No One Condemns the Expense, Just Who Pays?

Sarah Burke’s death has become a condemnation of US healthcare because the $200,000 or so bill has put a tremendous strain on her family which required them to seek money from friends, family, and fans. The above article by Kari Huus states “The need for a fundraiser — to help her grieving family avert bankruptcy — was viewed by some Canadians and U.S. observers as a condemnation of the U.S. health care system.”

Alessandro Garofalo / Reuters, file
Sarah Burke at the FIS World Cup Grand Finals in 2008

What’s interesting to me is that no one apparently is condemning the number of studies, surgical procedures, or heroic efforts that directly tie in to that $200,000 bill. In fact, the article states “‘The irony is that had the accident occurred in Canada… her care would have been covered because, unlike the U.S., Canada has a system of universal coverage,’ wrote Wendell Potter, an insurance executive-turned-whistleblower who writes for iWatch at the Center for Public Integrity. ‘No one in Canada finds themselves in that predicament, nor do they face losing their homes as many Americans do when they become critically ill or suffer an injury…'”

So it’s not the actual cost or the number of heroic efforts taken to save the life of an icon, it’s that the money was owed to the healthcare team not by the government but by the family. Of course, it’s a tragedy that a family can go to financial ruin trying to cover a catastrophic medical event. Nevertheless, the money must come from somewhere. This raises the question of why wouldn’t the Canadian government pay for her care in the US? It doesn’t appear that anyone is arguing about what was done. If an American has a skiing accident in another country, will insurance cover their medical coverage there? Some contracts do, some don’t. If you travel internationally, you should know. Certainly, if you are involved in a high-risk activity/sport, this disaster only highlights the importance of knowing.

Unfortunately, what the article doesn’t address is that people pay one way or another for medical care. In the US, we buy insurance. In Canada, they pay higher taxes. On average, a Canadian pays a 35% tax rate to the American who pays 30% in income tax. There are other levies and taxes in Canada so that their effective tax rate is actually a bit higher. And for the wealthiest Canadians, the tax rate is disproportionately and substantially higher.

The other item that the article doesn’t mention is the length of time that it takes to get what is deemed “elective” care in Canada. I have a friend who is an otolaryngologist in Calgary. He says that it takes over 10 months to have a septoplasty, something that an American can get in a week or two if desired. Kids who need ear tubes have to wait 3 months. If a child has fluid in the ear causing hearing loss for 3 months, in the US they go directly to surgery to prevent speech and language delays that can occur when hearing loss persists any longer. In Canada, that means those kids would have to wait an additional 3 more months to get those tubes.  How do the otolaryngologists handle it? They see the patient once and add them on for the OR for 3 months out. If the child improves, they cancel surgery, but it’s the only way to get a child into the OR in an appropriate timeframe if they don’t improve.

I’m 1/2 Canadian. My Canadian grandfather had an abdominal aortic aneurysm which had grown at a rate that in the US would meet indications to proceed with repair within a week. His surgery was scheduled 6 months out–he died within 10 days of the surgery being scheduled (more than 5 1/2 months before he could have received a life-saving procedure). My grandmother complained for months soon thereafter of not being able to eat and having abdominal cramps–not that she didn’t want to eat, but that she couldn’t. Physicians felt that she was grieving and did not want to order any expensive imaging to assess it further. When she began to lose weight at an alarming rate 3 months later, a CT was obtained that showed an 8cm colon cancer. So to those who say that Burke’s family’s tragedy wouldn’t occur in Canada are ignoring the other tragedies that do occur there. I would have traded my house to have a few more years with my grandfather. Money is replaceable, time is not.

Those who throw up their hands at this kind of cost seem to forget that the money comes from the people, whether in the form of taxes or in the form of insurance premiums.

I’m always struck by how a tragic story can be used and abused by various groups to tout the virtues of their agenda. As family, friends, the sports world as well as a nation mourns the loss of Ms. Burke, let’s table the soapbox for at least a time and let us applaud the generosity of those who supported the financial strain created by the world’s most advanced healthcare.

–Richard D. Thrasher III, MD

 

Posted in: Controversial Medicine, General Medical, Interesting Stuff

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