Wednesday, November 4, 2009

universal means universal

I found the last sentence of the article most shocking “If universal health insurance is a core Canadian value, we need to ensure that it is, indeed, universal.” Throughout the whole semester we have been Canada as an example of universal health care; I am surprised that it is not. Immigrants and refugees are a vulnerable population; they should not be punished for residing in a new country. I do agree there should be a probation period where they have to wait until they become a legal resident, but not months or years to find that they are denied health care. Barriers, such as identifying documents or income should not be a reason to turn them away. This only complicates their lives, especially health, of new-comers. Ignoring their need for health care only makes them and their future generations sicker- by not receiving prenatal health care and care for their children. This also affects the country indirectly because they are now living on their land; even if the country may not like it, the immigrants and refugees are now one of them. Canadian government can help reduce this disparity by granting immigrants and refugees some type of coverage, subsidized coverage for those who can’t afford health care, faster administration periods to speed up the waiting periods, and provide emergency care for them. In the end, immigrants and refugees are still human, and like all humans, they deserve health care.

Hm, Immigrants+Uninsured= No Health Insurance

I guess yeah, that's what it comes down to. Which government is willing to cover you? Every government somehow has a vested interest in its own citizens because they have to take care of their own well-being and "kind." However, for example, Canada will give "professionals" more of a chance to attain their national health insurance. That, is something that is not fair in my own opinion. Since when is health based on your ability to give back to society?

Vulnerable populations are vulnerable for a reason--they can't get the care they need, yet they are the most in need, it's absolutely unbelievable. There has to be a way for all the nations of the world to congregate to come up with a joint act to treat immigrants in a way that is fair, or else these issues will forever be perpetuated through time. In a utopian society, all sovereign nations would take care of their health care systems in an effective and efficient way, so that no matter where one goes to, they will be covered at least minimally.

There is no real answer for this kind of issue, and even if there are any answers, it's an iffy one at that.

Tuesday, November 3, 2009

Refugees, jobless Americans, and a second chance

There are two points I need to mention. Reading the article, I see a similarity between the refugees who seek medical care and those people in the U.S who are sick but lose their health insurance when they become jobless. Both groups can not get medical care at the time that they need it most. So the argument is the same. From the humanitarian perspective, both groups, and in fact all groups, are deserving for getting medical care.
For explaining my second point, I should repeat the argument that is used against the "undeserved". Some claim that it is their fault that they are sick, and the society does not have to take care of them; and that if they tried harder, they could've avoided the bad situation. Well, then I must say that the followers of this argument do not believe in second chances, surprisingly. And that's surprising because for example in our society, we get second chances for almost everything. From dropping classes to returning merchandize, we get second chances everyday. But we don't get it for an important thing such as life-quality. So if some blame those people for putting themselves in such bad positions, they could at least believe in giving them a second chance. And a second chance for improving one's quality of life could never be real without the most basic need provided, which is health.

why the loophole in universal insurance

My concern is that, if there is universal insurance in Canada, why is there a loophole for these legal immigrants and refugees? I think it’s different if they are illegal because then we can blame or understand if they are sent back to their native countries for example but since the government of Canada allowed for these immigrants and refugees to stay, why have they been neglected? Why do they have wait for health care. It is indeed not fair on this population to lack health insurance, and it’s true the Canadian government needs to put in place resources and infrastructure but does that mean there should be delay care and assess. What happen to free assess to health care and why is the gap to antenatal care for example so great to this population? Why hasn’t the government plan for the provision of health care for these vulnerable populations? It is necessary to have health facilities and free assess to care for this population if there are allowed in to live legally in Canada.

I agree with the writers in the article to research more on this population for the government of Canada to see the need to provide better health services for this population.

When a country such as Canada provides universal health insurance it need to provide universal health insurance and not allow discrimination among its vulnerable population as the problem there today.

Universal Problems

I was also most struck by how familiar some of the issues described in the article seemed. Its ironic that one of the major arguments against universal health care in this country is the idea that we will be paying for illegal immigrants to get health coverage, when in the countries with socialized care, some legal immigrants are denied access!
I was also struck by how this seems to be a universal problem, it doesn't seem that any country has really come up with a viable solution. Its the same problem everywhere. Nothing is free. The crux of this issue comes down to the idea of whether or not the access to health care is a universal human right, and the fact that no matter what we say or think, health care is rationed because it has a cost. Rationing has to provide the functioning, law-abiding members of society with their care over those who are illegal or not participating in society, or else there is no incentive to participate in society. This argument clearly breaks down when talking about the working/contributing disenfranchised who are just unable to to become one of the "haves" instead of a "have-not". Of course, it also brings up the idea of how each country deals with immigrants and refugees, whether the policies of that country protect them, or criminalize them, adding a degree of complexity and some policy issues to the table.
It seems to be a theme in our discussions and readings that health care is interconnected with the core values of society, which is why a complete overhaul of health care would require fundamental shifts in our core beliefs, our immigration policy, our tax structure and our legal system. It starts to look like a tall order.

To cross or not to cross ....the border...

Immigrants are already a vulnerable population and for them to enter a foreign country they have so many things to deal with. Health care should be the least of their worries. Everyone deserves a chance to succeed and in their vulnerable times, I think we should be honored that they chose our country to join. I do think that they add a stress to the country as a whole though. We dont know what their health conditions are and if they are contagious or possibly bringing a new disease to our country. We dont know if they need medical help yet. But they shouldnt be excluded. The Canadian government might need a few pointers at this point. Im not sure of the details but I am aware that people from the US do go to Canada for some medical treatments. I am not happy with the US "health care system" if thats what you want to call it right now. So I think many US citizens travel to Canada for treatments. But what if everyone just ran away to Canada from the US? How would this affect their system? The Canadian government should be more strict, yet still accept immigrants. They should have some type of "list or checkpoint" to determine who belongs to their country for record purposes but they should also provide health care to all. I dunno, health care is just something that is so important because it can affect several people in the vicinity of one sick person. Its like helping one sick person for the benefit of the whole. Think about it, because the flu is contagious, etc.

The immigrants and refugees population probably needs more health care services than general population and the numbers of this vulnerable population are actually growing everyday. The most challenging problem will be the impact on economic; lacking of insurance not only affect the immigrants and refugees population’s economic status, but also alter the whole nation’s economic patterns. The government has to spend more money on health care for the growing immigrants and refugees population, and that also cause each individual in Canada has to share the growing risk and spending; ultimately, the increasing of health care budget will actually impact the whole nation. If it’s possible, maybe the Canada government could try to start some program like delivering non-profit health care for the immigrants and refugees population at the public clinics and hospitals for a short period of time before they are approved by the universal health care system, then they don’t have to worry about the cost of getting the health care without insurance; and the government could also provide some benefits for the medical provider who volunteer in the program. It might not be the best solution, but it still might be an alternative plan to deal with the present situation.

Immigrants are members of society too !!

It's difficult for policy makers to organize social services for immigrants. Most nations historically have had dynamic populations, so therefore immigrants shouldn't be excluded from social systems. However, I understand the other side that, especially in large nations, such as United States, it is difficult to maintain organizational stability (costs, access, etc.) if there isn't proper identification and knowledge of population size. That's not the immigrant's fault though, that's the government's fault for not organizing social services more efficiently. I believe immigrants should never be excluded from social services, they are humans in society too.

However, in Canada, one problem is that because of the United States' faulty health care system, many Americans travel to Canada to seek medical services taking advantage of the free health care. This actually in turn could be weighing down Canadian's system therefore marginalizing immigrants who actually live in Canada, but also don't have proper identification.

I don't know to what extent this is an actual problem, but it's just a thought. I was thinking of the part in "Sicko" when the American woman travels to Canada and gets rejected a couple times by clinics because she didn't have proper identification which made me think of true immigrants who had moved to Canada. They shouldn't be rejected health care!

moving forward

I think one of the biggest things that struck me as I read the article is that no system is perfect. Here in the US, as we struggle with our own system, we frequently look at other systems especially ones like in the UK and Canada which have a national health system as ideals for own healthcare system to move towards, but when we do this we forget that with each system comes problems. Each country no matter what healthcare system has trouble dealing with immigrants, illegal or legal but still trying to be integrated into the new system. Many people go without healthcare, and frequently health insurance for a variety of reasons. Some people can't afford it, some people don't know how to access it, some people don't know how to apply for insurance, or maybe even how to correctly apply for a new citizenship. This shows several inherent problems. I understand that especially in today's world countries cannot support all the people that may want to immigrate into their country, but we do need to create easier more effective systems for people to attempt to apply for citizenship. There should also be a similarly easy and efficient process to apply for health insurance. Making an application so difficult to read that one needs a Master's level education to correctly fill out the form is also a type of cherry picking just like screening for chronic disease or previous injury. Second issue, I am unsure how to deal with the problem of people choosing to move into a country, and either not applying for citizenship or having applied and not received approval still choosing to stay.

Finally my most important issue is access to healthcare. People need healthcare, whether they are rich or poor, insured or not, and citizen or not. When people fall through the crack in the insurance system, in the healthcare system and even in the government system it creates a major issue. We have seen in the US that hospitals are struggling with people coming into the ER because they know they can receive healthcare there. Then the hospital is left with unpaid bills, and frequently lack the beds for other patients. Maybe a potential way to try to start working on the issue would be to create a system similar to ones in other countries which offer physicians benefits for the number of primary care patients they see, but instead offer physicians benefits for seeing the uninsured or non- citizens in their primary care clinics in exchange for dropping their fee or perhaps creating a payment plan for the patients that takes into account their financial status or potentially other ways they can pay. I believe I read a newspaper article about some physician and other professionals in the US who worked on a barter system for services. This way patients can still be seen in the appropriate healthcare facilities, and there is less chance of people sliding through the cracks.

Monday, November 2, 2009

Canada: "Universal" Health Care

This article is authored by a Canadian writer and is fundamentally about Canada's "universal health coverage" however, the author uses examples such as, "A study involving 1283 women from 10 European countries,2 for example, revealed that, compared with women born in their country of residence, foreign-born women were 3 times more likely to receive inadequate prenatal care; those without health insurance, however, were 19 times more likely."to prove the inadequacies of universal coverage in countries where immigrants and refugees are under served and under represented.

It is apparent that even in seemingly functional universal health systems such as those in Canada and the UK, there are flaws and the under served are still falling through the cracks. It was mentioned that many physicians and caretakers in Canada donate a portion of their time or do not take their fee when dealing with non insured patients. I would suggest to the Canadian government that they create some sort of program where they pay physicians a reduced fee for a few hours or ask physicians for a small amount of donated time per year at a free clinic for immigrants and refugees. The population will be triaged assuring that pregnant women and the most sick are seen in order of importance and are assured that they will not be turned away.