today's Toronto Star has a timely column by their Business Columnist:
http://www.thestar.com/news/insight/...h-care-systems
A tale of two health-care systems
Published On Fri Feb 18 2011
By David Olive
Business Columnist
I have a dear friend in Michigan whose older sister died in October of a heart attack at age 76. When she passed away, Agnes had been living in her Dearborn house only by the grace of corporate bureaucratic inertia.
Agnes had defaulted on a second mortgage she had taken out to pay medical bills that peaked at $99,000. Bank of America was poised to seize the house once it decided what it would do about this particular bad debt. The impaired mortgage was among the hundreds of thousands of so-called “toxic” mortgages held by lenders worldwide in the unprecedented U.S. housing crisis that triggered the global Great Recession.
Agnes and her husband, Bill, had realized a modest version of the “American Dream.” They owned their house outright. But Bill suddenly began accumulating tens of thousands of dollars in medical bills after suffering a stroke in November 2004. He died of complications from the stroke two months later.
Determined to honour the debt obligations, Agnes in 2005 took out an “adjustable-rate mortgage” (ARM). She tapped her only source of funds, the equity in her home, to settle her late husband’s medical bills.
A relatively new and seductive “innovation” of Wall Street that gained tremendous popularity in the United States in the previous decade, adjustable-rate mortgages bear low initial “teaser” monthly payments. These later “reset,” or skyrocket, typically beginning in the third year of the mortgage.
ARMs are cousins of the even more toxic “subprime” mortgages equally popular in the 2000s. The notorious subprimes were offered — like candy — to borrowers who lacked adequate collateral and income, were unable to make a down payment, and had a poor credit history. The predictable massive defaults on these dubious ARMs and subprimes have so far cost the global financial industry more than $2 trillion (U.S.) in bad debt.
The pain was no less acute for the borrowers. Agnes’s initial $345 monthly mortgage payments in 2005 leapt to more than $900 by 2008. The sudden cash squeeze prompted Agnes to apply for credit cards she used to pay for things like property taxes, utilities, food and medicine.
It wasn’t long before Agnes fell behind in payments on her maxed-out credit cards, her property taxes and the mortgage. This triggered more interest-rate hikes and late fees that were tacked on to a debt load that had already overwhelmed Agnes’s resources. Agnes’s initial $60,000 loan burgeoned into a $133,000 debt in the short space of five years.
The mental strain for Agnes was considerable as the dunning notices began pouring in. Agnes’s sister, my friend Janet, is convinced it was the escalating stress that killed her sister. Laid low after gallbladder surgery in 2008, Agnes was not in ideal health in her last two years as she struggled with creditors.
Agnes was one of several million Americans expected to lose their homes by the time this unprecedented crisis has run its course. The new-found austerity of Americans who have lost their homes or fear that prospect explains in large degree why the U.S. economy stubbornly fails to recover.
My own father died last spring, at 85. He succumbed to a series of maladies including diabetes, shingles and a rapid, steep decline in his hearing and eyesight. Dad had been treated by many specialists, in gerontology, ophthalmology and audiology. Despite long odds against success, Dad had corrective eye surgery at Toronto Western early last year. It was ineffective.
From the time of my mom’s first of two hip-replacement surgeries almost a decade earlier, Ontario had been providing home health care to my parents at no cost to them. This was done through the Community Care Access Centre (CCAC) branch of the Ontario health ministry.
Conditions in my parents’ Scarborough home began to worsen in 2009. Mom and Dad were isolated in their suburban home now that Dad could no longer drive. They lived far from their GP, the nearest pharmacy and grocery store, and from me, in High Park. In early 2010, the CCAC district supervisor, Katie, decided to intervene.
Katie began routinely double-checking to ensure that only fresh food was on hand and that my parents’ meds were up to date. Kate briefed me by phone at least fortnightly on worrisome conditions I had overlooked in my own visits.
When Dad died, on June 24, Katie immediately increased the one-hour CCAC visits from three times a week to each weekday. The next time someone uses the expression “faceless government bureaucrat” in my presence, they’ll have to explain to me why Katie — who knew my parents for all of three months — became such an integral and affectionate member of our family that she was at Dad’s funeral to console me and Mom.
It was the CCAC, too, that acted quickly on the emergency nursing-home placement for Mom ordered by my parents’ GP. In the government’s assessment, Mom’s early stages Alzheimer’s disease merited jumping the queue for nursing homes.
Within five weeks of my father’s passing, Mom had relocated to Shepherd Lodge, also in Scarborough, and one of the best nursing homes in the province. Here she would be safe. With her own severe hearing disability and limited mobility, I worried Mom would not be alerted to an outbreak of fire in that Scarborough frame house, or be able to navigate her way to safety.
Mom’s care now is around the clock. Her aversion to medication has been trumped by caregivers who ensure that Mom takes her many prescribed medicines at the proper times and doses. Her three nutritious meals taken at set times, replacing an irregular eating pattern, soon cleared up her digestive complaints. And lights-out at 11 p.m. has Mom, a longtime night owl, sleeping soundly for the first time since her 30s. At modest additional cost, Mom has her hair done fortnightly rather than every few years, and delights in the novelty of frequent manicure and pedicure treatment.
Shepherd Lodge isn’t paradise. Like all institutions and workplaces, it has its rules that restrict one’s freedom. No one wants to go to a nursing home. But Mom is making the adjustment to a new way of life with the help of loving family and friends, and especially the competence and good cheer of her new 24/7 caregivers.
These two stories are strikingly similar in a crucial respect.
Health-care costs are burgeoning in all major economies. Baby-boom demographics and ever-improved and costlier medical treatments already consume a huge portion of society’s resources. We have to do a better job of preventative care in our personal lives if we hope to keep those costs from crowding out other needs. And we must pioneer every imaginable cost-efficient improvement to the system.
Beyond that, these two stories sharply diverge. My parents never saw a bill from a hospital, a GP, surgeon, clinical specialist or the CCAC. There is rent to be paid at Shepherd Lodge, to be sure. (About $1,700 a month). But Ontario shouldered most of the cost of building that facility, and covers more than 80 per cent of its operating costs. And if the day comes when Mom and I cannot afford our entire rent at Shepherd Lodge, Ontario has a means-tested subsidy program to help cover the difference.
In short, a family medical crisis in Canada tends to be just that, a health crisis. It is rarely also a financial crisis. For that I thank my fellow Canadians. They have each chipped in to care for my parents. And I make my own contribution to the welfare of friends I have yet to meet in Kelowna, Hay River and Yarmouth.
In that sense, we are a nation of caregivers, every one. “Taxes are the price we pay for democracy,” a wise person once said. One could add that it’s the price we pay for the health care, education, law and order, and environmental protections that secure a blessed future for our progeny.
That wise person could have been Desmond Tutu or June Callwood. But, as it happens, it was Franklin Roosevelt. His vision of a caring society is, from the news that crosses our porous border with the U.S., currently out of favour with many Americans. The downright antipathy to progress just now among our friends to the south recalls the line that closes the account in The Great Gatsby: “So we beat on, boats against the current, borne back ceaselessly into the past.”
Is that another of F. Scott Fitzgerald’s canards, along with, “There are no second acts in American life”?
Regardless, we will go on in Canada with our practice of collective action on behalf of the individual, and individual contribution to the common good. We’ve been at this now for more than a century, and it works. My mother is alive and well because of it.