One of the best things about last weekend—and there were so many—was the conversation. Scully let me crash at her cute little house, and we talked. A lot. In fact, I was a bit worried that I was boring her by the end of the weekend. But evidently not, because she kept the conversation going.
What did we talk about? There was the usual stuff you would expect: diabetes and running and bicycling; races we’ve run; people we know in common; Canada and the United States; what we do for a living; and Lisa. We also talked about India, movies, photography, food and our issues about it, English, French, Montréal, relationships, and the Ontario building code. Not to mention a whole bunch of personal stuff that we’ll just keep to ourselves, m’kay?
We spent a long time on Friday night talking about healthcare costs and insurance in the United States and Canada, who pays for what, how much things cost, how easy it is to get access to services, and so on. (I think this is the diabetic version of “How do you say in your country?” BTW, the answer in Canada is “toque.” Isn’t that precious?)
Basically, it comes down to this: In both the U.S. and Canada, it’s fairly easy to get low-out-of-pocket-cost access to doctors and basic procedures if you have insurance, but prescription medications and diabetes supplies are wicked expensive in both countries. Some drugs cost consumers/patients less in Canada, but pump and CGM supplies have much lower copays (for some of us) in the U.S.
There’s a form of rationing in Canada by limiting how much various plans will pay for, as well as by de facto waiting lists for non-emergent procedures. While in the U.S. we let our employers and insurance companies ration our care by determining how much they’re willing to pay for. In the U.S. and Canada if you have more money, you have better access to helpful things (such as CGMS and all of the test strips you need.) And in both of our countries there are slow-moving regulatory systems that keep us from having access to the most exciting self-management devices and technologies.
I’ve been thinking about all of this in the context of the on-going debate over the U.S. healthcare law, which turned two last Friday, the day that I left for Canada. Happy birthday, Affordable Care Act! Monday, as I flew back, the U.S. Supreme Court was hearing arguments about whether it would survive to its third B-day. 
Leaving aside the politics of healthcare in the U.S., one thing is clear: Taking care of our diabetes costs too damn much for what we get. No one in any country should have to make choices about whether and how to manage the basic parts of their disease based on costs. The only way we’re going to fix the healthcare crisis in the U.S. and make it possible for people with chronic illnesses in any country to afford what they need is to lower the overall cost of healthcare so that money is free to go where it’s really needed.
Let’s spend less time thinking about how we pay for things and spend more time trying to make them more affordable.
1 — I’m sympathetic to the argument that it’s Constitutionally strange to compel a citizen to buy something from a private entity. Of course, I also completely buy the argument (a) that a citizen’s failure to have insurance has a significant detrimental impact on my ability to afford my insurance, doctors, and prescriptions and (b) that everyone needs to use the healthcare system, often at times that they don’t expect. Both of these make “buying” healthcare much different than buying a car or anything else “for the common good.” Finally, as much as any other part of the core American value system, I am a firm believer that being a nation that values the rule of law is part of what has helped the U.S. become the more-or-less equal, free, and prosperous society that it is now. If the “individual mandate” portion of the law is ultimately deemed unconstitutional, I wouldn’t be grievously disappointed if the Court overturned it (even though I like it).
Obviously, the answer is more radical—and likely much more legal—than the current system of forcing people to buy private health insurance. Get rid of the ineffective system of private insurance as the primary gatekeeper to healthcare, put everybody into a single-payer system, and pay for it via federal taxes.