America Canada Great flag

I recently returned from ten days in Alberta, Canada visiting the small town of Stettler where my hardy and adventurous relatives settled in the early 1900s. People from all over the world came to the area in droves, attracted by cheap land grants offered by the Canadian Pacific Railroad that was hoping to create new towns (and presumably customers) on the vast and largely unpopulated prairie.

The contrast between what I saw in Alberta and what we are currently experiencing in the U.S. is stark, particularly when it comes to infrastructure. Even though I live in the beautiful, but some what ostentatiously upscale county of Marin in Northern California, the road to my house has only been paved once in the 30+ years my husband and I have lived there—and even then, for some inexplicable reason, the city failed to pave the part of the road that connects my street to the main thoroughfare of our town. It is only a bit of an exaggeration to say that the potholes get so big in the winter that you could take a bath in them. In Alberta, all of the streets we drove on were smoothly paved with nary a pothole in sight. Even in very small communities with only four or five thousand inhabitants, the roads were well-maintained whether paved or, in the outback, neatly graveled.

 

Public infrastructure reminded me of my childhood

Other types of public infrastructure were also impressive and reminded me of my childhood when the Greatest Generation was still in charge of making public policy decisions. Imagine this: All throughout the places we visited in Alberta, there was soap in every soap dispenser and paper towels and toilet paper in every public restroom. There was no trash on the roadsides and they even had tidy bear-proof garbage cans in the National Park.

Double rainbow AlbertaBanff, the National Park where we spent three days was stunning, with sparkling lakes, majestic mountains, and lush forests. We even had a rainbow fest (with double and even triple rainbows) on our drive back from Lake Louise to Canmore. Again, the infrastructure to support visitors was excellent with free parking and shuttle services, clean plentiful public restrooms, and, are you ready for this, park rangers who were actually teaching nature to kids and adults. The last park I visited in northern California not only had no Rangers, but the historical sites of the first people, the Miwoks, were falling apart.

One particularly interesting bit of infrastructure was Quarry Lake near the town of Canmore. Prior to becoming a lake, the area was an open pit for coal mining. After the pit was no longer profitable, instead of leaving it as an ugly scar, the community raised money to fill in part of the pit and transformed it into a recreational lake for swimming and floating with nearby biking and hiking. Now that’s a good idea!

 

And they have universal healthcare

I didn’t see a single public road, building or stadium branded AT&T or Oracle or Bank of America. In fact, our trip was remarkably ad-free compared to the constant barrage of billboards and other advertising bombarding us every day in every place and every way in the U.S.

The people we met were all civil, in fact, kind and—did I mention this?—everyone has healthcare in Canada. For all of you who still believe the U.S. has the best healthcare system in the world, let me ask you the last time someone in America spontaneously told you how great their healthcare was? Here is how one woman in the small town of Bashaw in central Alberta described it to me. Her husband had had multiple medical problems, having suffered a heart attack in the 90s. Everything he needed after this serious illness was covered by Canada’s national healthcare system. As was all of their care throughout the ensuing years. She said he would be dead and she would be destitute if they had to pay for all those services themselves. She also said her Province (Alberta) has a commitment to helping seniors age in place so support services and resources (e.g., wheelchairs, etc) are also free. This is not an elitist urban Province, it is a primarily rural agricultural region—similar to areas in the U.S. that voted Trump—and yet, the people who live there told us by and large they feel secure knowing their healthcare needs will be covered. They also wondered how we were holding up under our new administration. And, they said they felt sorry for us that our healthcare system, such as it is, is such a mess.

 

Honoring their diversity

Perhaps you are thinking, yeah, Canada can do all that because it is a relatively small country compared to the U.S. and the population is homogeneous. But, what we saw in Alberta was an unexpected amount of cultural and racial diversity. The parade at the famous Calgary Stampede was a grand celebration of that ever-growing diversity; there were myriad groups marching and floats driving that honored populations from all over the world who now call Canada their home. There were people from many different parts of Africa, Asia, and the Middle East. We saw Sikhs, Christians, Muslims, Hindus, Buddhists, and, who knows, probably even some Atheists. The restaurants in Calgary reflected this diversity so we were able to feast on steaming bowls of Pho before heading out to Banff.

Most people we talked to were happy with their lives and proud of their history. Every little town we visited had a museum that chronicled the town’s history since the turn of the century. The only complaint we heard on the trip was from one Uber driver, originally from Africa, who told us he used to be a bad boy but is now born again. He said he didn’t like it that there was little tolerance for him proselytizing in the streets!

 

MAGA

I realize this story is only based on anecdotes from my brief stay in Alberta, but still, I couldn’t help thinking that if President Trump or anyone with any power in our government really wanted to “Make America Great Again,” they would send a delegation to Alberta and copy everything they are doing. We certainly could be, and in fact, we are, in many cases, doing much worse.

Patricia Salber MD, MBA (@docweighsin)

Patricia Salber, MD, MBA is the Founder and Editor-in-Chief of The Doctor Weighs In. She is also a physician executive who has worked in all aspects of healthcare including practicing emergency physician, health plan executive, consultant to employers, CMS, and other organizations. She is a Board Certified Internist and Emergency Physician who loves to write about just about anything that has to do with healthcare.

10 COMMENTS

  1. They aren’t providing a defense shield for the rest of the free world so they have more money to work with. And much less populous relative to the natural resources they can all.

  2. Although I appreciate the awe and respect you have for the people and the beauty of the region, what I was looking for was an unmasking of how such a thing was accomplished. Something somewhere has to give. Are the healthcare providers, doctors, nurses, and the like, properly compensated? Is medical school free? Are premiums outrageous? Are the insurance companies nationalized? What gives?

    Here’s what I know, I’m a 49 year old male who exercises regularly, nonsmoker, vegan diet, with no health issues. Before Obamacare I was paying $225 per month for a decent health care plan, a few years later my premiums went to over $700/month. I’m also an employer and some of the older employees saw increases that caused them to either change to a different plan (less decent) or drop company insurance altogether. This was as a direct result of Obamacare.

    Before O’care I understood that, if I’m paying for my own healthcare my premiums and deductibles, for the most part, are as a result of my state of health. Therefore I work on that part of my life, so as to decrease my outlay of cash, and enjoy a longer happier, healthier life. But if I’m forced into the same system as someone who doesn’t exercise, smokes 3 packs a day, eats like a camp-ground raccoon, has self-induced diabetes, and qualifies for reduced premiums (on our dime) then I’m going to be paying much more. Don’t even get me started on pre-existing conditions.

    I agree that insurance companies are a big part of the problem, but so is the outdated and overextending tentacles of a 170 year old organization, The AMA.

    I’m not saying that there isn’t a model that will work, but so far I haven’t heard anyone talk about a system that includes personal responsibility.

    • There have been many experiments aiming to reward or punish people based on their personal responsibility for their health habits. Most have had very modest, if any success. The problem is that bad things can still happen to “good” people – like you – who are doing everything they can to stay healthy. But a drunk crosses the double line and hits them head-on or they get cancer from an exposure to a carcinogen that they didn’t know about. I could go on and on. Insurance is just that – insuring against the unexpected and more recently helping people to pay for prevention that they can’t do on their own (think colonoscopy or mammograms). As far as the increase in premiums, it is interesting that most people don’t talk about the most important cause of escalating health care costs: the cost of the care itself, in particular, the unjustified escalation in pharmaceutical costs in the US (controlled in most other wealthy countries), the overuse of procedures that bring little or no value, and other examples of waste, abuse, and even fraud, that drive up the cost of care. Since, by and large, politics contributed to the mess we are in (remember Congress banned the negotiation of drug prices in Medicare Part D), it may take politics or a huge disruption (such as Amazon buying up massive quantities of drugs and selling them to plans and people cheaply) to get us out.

    • Why do you think “something has to give”?? Healthcare providers in Canada are compensated very well. Nurses are unionized, other support staff also have union representation. Medical school is not free in Canada. We don’t pay premiums for basic health care. Our insurance covers things like prescriptions, glasses, dental, And supplemental services like massage therapy and chiropractic care. Premiums are around $150 for a family, a lot of employers pay a large portion or all of that as part of their benefit package. And no, insurance isn’t nationalized.

      You seem super concerned that you might end up “paying for someone else” that you feel is less deserving than you. In Canada, we don’t think that way. We believe (as do most developed countries) that a prosperous country has an obligation to keep it’s people healthy. That the security we have, knowing that don’t have medical bills or premiums or deductibles is worth so much more than what we pay out in taxes (and if you look into it, we don’t actually pay that much more than you do, and in some cases, less – And we get so much more).

      In Canada, I’m in the same system as everyone, and I don’t pay anything.

      In America, you have two problems from what I can see. The insurance system instead of a national health care system; and your health care costs are ridiculously inflated and don’t reflect the true cost of care. As long as those two things remain true, you’ll never have affordable care for everyone… which is a shame

      • Talitha

        I just found this article. Check it out. http://www.nationalreview.com/article/446689/canada-single-payer-health-care-system-failures-cautionary-tale

        Is it true that in Canada, bureaucrats, not doctors determine what medical procedures are necessary? That’s a little scary.

        It also says that with regards to quality of care, backed by a 2014 report by the Commonwealth Fund, Canada is behind most other developed countries, ahead of the US only. And that 29% of adult Canadians who are sick and need to sea a specialist must to wait 2 months or longer to do so.

        The article does tease out an important issue I hadn’t considered. Even though your system is sadly lacking, Canadians see themselves as pioneers in health care and believe that access is a basic human right. It’s part of your identity. And you’ve been brainwashed into believing health care costs you nothing when on average you pay $10,500 per year for it through your taxes. Maybe you don’t pay this much yourself, you may be one of the millions who’s healthcare is being subsidized by the taxes of others.

        You are right, I am concerned that I am paying for the health care of others who are totally oblivious of the need to take care of themselves. Of course you can’t plan for every contingency, things go wrong, you can get hit by a bus, you can get bitten by a spider, but every year more than 600,000 Americans die of heart disease. And annually, the healthcare costs associated with just heart disease are more than $300 billion in the US. So while you admonish me and label me as an uncaring individual, fearful of paying for someone else’s care, I still hold to the belief that a system that includes preventative care, nutrition and exercise, is much better in the long run…for everyone involved.

        • Tabitha, do you honestly believe that in the U.S., DOCTORS determine what medical procedures are necessary?

          Here in the reality-based universe, it is the bean-counters employed by the for-profit health insurance corporations that decide whether medical procedures will be paid for.

          If a government “bureaucrat” makes an unfair decision, you have SOME recourse. You can contact you state or federal representative, and they will have staff members look into the matter. If the abuse is egregious — AND the politician thinks that addressing will make them look good — they will start advocating on your behalf. Your only recourse to abuse by a corporation is to spend years and tens of thousands of dollars to take them to court.

          And the delay in receiving care that Canadians endure is for procedures for conditions that are NOT life treating, like knee replacements.

  3. Single payer health care can benefit everyone by making health promotion an integral part of health care. We can also use policy incentives to help people make good choices when it comes to health. For example higher excise taxes on tobacco reduces the prevalence of smoking and shifts some of the social burden for treating smoking related diseases onto those who smoke. Denmark does the same things with sugary drinks. A 16 ounce coke costs about 5 or 6 dollars. But their obesity rates and diabetes rates are lower than ours. If people know they can get regular checkups without “braking the bank” they could catch disease earlier when they are less expensive to treat, and more likely to result in a cure.

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