In the last installment of “Straight Talk,” I shared with you some amazing things that recently happened with my eyesight. I had cataract surgery and my ophthalmologist returned my eyes to 20/20 vision for the first time in 50 years!
As I was going through the process, astounded at how good and fast it was, I couldn’t help but wonder how other countries handle cataract surgery, which is a common medical need as people age, especially the countries with more government involvement in paying for healthcare. A model of single-payer, government-run healthcare in which the private insurance we have today would be eliminated or at least restricted is gaining popularity in polls, like this one from the Reuters. So how would a single payer health plan change the patient experience to have their eyesight restored?
Oh Canada, That’s a Long Time to Wait
Let’s start with our friends north of the border in Canada. Canadians receive healthcare through a program taxed and financed by the provincial (state) governments all over their country. Canadians then access healthcare without out-of-pocket costs for many services.
The outcomes, results and waiting times for many procedures financed by the government system are tracked by the provincial governments and interest groups like the Fraser Institute. Once I understood how each group’s data on wait times was computed, I found very little variation between them.
“So Mike, that’s interesting and all, but what if you had been in Canada instead of here on your Blue Cross plan?”
In Canada, I would have started the process of getting cataract surgery with a visit to my primary care physician. That doc would examine me and then refer me to an ophthalmologist IF he thought my cataracts were sufficiently thick and dense to interfere with my daily life. Primary care visits are pretty quick in Canada; typically just a couple of weeks to get in. Of course, if my PCP didn’t think my cataracts were bad enough, that’s where this story would end.
If referred, I would get an ophthalmologist appointment about eight to 24 weeks after the referral from my PCP, depending on which province I lived in. About 50% of Canadians assigned to an eye doc have an appointment in 11 weeks or longer after their PCP visit. At that appointment, the doc would test my eyes and IF she or she determined the cataracts were a significant barrier to my daily activities, then I would be able to schedule surgery for many weeks later.
Government-funded cataract surgery in Canada is a bit different than it is here. First of all, I would have had to wait another 12 to 44 weeks1 to get my first eye done (average was about 27 weeks). Then eight weeks later, I would get the second eye done.
The Canadian plans do NOT pay for replacement lenses that correct your vision; they simply remove the cataract. So I would have clearer vision but still be wearing the very thick glasses I went in with. If I wanted corrective lenses, I would have to pay completely out of pocket for those, as opposed to here, where Medicare and private insurance cover them.
To sum up, Canadian patients with cataracts wait up to 48 weeks from the time they make their primary care provider appointment until their surgery is complete. Or to put it another way, 11+ months. That’s 11 months where they could still fall down, read the wrong prescription label or not be able to drive – and that’s if the providers determine their eyes are bad enough to warrant the surgery in the first place. If not, they need to wait until their eyes get worse enough to be referred for surgery.
And, Canadians who do have the surgery get inferior outcomes because there is no vision correction included. But, it is totally free (besides the taxes you pay) while you are going through it.
Oh Say Can You See in the U.S.
Compare that to my experience here.
First of all, I didn’t have to go to a PCP to gate keep my eyes; I made an appointment directly with an ophthalmologist who saw me within two weeks. Two weeks after that, I had my first eye surgery; 30 days later, I had the second. Overall, from the time I made my first appointment to the complete second eye was eight weeks. And my insurance paid for the surgery AND corrective lenses, so no more glasses for me except to see within three feet.
Today, there are 146,000 people on any given day in Canada2 waiting to have their eyes cleared (not corrected) under their government-issued plan, and most will have invested nearly a year before they can see again.
God Save the Queen’s Eyesight
Ok, Mike, but what about in the U.K.? Their health system is government funded and managed too, right?
Computing the wait times in the United Kingdom for cataract surgery is a bit trickier. There are big variations in the different regions, and the National Health Service (NHS) has a “guaranteed specialist maximum waiting time” of 18 weeks. But, this goal is rarely actually reached.
In Wales, for example, in 2014, more than 50% of eye patients were waiting more than 36 weeks to see an ophthalmologist simply for their appointments, without factoring in the waiting times for the surgery. They’ve recently improved on that, but about 20% of eye patients in Wales waited more than 26 weeks to start treatment in 2017 and 2018. That was AFTER referral.
Just a few years ago (in 2016), the U.K.’s Telegraph reported on a study from the Royal National Institute of Blind People that the NHS has resorted to a “lottery” because the demand for cataract surgery had so far outstripped providers’ capacity to perform them. Wait times have ballooned to 15 months for this “nonessential” surgery. That’s a nice way of saying someone in charge was rationing the treatments out to the neediest patients.
In fact, the criteria listed in the article for deciding who needed vision surgery most included things like “how many falls they have had.” In some areas of England, those “pushed up the list” could have surgery in as little as two weeks. But, rationing is in full swing because their population, like ours, is aging and there simply aren’t enough healthcare providers or resources to provide the services through the government health plan in the needed volumes. Government-financed healthcare is also government-MANAGED healthcare, in most cases.
On a good note, cataract surgery under the NHS in the U.K. does include corrective lenses, so most folks there do not end up wearing glasses for distance vision after surgery.
As you can see, the two systems most often held up to us as potential models for America in terms of financing and managing healthcare don’t seem to be handling this critical surgery (what’s more important than your actual vision?) anywhere near as well as here.
Which brings up another question: Is cataract surgery more expensive here or there?
But What Does It All Cost?
As you know, Blue Cross negotiates rates with healthcare providers for their services. The insured rate Blue Cross came up with for my basic cataract surgery worked out to about $1,500 per eye. That’s right at $3,000 for the basic, vision-correcting surgery.
Now, full disclosure, I elected to invest more money into a special, astigmatism-correcting lens and laser surgery for one of my eyes, running that total up another $2,000, which I paid out of pocket. It was my choice to make sure I wouldn’t need glasses afterward.
The Telegraph article estimates that cataract surgery in the U.K. runs £1,000 per eye (in 2016) or roughly $2,527 U.S. in today’s dollars for two eyes. That’s actually very comparable to the rate an insurance company would negotiate on your behalf here in the U.S.
Of course, in the U.K., where healthcare is funded by a 20% tax on every transaction, the patient pays nothing when they have treatment; they simply have to wait until their number comes up. In our system, you might have a deductible or coinsurance depending on your plan and what time of year you have the surgery done, but you can have the surgery done whenever you want here in the U.S.
These are important considerations. We need to take them seriously.
So, the next time a politician starts talking about “government-run healthcare” or “single payer” or “Medicare for All,” you might want to consider how that’s going for the countries that have been at it for many years, the ones we supposedly want to MODEL our future healthcare upon. Like Canada or the U.K.
Straight Talk is I’m VERY glad I had everything done to my eyes HERE. You should be too!