Back in the late 1970s my father was diagnosed with cancer. The illness eventually was the cause of his death. Before he died, however, there were a lot of medical interventions, some of which eased pain, others helped him live a bit longer. Along the way there were some very meaningful times with family and friends. One long time family friend, who was a doctor, said to me after one of his visits, “I had no idea what some of the drugs he is taking cost. I prescribe drugs every day without knowing what they cost. Frankly, the medicines that my family needs come almost entirely from free samples provided by pharmaceutical companies.”

Physicians are busy. Most are in their profession because they want to help people not because they enjoy running a business, dealing with insurance billing, keeping track of accounting, and winding their way through the increasingly complex US health care system. For profit companies that make their income from selling devices, drugs, and services to people who are facing illness have developed a wide variety of techniques to promote their businesses. One of those techniques is providing physicians with access to free samples of medications. By distributing those samples to patients, the doctors become familiar with brand names and are more likely to specify those names when writing prescriptions. I suspect that doctors, when scanning lists of possible treatments that come up on their computers tend to lean towards ones that they have previously used successfully.

I was thinking of the doctor who prescribed medications without knowledge of their costs yesterday. After a visit with my family doctor on Monday, it was recommended that I see a specialist for a condition that is not life threatening and is common with folk my age. I agreed. My doctor said to me, “I’ll send the referral in today and you can call tomorrow to make an appointment.” Later in the conversation, I mentioned that I have a trip planned for the very end of the month and the doctor said that there should be no problem seeing the specialist before my trip. I called the office of the specialist to make an appointment the next morning. They gave me the next available appointment which is for July 11.

It is important to note that my situation is a non emergency and the wait will not result in discomfort or problems for me. I am aware that when there is an emergency the health care system can respond more quickly. A little over a year ago, when I experienced a hearth arrhythmia, that same family doctor made a referral and I was seen by the cardiologist within a week and received a successful procedure with no delay. My experience this week is not the only pace at which the health care system works.

I am struck however, because I know that delays in receiving diagnosis and treatment has been one of the criticisms of the Canadian health care system. Each time health care system revisions are proposed in congress, there are critics who argue that a single payer system like the one in Canada will result in delays in health care. Living near the Canadian border I listen to Canadian radio quite a bit and I am familiar with the debates over health care in their system. One of the discussions that comes up frequently is about a shortage of doctors and nurses in the system and efforts of provincial and federal governments to address that shortage. Not long ago, participants in a radio panel were discussing delays in the Canadian health care system and one of the statements was made that there can be delays of over a month to see certain specialists. Among the specifics offered in that conversation was the same specialty to which I was referred. If I am interpreting what I’ve heard correctly, Canadians are worried about having to wait over a month for a specific type of health care. Our system, which is touted as having fewer delays in service offered me a delay over three times as long.

It is clear that neither country has a perfect system. In both countries those with access to wealth can command higher levels of care. In both countries those who can afford to travel for care can access care that is unavailable or delayed in some places. There have been temporary closures in emergency rooms in British Columbia caused by a shortage of health care workers. Obviously a closed emergency room is a significant threat to communities. There are other problems with the Canadian system that are regularly discussed on the radio.

What I know about issues of the US health care system is less complete. We have had the benefit of very high quality insurance for all of our adult lives. After we completed our educations, where we had access to first rate university health care systems, our insurance was provided by the congregations we served who purchases that insurance through a denominational program that offers excellent coverage. Now that we are retired, in addition to Medicare for which we are qualified by our age, we have a supplemental policy that is excellent. We pay those premiums, which cost thousands of dollars each year, but which we can afford due to the pension that has been provided by those same congregations.

We are fortunate. We can access the health care we need. I am well aware that there are many who don’t have that luxury. Medical bills remain a leading cause of personal bankruptcy in the United States. The high cost of access to routine health care has resulted in many waiting too long before seeking treatment resulting in increased costs. Lifesaving medications are sometimes only accessible at huge financial costs to the patients and their families. People literally choose between food and medication.

I am fortunate that despite a few delays and occasional complex issues with insurance billing codes that require patience and many phone calls to sort, we have so far negotiated the health care system without major problems. On the other hand, as we age, we will continue to increase our use of the system. For now, I don’t have any reason to complain. I wonder if that will continue in the years to come.