A twin citizen’s selection between two imperfect programs [PODCAST]

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Licensed coach Kathleen Muldoon discusses her article, “Selecting between care and nation: a twin citizen’s Independence Day reflection.” As a twin U.S. and Canadian citizen and mom to a toddler with complicated well being care wants, she explores the profound pressure of navigating two vastly totally different programs. Kathleen recounts the painful, private determination to show down a job in her native Canada after discovering its common system, whereas philosophically aligned along with her values, would seemingly fail to offer the well timed, specialised help her son requires. The dialog delves into the “quiet grief” of selecting the fragmented however fast-moving U.S. system to satisfy her son’s wants at the price of her personal well-being and a return to her homeland. Kathleen explains how this trade-off informs her work in medical humanities, highlighting how well being care programs mirror deep cultural priorities about interdependence and worthiness, and the hidden emotional prices for the caregivers who should stay inside them. The important thing takeaway is that no system is ideal, and true citizenship includes loving a rustic sufficient to call its limits and bravely holding the stress of uncomfortable selections.

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Transcript

Kevin Pho: Hello, and welcome to the present. Subscribe at KevinMD.com/podcast. At the moment we welcome again Kathleen Muldoon. She is a licensed coach and a professor of medical humanities. At the moment’s KevinMD article is “Selecting between care and nation, a twin citizen’s Independence Day reflection.” Kathleen, welcome again to the present.

Kathleen Muldoon: Thanks for having me.

Kevin Pho: All proper, so what’s your newest article about?

Kathleen Muldoon: My newest article got here collectively as I used to be sitting on this area that all of us simply went by way of as a rustic. In North America, we now have three vital shared international locations with very totally different programs of care. It simply so occurs that I’m Canadian-born, and I moved right here for grad college in 2000, so I skilled the Canadian well being care system rising up however turned of age as a medical educator, a coach, a caregiver, and a dad or mum within the U.S. system. I’m a dad or mum of a kid with important medical complexity.

Particularly this 12 months in 2025, in that point interval between Canada Day, which is July 1st, and Independence Day, July 4th, was additionally the time interval the place Medicaid cuts have been being mentioned and bounced round between the Senate and the Home. It simply actually struck me: that pressure of navigating programs that should help care. What does that imply, each for myself, as somebody who trains future well being care suppliers and who works with physicians who’re experiencing the ethical damage of the stress on the system right here within the U.S. and elsewhere, and as a caregiver myself? What does this imply that we’re eager about the place our priorities lie by way of how we help the well being of our inhabitants? That’s the place the article got here from.

Kevin Pho: All proper, so such as you, I’m a twin citizen myself. I truly grew up in Canada as nicely, however I’ve been within the States for 30-plus years, so that point interval between July 1st and July 4th, I can perceive. I nonetheless have a whole lot of household in Canada. I can perceive that liminal area, as you place it in your article, yearly between these two dates. In your article, you discuss a selection between working in Canada and dealing in america. So inform us about that story.

Kathleen Muldoon: I used to be just lately confronted with a selection about accepting a proposal for a place, which might’ve been fantastic, and truly in my hometown the place a brand new med college is being constructed. I actually wished to go. There’s a big a part of me that misses residence, being near household, and espouses these Canadian values of variety, interdependence, and group care. However what I spotted in contemplating that selection is that I deliver my complete self there, together with my household and together with my son, who has one thing like 22 well being care specialists that help his wants. I’ve ageing household, and watching them attempting to navigate the system of residence and community-based companies, which I believe I’ve turn out to be fairly an professional at managing right here for my circle of relatives, is difficult.

I needed to come to the choice. Canadians actually view our well being care system with a way of pleasure, and I believe at the same time as expats. For my son, who exists on the distinctive stage of care, a common system doesn’t at all times meet his wants. I perceive that there are some conversations about having a blended mannequin and what this implies transferring ahead in Canada. But it surely compelled me to reckon with the truth that the programs listed below are very individual-focused, and a whole lot of the care coordination falls to the dad and mom and the caregivers. I say caregivers by way of the individual managing the care, and a whole lot of instances that’s the guardian or the dad or mum with possibly some help within the U.S. from a help care coordinator.

What I used to be compelled to reckon with, and the rationale why I turned the job down, is that I don’t suppose it might be one of the best match for my household proper now. Provided that the common system is constructed for almost all, and as he exists on the distinctive stage, I simply don’t suppose that his care wants may very well be met. So I needed to make this selection. It’s nearer to my household, and I’d have extra pure helps, possibly, and a group by way of blood there. I constructed a group by way of commonality of caregiving expertise and advocacy right here. And that is, for now, what fits my household, even when my coronary heart belongs residence.

Kevin Pho: So let’s speak concerning the distinctions between the Canadian and American well being care programs. You talked about earlier that many Canadians view their well being care system with pleasure. For many who aren’t accustomed to the Canadian well being care system, simply broadly talking, why is that so?

Kathleen Muldoon: That’s a giant query. After I was first studying about Canadian historical past as I used to be rising up, experiencing it and all these issues, oftentimes we give it some thought by way of how we’re totally different and the way Canada’s been formed by being in such shut proximity to america. So there have been totally different selections that Canada made about reaching legislative independence from England and the sample of selections round dialog and peacekeeping which have formed Canadian nationalism.

Well being care is intimately tied into that. Tommy Douglas, who is among the co-founders of the common system, is, I believe, thought-about a Canadian hero. After I consider Canadian heroes, I consider Terry Fox. I consider people who did lots for bringing to nationwide consideration the best way that we look after one another and have that interdependence.

The common system in Canada espouses these values that we’re a collective society that values caring for one another throughout the life spectrum. That’s simply ingrained into all the things, from beer commercials to a whole lot of the CBC programming. So, I simply suppose it’s laborious, and I believe we’re referred to as into group to collectively check out how that is serving us and the way is it transferring us ahead, which is de facto laborious for anyone to do, however take into consideration a whole nation being referred to as into doing it.

Kevin Pho: It’s powerful.

Now, you talked about earlier that one of many determination factors was since you’re a caregiver, clearly, and your little one required—you talked about—20-plus physicians and specialists. So speak extra about that call and the way that highlights a number of the distinctions, the strengths and weaknesses, between the 2 programs.

Kathleen Muldoon: My son has important care wants, and in Canada, it’s more durable. My son is 11 years outdated now. Transferring an 11-year-old little one who didn’t develop up and accumulate these suppliers—that workforce—by way of his development to go and attempt to assemble a workforce of pediatric specialists is tough. It’s tougher to return by these pediatric specialists. It’s tough to navigate wait lists, particularly when you might have ongoing and continual situations that require preventative administration. What I noticed is that it’s tough not solely to get into the specialist but in addition to create that workforce of care, particularly if you happen to’re not in a metropolitan space. The house and community-based companies are based mostly on extra of a rehab mannequin as a substitute of ongoing care.

The distinction is that my son’s workforce right here was constructed as he grew, so I’m very comfy with the variety of the members. We even collaborate exterior of his care on some analysis initiatives and issues. However right here, particularly as it’s a state-by-state foundation how Medicaid is enacted, there is no such thing as a… Arizona has usually been ranked because the primary state for helps for folks with disabilities, and so there are not any wait lists to care. I can self-refer to specialists. His residence and community-based companies will likely be, because it stands at the moment, ongoing in help, and we shift the purpose. It’s not graduating.

For instance, my son makes use of a wheelchair and an augmentative communication machine. It’s understood that the purpose is to not get my son strolling. He’s not going to leap out of the wheelchair and begin dancing round. However how can we strengthen and use the talents that he does have for perform, for as a lot independence as he may have? That features serving to to face for transfers, having the ability to talk in a number of and different conditions together with his eye-gaze communication machine, and utilizing his head change array to drive his wheelchair on his personal.

These are all very distinctive circumstances that require ongoing help, not in magnets the place you get 5 classes and you then graduate, which has been my expertise supporting from a distance a few of my members of the family who’ve in-home care wants within the Canadian system. The distinction is that he’s in a position to get that individualized stage of care due to the shared system between our personal insurance coverage, which covers a few of that, however most of it’s truly postpone into the Medicaid system for these residence and community-based companies, which aren’t usually lined by personal insurance coverage.

Kevin Pho: So I hear that you just’re, in fact, couching these companies as a result of we don’t know what’s going to occur sooner or later. From the place you stand, inform us about how a few of these threats and cuts to Medicaid will have an effect on a few of these companies going ahead.

Kathleen Muldoon: Medicaid, I believe what folks don’t acknowledge, and what I’ve been advocating laborious for over the previous couple of months right here with our legislators in Arizona, is that Medicaid is definitely the invisible spine that retains our well being care system within the U.S. functioning. It retains the business working. It retains it funded. Even if you happen to’re not anyone who makes use of Medicaid, with out these helps, remedy clinics shut, and particular schooling departments should let workers go as a result of that’s all underwritten by Medicaid funding.

Premiums can skyrocket—and after I say premiums, I imply personal insurance coverage premiums—as a result of individuals who have been utilizing Medicaid to help residence care, oftentimes with institutional and hospital-level of care however getting it within the residence by way of Medicaid, can now not entry these companies. They go to the hospital, hospitals turn out to be overwhelmed, wait instances enhance and turn out to be unmanageable, and folks find yourself in hospitals. In order that they’re utilizing programs in ways in which they weren’t constructed for as a result of that infrastructure that all of us take without any consideration is being challenged.

A story that I’m listening to is both, “My son is so disabled, it gained’t have an effect on us,” or, “That’s not a problem I’m concerned with as a result of I don’t use Medicaid.” I believe that there’s a misunderstanding about how a lot Medicaid ties the entire system collectively. So I believe that we are going to really feel the impacts throughout the board. I say that as somebody who’s coaching well being care professionals and training folks by way of their fears about what’s to return. I say it as a caregiver and seeing how that is going to straight impression my household, however I additionally say this to this clinician viewers: You might be additionally the frontline employees of this care. If care is the core worth that we maintain, then I believe that we have to acknowledge that these programs are about to be challenged.

Kevin Pho: Do you ever really feel that you could be revisit your determination and maybe think about a switch to the Canadian system going ahead?

Kathleen Muldoon: I give it some thought usually. The factor that saved me right here is the helps that we now have been very grateful to work together with to this point. If that modifications, then I believe on the core of all of my decision-making, a whole lot of my writing, particularly in your pages, facilities on the truth that I’m authentically and holistically knowledgeable, a mom, and a caregiver, and I middle my household in all of my selections. So if one of the best care transferring ahead could be to maneuver to Canada, I’m open. If anyone’s watching, I’m open. I’m simply kidding. However sure, as a result of I believe typically we now have to decide on between our shared values, and to me, a part of that’s loving one thing sufficient to call its limits, and that features the programs that we work inside.

Kevin Pho: We regularly hear about many issues that america can be taught from Canada: the common system. Some proponents are going to be supportive of well being care being extra government-run. Are there some issues that the Canadian system can be taught from america? Basically, after contemplating all the things, you determined to remain partly due to the huge variety of help programs in your son. Does that time to some issues the Canadian system can be taught from the People?

Kathleen Muldoon: I undoubtedly suppose so. I believe that particularly as extra medical colleges are popping up in Canada, my understanding is that there must be a dialog round how are you rising these residency spots? How are you rising entry to care in order that the wait lists for preventative and ongoing care are decreased? To my information, there is no such thing as a system of, for instance, doctor assistants in Canada. I educate in an osteopathic medical college; that’s not a kind of coaching that exists in Canada on the present time. So I believe by way of the way you create area for rising the well being care workforce to lower the burden, that’s one thing to be thought-about.

However I additionally suppose one of many issues that I worth right here is that you’ve to have the ability to meet the wants of individuals, even at these extraordinary ranges of care. In every single place, as well being care has gotten higher, persons are dwelling longer, and incapacity contains outdated age. Having these help programs in place to succeed in people who want and would fare higher with in-home helps contains having higher programs of residence and community-based companies that aren’t based mostly on a rehabilitative mannequin however are based mostly on high quality of life. Palliative care comes up usually in our conversations, as does major care. What does that seem like, and the way do you help folks to maneuver into these fashions?

These are the issues that I believe are precious from the American system because it exists proper now: that there’s a partnership between personal ranges of insurance coverage and possibly… I truly learn a chunk in your web site about what a blended mannequin seems to be like and whether or not there are benefits to having personal insurance coverage, particularly for individuals who have distinctive ranges of care that may very well be shared with a government-based public system. However we now have to maneuver away from the mannequin that public well being care is sick care and extra in direction of public well being care truly supporting high quality of life. All of the analysis reveals that that is greatest occurring with pure, important help and in folks’s houses and of their households.

Kevin Pho: We’re speaking to Kathleen Muldoon. She’s a professor of medical humanities and a licensed coach. At the moment’s KevinMD article is “Selecting between care and nation, a twin citizen’s Independence Day reflection.” Kathleen, as at all times, let’s finish with some take-home messages that you just need to go away with the KevinMD viewers.

Kathleen Muldoon: What I actually need to encourage folks is: don’t be afraid of these powerful questions. To be able to actually interact with making a system higher, which to me is an expression of affection, we now have to have the ability to title its limits. For me, the large inquiries to grapple with are: What does it imply to be a part of a career the place care is at its core and the place we’re having to navigate tough selections to offer one of the best look after the people who we love? That may very well be somebody in our household, or it may very well be our sufferers. So don’t be afraid to wrestle with these questions as a result of I believe that’s the place the solutions are going to return from.

Kevin Pho: Kathleen, as at all times, thanks a lot for sharing your story and perspective, and thanks once more for coming again on the present.

Kathleen Muldoon: Thanks.