I am biased in this question, since I live in Canada. Let me tell you my story… which I’m afraid certain Republicans won’t like.
In late October 2008, I went to the doctor and he ordered a complete physical — lots of blood work, stool samples, the whole enchilada. A week later I went back for the results (now early November) and he went through them. Everything was fine, except my TSH levels were <0.01. This meant that my pituitary gland basically wasn’t making any TSH (a hormone). The doctor said that I needed to go to a specialist and asked me if I wanted him to contact one for me; he did say that it would probably take 4-5 weeks but since I probably had this condition a year or two, likely I could wait that long.
The next EVENING, after dinner, I get a call from the specialist. She says that she’s completely booked, but if I come in at 9:30 she will squeeze me in before her regular day started. So I went in for my appointment. Total time to see the specialist: under 2 days.
She looks at the chart and says: okay, so the way this works is your Pituitary gland makes TSH to tell your Thyroid to produce some hormones (T4 and T3, mostly). So if the Pituitary gland is making zero TSH, what’s happening is it’s essentially taking its foot “off the accelerator” and your Thyroid should slow down. Mostly likely, what’s happening is that your Thyroid is making a whole bunch of T4 without instruction from the Pituitary gland. Of course, it may also be that your Pituitary gland is out of whack, but that’s even more rare. Therefore, she ordered more tests (for T4 and T3) and told me to come back in 3 days (it might have been 2 days).
I went to the government funded clinic. There was no wait. No wait as in I didn’t even sit down. Fifteen minutes after my appointment with the specialist ended, my blood test was complete.
Two days later, I see the specialist again. She says “okay, it’s clear that you have hyperthyroidism, which is an overactive thyroid. I need to see just how overactive it is, so I need to send you to a hospital to take a thyroid test. What you need to do is not eat <list of foods> for 3 days once the hospital calls you. They’re pretty busy, so it might take 4 weeks or so. Do you want me to phone around and see who’s available first, or do you have a preference in hospitals?”. I chose for her to phone.
Two days later, I get a call from the hospital asking me if I can come in the next day. I say “sure”, but asked if there was any food or drink I need to avoid first (in the past, I’ve done tests where you can’t do things like drink anything for 24 hours first or whatever). They say “oh, yeah, we thought the doctor told you this already. It turned out I had to wait another day or two because that very night I just happened to have had sushi for dinner (the seaweed is high in iodine). Not their fault…
Anyway, 5 or 6 days after meeting the specialist I went in to drink some radioactive iodine at the appointed time and to then get scanned. I got to the hospital an hour early (and paid for 3 hours of parking at $3 per hour). I go to the front desk of the Nuclear Medicine department and they say: “Oh, you’re early. Come on in.”. Total wait time is, uh, negative one hour.
I’m out of there within half an hour or so. But I’ve paid for 3 hours of parking. I’m beginning to see how the medical system in Canada is funded. They get you to buy more hours of parking than you need. I drop off $10 with the ladies auxiliary in spite of this.
The doctor sees me a day or two later. We decide to try to slow down my thyroid using Tapazol, which is the European solution to the problem. Every week or so for the 6 or 8 weeks, I see the specialist and have a blood test. EVERY SINGLE APPOINTMENT has a wait under 15 minutes and EVERY SINGLE visit to the biomedical lab for the blood test has NO WAIT AT ALL. Well, there was one where I waited 5 minutes. But all the others were zero wait.
Twice, I get phone calls the day after my blood work, from the doctor herself, at home at about 9:30 pm for an adjustment to my medication.
The Tapazol isn’t working fast enough for her and my thyroid is actually producing MORE T4 than ever. Apparently I have a bionic thyroid, immune to the poison of Tapazol.
Think of Tapazol as being like chemotherapy… and what’s the American alternative to chemo? Right: radiation. So she decides I have to have a dose of radiation. A high enough dose that for 3 days I shouldn’t be near anybody. She sets up an appointment again with the hospital for me to have this mega dose of radioactive iodine.
I’ve had no waits so far, and decide to “test the system”. Besides, there was an article in one of the National Geographics that I wanted to read (it was about that Afghanistan girl with the incredible eyes – at my last visit I had seen this picture that referred to an even earlier National Geographic article about that girl: this article was apparently a follow up to see what had happened to her. Anyway, this time I go to the hospital well over an hour early because (a) so far I had had NO WAITING and (b) I wanted to read that article.
Just as I find the National Geographic I was looking for… I get called in. Total wait time: under 5 minutes.
You get the picture yet? No waits. No cost. A doctor phoning me at home. I could go on (and will if you like)… but how about this: It’s now March 7th and my latest blood test shows that my thyroid is STILL not slowing down very much. And I’m about to go on a 2 week cruise through the Panama Canal. So the doctor orders another blood test and simultaneously sets up an appointment for a second does of radioactive iodine at the hospital for March 10th (which just happens to be my birthday).
I have an appointment on the 9th first, though, to see how well my thyroid is absorbing iodine. This is important to do ahead of time because they need to know how much radioactive iodine to give me so that enough is absorbed by my thyroid (thereby damaging it, which will slow down it’s T4 production).
On the 10th, the specialist at the hospital says it would seem that it has to be a huge dose because there’s really not much uptake. But the note from my “normal specialist” says to wait for a call from her before proceeding. Within about 5 minutes, while they are preparing my super strong dose to kill my super duper thyroid off, the phone rings: it’s my doctor. The latest measurements say my T4 levels are now normal. The hospital specialist says “Ha! I knew I had the correct does the first time.”. I leave the hospital.
Again: no cost (other than parking). No waiting. A successful conclusion. About 3 calls at home from my doctor to modify my medication levels, my doctor calling the hospital to cancel the second dosage, going with the European method first because I’m not a fan of radiation.
Okay, then how about this: for one of my appointments, the specialist CAME TO HER OFFICE ON HER DAY OFF so that everything could be completed before my Panama cruise.
So, you see, I don’t think I can answer this question in an unbiased fashion. Our medical system may not be perfect, and for sure there are mistakes that happen. But in my personal experience it seems to work just fine. If they want to raise my taxes a bit more so that the medical system doesn’t suffer and so that the doctors and nurses (all of whom have treated me with good humor and appropriate respect for the past 53 years) are not underpaid, I’m okay with that.
But my biased answer is: A.