Off Mic

What I'm about to tell you, I've told very few people. It's about my mother and the Canadian health care system. She died last summer. It was an excruciating four days in the hospital.

But before I give you the details, let me first tell you about my assignment for this month's episode of Envision San Diego , "Right to Health". We compare American privatized health care with Canadian universal coverage.

I'm a Canadian. I grew up with free health care. Yeah, I know Canadians pay more in taxes.  It's a country that casts a wide social net and for that, they pay. In our show we address wait time, cost and quality of care. And we ask the question: "Is health care a right?"

While working on the show, I met an American woman who tried to refinance her house to pay for an MRI. Her name is Leigh Ann Brady. She has back pain and has been unable to work as a waitress for a year. She has no health insurance. I also spoke with Chris Van Gorder, the president and CEO of Scripps Health. When I told Van Gorder I had interviewed a woman who couldn't afford an MRI, he immediately offered to help.

The journalist's dilemma: am I somehow becoming an advocate and changing the story by helping to arrange a free MRI for Brady? I know that question should give me pause, but honestly, it didn't. Not for long anyway. A woman in pain needs a test and here's the head of five hospitals willing to help. Of course I called Brady. And she got her free MRI from Scripps, thanks to Van Gorder.

I told my sister in Canada this story. She immediately pointed out the irony. "You can help a woman you don't even know get an MRI, but you couldn't do anything to get your own mother a CAT scan," she said.

Back to those four excruciating days in hospital. The first day in the emergency room, my mother needed a CAT scan. But the hospital doesn't do CAT scans past 4:00 p.m. They sent her home and told her someone would call; she'd have to wait for the test. It was the beginning of a cascade of events that eventually lead to her death. The appointment for the scan wasn't made until after she died.

I know firsthand how waiting for health care can be devastating in a system that is forced to ration limited services. And I also understand how accustomed Canadians have become to a health care system that demands people wait weeks or even months for routine tests, procedures, even simple visits to a doctor. But as a Canadian living in America, I can't say that excluding 46 million people (that's how many have no health insurance in the U.S.)  from getting any care at all by virtue of financial or employment circumstance is a more equitable system. There are Canadians who wish they could pay for health care and get it sooner. And I know there are Americans, some of them you meet in our show, who believe the Canadian way, albeit a system that makes you wait, is more humane. But to quote another Canadian living in San Diego who is profiled in our show, Geoff Leibl: "There's no point in having free health care if you're going to die waiting for it."

Perhaps Canadians are just too patient and too polite to demand more from their government and Americans too worried about taxes and government intervention to ask for anything at all. In my opinion, neither is acceptable.

Envision San Diego's Right to Health aired Wednesday February 25 at 7:00 p.m., on KPBS Television.

stephen from san diego
February 24, 2009 at 06:01 PM
The guest mentioned the US spends 17% of it's gdp on healthcare cost, compared to 10% in Canada. The difference being the administration cost. If the savings expected in the overhaul of the system will cut admin cost, has anyone considered the amount of heathcare administration workers who will be laid off if the revamp is successful? I think we will have to bail them out if the industry shrinks that much.

Ben Grage from San Diego
February 25, 2009 at 05:36 AM
It is amazing to me how a ceo from Scripps will bend over backward for a person who is referred by a reporter, since that ceo knows full well that he will get credit for doing what is right. Single-payer healthcare is the only reasonable answer to the problem of healthcare in this country. That would eliminate so much of the administrative bureacracy in the current healthcare system. We need to emulate the Canadian system or the European system. In Canada, they have universal coverage, their infant mortality rate is lower than ours, they live on average approximately three years longer than Americans, and they do all of this at approximately half the cost we do. Bring on the Canadian model!!!!

Dan from La Mesa
February 25, 2009 at 08:46 AM
I have been a Registered Nurse for 25 years, the past 10 of which I have worked for Sharp HealthCare. Sharp treats its employees very well and provides us with very good health care benefits. Sharp also provides constently high-quality health care to thousands of people in our community, many of whom have no health insurance. The 46 million Americans without health insurance often are forced to forgo conventional preventive health care services and medicines that can help them maintain their health and optiamlly manage their chronic illnesses. Consequently, the vast majority of uninsured Americans do not seek healthcare services until they are very ill and/or desperate. At that point, they go to the nearest emergency room for primary care services which they could receive in community clinics if they only had either the funds or the insurance to pay for comminity-based preventive care. As the only industrailized nation without universal health-care coverage for its entire population, the U.S, has the most expensive healthcare system in the wor;d (spending 17% of our GDP on healthcare). Meanwhile, our nation's infant mortality rates, average life-span and overall health status are all far worse than those of many indutrialized and some less developed nations. I applaud President Obama's recent initiative to begin to reduce rapidly-escalating American health-care costs and Congress' recent extension of health coverage for the children of the unisured working poor. In order to bring about universal health-care coverage for all Americans, we the people need to stand up and make our needs known and our voices heard. If millions of average citizens take the intitiative to support universal healthcare coverage for all, Congress and the President will eventually follow suit.

doctor from San Diego
February 26, 2009 at 03:46 AM
Health care and Costs are the BIGGEST SCAMS in America ! "Van Gorder tells the story of a 63 year old man who walked into a Scripps emergency room almost three years ago. His diabetes was so out of control he needed his leg amputated. He spent a year recovering in ICU. He had no insurance. Chris: Cost us over a million dollars to take care of this gentleman. That’s at cost. A million dollars." At over $2,700.00 per day this has to be the Biggest COST SCAM Scripps Hospital charges. In Canada this same operation and stay is FREE to any Canadian citizen and the cost to the government is 1/10 of this charge that scrips hospital charges. I guess if the doctor lives in La Jolla he needs to charge a COOL Million. It's just a another example of OVER CHARGING and then making claims of how MUCH they helped and how MUCH the loss was.. PLEASE FIRE THIS GUY Van Gorder for over charging patients! SCRIPPS HOSPITAL IS the Biggest CRIMINAL in the NEWS TODAY!

Antonio Vaz Antunes from San Diego
February 27, 2009 at 04:07 PM
I am a Portuguese citizen living for 5 years now in the States, and my comment is that we should be looking around the world without prejudice or misconceptions for the best health care. Canada i'm sure is a fine country, but in terms of health care ranks 30th world wide, Number one and two are France and Italy, and yes.... Litle backwater, edge of Europe Portugal ranks 12th, much higher than USA, or Canada. Our system is way more eficcient, and its based in small preventeion health centers, that filter most of the disieses, large central hospitals, and yes private hospitals that operate with insurance or cash. In my country the system is universal and tends to be free. You pay some fee acording to your income, nothing astronomical i might ad, and if u want or can u can have private insurance. Since insurance companies have to compete with universal care the same companies that operate here in the states charge a fraction of what they charge here. In Portugal i had cancer, from the first visit to the doctor, to the operation table, it took me 2 weeks. Here i lived two years without insurance..... By now if i had the same condition.... U know what would have hapened.

Greg Duch from San Ysidro
March 12, 2009 at 02:40 AM
During the past 12 months, I've spent 8 days in hospital. Before and after my internment, I was forced by "the system" to rely on emergency room "care" on at least four other occasions. I am fully covered by insurance, barely a dime in terms of out-of-pocket expenses did I pay. Yet, I would have gladly paid to have been spared the repeated nightmares of local health care. I am forced to relate that I am very grateful to the Creator, that I was conscious and able to speak on my own behalf, and monitor what/how things were being done to me. I have an abiding belief that were I unable to have spoken/advocated/monitored my "health providers" on my own behalf, I would have been carried out of the back door of the hospital, in an inanimate state, due to fatal flaws in the healthcare dys-tem. Still alive. Greg

Gerry Hunt from San Jose, CA
March 13, 2009 at 10:12 PM
As I read Kelley Weiss’ Lawmaker Discuss State Run Health Care Program (Mar 12th) I wonder whether she is reporting on an event or lobbying for an ideological view of the event. She quotes a Republican policy advisor’s spin, but she doesn’t give any weight to any possible counter view that might involve facts. It would not leave Californian’s billions of dollars in debt because healthcare costs would be paid from a separate Healthcare Fund, not the General Fund. Two series of computer modeling studies have proven the economic viability of this plan. The healthcare premium costs now paid for all state, city and county Legislators, Administrators, and employees would be replaced by healthcare taxes that would average 65% of those premium costs. That’s a savings of 35% of existing state, city and county costs. And those healthcare benefits would be more comprehensive, including dental, vision, and prescriptions in addition to doctor and hospital services without copays and deductibles for at least the first two years. All California residents would receive equivalent healthcare benefits funded by health taxes on earning rather then free market premiums that are unaffordable to 22% of our residents and leave another 20% underinsured .

Greg Duch from San Ysidro
March 14, 2009 at 12:07 AM
The health care system is not functional; AND nowhere is this more obvious than in hospital emergency rooms. There is no SYSTEM to emergency health care. It is an avalanche of chaotic events, out of control. When you enter a E.R., try to figure out WHO is in charge. You can't. No person is in charge, nobody is managing the operation, PROCEDURES, and efficiency of the E.R. Try to ask anyone on the E.R. staff a question. You will get nothing that approaches a meaningful or accurate reply. You, as a patient or family member, are completely helpless, and caught in a maze of uncertainty, that seems to have NO EXIT. WHAT IS MOST SCARY: the same REALITY Is sadly true of the members OF THE HOSPITAL STAFF!!! THE BLIND STAFF HOPE TO BE LEAD BY OTHER BLIND STAFF.

Greg Duch
March 15, 2009 at 11:02 PM
I am always impressed by the ingenious ways in which ER staff find to avoid communicating effectively with other staff members, especially those persons at a different level in the pecking order of the hospital. BTW-Patients have no place on anyone's pecking order in the hospital. The most chaotic, potentially the most perilous periods during the day in hospitals are the hours which overlap the ending of one shift and the beginning of the next shift. These hours of the day are not recommended for going into cardiac arrest. FIRST THINGS COME FIRST--- PAPERWORK and post-work personal plans are the top priorities of doctors, nurses, cleaning personnel, security guards, et al during "shift-change time" at hospitals. Patient-related activity goes into a hibernation mode at shift change. So, if you need anything ( water, food, medication, IV fluid, CPR ) don't wait till shift change to ask for it Greg

Greg Duch from San Ysidro
March 22, 2009 at 09:33 PM
HOW TO SURVIVE A STAY IN HOSPITAL: When you are very ill, hospitals can pose significant challenges to your chances for recovery. Despite all of the P.R. in those happy TV and radio commercials, the patient vs. institutional hospital relationship is an adversarial one at its heart. The core issue revolves around money; and whether you, as a patient, are a net loss or a net profit for the hospital. To maximize your chances of receiving appropriate care, right now, decide who will serve as your "GUARDIAN ANGEL" when you are too sick, while hospitalized, to advocate on your own behalf. Obviously, you need someone to act as your proxy; someone who knows you, knows your personality, your finances, and your deepest concerns. In addition, that guardian angel should be reasonably familiar with any chronic condition you are dealing with; and familiar with the culture of health facilities, especially the one you are confined to. Above all, that person must not be timid regarding asking all questions which (s)he feels are relevant to your health care; questions which you yourself would want answers to. A hospital, its administration, its social work offices, its finance offices--not to mention the bevy of doctors, nurses, nurses aides, dieticians all present a FORMIDABLE front to the lonesome patient who is reliant upon all of them to survive. NONETHELESS, you cannot afford to be INTIMIDATED by ANY STAFF MEMBER. YOU HAVE EVERY RIGHT TO ASK AS MANY QUESTIONS AS YOU WISH,-----AND TO RECEIVE ANSWERS, from whomever can supply them. If not, the personnel involved is being negligent at a very basic level. It is your OWN LIFE, afterall. Speak up, or have someone else be able to speak up on your behalf,-----the life you save may be your own. Knowledge is power. Don't be caught powerless. NEXT TIME--HELPFUL HINTS TO INCREASE YOUR CHANCES OF SURVIVAL-- SUCH AS: ask, ( at worst, all they can do is refuse )- ask if you can possibly be placed in a room near the nurses station before you are wheeled to a floor. Why? --the closer you are to the staff the more attention you'll get, and quicker response times to your valid needs and wants. Out of sight, out of mind is a truism which pertains to hospital care especially. More hints to come, I hope. Stay well. Greg D.

Greg Duch from San Ysidro
March 24, 2009 at 12:41 AM
THE BENEFITS OF APPLIED TECHNOLOGY AND THE INFORMATION REVOLUTION IN HEALTH CARE---- Unless you have never been seen by any physician; nor ever been to any hospital, including the ER; unless you have never had a prescription filled at a licensed pharmacy, unless you've always paid cash to all of your doctors and hospitals, chances are very good that your "health provider" knows more about your medical history than you do. In the same "vein"--- Your friendly local pharmacy cashier has access to the record of every drug you've ever purchased there ( and elsewhere), AS WELL AS: how often you've taken the drug, what strength, for how long. ARE YOU A DOC-HOPPER? THE CASHIER AND PHARMACIST KNOW ALL OF the doctors you've been to, etc. Do you get your prescriptions at a combo supermarket/pharmacy; and do you use a "SHOPPERS' CLUB" CARD; LIKE A "RONS CARD" to purchase items other than prescriptions----great! Have you been convicted of a DUI? RON'S WILL HAVE A COMPLETE RECORD OF ALL OF THE ALCOHOLIC BEVERAGES that you've purchased with your RON'S CARD, all of the decongestants, with or without pseudoephedrine; all of the pain relievers, all of the over-the-counter contraceptive devices, all of the soft-porn mags, all of the whatever else you've purchased there with your RONS CARD, in addition to your prescriptions which are recorded for eternity, with or without a RONS CARD. All of this data is easily shared with any official agency which can offer a minimally legitimate excuse to access your history. The nice thing is that you can probably get a printout of ALL OF YOUR PURCHASES for your own keeping, dating from as far back as you've used your shoppers' card. Everyone else knows what you've purchased, why not have a record for your own use? NEXT TIME: GIVE US BACK OUR BED OR GIVE US YOUR LIFE! STAY WELL AND OUT OF THE HOSPITAL!!! Greg Duch

Greg Duch
April 02, 2009 at 10:46 PM
WANTED DEAD OR ALIVE: Once again, I had a direct interface with the local health care system in the ER of a local hospital, SHRAPPS MEM. This most recent trip should NOT have been necessary--as is the case with so many ER visits by myself in the past ;--and by so many other ER patients, crammed into ER waiting rooms. Yet the health care system still is designed, and operates to make certain that future visits to ERs and in-hospital stays will be unavoidable. From the moment you hobble into, or are wheeled into any ER, UNNESSARY UNCERTAINTY is the chief certainty you will experience. I was hospitalized for eight days last August at a different local hospial. I developed a case of sepsis--that is a bacterial infection of the blood's circulatory system. Blood carries nutrients, such as oxygen to all of the body's vital organs, such as the heart, brain, liver, etc. When the blood carries bacterial infection, those same vital organs tend to shut down rather quickly. When the heart goes into "cardiac arrest"- that's just another way of saying that the heart has quit its job permanently. Anyway, after many exposures to health care as provided by a variety of local facilities, it is clear to me that the dystem of healthcare guarantees negative outcomes all too often. There literally is a system for determining how long a patient should be treated in an ER, before being sent on one's way. There is also a sophisticated "guide book" to dictate how long any particular illness, disease, trauma should be treated in hospital. The guide book to one's length of stay is fairly boiler plate in nature. The following are used to illustrate a point and are NOT indicative of official "GUIDELINES" for the cornucopia of medical problems. Urinary tract infections--3 days. Mild stroke- 5 days. Bypass operation-- XX days. If you go beyond your alloted, apportioned, expected stay in-hospital, because;say you have a sudden, unexplained hypertensive crisis; well you are JUST NOT BEING A COOPERATIVE PATIENT! Once you've exceeded the customary allotment of in-hospital days, the social worker will knock on your bed on a fairly frequent basis to ensure that you are doing all things necessary to make ready to surrender your bed to the next victim. If you likely still feel quite ill, no matter. Your time is up. If there is another potentially dangerous complication lying just below the surface., well you can always return to the hospital, if you need to, that is, if you survive. So whether you are being treated in the ER; or have been admitted into the hospital for treatment of a longer duration; the clock starts ticking immediately on your time remaining in the ER, OR as an inpatient. BTW, in my experience, discharge planning exists only in glossy hospital PR booklets. The hospital social worker is there to get rid of you, dead or alive. For example, this past Sunday, I asked for a medical referral. In their unrelenting HASTE TO DUMP ME, I was given an incorrectly spelled name of a presumably still-practicing doctor. However, the doctor's phone number, acc'd to the "discharge" sheet was 234-876; ---I suppose area code (619). Now most phone numbers in San Diego have seven numerals, in addition to the area code. My referral phone number had just six!!! ---234-876. Perhaps the doctor practiced in Mexico???? The lack of any meaningful discharge planning is especiialy crucial for those elderly who are not likely to be able to return to their homes, after being asked to vacate their hospital bed tomorrow by the happy, smiling social worker. To me, this is just plain scandalous. So, when you or a loved is taken to an ER; or admitted to the hospital, remember your clock is ticking. Sooner or later, usually much sooner, the hospital social worker will come by your bed and say: "WE WANT YOUR BED, DEAD OR ALIVE!" If you should get sick again, AND YOU DON'T DIE, you can always COME BACK to the hospital ER.--again, and again and again, until you drop. STAY WELL AND OUT OF ANY HOSPITAL. Greg Duch