all while spending less, per capita, than the U.S.

Like all countries, Canada’s challenge is the ever-rising cost of an aging population with chronic diseases. But let it stand that through my eyes as physician and patient, I have witnessed the societal benefits of having a publicly funded health insurance system. All Americans would be wise to loosen their grasp on free-market medicine and consider how the moral enterprise of single-payer health insurance might actually be a good thing for the whole country.

* Author Bio: Dr. Shaw trained in dermatology at Oregon Health Science University. After a few years in community practice, he moved into academics and held leadership positions at the University of Chicago and the University of Toronto. He published a career memoir ROOM FOR EXAMINATION: MORE THAN SKIN DEEP, in 2012.

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2 comments on “A Night in a Canadian Emergency Room

  1. humanemedicine on said:

    Dr. Shaw’s response: “Ms. Lukofsky’s comments are welcome. The use of the term ‘socialized medicine’ unfortunately does not advance the dialogue and shuts off meaningful discourse. It’s a conversation-stopper. I agree that some of the delays in diagnostics and referrals to specialists can be frustrating for some patients but it is rare for serious disease to be overlooked in clinically significant ways in Canada. The vast majority of patients receive appropriate and timely treatment. (The under-insured in the U.S. do not receive appropriate and timely treatment).

    Also, the benefit of never having to file for medical bankruptcy and having all serious hospitalizations and inpatient care completely covered truly ‘lifts all boats’ and raises the quality of life of all Canadians.

    Americans may think that instant MRIs and like are desirable, but there is a growing understanding that over-diagnosis and over-treatment have major downsides and can contribute significantly to complications. More is not always better on the testing and treatment side.

    In terms of how to pay, in summary, the taxes that would go toward universal healthcare would be a much smaller outlay that what families and individuals currently pay the insurance companies in premiums and are then restricted in what doctors they can see, the deductible, and much more.

  2. humanemedicine on said:

    From Marla Lukofsky (Toronto, CA):
    “Dr. Shaw’s ER experience is an accurate one in that, there are no bills for ER services, after being treated whether with a plethora of tests or medication administered in house. Having lived in the USA for over a decade and many more in Canada, I too can compare both. As far as being treated in ER or seeing a GP visit or a specialist, there are no bills. This is a wonderful thing, hands down. No doubt about it. There are some drawbacks to socialized medicine, however. One has to be approved by one’s GP and a request sent, before one can see a specialist and even when one gets that paperwork approved, it could take months and months to see someone who could help you, treat you, or even cure you. Sometimes things are red flagged to speed things up but again, that’s if you are lucky enough to have a GP on your side and one that has the insight to do that. Also, some tests are not standard care in Canada as they are in the USA and when things cost money, things are held back even if it’s the best thing for you. I found the US medical care at least in Los Angeles, superior to what I have received in Canada in certain respects. Money plays a large part in healthcare decisions. Therefore, the money thing is a double edged sword. It’s nice not to pay for an MRI, but you might wait 3-6 months for it and it could have found a cancer at a much earlier stage. And, it’s hard to pay for an MRI in the US but if you can, you can get it promptly and see the expensive specialist if you can afford to. The pros and cons of medical care is a slippery slope. We all deserve to have access to healthcare no matter what the cost. Higher taxes pay for socialized medicine in some countries. Insurance companies pay for it in other countries. My preference is to have good healthcare first and foremost. The question is, who shall pay for it?”

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