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Politics Of Health Care

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Editor 's note: Mrs. Selma Weisman, who has reeenilv moved to Ann Arbor from Seattle, Washington, calleJ the Free People 's Clinic MEDICA L MEDIA TORS service, to find out who we wen; what uv were doing. She was eager to sharc with us lier extensive knowledge ahout rhc healih care srsieni. Mrs. Weisman was raised and schooled in Canada, aiul since l() 54 has worked in the United States ai a medical social worker. She spoke to a Free Clinic Political Education meeting, after which iliis interview was arranged. FPC: Why don't you begin by talking about your personal background in Canada, and your professional background in the U.S. Mrs. Weisman: I graduated from McGill University School of Social Work in 1954, after training at the Royal Victoria Hospital. From there, I carne to the United States, to a job I had lined up at Beth Israel Hospital in New York City, and I've been working as a medical social worker here since then. Now, I haven't ever worked as a medical social worker in Canada, so I'm not really that familiar with all the ins and outs of it, like I am here, but my mother, my brother and his family are all up there, and they've told me alot about it. Also, when I was going to school, the professors were actively in favor of the socialized health care measures before Parliament. Even though it was 20 years ago, it was alieady predicted what population trends would be, how there would be alot more older people alive longer, and what Canada's health care needs would be. We knew we would be faced with alot of problems on a rationa] level, really at every level, caring tor these older people.... And the province of Saskatchewan already had socialized medicine in 1954. FPC: What do you see as the essential differences between the health care systems of the U.S. and Canada? Mrs. Weisman: Now that they have socialized medicine in Canada, medical care there is geared toward meeting the patients' needs. Medical care here is geared mainly for the convenience of the doctor. The medical profession is on top of the health care in this country, and they run it the way they see fit. In other words, the insurance programs, public health programs, the few rehabilitation programs there are, all have to run at the approval of doctors. A true medical program that would be meeting the needs of the public would be geared to the whole team workng together, rather than one profession manipulating and being head of it. Insurance programs here are all geared for the doctor's convenience. Most of the reimbursements are paid through hospitals. and so you have a situation where it is convenient for the doctors to have their offices either inside or very close to the hospital, so he can just get up and walk there. But this isn't necessarily convenient to the people. Parking is very difficult, and a lot of times people don't even have the transportation to get to the facilities. There is no community-based help. One of the worst things here is the fact that the United States has no comprehensive preventative health care. Insurance companies always rule out physical check-ups. It's the first thing you see when you open up the policy: no checkups will be covered. If people were allowed to have check-ups once a year like they should, so many problems could be caught before they got to an acute stage. A yearly physical is really the most important care there is. And here, if you're unemployed, and don't have any health insurance through your job, you're out of luck. My husband got laid off with 60,000 other people at Boeing in 1%9, where they had an excellent health plan I mean excellent within the limits of what is offered here. Physicals were not included, eye exams, several other things....And why? Why eye exams? What makes your eye different from your nose or your ear? Blindness, cataracts, glaucoma are all serious medical problems...Anyway, suddenly 60,000 people had no health insurance, and most of them were married and had children. If they got sick, their savings were wiped out. Luckily for my family, I had health insurance through my job. FPC: Could you talk a little about how the (anadian health system is organized. Mrs. Weisman: There are differences from province to province, but in general, Canada has free comprehensive health care. Every citizen gets a health card, and when you go to the doctor or hospital you present your card, and the Government pays the bill. When I say "free" I don't mean completely free. Medical care is paid for through taxes. In Ontario, I know, the people pay approximately $10 a month additional on their taxes. My family would pay about $100 a year for our income bracket, but this is for complete coverage and hospitalization. There are some deductibles, depending on the province. For instance, you might have to pay a dollar out of your own pocket for certain kinds of care. My sister-in-law told me they pay $3.00 an hour for a psychiatrist for their daughter. (Note: compared to $50-60 per hour here) My feeling is that the $100 more a year is certainly well worth it for the coverage. My husband has a good job here, and he's paying S7.00 a month for the company's health plan, for much poorer coverage. I don't consider the extra $3.00 a month to be that much more since it covers everything. Hospiatlization is completely covered in Canada, though the length of stay you're allowed varies from province to province. Some have 60 days, some more, some less. And if a Canadian citizen has to be hospitalized here, for instance, or anywhere in the world, the Government pays for it. FPC: Have you had any experiences as a U.S. citizen with the Canadian health system? Mrs. Weisman: Well. when we first moved here, I was told that I would never be able to get my son an appointment with an opthalmologist unless I made it months in advance. Now, I was told alot of things that I later found out were not true,but, in general, it's very hard to find doctors around here because they're all attached to the hospitals. If s a very strange system. They have their offices in the hospitals, so they're not readüy available as family doctors. Anyway, I was told that a complete eye exam would be $25.00. But we were going to be in Ottawa, and there the doctors have their offices everywhere, in the outlying areas, and they're not attached to hospitals as they are in this strange city. My son got the exam, and the charge was $15.00. The nurse apologized for having to charge so much, because she was so sorry I didrTt have a health card. She said, "Oh, you poor dear!" Nowadays, Canadians feel sorry for people in the United States. The conditions down here are very sorrowful, very poor, and they say: we don't want that to be the quality of our lives. It used to be very common for Canadians to want to come to the United States. When I came in 1954, it was an accepted thing. Now that's stopped. People there don't want to come here. f PC: You've worked with the problems of the elderly. Could you talk a Hule about the history of Medicare. Mrs. Weisman: Medicare began in 1967. Everybody was excited about it because they thought it would be a real help to the aged. And it was in the beginning, for many people who had not been able to afford any medical care, and had many untreated ailments. So what happened was, thè first couple of years the Government was astounded to find that the program was costing billions more than they had anticipated because people liad never had routine physicals, and they were walking around with problems that should have been taken care of years before but never were. So, of course, people used the program. What did the Government expect?! Everybody came in and got taken care of when they found they could do it with the card. The Government realized they couldn't afford Medicare. They had to find a way out. They started to cut the available services. Like the 1 20 days of free hospitalization that the Medicare booklet offers was cut back to 5, except for really acutely ill patients who need intensive care. And nursing home care was drastically cut down, from three months to very little. This can be very unfair. And one of the biggest problems is that the patients don't know where they stand. The Handbook has never been reprinted since 1967. They open it upand read what amounts to wild promises that won't be fulfilled. And it's a terrible thing to try to explain to people that what's in the booklet isn't so, because the booklet very clearly states 1 20 days, and they don't understand why they're being pushed out. They've paid taxes all their lives, and they can't understand why they're being treated this wav. FPC: Patients who are forced out of hospitals, what alternatives do they have? Mrs. Weisman: Not many unless they have insurance or someone to pay their bilis, and many don't. If they qualify for nursing care, like if they have a broken hip, they can get ten days, which isn't enough, but it's something. Medicare had a visiting nurse service where they would come to your home, but this was drastically cut. In Seattle, when this was cut , there was suchan uproar that it got refunded for a while. But the point is that the government can cut anything it wants to really.... People who I worked with who were pushed out of hospitals were very angry and frustated. There is no easy solution. For instance, Nixon abolished the requirement that nursing homes have a social worker on that staft, and Medicare does not require - hospitals to have social workers either. so these people have no access to information even. And the information that a clerk in the business office gives you is very often completely wrong. FPC: The other night you spoke about Canada limiting doctors' incomes. Could you talk more about that? Mrs. Weisman: This has just happened this year. The doctors fought the entire socialized medicineprogram in Canada, the same as doctors here fought Medicare, and they're now fighting almost all the national health insurance proposals, all except the most conservative. After socialized medicine started, and patients who had never been able to afford medical care began flooding in, the doctors began making alot of money; that seems to be what they're interested in. So after a while, their objections feil off. But then, the Government found that some doctors were abusing the program by screening alot of patients, like going through a mili, and calling it an officie visit. The Government feit that it was impossible to see this many patients and give good medical care. Some of these doctors were making $1 50,000 a year. The same thing happened here with Medicare. Until the Government cracked down and told the doctors they couldn't do it, some of them were making S300,000 a year seeing MedicarèMedicaid patients! So now, in the province of Quebec, no doctor can make more than $75,000 a year. Now I may be wrong, but my sister-in-law told me that her brother, who is án allergist, had his income limited to $40,000 a year. So now he only works a four day week. FPC: What kinds of changes would you like to see in the health care system in the U.S.? Mrs. Weisman: At present, our health care system is very poor. I think we have one of the worst health care systems in the world, compared to other industrialized countries. We have the greatest technology in the world but the poorest health system. FPC: Why do you think this is? Mrs. Weisman: Because we are so caught up in the "free enterprise system," that we don't want to force regulations on the medical profession. For many years, socialized medicine has been a dirty word here. The AMA is a very powerful unión in this country. They control the entire medical profession. But it's not just the AMA: they are one of many. It's the drug industry, and the insurance industry. All of our medical care is being run by very strong, powerful industries and they want things to stay as they are now, because they're doing very well with the status quo. They don't want change. So, of course, anything that comes along to change the System, they're going to put up a terrific fight. For.instance, this business of changing drug na mes f rom "brand names back to the generic (chemical) names, which would make things easier and a lot less confusing for everybody, the drug industry has fought it all along. They want even more money. They say they need the money for research, but I'm a little skeptical of that. They make a fortune. Drug Companies do very well on thë stock market - all you have to do is look. They can back powerful lobbies in Washington, and help their friends into office. And though we need to have health care for free for everyone, this would spell change. It might mean that medicines would be cheaper. Or that doctors would have their incomes regulated... Who's in favor of socialized medicine, really? FPC: Only the patients. Mrs Weisman: Right - but they don't have the money or the organization, and that means they don't have power.