Friday, 7 September 2012

OBAMA vs. ROMNEY: a U.S./Canadian doctor’s perspective

It’s the morning after the Democratic National Convention and my head is reeling at the extreme importance of the upcoming U.S. election. I believe I am uniquely qualified to comment on this issue:

·         I have both an MD (with two specialties in chronic illness) and a PhD in medical research (specializing in population studies, statistics and health economics)
·         I trained in medicine in both the U.S. and Canada
·         I have worked as a doctor in both the U.S. and Canada
·         I have lived roughly half my life in each country, including at least a decade in each country as an adult
·         My specialty has been patients with chronic pain, especially fibromyalgia, for which I am considered a world expert in research
·         I also have worked with migrant Mexican farm workers in California
·         I worked as a physician in California during the 1980s AIDS epidemic
·         I have followed U.S. politics since I was 18
·         I actually care about people

And so it is that I watched the Republican and Democratic national conventions every evening they were on TV, with great interest. And again, my head is now reeling.

On one hand, you have Obama and Biden, who are actively moving the U.S. system towards universal health care in a way that will, in some ways, mimic what Canada has had since Saskatchewan Premier Tommy Douglas first introduced ‘universal health care’ in 1946.  On the other hand, you have Romney and Ryan wanting to return to the minimal coverage system the U.S. had had for decades, until Obama was elected and moved to change it.

Over the next series of blogs, I want to comment upon the differences in the visions of these two men. But let me start by comparing the current Canadian and old American system.  I’ve often said that the Canadian health care system is equally bad for everybody.  I say this because waiting lists can be and often are very long... sometimes months even for cancer surgery, or up to 18 months for back surgery.  There is an almost universal shortage of physicians. In London Ontario, where I now live, a recent estimate was that roughly 10% of its 350,000 residents had no family doctor.  They must rely on various urgent care clinics and emergency rooms, which will provide some but not all services (for example, you usually need a family doctor to fill out a disability form for you). So again, the system often is not nearly as good as it should be... but it is equally bad for everyone.

With the old U.S. system, you can almost have some hot-shot surgeon cut off your nose, turn it upside down and sew it back on... and you can have all this done yesterday and eat steak for dinner that night... but here’s the rub... IF you have the right insurance. But it you don’t... as my father would say... tough beans!  While I was in California working at a northern California clinic that provided health care to migrant Mexican farm workers, back in the 1980s, I heard of a young, pregnant Hispanic woman who bled to death in a taxi, traveling between emergency rooms because she didn’t have the necessary insurance for the first hospital to treat her. Her unborn baby died too. I also remember that time, I believe back in the early nineties, when thousands of pregnant Floridians (women, obviously) flocked into Georgia to get their pre-natal health care, because Florida doctors refused to see them. The old American system, then, can be great for some, but virtually non-existent for others.

From what I’ve read about Obama’s plan, he is not proposing the Canadian system. What he is proposing is access to health care for everyone, irrespective of who they are and whatever insurance they have. Many, many Canadians carry private insurance too, to cover things (like medications) that the universal health care system does not cover.

I won’t be shy about it... I am staunchly in favour of Obama’s versus Romney’s plan.  Is Obama’s plan the best plan ever? I don’t know and hence won’t comment. But it is vastly better than the minimalist system Romney and Ryan want. 

I will start from an economic standpoint, because so many critics will rebuke me by saying that the U.S. can’t afford universal health care.  The truth is that universal health care will almost certainly cost the system less. In Canada, for example, the cost of most laboratory or imaging tests is anywhere from 5 to 10 times less than the cost of an identical test in the U.S.  Those Canadian snowbirds (that’s what usually elderly Canadians who flock to the southern U.S. in winter are called) who are unfortunate enough to become ill or injured while south of the border find out if they don’t have good traveller’s insurance.  I once had a patient who went into an emergency room in Florida to have a routine blood test done, to monitor his diabetes, only to receive a bill for thousands of dollars afterwards. He was charged not only for the test itself, but a consultation fee to pay the doctor who interpreted the test, and the doctor who briefly saw him in the emergency room to order the test. In Canada, that test would have cost him zero. And what would the cost to an American travelling in Canada be under the same scenario... likely less than $50.  The fact is that U.S. hospitals often charge exorbitant fees for tests, knowing that insurance companies only will agree to pay a fraction of it. Someone who doesn’t have insurance doesn’t have that leverage, so they are charged the full amount. That’s why medical care in the U.S. can be so damn high.
Providing structured universal health care for everyone will give everyone that leverage, keeping costs lower.

But won’t the government be paying those costs? Sure. But remember that they will be able to negotiate much lower rates. Besides, here’s what they won’t have to pay... they won’t have to pay for all those sick and disability days people who are untreated or inadequately treated will have to suffer through.  And people who don’t lose everything paying unreasonable medical bills will be able to pay their taxes, instead of declaring bankruptcy.  AND they’ll be more likely to spend money at stores and local businesses to stimulate the local economy. And I could go on.

But I want to get back to why I really prefer Obama’s plan.  It goes back to the reason I went into medicine in the first place... it’s because I care.  The word ‘care’ is, after all, within the term ‘health care’.

What I care about is fairness for all people, irrespective of who they are. Again, the Canadian system is flawed but, at least in theory, it is no more flawed for the single mother of two than it is for the Prime Minister himself. Pregnant women should never die in taxis in Canada because they don’t have health insurance.  Compassion and care for the sick is not compassion and care for the wealthy sick or the insured sick. It’s compassion and care for everyone.

In the next blog, let me talk about why this is particularly critical for those with fibromyalgia.

Kevin White, MD, PhD
Award-winning author, researcher & speaker
Visit my website to vote on which president YOU think would be better for the person with fibromyalgia or chronic pain – Obama or Romney


  1. Hi Dr. White, There is now a law that prevents a patient from being transferred to another hospital for any reason unless that patient is stable. That law is called EMTALA. The Obama plan that has passed will systematically destroy the U.S. healthcare system. As you have stated, in Canada people have no access to healthcare. That's why they come to the U.S. for their healthcare if they can afford it. Obama's plan will result in a shortage of doctors and research for cures of many illnesses will come to a screeching halt, including FMS. There will be no access to physicians for FMS, because there will be care rationing. The Obama plan will discourage excellence, because there will be no competition. It would be a good idea to rethink the economics and dominoe effect Obama's plan will cause. Sincerely, Valda Garner, RN, BSN, MAOM

    1. Hi Valda: Just to clarify. I never said that Canadians have NO access to healthcare, just that it is often (not always, but often) delayed relative to those in the U.S who have good insurance. It is clearly superior to those in the U.S. who have no or little insurance. So it falls in the middle. I also note that this pregnant woman and her baby I spoke of died in 1988 or 1989, AFTER EMTALA was passed.