Landry: Two surgeries in two countries illustrate the high cost of US care

October 29, 2013 

Two friends of mine had joint-replacement surgeries this year. One is a 60-year-old retired Canadian who had a hip replaced. The other is a 61-year-old American who had to stop working because of her knee, which she had replaced.

When the Canadian government worker retired last year, he kept the health insurance he always had. His monthly premium is $58, and his former employer continues to pay it.

When the American could no longer work because of her knee, she lost her job and benefits and was all but uninsurable. Fortunately, her husband is a retired state worker, and she is covered under his policy. Her monthly premium is $630.

Both of my friends saw their primary care physicians and were directed to orthopedic surgeons. The American had a strong financial incentive to select a surgeon within her insurer’s network, and her doctor was happy to make a referral, which she accepted.

The Canadian searched the website of the College of Physicians and Surgeons and other sites that rate surgeons and chose an experienced surgeon without being limited to any network or hospital affiliation. Both the Canadian and the American were able to see their surgeons within a few weeks.

The American was given no say in the type or manufacturer of the artificial knee. Her surgeon decided for her. His choices were likely limited by the FDA, which protects domestic manufacturers that enjoy a profitable oligopoly.

The Canadian was encouraged to research replacement hips because some use metals while others use ceramics, and each has its pros and cons. There are many manufacturers, and the patient made the choice.

Both the Canadian and the American were able to schedule their operations within weeks, and both operations were in general hospitals where each patient had a private room. Both received post-operative care by way of physical therapy and follow-up visits to their surgeons, and they have recovered from their operations and gained mobility.

The Canadian had no co-pays, deductibles, co-insurance or any other out-of-pocket expense of any kind. The insurer paid for the operation and the follow-up care.

The American asked for detailed bills from all providers and was blessed with a blizzard of paper from the surgeon, hospital, anesthetist, physiotherapist and health insurer. She paid approximately $6,500 out of pocket for the surgery and continues to pay $52 co-pays for every visit to the physiotherapist.

Both of my friends got needed medical care in a timely manner, but the American did so only because she had $6,500 in the bank. Otherwise, she would have had to bear the pain while she was saving up or would have had to borrow the money. In the United States, we spend almost twice as much per capita on health care as do the Canadians, and our health outcomes mirror the experience of my two friends.

Americans with insurance and money in the bank get excellent care but are left poorer from the experience. Nearly 2 million Americans will go bankrupt this year because of unpaid medical bills. More Americans go bankrupt because of medical bills than any other type of debt.

Americans have every right to be proud of our “American Know How,” and in many ways the American way of doing things is the envy of the world.

Not so with the American way of delivering health care. Our system is bloated with inefficiencies and crushing administrative costs, and Obamacare is just another boon to insurance companies.

The Canadian health care system is known as Medicare and, in many ways, it is like our own Medicare system. Although I label myself a conservative, I have come to believe that we should expand our Medicare system until all Americans are covered and provided a level of medical care on par with the best offered in any other country.

We should not let American hubris stand in the way of doing what is right for all Americans. In order to get there, we will need politicians with backbone. I am not very optimistic.

Contributing columnist Marc Landry can be reached at

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