The Money Mustache Community
Learning, Sharing, and Teaching => Ask a Mustachian => Topic started by: dougules on August 25, 2016, 10:43:06 AM
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Canadians - I'm sure you know that government-run healthcare is a lightning-rod political topic in the US here. One thing that gets thrown around in that mix is Canadian health care. One side of our political system says it's great. The other side says Canadian healthcare is terrible with people either suffering or going south for better care. Unfortunately, it seems like nobody here is willing to brave the moose attacks and frostbite to actually ask Canadians.
So, now that you have internet up there, how is your health care? How do you think it compares with the US and the rest of the world quality-wise? Do you have any gripes? Any other comments in general? Has anybody you know gone across the border for health care? If so, why? I'd especially like to hear from anybody that's had medical issues.
Folks outside North America - Please chime in on health care in your country, too.
Folks in the US - I really would like to avoid a flame war even though I'm pretty much asking for one. Please start another thread if you want to have a discussion with other folks in the US or just get vicious in general.
PS If there was already a thread on this one, please point me to it.
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Great question! The other common refrain is "sure they don't have to pay for healthcare, but they also pay a ton in taxes so it's not really free." I'd be interested in hearing a take on this from the forum's Canadian's too. I found this: https://simpletax.ca/calculator -- do the numbers there seem about right based on your experience?
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Generally our health care is good. The physicians are well trained, the nurses are good, the facilities are decent, if you park at a hospital parking lot you will be charged an awful lot of money though.
As far as waiting goes . . . If you have an emergency condition you're seen immediately, and will get whatever tests and procedures are necessary. If you have an annoying but non life threatening condition (particularly one that needs a specialist) you might need to wait a couple months. If you go into an ER with a slight cold in December, you might be there for 12 hours before you see the doctor who will tell you to go home and drink lots of fluids.
Not everything is free. If you want a private room in a hospital you pay for it. We don't get dental, optometrist, or drug stuff for free. Our drugs are usually reasonably priced because we do negotiations to buy in bulk and get reasonable discounts.
Generally speaking, while there are some annoyances with the health care (long waits for non-life threatening problems) most people are pretty happy with what we've got . . . especially compared with the situation our southern neighbours 'enjoy'.
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As an immigrant to Canada I have been very impressed with the Canadian medical system.
I was amazed that having a baby cost me NOTHING and I had a private en-suite room that I could stay in for as long as I liked.
Since having my baby I've had a few emergency room visits (allergic reactions, croup etc) and the baby has always been seen almost instantly. I burned myself quite badly and was surprised when the emergency room doctor gave me his schedule for the next week so I could drop back in each day to see him and have the dressing changed.
With all that being said, I do think we have wait lists for surgeries like hip replacements, but my interactions with the health system so far have all been fantastic.
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It's great. I'll be the first to admit I'm a very low user of the system due to overall excellent health, but the few times I've needed it, it's been there for me. There have been two notable times:
1. When I had my tubal eight years ago. I had to wait a few months, but it wasn't exactly a dire emergency. Free, though it was a lot of work to find a doctor who would do it.
2. When I had meningitis three years ago. I was seen immediately in the ER - as soon as I started describing my symptoms, a wall opened next to me leading directly into isolation. That was pretty surprising, since it looked like as normal wall if I remember correctly (though I was delirious). I wonder what a week in an American hospital, plus a spinal tap and meningitis meds, would have cost me, even with insurance - I imagine it would have been ugly.
As far as taxes go, I don't pay a lot, at least by my interpretation. I believe last year about 6% on our gross income of ~75K.
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Fwiw, my ex husband is from Canada, and he was convinced that his grandmother (who raised him) would still be alive if it weren't for the long waits in-between tests and treatment for her health concerns.
My father in law lives in Costa Rica and described having to be held down by two huge men when he got a colonoscopy. I guess they try to save money on anesthesia? Nevertheless he sings the praises of the national health there.
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Yup. Outstanding (most of the time; horror stories definitely exist) for health crises. Having a baby; having a heart attack (or just chest pains); my MIL had a brain tumour; grandfather had an aorta rupture, etc etc. No worrying about costs, no questions about insurance, just timely, first-world care.
Chronic health conditions or not easily diagnosed non-life-threatening issues? Sigh. Long wait times to see specialists, long wait times for routine surgeries, etc. This is the area where people who can afford it will often do the medical tourism thing. They will have the diagnosis for the hip replacement or whatever, and simply decide, this is worth spending $10,000 to zip across the border or travel to Mexico and just get it dealt with.
Many employers provide what we call "extended health" benefits to get private hospital rooms, services like massage or physio, dental and optical coverage. If your employer doesn't, you can also buy this privately for a few hundred dollars a month.
In BC, our government has prioritized low income taxes (I think in our middle bracket--$35,000-75,000 income--we pay about 7.5%?), and charges user-fees for everything else, including health care premiums. So my DH and I pay $136 combined/month for our health care. This is the maximum; the premium can be reduced or is waived for those with low incomes. Employers often cover this as well (ours do).
We also have a pharmacare program here in BC that does help keep prescription costs down, and the concensus seems to be that a national pharmacare program would pay for itself quickly in savings gained by negotiating drug costs nationally instead of provincially. We'll see if that materializes at some point.
Most of us, I think it's safe to say, feel like we would still vastly prefer this system than the horror show we see in the US. And most of us think we can work within the system that we have to improve it--and lord knows there's lots to improve. There is zero political or social will to stop having a single-payer system, regardless of the myriad of ways in which single-payer systems can be tweaked to be better. We compare our system to Europe and other single-payer systems, not the US's, for the standards we should be aiming for. Unless you're rich; in which case there are definitely people in our 1% who would like the option of the healthcare available to the 1% in the US (or how they imagine it is, anyway). :)
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Our health care system is fantastic. I've been fortunate enough not to need too much care, but just the fact that I can see my doctor anytime, with any concern, and be seen fairly quickly (for free) is something I don't take for granted. I have had 2 emergency room experiences and have received excellent care there as well, and once it was established that I was truly an emergency case, I was seen right away, with no wait.
Well worth the taxes IMO. They are not exorbitant. Plus if you're FI and earning $100k as a couple in qualifying Canadian dividend income it is technically possible to pay zero taxes. I'd say for the purposes of this forum, the health care system makes mustachian early retirement in Canada much more feasible than in the US. (plus we have paid parental leave, I believe it's something like one year at 80% salary.)
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Our health care is great but not perfect. Is anyone's perfect?
There are doctor shortages, wait times etc.
Also medical is covered but not dental, eyes, orthotics (ie. back or knee brace) or prescriptions. You also pay for ambulance trips. You need private-insurance, work insurance or pay out of pocket for those. Oh IVF is not covered either, except Quebec, and I'm not sure they are still funding that.
Every province (state) deals with health care differently and there can be slight differences between areas.
Prescriptions can get expensive. I know someone who can be hospitalized and the cost is covered but if she is not admitted one shot costs $3000.
Some special and new treatments are not covered and it takes a while for those new treatments to become the standard. Those are probably the people you hear that travel to the US or mexico for treatment. Also, cosmetic surgery isn't covered, no should it be.
Generally, when me or my family has needed care we are happy. I do have a family doctor and found an OBGYN when needed. My C-section was fully covered, not my "plan" but I never had to question what things cost. Oh, yeah, I had a small private en-suite room too. My mom paid a little extra for the larger private room with the full bed for guests. I think some mid-wife costs are also covered but that really varies by area. My SIL in the US had health insurance but no birth coverage. The doc suggested an unnecessary c-section. She was fine with a natural birth, her 4th. One day in the hospital, natural birth $5000 out of pocket. The C-sec would have been $10-20K. I can't imagine a doctor up-selling. Oh wait,... I can, I go to the dentist.
I had an emergency CT scan recently after waiting about 5h in the ER, saw the Doc at the 2h mark. In a 6 month period I have been followed up by an appropriate tests and a specialist 3x & all is good.
I think mental health is very hard to deal with and I have been somewhat disappointed for some family members.
IF you can walk into the ER you don't belong there & then you may wait 12h. But there is a shortage of clinics or proper education of where most people should go for a "minor emergency" (that's an oxymoron, but you know what I mean). There is now a good web site that shows ER wait times in our area. Currently 30 min at the Children's, 1 h at the one closest to me but 3:45 at another major hospital. And we can go to any hospital. I have 11 ER choices in the greater area. Don't you have some weird thing in the states where you can only go to some hospitals? I might pick a small suburban one for stitches, but I will go to the University Hospital if its serious.
But the huge thing is I know NO ONE that has had to declare medical bankruptcy. 62% of US bankruptcies are for medical reasons.
http://www.amjmed.com/article/S0002-9343(09)00404-5/abstract
If you have a disabled child or a conic illness and can't work the extra costs would add up.
But I can't even imagine that a yearly check-up, ER visits, birth, cancer treatment, heart surgery and trauma surgery would not be covered.
No one asks to be sick. Sure there are lifestyle choices, so we tax the hell out of cigarettes and booze.
PS. I've never been critical of MMM before but if his family's health took a turn for the worse they would be welcome back in Canada. Our health care is a very big safety net for a Mustacian.
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I'm old enough to remember life before universal health care. My parents would debate whether an illness or injury was bad enough to see a doctor, because that would mean the money had to come from another necessity. I suffered with whooping cough for weeks before finally being taken to the GP. My Dad had hepatitis that went untreated for a long time, because he didn't think he could afford treatment. I never want to go back to that time again, or see anyone else in this country have to go there either. It pains me to know that many in your country forego health care because of the cost. That people lose their homes, and financial well being because of medical bills. We don't think of health care as just a commodity to be bought or sold (although it is of course). I think most of us see it as a basic human right that we're each willing to fund for the good of us all.
The wait times are sometime atrocious. Hip replacement and cataract surgery are two that I hear about often. Depending on your province, mental health care is full of cracks and holes. Doctor shortages are often the result of short sighted politicians, who reduce spaces in medical schools, and then wonder why we have no doctors. The province I live in is still recovering from decisions made decades ago. But as people said already, when you have an emergency, we are all so glad to whip out our health cards, and know that things will be taken care of. My sister shattered her ankle a couple of years ago. It required orthopedic surgery, physical therapy, days in the hospital, etc. Her bill? I think a few bucks for the rental of a wheel chair for a few weeks. Her wait time in emerg? Zero. She was in having x-rays within moments of arriving. My Dad had lung cancer. Surgery, radiation, chemotherapy, home visits by nurses for wound dressing, prescriptions for ointments, pain killers....... The list goes on and on. His costs? $2.11 per prescription. That's it. He received absolutely stellar care.
I look at the discussions Americans have about which health plan to choose, how much it costs, what the restrictions are, what the copays are, can they afford the costs and still retire, and it makes my head hurt. I don't personally know any Canadian that would give up what we have, warts and all. We all want improvements to the weaknesses, but in the meantime, what we have is pretty good.
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I'm a Canadian ex-pat living in the US. I did a fairly crude calculation a while back and I pay more for health care than I would through my Canadian taxes (and have a lot more angst about what's covered, what's not, etc), but my tax rate overall is lower because I live in a state without income tax and have more deductions (mortgage interest, in particular). My family is still in Canada and can speak to the triaged care. My mother's knee replacement surgery was post-poned 4 times (but still free), but when my cousin found a lump in her breast she received a biopsy the next day.
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My experience as a healthy middle-aged woman has been pretty good. I've only ever lived in Canada so have nothing to compare our health care system to.
I pay $75.00 a month for medical care and this, so far, has covered every doctor visit, specialist visit etc. I had the same family doctor/g.p. for 23 years until she retired last December. It took a little bit of doing to find a new family doctor. In between, I went to a walk-in clinic that I actually really liked. Prescriptions, dental care, physiotherapy and counseling are not covered under the medical care premium. However, through my husband's work we have decent coverage for prescriptions and dental care.
When my parents have had medical problems, they have been happy with the system. Last year both of them had cataract surgery and my mom broke a bone in her ankle. So a few hospital visits there. It seemed efficient and decent to me as an observer since I often took them to their appointments and to the emergency room when my mom broke a bone.
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I've moved around a lot but I've been in my current location for 10 years now. I can't remember the last time I've had a family doctor, I just go to clinics. If you go to a clinic after 5 there may be less doctors around but also way less patients. I don't know if it's because people are skipping work or what. I've booked a general check up at a clinic, they make you go to other places for a cardiogram and blood work but it was all free.
I've been to the emergency room at the local hospital a few times, the longest I waited was an hour and a half. I know people complain about wait times but if you aren't dying you have no business in a hospital. The only reason why I was there was because my girlfriend thought I should "get it checked out" right away. I've noticed in emergency rooms that if you are there early Sunday morning 6-7 no other patients are around. It seems strange that people show up during business hours only, I think it might demonstrate that most people go for non pressing reasons.
We pay a lot of taxes but we don't worry about what's covered and what isn't (too much). It seems all the threads about the US system are full of Americans contradicting themselves on how the system works - PPO, HMO, ACA, BLKFFKSJDJADJ these threads are insane. I bet if you added up what you guys pay in insurance versus what we pay in taxes you guys lose.
I find it hilarious that anyone would think health insurers are looking after your best interests. I remember reading an article about phantom Doctors. Before going into surgery you have to make sure everyone and everything including the air ducts and janitor are "in network". Then while you are knocked out another Doctor sneaks in and holds up an IV and six months later you get a bill for 140k?? WTF!!? Argh can't find the article!
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I feel blessed to live in Canada with its amazing heath care. Yes, it can take months to see a specialist and they are physician shortages. People do not go bankrupt when there is a health emergency. The medical staff are well trained with excellent hospitals.
I also would like to mention that are prescription drugs are much more affordable than the States. A couple of years ago, I was researching a drug I was prescribed by my GP. Many of the reviews that I read, stated how expensive it was in the States and I was surprised to learn that info. In Canada, I was paid $12/month and went to look at the cost in America and it was 90+/month. I was dumbfounded.
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I've had four surgeries in the last three years (hopefully no more for a looong time, knock on wood). I am, in fact, presently at home recovering from the last minor one which they just did this morning. I think the quality of care throughout has been excellent, and I haven't had to worry about costs at all. Drugs can get expensive but there are some programs to help with that if you need it (I do hope that setup can be improved, maybe by means of a national pharmacare program as mentioned earlier in the thread. Here in Alberta there is a provincially subsidized Blue Cross insurance program you can get into if you're underinsured for drug coverage and you're diagnosed with a serious illness - you pay something like $50/month for it, regardless of your condition).
Many provinces do have health insurance premiums that you pay to the province (we don't in Alberta), but the premiums are pegged to your income level, and are capped at a pretty affordable amount...when I lived in BC several years ago, my income was high enough to pay the full premium, and it was < $60/month for a single person at that time. Some employers pay those premiums as part of your benefits, and lots of employers also have group insurance for the stuff not covered by the province, like dental care etc.
You can go to a walk-in clinic and be seen by a doctor the same day for non-emergency concerns. You may have to wait some hours depending on how busy they are. Ditto for the emergency room waiting; it just depends. I have done this several times and never had any complaints. I mean...I don't mind waiting if it's not an emergency, and if it really *is* an emergency, you'll be seen right away.
You can choose your own family doctor, but depending on where you live, it's not always easy to find one with openings (especially if you hold out for someone you have a rapport with, as I did, and don't want to go with the one dude who always has openings because people don't like him). However, there are always the walk-in clinics. Even if you do have a family doctor you might end up going to the clinic if you want to see someone that same day (amusingly, the last time I did this, it WAS my family doctor I saw at the local clinic, because it was her day to work there!) No cost for the walk-in clinic of course.
I keep saying "province" because health care is a provincial responsibility; there isn't really any such thing as a national health care system here (like the Brits have). I think the system is pretty good in every province, but some things vary between jurisdictions. There's a HealthLink number in Alberta that you can dial at any time of day or night to talk to a nurse - great if you have a question that isn't serious enough (or you don't know if it's serious enough) to go see a doctor about. A lot of provinces (maybe all?) probably have something like that. I called in once and the nurse was very helpful.
It is not perfect. But even though I've never lived somewhere that didn't have a system like this, I am completely convinced it is much better than having a privatized system. Every country in the world rations health care to their population in one way or another - by wait times, ability to pay, or both. I'd so much rather have a system where people are triaged and prioritized by actual medical need than by bank account. I'm pretty sure most of my fellow Canadians feel the same way.
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...and you don't even always have to pay for parking. For today's surgery, because it was more minor, my surgeon did it at a small town hospital he also works at; no parking meters. Free hospital parking totally exists outside the cities. :)
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Great question! The other common refrain is "sure they don't have to pay for healthcare, but they also pay a ton in taxes so it's not really free." I'd be interested in hearing a take on this from the forum's Canadian's too. I found this: https://simpletax.ca/calculator -- do the numbers there seem about right based on your experience?
And yeah, that's a good site. I actually use that same site to submit my tax return every year, and it does a great job.
I have the impression that personal income tax rates are mostly pretty similar between Canada and the U.S., but then we have a much lower level of military funding. We might have higher marginal rates on high income earners too, but I'm never going to reach those stratospheric levels, so I don't really care. ;)
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Don't mean to hijack the thread, but I'm interested in knowing the answers to the following questions.
1. If you pay more taxes because you have a high paying job, do you get better health benefits?
2. Is the real cost of care in Canada different from that of the US?
3. Do the rich and the poor feel the same way about public health care in Canada, or are they divided?
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If you use the normal universal system all Canadians should get the same level of care. However, private clinics are popping up for things like MRIs, cataract removal. If you find the wait time for non life threatening health concerns come up and an MRI is needed you could get it done at a private clinic. If you are homeless and suffer a heart attack you will get the same level of healthcare as anyone else at that same hospital. It's possible poorer areas have "lesser" hospitals.
Being your own advocate also helps, if you are aggressive or have someone be your advocate with Doctors that definitely helps, however I'm sure this helps in the US as well.
Drugs are not covered, but I believe provinces may have plans in place for those on poverty level incomes. You can of course buy private drug insurance. Any drugs provided while in the hospital are covered.
Is real cost different? It seems to cost twice as much per capita in the US than in Canada: https://en.wikipedia.org/wiki/List_of_countries_by_total_health_expenditure_per_capita (https://en.wikipedia.org/wiki/List_of_countries_by_total_health_expenditure_per_capita)
As for question three, I think the "feeling" is that many of the rich would like to jump the queue for certain things or allow more private enterprise in areas such as hip and joint replacement. I'm not sure a generalization on how the rich or poor feel about universal health care in Canada is possible. My girlfriend and I make over 250k a year and believe in the Universal health care system, I think I'm filthy rich. Do other plus 250K couples feel the same way? Not sure. I'm not aware of any opinion research done on the subject.
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I agree with pretty much everything that has been said. I feel very lucky to live in Canada where healthcare is universal, not free. We pay for it through taxes. And everyone receives the same level of care.
Three years ago I had an apples to apples comparison of the U.S. and Canadian healthcare systems. My husband had a stroke while we were in Las Vegas. I was required to pay $1500 in the E.R. even though we had private insurance. (Our universal healthcare does not cover us in other countries.) I'm not sure what would have happened if we didn't have the means to pay the $1500. Anyway, the care in LV was superb, state of the art even. He was in ICU and had a private nurse. Every time she, or anyone entered the room they brought a computer with a scanner and scanned his wristband and whatever medication they were giving him. The hospital seemed very empty, almost deserted, but that may have been because it was over American Thanksgiving. The total cost for one week in the ICU and private air ambulance back to Canada was about $200,000. Word of warning to fellow Canucks, never leave the country without insurance.
When we arrived back in Canada he was taken immediately to the ICU in our hospital. The hospital was much more crowded and seemed a little run-down compared to the one we had just left in LV. But the care was still very good. He was supposed to have his own nurse, but it seemed like several of them would go on breaks at the same time, leaving the others to cover, so I was often hunting someone down when he needed something. Of course there was no scanning of the wristband, or anything like that. The only cost I had was for parking, as others have mentioned, and it actually wasn't that much. He was only allowed two visitors at a time, and everyone had to leave for an hour during shift change, which was really annoying.
Overall, both hospitals were very good, but I felt that the U.S. one was a bit better, but of course that comes at a premium. And you have to remember that it is a business. One of the doctors who treated him in LV didn't file through the insurance company for some reason and sicked a collection agency on me. I just told them to call the insurance company. It's not my fault they didn't submit the claim. But that just shows how each doctor is running a business.
I think having universal healthcare just removes some of the stress of getting sick or injured. It never even crosses my mind how much something costs, or if it is covered, or if the insurance company is going to deny my claim. Personally, I wish it covered more, like dental, vision, prescriptions, physiotherapy, but I guess there are limits as to what the system can handle, and how much people are willing to pay in taxes.
As an aside, our healthcare here in Alberta is now covering bariatric surgery.
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There is definitely provincial variation. So far in Alberta it's been way better than in Manitoba. It's really hard to get a new doctor in Manitoba but in Alberta it seems there are many doctors accepting new patients. I had three doctor visits recently and I was seen as a walk-in immediately and was always the only one in the waiting room. In Manitoba the walk-in wait was minimum 2 hours.
And in Alberta you have the option to pay for private services, but no such option in Manitoba for most services.
I'm overall very happy with our healthcare system. My income isn't that high so my taxes are quite reasonable. Sometimes it's hard to get a diagnosis but I'm sure that happens everywhere.
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Is real cost different? It seems to cost twice as much per capita in the US than in Canada: https://en.wikipedia.org/wiki/List_of_countries_by_total_health_expenditure_per_capita (https://en.wikipedia.org/wiki/List_of_countries_by_total_health_expenditure_per_capita)
As for question three, I think the "feeling" is that many of the rich would like to jump the queue for certain things or allow more private enterprise in areas such as hip and joint replacement. I'm not sure a generalization on how the rich or poor feel about universal health care in Canada is possible. My girlfriend and I make over 250k a year and believe in the Universal health care system, I think I'm filthy rich. Do other plus 250K couples feel the same way? Not sure. I'm not aware of any opinion research done on the subject.
Yeah, Americans pay more for worse health outcomes, in aggregate. But all those private profits (and the staff to sort out what sounds like a very complicated billing structure) have to be paid for somehow.
I don't get the sense that we have any major social division between rich and poor about whether we should have publicly funded health care. It has very strong public support, and (though I haven't seen data on this either), I think that holds true across all socioeconomic classes. It's not unanimously supported, but what is? It's strongly supported enough that I don't think it would be politically possible to eliminate it.
I was born after universal health care was introduced; I have no memory of it being any other way. Things like American billboards advertising hospitals blow my mind every time I see them. It just seems wrong for this to be commercialized. I think that's not an unusual reaction for my generation. (Just trying to give you an idea of how deeply the cultural support runs.)
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Great question and topic. Thank you to all who have shared.
There are about 36 million people in Canada. If they all reply as positive as those so far, does anyone think it will make any difference in the U.S.?
Are there really 0 horrible experiences in MMM'land?
I hosted a friend from Ireland for an afternoon last week. I asked him what he thought about his healthcare. He thought it was ok, but getting better. Sorry I do not have more to contribute to the thread.
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Don't mean to hijack the thread, but I'm interested in knowing the answers to the following questions.
1. If you pay more taxes because you have a high paying job, do you get better health benefits?
2. Is the real cost of care in Canada different from that of the US?
3. Do the rich and the poor feel the same way about public health care in Canada, or are they divided?
Just wanted to respond to the first question. Although it's true that we "pay for health care through our taxes", it's not a direct relationship. Our provinces set our tax rates on a whole variety of issues; all the taxes end up in general revenues, and health care is paid out of that. Even here, where we do pay a specific health premium, the money that's collected goes into general revenues. And although health care is a provincial responsibility, it is regulated at the broadest level by the federal government (with a policy that really just says that the provinces have to provide a universal system, doesn't specify any rules, AFAIK) and the feds do transfer $ to the provinces specifically for health care (which of course comes out of our federal taxes, but again, just from general revenues).
So while it's generally true that higher paying jobs have better health plans, this is because of the extended health plans that employers and/or employees pay for through private insurers. There is no difference in the care received by rich and poor, employed or unemployed, as long as it's accessed through the universal system. However there can be large discrepancies experienced between those who have good extra benefits, or who can afford to pay out of pocket to speed up particular procedures (as already mentioned).
I think the difference in care experienced between rich and poor is more about the kind of prejudice that exists on the part of health care providers. There have been terrible stories for years (outlier stories, but still) of the homeless person who goes to the hospital, is assumed to be drunk and/or high, so is pushed to the back of the line and not taken seriously, and who dies in the emerg waiting room of a serious health issue. Happens to first nations patients occasionally too. Horrifying. But not so much about the health care system as our society generally. :( Ditto that the really poor who don't have extended health benefits can really suffer for lack of dental care or eye care, or mental health services. There are non-profit groups that help with this, but it's a real problem.
Again, though, I have a hard time believing that those sorts of cracks in the system/prejudices don't happen in the US as well?
Rich or poor can all walk into a clinic or the emergency room and get good quality care, without worrying about the cost.
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Don't mean to hijack the thread, but I'm interested in knowing the answers to the following questions.
1. If you pay more taxes because you have a high paying job, do you get better health benefits?
No, the only thing you may be able to pay for is a private room or better after care like physio, etc.
2. Is the real cost of care in Canada different from that of the US?
I think our Dr are paid less but they also pay less in liability insurance.
I know different fees are negotiated for Rx and implants. I've heard Italy pays very little for implants so companies don't like marketing there.
3. Do the rich and the poor feel the same way about public health care in Canada, or are they divided?
I think we are all pretty happy.
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I've had a few times where I needed to rely heavily on the health care system in Canada. Once, I had an emergency room misdiagnosis that almost let me die. This was Doctor error, and could have happened anywhere though, IMO. 2 days later, when I went back, I was nestled in the bosom of the system until I was well again, including surgeries, medications, care and consults with 3-4 top specialists, round the clock care for a couple of weeks and follow up care at home for months.
It also resulted in follow up surgeries, one of which I had to wait a god-awful long time for, but it was rather low priority (just intermittant pain when I tried to do certain activities).
We've had too many other encounters with the system - wife giving birth twice (including scary Helpp syndrome for the first), chest pains, scares with the kids, etc.
Overall, I give it an A-. It feels unbelievably good to have a top-notch system full of caring people to depend on during times of crisis. It's not perfect, but it's darn excellent, and I live in one of the poorer provinces.
I can't imagine what it's like to have to add financial and administrative worries on top of dealing with a serious health issue. Personally, I think there's a role for the private sector in the system, including possibly a bigger one in Canada, but at the core I want doctors making decisions about my health based on need and not cost (within the affordable limits of our society).
The one thing I find absolutely striking that no one here has mentioned yet is simply how much more efficient the system is overall than the private one in the US. Cost vs outcomes aren't even close, from what I understand. From what I can tell, it's because the US system is so grossly inefficient in its administration - lawyers and doctors and administrators fighting over who pays for what, and administrations inflating treatments required to increase revenues. Also, people have to have a huge amount of personal knowledge about health care plans and legal nuances that ties up a lot of mental energy that would be put to better use understanding their health issues and taking care of themselves.
Also, I fundamentally disagree with the notion that someone's life/health is more valuable simply because they have more money - all people deserve equal access to health care, because we're all people. Some of the best people I've known in my life don't have 2 cents to rub together (mostly because they were generous to a fault). I've also met too many scuzzy rich folks. I don't profess to be in any way qualified to judge who should get better health care - but I know how much money you have in the bank is a ridiculous comparison - so I want everyone to have equal access.
I wouldn't even consider the thought about trading our system for anything that I've learned about in the US. I'd (eagerly) look at other countries that have universal health care to see if there's better ways of implementing ours, but not to get rid of it entirely, or to change it so the rich can get preferred access.
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A bunch of us have no doctor.
My child will wait a year for a specialist appointment, and can then have one once a year after that.
Neuro-care is shit.
The hospital emergency room did absolutely nothing when I had a severe injury, was left to figure it out myself, have a month of bed rest, and spend over $1000 doing so.
I'm glad they kept my kid alive, but was stunned and angry when I learned that hospital is behind parts of Mexico for preemie care.
I have had two excellent doctors. One died, the other I drive nine hours to see.
I've started using private care where it's an option.
Can I ask what the nature of your specialist appointment for your child is, and what province you're in? What was the severe injury that the ER didn't treat when you went in? What exactly was your concern with the care for your premature child?
Your uniformly poor experience is different from that of most people I know, I'd be interested in getting more specific details of the problems.
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When my husband and young son and I visited Quebec about 13-14 years ago (we are US citizens), my son became ill and we took him to an urgent care walk in clinic. We had to wait about 20 minutes to be seen. Afterwards, the clinic staff apologized profusely that they had to charge us about $20 since we weren't from Quebec. I had to laugh- even with our insurance, an urgent care clinic visit in the US would have required at least a $100 co-pay. We also had to pay about $20 for his prescription.
Thanks kind Canadians!
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One other big question, what do Canadian doctors and nurses think of the differences of working in Canada vs the US? That's the other side of the equation. Any Canadian medical types on here?
-Because of a doctor shortage I haven't been able to switch doctors, even though I'm dissatisfied with mine. (I don't think this would happen in the US, for a bunch of slightly off-topic reasons)
I haven't switched doctors in a while, but I think that's also becoming an issue in the US. From what I hear a lot of doctors are getting pickier about what insurance they take. A lot of them aren't accepting new patients either.
I have gotten medical care in the US and in Mexico, and I encountered emergency room waits in both places, with the added insult of having the visit cost money.
Emergency room waits can be pretty bad here, too. I've personally waited like 4 hours. You probably would get seen sooner if your issues were very serious.
Did you just happen to be in the US when you needed medical care, or did you specifically go to the US for health reasons?
Fwiw, my ex husband is from Canada, and he was convinced that his grandmother (who raised him) would still be alive if it weren't for the long waits in-between tests and treatment for her health concerns.
It sounds like the only serious gripe is wait times. And that sounds like that's only for things that aren't (or don't appear to be) life threatening. I guess wait times will sometimes make people fall through the cracks if something benign looking turns out to be serious.
It sounds like y'all are about 90% happy about your situation, though.
Any theories on why wait times are worse in Canada? Or are they? I don't think believe that's an issue here, but I don't know for sure. Is there possibly some other trade-off we're making for less of a wait? Cost?
I think mental health is very hard to deal with and I have been somewhat disappointed for some family members.
Mental health is no cakewalk in the US either. Here in Alabama one insurer has a near monopoly on health insurance. Until a few years ago they only covered two psychiatrist in the whole state. The company I worked for happened to be headquartered in New Jersey. They used the same insurance company, but they had a NJ-based plan that covered a lot more psychiatrists including mine. I still had a big annoyance because the claims had to be filed through the Alabama division of the insurer. I had to call multiple times to spell out the fact that I had a NJ-based plan. Fortunately that all changed before I signed on with a company headquartered here.
But the huge thing is I know NO ONE that has had to declare medical bankruptcy. 62% of US bankruptcies are for medical reasons.
http://www.amjmed.com/article/S0002-9343(09)00404-5/abstract
If you have a disabled child or a conic illness and can't work the extra costs would add up.
But I can't even imagine that a yearly check-up, ER visits, birth, cancer treatment, heart surgery and trauma surgery would not be covered.
No one asks to be sick. Sure there are lifestyle choices, so we tax the hell out of cigarettes and booze.
PS. I've never been critical of MMM before but if his family's health took a turn for the worse they would be welcome back in Canada. Our health care is a very big safety net for a Mustacian.
Yes medical bankruptcy is a huge issue that a lot of people here just seem to accept as a fact of life. I'm a little skeptical of MMM's take on budgeting for US health care, especially given regular psychiatrist visits for my prescription. A chronic condition could be way worse on the budget than a big short term problem if you have catastrophic coverage with a big deductible. MMM doesn't have to really worry about it since he could go back to Canada if the SHTF. I guess there's always Mexico for me.
Word of warning to fellow Canucks, never leave the country without insurance.
+1 Being in the US without some kind of medical insurance is playing the lottery in a bad way. What can Canadians do for insurance if they just want to take a daytrip to the US? I'm guessing a lot take a big financial risk they're not really thinking about?
A bunch of us have no doctor.
My child will wait a year for a specialist appointment, and can then have one once a year after that.
Neuro-care is shit.
The hospital emergency room did absolutely nothing when I had a severe injury, was left to figure it out myself, have a month of bed rest, and spend over $1000 doing so.
I'm glad they kept my kid alive, but was stunned and angry when I learned that hospital is behind parts of Mexico for preemie care.
I have had two excellent doctors. One died, the other I drive nine hours to see.
I've started using private care where it's an option.
What part of Canada are you in if you don't mind my asking? US medical care is probably pretty crappy too if you're way way out in the sticks.
Wow. Long Post.
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Canadian Health Care worker here
Is our system perfect? No.
Wait times are longer, but thats because fewer people are being left out.
We also have a very aging population making high demands on the system. Every tom dick and harry can access a doctor. It might take a while, but it is possible.
And more people are having more complicated health problems every year.
And because everyone has easy and mostly free access to the system some do abuse it. Its unfortunate but there are only so many resources to go around.
For example a day in the Intensive Care Unit for one person is $5000-8000. its a lot of money to keep very sick people alive
Ive been sick and had to wait weeks and months for MRI scans, and later orthopedic surgery. But it got done and now i'm healthy with out huge medical bills.
I didn't loose my house or my job over it.
I wish we had some private parts to the system, such as scans and simple testing. it would ease the back log because the people that are able to afford it and feel urgent enough could pay, leaving room for more other people to use the free resources.
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We know our systems have issues but go to private health care? No way. Small places tend to have fewer resources but people get transferred to nearby cites if necessary. I had been depending on walk-in clinics but when a new doctor arrived I got on her client list. In the last few months I have had my first appointment with her, had my tetanus and pneumococcal vaccinations (I will have to pay if I decide to get the shingles vaccine, it is not covered, but my private insurance will probably pay for most or all of it), my pap smear and mammogram, knee x-rays, blood work and some minor surgery, a followup visit with my doctor, and have another appointment in November for more followup. My total cost has been $4 for parking. I had the knee X-rays same hospital and time as the mammogram, and then just walked across the street for the blood sample. A few years ago I would have said our local hospital was not very good, but there has been a lot of effort lately to improve it, and I was pleasantly surprised how well and professionally done everything has been this summer.
On a broader scale, I have had friends and relatives with all sorts of major health issues, and they were handled well and promptly. I am talking heart valve replacement, kidney transplant, knee and hip replacements, lung transplant, breast cancer surgery level of care. All covered by Ontario and Quebec health insurance plans.
People get private health insurance to cover the things the provincial plans don't cover. When I was retiring I had my choice of decent low-cost insurance through my previous workplace (my union had arranged a group policy for its members who retired), alumni associations, and Costco.
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Our health care system is not perfect, but it is pretty good. I do believe this is a government responsibility that should be funded by taxpayers. I pay a lot of taxes and get no better services than a low income user and I'm fine with this. I am more than willing to pay towards a system that supports good health outcomes for the entire society by removing financial barriers.
I think triage is a good way to explain what happens with medical care here. Urgent conditions tend to get seen quickly. From personal family experience, cancer surgery/treatment is swift and fantastic and free.
We have annual limits on prescription fees for covered drugs - the remainder is subsidized.
There are long wait times for non-urgent and elective surgeries. Finding a family doctor is difficult in many places due to shortages. Walk-in clinics tend to back stop this gap.
Regular dental care is not covered and mental health services are only in some situations.
My husband's employer provides extended medical coverage so we are also covered for dental, physio, counselling, acupuncture etc. The cost to the employer is about $300/month for the entire family.
I can't tell you how grateful I am not to have had the stress of wondering how to cover unexpected medical bills ever in my life.
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When my husband and young son and I visited Quebec about 13-14 years ago (we are US citizens), my son became ill and we took him to an urgent care walk in clinic. We had to wait about 20 minutes to be seen. Afterwards, the clinic staff apologized profusely that they had to charge us about $20 since we weren't from Quebec. I had to laugh- even with our insurance, an urgent care clinic visit in the US would have required at least a $100 co-pay. We also had to pay about $20 for his prescription.
Thanks kind Canadians!
This was my American boyfriend's experience too. He had an emergency eye problem on a Saturday, got an appointment that afternoon. The apologized for charging him $50 because he wasn't from Alberta, diagnosed the problem and gave him a $30 prescription. They also told him to come back Monday and they wouldn't charge him anything for a checkup. He went back to the US the next day, had a final checkup there later that week which cost him over $100 iirc.
I'm quite healthy and have no chronic health problems and am always amazed at the speed at which we receive health care here. Like everyone else said, if it's urgent, you get care fast. If not, you may wait.
My opinion may be a little skewed due to the fantastic employer coverage I have in addition to universal coverage.
I only know one person who has gone to Mexico for faster and cheaper dental surgery. The people I know, rich or poor, wouldn't trade our system for the US system.
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A bunch of us have no doctor.
My child will wait a year for a specialist appointment, and can then have one once a year after that.
Neuro-care is shit.
The hospital emergency room did absolutely nothing when I had a severe injury, was left to figure it out myself, have a month of bed rest, and spend over $1000 doing so.
I'm glad they kept my kid alive, but was stunned and angry when I learned that hospital is behind parts of Mexico for preemie care.
I have had two excellent doctors. One died, the other I drive nine hours to see.
I've started using private care where it's an option.
I had the impressin that private pay physician services are not allowd in Canada. Am
I wromg? Or was that some province by province thing?
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>Others have to get a doctor's note, after they've recovered, saying they had a cold on a given day thus could not be at work.
My understanding is that this is not a requirement of the medical system at all, but may be required by your employer when you are absent.
I'm glad you've been able to advocate and get to a good level of knowledge. My family and I haven't had your experience with the medical system, although we have experienced misdiagnosis and this is frustrating - and waits for non-urgent care. I agree that a good family doctor can be really helpful and they are hard to find.
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A bunch of us have no doctor.
My child will wait a year for a specialist appointment, and can then have one once a year after that.
Neuro-care is shit.
The hospital emergency room did absolutely nothing when I had a severe injury, was left to figure it out myself, have a month of bed rest, and spend over $1000 doing so.
I'm glad they kept my kid alive, but was stunned and angry when I learned that hospital is behind parts of Mexico for preemie care.
I have had two excellent doctors. One died, the other I drive nine hours to see.
I've started using private care where it's an option.
I had the impressin that private pay physician services are not allowd in Canada. Am
I wromg? Or was that some province by province thing?
Yes, it's province by province. Here I can pay for my own MRI, not in my last province and I've always had the option to go to some associated services (physiotherapist in my situation usually) and just pay myself- skip the doctor altogether. In the Northwest Territories eye exams were also covered under provincial health care, but in other places are usually pay for self or under an extended health care insurance plan.
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I've started using private care where it's an option.
I had the impressin that private pay physician services are not allowd in Canada. Am
I wromg? Or was that some province by province thing?
You are not wrong; there are no private pay physician services (although the occasional private clinic has tested those boundaries in various ways). However, there are lots of other kinds of private services: alternative therapies, naturopaths, etc and many services are "subcontracted": private service providers contract to the government, who covers our costs to them. So MRIs, blood work, prosthetics, etc, etc--anything that's not primary care--are all done by private companies. When you are referred there by your GP, all payment is done by the health system. However it's also often possible to pay directly for their services without going through your GP or the health system. This may be true for other specialists, too? I'm not sure. I think this is what Scrubby was referring to, though; that she now prefers to stay outside the health system and go directly to the services she wants herself and pay out of pocket. You can't do this for emergency care or primary care, though. You can't walk into a hospital and pay for services (although as others have described, if you're not a resident, you may be charged a nominal fee).
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When we travel we need seperate insurance.
I have never had to use it but I am afraid of the loopholes if I did.
I have 15 days covered if I book my flights with my travel card. I reciently added 2 more weeks for my family for less than $100.
They are actually quite good about it & you can be on day 10 (prob even 15) of your trip & call to add the coverage.
There are often horror stories of pre-mature babies being born or a more recient one where a trip delay went over the 15 days of coverage, the husband got sick on day 16 & stuck with a big bill.
They also deny for pre-existing conditions. So what if you have had 2 minor health things in the past, get them checked & everything is "fine". No ongoing treatment. So now do you have a pre-existing condition?
A friend had a mild heart attach in his 40s. Is he screwed from traveling now?
Travel health insurance horror stories give us a taste of how good it is in Canada.
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>Others have to get a doctor's note, after they've recovered, saying they had a cold on a given day thus could not be at work.
My understanding is that this is not a requirement of the medical system at all, but may be required by your employer when you are absent.
A plain reading of scrubbyfish's post reveals that she was clearly not under the impression that "the medical system" requires employers to mandate notes from doctors. Her actual complaint, with which you did not engage, was that the medical system "allows" employers to condition sick days on obtaining a note from a doctor, which (according to her) is a drain on the resources of the public. Since provincial legislatures have the power to regulate contracts between employers and employees (see, e.g., Canada (Attorney General) v. Ontario (Attorney General), [1937] UKPC 7 (http://www.bailii.org/uk/cases/UKPC/1937/1937_7.pdf) at *2, aff'g [1936] SCR 427, 1936 CanLII 30 (https://www.canlii.org/en/ca/scc/doc/1936/1936canlii30/1936canlii30.html)), it is arguably fair to lay the blame for scrubbyfish's complaint, as she does, on "the medical system" insofar as it is presumably within the power of the provincial legislatures to require employers to offer employees a certain number of sick days per year, where a "sick day" is defined as a day of absence where no notice is given by the employee, and where an employee is not required to provide any documentary evidence in support of the absence or the lack of notice therefor, other than an assertion that he or she was sick. The fact that provincial legislatures have not enacted such a provision into law could arguably be construed as a failing of "the medical system". I offer no view on the the merits of this legislative proposal, other than to observe that you did not read scrubbyfish's post fairly.
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Pretty good. I'd say it's generally as good as the NHS was before I left the UK, except: dental and vision isn't covered.
I mean, I know teeth and eyes are optional extras, but still!
In the UK an eye exam was about $50, and dental for one set of treatments was capped at about $90 iirc. That was nearly a decade ago, and I believe things have declined somewhat since then.
Edit: this is Ontario. There is an additional healthcare tax, too.
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A bunch of us have no doctor.
My child will wait a year for a specialist appointment, and can then have one once a year after that.
Neuro-care is shit.
The hospital emergency room did absolutely nothing when I had a severe injury, was left to figure it out myself, have a month of bed rest, and spend over $1000 doing so.
I'm glad they kept my kid alive, but was stunned and angry when I learned that hospital is behind parts of Mexico for preemie care.
I have had two excellent doctors. One died, the other I drive nine hours to see.
I've started using private care where it's an option.
Can I ask what the nature of your specialist appointment for your child is, and what province you're in? What was the severe injury that the ER didn't treat when you went in? What exactly was your concern with the care for your premature child?
Your uniformly poor experience is different from that of most people I know, I'd be interested in getting more specific details of the problems.
The original scrubbyfish post is gone, which so far was he only full negative post of the Canadian system. Why? Was it a troll post? Did scrubby have a change of heart? Are all of the negative posts being removed, or are there truly 0 full negative experiences?
Thank you to all who have shared.
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>Others have to get a doctor's note, after they've recovered, saying they had a cold on a given day thus could not be at work.
My understanding is that this is not a requirement of the medical system at all, but may be required by your employer when you are absent.
Her actual complaint, with which you did not engage, was that the medical system "allows" employers to condition sick days on obtaining a note from a doctor, which (according to her) is a drain on the resources of the public.
The medical system does not "allow" this. The medical system is both provincially and federally regulated. The province sets the standards for workers governed by the provincial legislation but the federal government sets it for federal employees.
In order to get a doctor's note in Canada for an absence from work there is a private pay fee. It is not a drain on the medical system. Employers usually do not require a note unless they suspect misuse of paid vacation days. Seems like a reasonable requirement in such cases and is a negotiated term of most union agreements.
Many provinces have formal sick-leave legislation requiring all employers to provide unpaid sick leave. I've never known an employer to require a note where vacation days are not paid.
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The original scrubbyfish post is gone, which so far was he only full negative post of the Canadian system. Why? Was it a troll post? Did scrubby have a change of heart? ...
The scrubbyfish post was clearly not a troll post, and I would be surprised to learn that her opinion that apparently was based on years of experience would have changed overnight based on the contents of this thread. It's more likely that she was exacerbated with and unimpressed by the replies, at least some of which appeared to be sceptical of her account and demanded details rather than just accepting what she said.
Are all of the negative posts being removed, or are there truly 0 full negative experiences?
There are plenty of negative experiences with "the" healthcare system (see below), but the nature of the topic is such that fully explaining one's negative experiences may require disclosing information that the poster is not comfortable disclosing or simply not willing to disclose, especially in this somewhat hostile environment, as the scrubbyfish example shows. This thread is not a reasonable way to evaluate the merits of any healthcare system that may exist in Canada.
Also, as noted by others, and in many of my past posts (http://forum.mrmoneymustache.com/off-topic/legitimate-criticisms-of-each-2016-presidential-candidate/msg999675/#msg999675), there is no such thing as "the Canadian [healthcare] system". The fact that the system does not exist also precludes reviews of it.
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They also deny for pre-existing conditions. So what if you have had 2 minor health things in the past, get them checked & everything is "fine". No ongoing treatment. So now do you have a pre-existing condition?
A friend had a mild heart attach in his 40s. Is he screwed from traveling now?
You can buy travel insurance that covers pre-existing conditions, but of course it costs more because there is more risk. So the answer to your question is no, he is not screwed from travelling.
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They also deny for pre-existing conditions. So what if you have had 2 minor health things in the past, get them checked & everything is "fine". No ongoing treatment. So now do you have a pre-existing condition?
A friend had a mild heart attach in his 40s. Is he screwed from traveling now?
You can buy travel insurance that covers pre-existing conditions, but of course it costs more because there is more risk. So the answer to your question is no, he is not screwed from travelling.
Exactly. If you are a Royal Bank customer in Canada, they offer insurance that will rate you a "C" for pre-existing conditions as long as you have been stable for 6 months, with no medical questionnaire required. I have a minor heart problem, and very few companies will insure me. So I pay twice as much as my husband for insurance, but am grateful to get it.
Re: Scrubbyfish. No, NOT a troll. About as far away from a troll as you can get! She has had some truly awful medical experiences, and as she explains in her journal, this thread has stirred up bad feelings and memories. So she has chosen to remove her posts, and herself, from the discussion.
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But I can't even imagine that a yearly check-up, ER visits, birth, cancer treatment, heart surgery and trauma surgery would not be covered.
Ontario Health Insurance Plan no longer covers a yearly check-up.
I feel like I see, over time, cuts and signs of scarcity (our province is a fiscal disaster). Longer wait times. Medical staff even more rushed and stretched thin. Reductions in service. I receive great care from a general practitioner and a few specialists, but I got on their patient lists years and years ago. I don't think I would get the same level of access now (or not without a lengthy wait).
I greatly appreciate that health care is funded by our taxes and that once you can access care, the quality I have experienced has been excellent. I do like that there's always the possibility to cross the border and privately pay for services in the U.S. if something isn't offered here or the wait time would seriously harm my health. (So in reality, two-tiered health care does exist: those who can pay for medical tourism and those who are captive to their home system.
Upthread someone mentioned "one-year paid maternity leave". Employment Insurance pays 55% of your gross wages from the past year (on which you have paid EI premiums) or $537 a week ($26,850 for 50 weeks), whichever is less. The benefit is taxable. Mothers receive 15 paid weeks to recover from pregnancy and childbirth, and either parent can take an additional 35 paid weeks to care for the child. You must have worked at least 600 hours (and paid EI premiums on the earnings from these hours) in the preceding year to qualify for benefits (so a student or self-employed person who didn't pay EI premiums does not receive this paid leave). There are restrictions surrounding working while receiving these benefits (depending on the circumstances, your EI benefit may be clawed back by 0, 50, or 100% of what you earn by working). It's another taxpayer funded program that is very nice to have in place, but isn't quite universal or utopian. (Some employers will top up the benefits to match a higher percentage or all of your pre-leave pay, but not everyone has this job perk.)
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The original scrubbyfish post is gone, which so far was he only full negative post of the Canadian system. Why? Was it a troll post? Did scrubby have a change of heart? ...
The scrubbyfish post was clearly not a troll post, and I would be surprised to learn that her opinion that apparently was based on years of experience would have changed overnight based on the contents of this thread. It's more likely that she was exacerbated with and unimpressed by the replies, at least some of which appeared to be sceptical of her account and demanded details rather than just accepting what she said.
Are all of the negative posts being removed, or are there truly 0 full negative experiences?
There are plenty of negative experiences with "the" healthcare system (see below), but the nature of the topic is such that fully explaining one's negative experiences may require disclosing information that the poster is not comfortable disclosing or simply not willing to disclose, especially in this somewhat hostile environment, as the scrubbyfish example shows. This thread is not a reasonable way to evaluate the merits of any healthcare system that may exist in Canada.
Also, as noted by others, and in many of my past posts (http://forum.mrmoneymustache.com/off-topic/legitimate-criticisms-of-each-2016-presidential-candidate/msg999675/#msg999675), there is no such thing as "the Canadian [healthcare] system". The fact that the system does not exist also precludes reviews of it.
So is it really 10 independent Providences and therefore 10 different systems (or 13 systems including the territories) instead of "the Canadian" system. Is that correct?
If so then we can get anecdotal accounts of those 10 systems instead of the "one" nonexistent Canadian system. I would ask other reviewers of those systems to repeat their stories here (or link to them).
Thank you for adding what you know regarding scrubbyfish.
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Here's a good link to some of the basics we've all been describing: http://www.canadian-healthcare.org/
There is a "Canadian Health Care System" in the sense that the provinces MUST deliver health care under certain guidelines. And I believe all the provincial systems follow the same basic framework: every resident in the country gets a provincial health card; health care is coordinated through your personal GP. If you don't have your own family doctor, walk-in clinics staffed by GPs can coordinate your care. All service providers are private businesses (even GPs) who bill the government for their services in regulated ways.
Obviously the system is highly complex and even covers elder care, etc (areas we haven't touched on yet).
There is variation among the provinces at the granular level in what extended health care services might be covered, for how long, at what cost, etc. They vary in whether residents are required to pay premiums, etc. There is some variation in how long wait times are for various procedures province to province, or certain innovative programs that might be available here and not there. There are similar issues everywhere, though, as is probably clear from our responses so far, though different provinces might try to address these in slightly different ways. Health care services in rural and northern/remote areas is a big issue. Health care for First Nations and other marginalized people can still be very problematic. After all, the system is built by and reflects our society at large, many warts and all.
I'm not totally sure what kind of anecdotal stories you're looking for, though, OP, or what you're trying to find out about our system? I think the responses here are pretty consistent: we have care quality that is consistent with other first world countries, higher public health outcomes than the US for a lower cost. We as patients generally don't have to consider cost at all when being confronted with health issues.
The system isn't perfect: it is a large bureaucracy that can be slow to innovate and change, has been slow to adapt, and is grappling with the same issues that most other health care systems in the world are grappling with, including in the US. Changing demographics (aging populations), changing care needs (especially around mental health), and growing demands and expenses as health care becomes more technologically driven.
We do not have death panels; I do not recognize our system in the fear-mongering tirades about the horrors of public health care that we see on tv in the states. Because we are familiar with the exaggerated rhetoric, Canadians can be defensive about our system and emphasize the gratitude we have that we are not living in a private, for-profit system. That doesn't negate the patients who fall through the cracks or who are deeply traumatized (like Scrubby) by their experiences with a system that hasn't served them. However, in my mind this is more a problem with the western medical model generally than a particular provincial set up.
Sorry to go on and on. Canadians can talk about health care like we can talk about the weather. :)
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Here's a good link to some of the basics we've all been describing: http://www.canadian-healthcare.org/
There is a "Canadian Health Care System" in the sense that the provinces MUST deliver health care under certain guidelines. And I believe all the provincial systems follow the same basic framework: every resident in the country gets a provincial health card; health care is coordinated through your personal GP. If you don't have your own family doctor, walk-in clinics staffed by GPs can coordinate your care. All service providers are private businesses (even GPs) who bill the government for their services in regulated ways.
Obviously the system is highly complex and even covers elder care, etc (areas we haven't touched on yet).
There is variation among the provinces at the granular level in what extended health care services might be covered, for how long, at what cost, etc. They vary in whether residents are required to pay premiums, etc. There is some variation in how long wait times are for various procedures province to province, or certain innovative programs that might be available here and not there. There are similar issues everywhere, though, as is probably clear from our responses so far, though different provinces might try to address these in slightly different ways. Health care services in rural and northern/remote areas is a big issue. Health care for First Nations and other marginalized people can still be very problematic. After all, the system is built by and reflects our society at large, many warts and all.
I'm not totally sure what kind of anecdotal stories you're looking for, though, OP, or what you're trying to find out about our system? I think the responses here are pretty consistent: we have care quality that is consistent with other first world countries, higher public health outcomes than the US for a lower cost. We as patients generally don't have to consider cost at all when being confronted with health issues.
The system isn't perfect: it is a large bureaucracy that can be slow to innovate and change, has been slow to adapt, and is grappling with the same issues that most other health care systems in the world are grappling with, including in the US. Changing demographics (aging populations), changing care needs (especially around mental health), and growing demands and expenses as health care becomes more technologically driven.
We do not have death panels; I do not recognize our system in the fear-mongering tirades about the horrors of public health care that we see on tv in the states. Because we are familiar with the exaggerated rhetoric, Canadians can be defensive about our system and emphasize the gratitude we have that we are not living in a private, for-profit system. That doesn't negate the patients who fall through the cracks or who are deeply traumatized (like Scrubby) by their experiences with a system that hasn't served them. However, in my mind this is more a problem with the western medical model generally than a particular provincial set up.
Sorry to go on and on. Canadians can talk about health care like we can talk about the weather. :)
Thank you for your clarity. I am not the OP, but I am seeking something from this thread. The U.S. system is what it is. Before ACA, it was what is was. I am still looking for ways to transform what we now have into something better.
Well before ACA, I was one of the chosen ones. My plan was paid for by my employer, I paid very little (about $30 a month), had a $200 annual family deductible, full choice of doctors, the works. My employer was paying a ridiculous amount for that coverage, and I received this benefit tax free. Did I earn it? Well, maybe you could say so. I eventually earned my masters degree and always got rave reviews. But every day on my way to work, I would see countless workers also working hard, most of them harder than me (anyone ever roof a house) and I knew if they even had coverage, it was not even close to what I had. It didn't sit right with me. Then the health care costs went out of control for more than a decade, my coverage was quickly reduced and the shared costs were increased. Even less of those workers I passed along the way had coverage. It was clear to me something needed to be done, and now we have ACA. Some things are better, some things are worse, and just like before ACA I think the present system is unsustainable.
In any system I understand there will be those who benefit, those who pay more than they get, those that are not properly cared for, etc. I simply want something better than we have now. It seems as though almost all Canadians, no matter the providence, think their system as a whole is better than ours because it costs less, provides better outcomes and you do not run the risk of a medical situation bankrupting your family. Even many of those with real horror stories still end it with "at least we don't have the U.S. system". I am embarrassed by it. I then hear we can not do that here because death panels, ER waits until you die, no meds, and every other fear tactic.
Right now I do not think our friends to the north have the model for us. Your 10(or 13) systems would need to be 50 (plus DC, plus 5 inherited territories) for us. Sounds incredibly expensive just to set up, but the alternative would be coming together as a nation to solve a problem. I do not think we have it in us politically and that is exactly how some of us want it.
If the constitution does not allow this problem to be solved, then I think it is time the constitution is changed. We changed it twice to decide what we are allowed to drink. Why can't we change it to provide basic care to its citizens. I know the questions of what is basic care, sex change operations, birth control, illegal immigrants blah blah blah. Prohibition was a valid reason, but not the health of the citizenry. REALLY? I know, not gonna happen, but why isn't it being asked?
This thread has already been a benefit to me, because I always thought there was 1 healthcare system in Canada, not 1 mandate that was solved 10(13) ways.
I do have 1 more question. How does your healthcare system work while traveling within your different Providences?
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BackYard Feast was right, the original legislation was federal but it was implemented by the provinces. This is a result of our constitution, where anything not specific to the federal government is generally provincial. This applies to health care and to education, so anyone moving between provinces has two major adjustments to make.
Radram, are there not many things that are state controlled? I don't see an issue (from here) of health care having to be federal. Our federal government has basic requirements, and does a lot of the funding, and I would suppose your federal government could do the same. It is hard for a poorer province/state to fund at the same level as a richer province/state without federal subsidies.
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I wasn't a heavy user of the Canadian health care system (Ontario), but there are some minor things I like better about the US system.
In the US, I can book a specialist appointment without a referral. This gives me the flexibility to get second opinions easily, or even a first opinion without wasting a bunch of time. And the technology tends to be a little fancier in American health facilities.
Why does it matter? In Ontario, I didn't have a GP. As others have mentioned, it could be hard to get one and even if you did have one, it wasn't always easy to get an appointment. I used a local walk in clinic, instead. This worked out fine until one incident - I was very ill and the doctor at the walk in clinic said that the reason I was sick was because I was allergic to my cats. He said this without an allergy test or any history of pet allergies. When I argued with him, he told me "Who's the doctor here?! Get rid of your cats or you won't get better." I don't know why he hated cats so badly. He refused to refer me to an allergist to get tested for this hypothetical cat allergy, and since this was in Canada, I did not have the ability to make my own allergist appointment because that's a specialist.
My brother's GP was in the same building, but not accepting new patients, so I walked up there and begged them to let me on their roster and get me an appointment. They did (I might have been crying), but I had to wait a week. In the meantime, I got more and more sick. In the end, it turned out that I had mono and a case of the flu on top of that. But enough time had passed that it had basically run its course and the doctor said there wasn't much he could do for me.
Another anecdote: My brother has severe bipolar disorder. He's used mental health services in Ontario, BC, and Alberta. He says that each province is different and the level of care varies considerably. I can't remember which one was best and which one was worst, though. He was in major cities in each province, too (Ottawa, Vancouver, Edmonton). For all of that, he has had access to services in each province and inpatient treatment when needed - however, good outpatient care keeps him from needing inpatient care. The Canadian healthcare system has created a safety net for him that I don't think really exists to the same extent in the US.
When he was first diagnosed, he had a psychotic episode. The police were called. He claimed that he had weapons (he didn't - he was delusional - but they didn't know that). They dealt with him compassionately, helped calm him down, got him to the hospital, where he was immediately admitted and stayed for over a month while he recovered. I don't really have confidence that the system would have worked so smoothly for him if he were in the US when that had happened.
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I wish the US government would negotiate drug costs on our behalf, and I wish they would regulate hospital costs better. As a user of healthcare in the US, it can be incredibly difficult to find out what something is going to cost you. There is no way to be an informed consumer of healthcare, because you have no way to "shop around." In that kind of consumer environment, we rely on the government to protect us. But the US government fails utterly to do so.
I think ACA has made a lot of strides with pre-existing condition and not letting insurance put a cap on care. Pre-ACA, my friend had some health concerns, and after visiting a specialist, it seemed that he might have Multiple Sclerosis (relapsing remitting). The specialist told him that since the symptoms weren't bad and since this was a first occurrence, it might be better NOT to get a diagnosis. It could be years before there was a re-occurence and there might never be one - but if my friend had a "pre-existing condition," he would have a very difficult time getting insurance, possibly for the rest of his life. In the meantime, the treatments for MS wouldn't necessarily be helpful to him until the MS progressed. He chose not to pursue a diagnosis or treatment.
On the other hand, now that insurance providers can't charge you extra for pre-existing conditions, costs under ACA have escalated dramatically. They say that people in the US are sicker than anyone predicted! Go figure. I think this strongly illustrates why our government needs to step in and regulate costs. Health insurance companies might not be making any money under ACA, but drug companies and healthcare providers/hospitals certainly are.
I'm still sometimes unsure, if I was diagnosed with a serious illness, such as cancer, whether I would stay in the US for treatment or go to Canada. I'm still a little afraid that there could be some loophole in my insurance that could cost me hundreds of thousands of dollars. I still don't "trust" the US healthcare system.
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I do have 1 more question. How does your healthcare system work while traveling within your different Providences?
I think the province that you are treated in just bills your home province. I know that when my daughter in law was visiting here from Ontario she came down with a bladder infection. It was a Sunday, and there were no walk in clinics open here that day (I live in a small city). So she went to the E.R. and was seen and got a prescription. All she had to do was show her Ontario health care card.
Here is a link that might answer some of your questions. http://www.hc-sc.gc.ca/hcs-sss/medi-assur/faq-eng.php
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Since you asked for et al.: Northern Europe here. We have a co-pay of up to $350 a year. This covers all medical and drugs, but not dental. Kids don't have any co-pay, and dental is also free until you are 18. Those that need it the most get help first, but there are waiting lists for less important stuff. A few things that hasn't been mentioned:
- Healthy people can work and pay taxes. Handing out free hearing aids will get more children through school and keep adults able to do their jobs. Disabled people are very costly in a welfare state, but I would imagine this is true to a certain degree also in the US?
- Doctors that are paid to look after the population instead of the customer, have the power to say no to unnecessary surgery and medicine. Recent studies show that up to 75% of the people waiting for a knee operation could be cured by physical therapy instead: https://www.sciencedaily.com/releases/2016/07/160722093239.htm There are plenty of studies about how back surgery can worsen the situation rather than improve it. The same goes for drugs; we can't get antibiotics unless the doctors are certain that the infection is caused by bacteria. Unless proven otherwise, the sore throat or pink eyes are probably caused by viruses, and you'll just have to wait it out. This also leads to us having the least MRSA deaths in the western world.
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Since you asked for et al.: Northern Europe here. We have a co-pay of up to $350 a year. This covers all medical and drugs, but not dental. Kids don't have any co-pay, and dental is also free until you are 18. Those that need it the most get help first, but there are waiting lists for less important stuff. A few things that hasn't been mentioned:
- Healthy people can work and pay taxes. Handing out free hearing aids will get more children through school and keep adults able to do their jobs. Disabled people are very costly in a welfare state, but I would imagine this is true to a certain degree also in the US?
- Doctors that are paid to look after the population instead of the customer, have the power to say no to unnecessary surgery and medicine. Recent studies show that up to 75% of the people waiting for a knee operation could be cured by physical therapy instead: https://www.sciencedaily.com/releases/2016/07/160722093239.htm There are plenty of studies about how back surgery can worsen the situation rather than improve it. The same goes for drugs; we can't get antibiotics unless the doctors are certain that the infection is caused by bacteria. Unless proven otherwise, the sore throat or pink eyes are probably caused by viruses, and you'll just have to wait it out. This also leads to us having the least MRSA deaths in the western world.
Thanks Gaja. That's very interesting. Especially that physio could cure so much rather than surgery. Back surgery is something I would be very wary of. I've had 2 friends who had back surgeries that didn't help. It reminds me of the time years ago when I was having some pain in one of my knees and my doctor told me I had a choice: get more exercise or take this prescription. I chose to get more exercise and haven't had any trouble since then which is maybe 20 years ago.
ETA: I started doing yoga about 4 months ago and I've noticed some differences already. Much easier to do a shoulder check while driving and my knee doesn't pop as much anymore. I never knew I was so stiff.
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There is a "Canadian Health Care System" in the sense that the provinces MUST deliver health care under certain guidelines. ...
Not exactly. "It would be open to [a province] to adopt a U.S.-style health care system. No one suggests that there is anything in our Constitution to prevent it. But to do so would be contrary to the policy of ... the other provinces and the federal Parliament." Chaoulli v. Quebec (Attorney General), [2005] 1 SCR 791, 2005 SCC 35 (https://www.canlii.org/en/ca/scc/doc/2005/2005scc35/2005scc35.html) at ¶ 176 (Binnie and LeBel JJ, dissenting but not on this point).
In other words, a province could legally abolish its public healthcare system, but that would be very unexpected (although not impossible) because of the settled policy in Canada of having public healthcare.
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BackYard Feast was right, the original legislation was federal but it was implemented by the provinces. This is a result of our constitution, where anything not specific to the federal government is generally provincial. This applies to health care and to education, so anyone moving between provinces has two major adjustments to make.
Radram, are there not many things that are state controlled? I don't see an issue (from here) of health care having to be federal. Our federal government has basic requirements, and does a lot of the funding, and I would suppose your federal government could do the same. It is hard for a poorer province/state to fund at the same level as a richer province/state without federal subsidies.
I think you hit on the 2 topics that have changed drastically in the past 250 years. I believe our constitution should be changed to include them.
I would be fine with having the federal government issue minimum requirements or guidelines, or whatever you want to call them, and then give each state the flexibility to achieve them how they wish. I think ACA is that attempt with healthcare and common core is that attempt with education. Many believe those are unconstitutional ideas and they might in fact be so. I believe they should be constitutional ideas and I would support amendments that would end those questions of constitutionality . I believe we will forever be in conflict with what those mandates should include, as we should be.
Yes, there are many things controlled by states, and with that you almost always see vast differences in effectiveness. I believe that is why the ACA exists in the first place. If ACA was proposed when most or all states were able to provide basic medical services for their constituents, most everyone would have said "go suck an egg", we are fine. But that was not where we were. Same thing now. More are covered, but still not all, and at a cost that is not sustainable. Something else will need to change. It doesn't need to be a national system, but it makes the most sense to me today based on challenges already discussed.
Likewise, if all 2nd graders (age is not the best way to group, but that is a matter for another day) were learning x,y, and z and a child from any state could move to any other state and still understand what was going on, common core would not even be a discussion. The vast differences between states is not sustainable long term for a successful nation. I very much agree with the idea of common core, though very much disagree with some of what it contains.
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There is a "Canadian Health Care System" in the sense that the provinces MUST deliver health care under certain guidelines. ...
Not exactly. "It would be open to [a province] to adopt a U.S.-style health care system. No one suggests that there is anything in our Constitution to prevent it. But to do so would be contrary to the policy of ... the other provinces and the federal Parliament." Chaoulli v. Quebec (Attorney General), [2005] 1 SCR 791, 2005 SCC 35 (https://www.canlii.org/en/ca/scc/doc/2005/2005scc35/2005scc35.html) at ¶ 176 (Binnie and LeBel JJ, dissenting but not on this point).
In other words, a province could legally abolish its public healthcare system, but that would be very unexpected (although not impossible) because of the settled policy in Canada of having public healthcare.
Hi Cathy - Yes a province could, but it would be political suicide to do so. After all it is not part of the constitution, it is just federal legislation, and that can always change. And if they opted out, the cost would be totally theirs. Look at Quebec and separate income tax, QPP instead of CPP, etc.
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Here is how it works for me.
Since I was a child if you need to go to the doctor you just go.
If you feel like you should be in emergency you just get there.
You don't ever ever consider the money of the whole thing.
Sure some things can take a long wait - an MRI, that sort of thing. But if you need to you can just pay for that $6- 700 a photo. So you can do that if you want. You can also go to India or somewhere else for something if you want to move faster. Most people don't. Some people with money do. Their choice.
I have had 2 surgeries in the last 10 years. Cost me nothing. I have been to emergency probably 4 times too. Cost me nothing.
I think it is a pretty good system (it has some flaws) because you are proactive with your health. I look at all the online websites where people are paying to talk to MDs online and I think it is a shame. I hear about all the people who would retire, but they need their healthcare and I think it is a shame.
Whether you work in a laundry or are a lawyer you get healthcare.
I can never understand why the US citizens don't just demand it.
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Great question! The other common refrain is "sure they don't have to pay for healthcare, but they also pay a ton in taxes so it's not really free." I'd be interested in hearing a take on this from the forum's Canadian's too. I found this: https://simpletax.ca/calculator -- do the numbers there seem about right based on your experience?
I moved from the cheapest tax province in Canada,(Alberta) to California, one of the higher taxed income / property tax states with a job with a "gold standard" company health plan (I chose an HMO plan... e.g., $20 copays only for non-preventative care, etc. less receipt submissions, etc)
My take home after taxes, SS, health premiums was nearly identical in the two locations, for the similar pay. (not including itemized deductions at annual tax time). So taxes are higher in Canada, and with 40% of taxes going to healthcare, (instead of the military), that has to be some of it... (Welfare being the other part)
I was shocked and amazed when a co-worker, at 42, was going in for elective knee surgery due to pain / diffiuculties, with only 6 week wait, a few thousand dollars, so that he could continue to play softball as he had done all his life. In Canada, joint surgery like this is limited to severe life quality impairment / unable to walk or unable to work issues only. Hip relplacements = yes, funded, but knees & shoulders = very long wait list due to quota type system.
One advantage of public healthcare is that, a bit like HMO's, they work hard to avoid costly surgeries, so c-sections, and surgeries are typically the last option after rounds of non-invasive supports.
I was also surprised when I realized that the US private health insurance providers had to cover emergency services for people who show up for treatment (life saving) but were indigent / poverty line. Passing those cost directly onto the remainder who pays for insurance, instead of spreading it across the whole state. It seemed there was a lot of this.
Admin costs are CRAZY in the USA... they need to track every bandage to every patient, but in Canada, it is "ward supply" and not worth bothering about. I think 1/3 of the nurse's time in the US is related to invoicing, and each room needed its own supply cabinet, ideally. The submitting invoices / receipts in the USA drove me nuts, imagine life not needing to do that... (except for vision, dental, etc)
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Husband's grandfather had a sister growing up (Canada) who got polio, had many surgeries, and eventually died when she was 30... It wiped out an otherwise wealthy family, and was before universal health care was voted in place in Canada. I don't think I wish that risk on anyone, and I am very glad to pay my share to ensure average, reasonable medical care available to all. When a loved one is sick is the LAST time you want to have to worry about money and debt.
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Don't mean to hijack the thread, but I'm interested in knowing the answers to the following questions.
1. If you pay more taxes because you have a high paying job, do you get better health benefits?
Fat Chance. Only if you fly to Thailand or Singapore... etc.
2. Is the real cost of care in Canada different from that of the US?
Yes, US insurance funds some pretty cutting edge and very, very expensive services, many more elective surgeries, to attract customers... and these rooms / hospital and "extras" are not always there for Canadians, only the moderately priced health care options are... Plus there are less administrative overhead costs... a lot less, in Canada.
3. Do the rich and the poor feel the same way about public health care in Canada, or are they divided?
Everyone wants universal care, at a good level for all (or at least, it is not an income based split).
However, those that are rich want to be able to buy extra services, like a shorter waitlist for elective MRI, or optional surgeries, but can't. The fear is that we end up with two tier healthcare if we paid private doctors directly. The weird part is that Canada (some provinces) is now accepting some foreigners for elective (fully privately paid) surgeries to offset hospital costs, procedures or surgery room time slots that are not available to Canadians. Why? Sometimes the operating room is built, and there is a doctor, but no funding for the operation above the quota amount allowed.
Also,
I actually think that the poor sometimes have better healthcare than the people with (family / money) support systems do...
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The Epipen scandal.
I thought I would post this here:
http://www.vancouversun.com/health/canadians+with+allergies+subject+same+epipen+price+hike+consumers/12159857/story.html
The cost went way up to $600 in the US.
Thankfully it is only $120 CAD here.
I am glad our government negotiates a fair price & keeps things in check.
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Thankfully I haven't had many requirements for our healthcare system, but would say that my limited experiences have been pretty exceptional. Two weeks ago, I cut my foot badly on some metal. Debated between which emergency room since there are 3 within a 10 minute drive. Picked one, rolled up to have 1 hour free parking right out front. Was check in by a triage nurse and waited about 45 minutes to see a Dr. After 15 minutes, I was sewn up, had a booster shoot and instructions for care and getting the stitches out. 4 days later my family Dr.'s nurse called to check on me because they received the report and wanted to know if I had an questions or on-going pain, infection etc. Overall...it could not have gone better in my opinion. Out of pocket cost. Zero. Having said that, I have heard a fair number of upsetting tails about wait times for cancer treatments etc. that make me so grateful that I haven't crossed that bridge with any loved ones yet.
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I'm in British Columbia Canada.
It's not really free, I get a bill every month for about $80 so I sometimes wonder why people say it's free.
If I get a prescription I have to pay 100% of the cost, if I go to the chiropractor I have to pay 100% also, same with the dentist and eyes.
Visiting the doctor has no charge, if you get in accident and go to hospital I think theres no charge.
I don't have a family doctor as theres a shortage of them here and they have a waiting list.
I looked into it once and the doctor didn't take patients with a close family member that had had cancer. Not exactly sure why, but if I remember rightly it had to do with money.
I suppose its good because everyone is covered for the heavy stuff and also the most routine stuff. Beyond that if I'm unlucky enough to get something nasty I hope I have enough money to jet down to the U.S.
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But I can't even imagine that a yearly check-up, ER visits, birth, cancer treatment, heart surgery and trauma surgery would not be covered.
Ontario Health Insurance Plan no longer covers a yearly check-up.
I believe they changed the name to a "personal health visit" that is free once every 12 months.
I will echo the generally positive sentiments in this thread about Canadian healthcare. Wait times can be very long for non-emergency/elective procedures but emergencies will be dealt with immediately. I have heard complaints that your recovery stay in a hospital can be quite short - staying overnight in a hospital (outside of the emergency waiting room) is something hospitals seem to be trying to avoid.
There are also good private add-on type services you can pay for outside of the hospital/clinic environment. For example, my grandfather had a stroke about a year ago (healthcare system took great acute care of him) but ever since he was released home he has been paying for a private home care company to visit him most days. They do stuff like help him go to the bathroom, help him in and out of bed, and basically all the other stuff that is hard for his 82 year old wife to help him with.
And I'll add that just outside of Toronto there is an absolutely world-class hernia clinic called Shouldice Hospital. They are still private (they existed pre-OHIP and have some kind of special arrangement in place) and are amazing.
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One other curiosity, does the Canadian federal government help out the poorer/smaller provinces?
On the other hand, now that insurance providers can't charge you extra for pre-existing conditions, costs under ACA have escalated dramatically. They say that people in the US are sicker than anyone predicted! Go figure. I think this strongly illustrates why our government needs to step in and regulate costs. Health insurance companies might not be making any money under ACA, but drug companies and healthcare providers/hospitals certainly are.
Somebody is paying the costs for people with pre-existing conditions whether it's through tax dollars, insurance premiums, or out of pock. Either that or people are just getting by.
Do you think people are healthier in general in Canada? The US is not great at prevention. There are way too many contributors like no exercise, car accidents, terrible diet, obesity, crime, mental health, etc etc. Canada has a lot of those factors, too, but I don't know what the comparison is.
I'm still sometimes unsure, if I was diagnosed with a serious illness, such as cancer, whether I would stay in the US for treatment or go to Canada. I'm still a little afraid that there could be some loophole in my insurance that could cost me hundreds of thousands of dollars. I still don't "trust" the US healthcare system.
I can't blame you at all. You never know what the bill will be. I might just settle for only getting a single bill. You go to the hospital and get different bills in the mail for months. You get one from the hospital, the GP, the Anesthesiologist, the lab, and anybody else who happened to be walking by the room at the time. Can they really not consolidate them? It's hard not to turn this into a thread about the US, although the comparison is good to hear.
Since you asked for et al.: Northern Europe here. We have a co-pay of up to $350 a year. This covers all medical and drugs, but not dental. Kids don't have any co-pay, and dental is also free until you are 18. Those that need it the most get help first, but there are waiting lists for less important stuff. A few things that hasn't been mentioned:
- Healthy people can work and pay taxes. Handing out free hearing aids will get more children through school and keep adults able to do their jobs. Disabled people are very costly in a welfare state, but I would imagine this is true to a certain degree also in the US?
- Doctors that are paid to look after the population instead of the customer, have the power to say no to unnecessary surgery and medicine. Recent studies show that up to 75% of the people waiting for a knee operation could be cured by physical therapy instead: https://www.sciencedaily.com/releases/2016/07/160722093239.htm There are plenty of studies about how back surgery can worsen the situation rather than improve it. The same goes for drugs; we can't get antibiotics unless the doctors are certain that the infection is caused by bacteria. Unless proven otherwise, the sore throat or pink eyes are probably caused by viruses, and you'll just have to wait it out. This also leads to us having the least MRSA deaths in the western world.
Thanks. I was hoping non-North Americans would chime in, too, even if Canada's the main country in discussion in the US on government involvement in health care.
Disabled people may just have to do what they can or rely on family and friends like in a lot of the world. And yes, profit motive can be a big factor in the US, so that might definitely play into cost comparison whether good or bad. We could have a long long discussion on either of those, but I'm trying to stay as neutral as I can on US health care for this thread. To say it's a heated topic here is understatement.
2. Is the real cost of care in Canada different from that of the US?
Yes, US insurance funds some pretty cutting edge and very, very expensive services, many more elective surgeries, to attract customers... and these rooms / hospital and "extras" are not always there for Canadians, only the moderately priced health care options are... Plus there are less administrative overhead costs... a lot less, in Canada.
There is definitely the claim that high healthcare costs in the US fund research. Can anybody speak to how medical research in Canada or other countries compares with the US, especially when you take private and public funding into account?
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One other curiosity, does the Canadian federal government help out the poorer/smaller provinces?
Yes, but not specifically to do with health care. There are equalization payments made to the provinces that are poorest from the federal government.
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One other curiosity, does the Canadian federal government help out the poorer/smaller provinces?
Yes, but not specifically to do with health care. There are equalization payments made to the provinces that are poorest from the federal government.
Not quite. There is a seperate mechanism for Health Transfer:
https://www.fin.gc.ca/fedprov/cht-eng.asp
https://en.wikipedia.org/wiki/Canada_Health_Transfer
It's a bit different from equalization in that the money must be spent specifically on health funding by the provinces. Equalization payments can be spent on anything.
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Mostly posting to follow.
Thank you for the insight into single-payer, and for being so cordial, eh!
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I have no idea if other jurisdictions do this, but this low-cost ($20) dog/cat vaccination clinic is sponsored by the Eastern Ontario Health Unit.
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One other curiosity, does the Canadian federal government help out the poorer/smaller provinces?
Yes, but not specifically to do with health care. There are equalization payments made to the provinces that are poorest from the federal government.
Not quite. There is a seperate mechanism for Health Transfer:
https://www.fin.gc.ca/fedprov/cht-eng.asp
https://en.wikipedia.org/wiki/Canada_Health_Transfer
It's a bit different from equalization in that the money must be spent specifically on health funding by the provinces. Equalization payments can be spent on anything.
Oh, I knew about the equalization but not the health transfer. Thanks!
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My family and I have had excellent care - no complaints nor do we take it for granted.
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Cathy mentions that a province is free to do what it wants. This is true but they could potentially lose out on federal funding. I think that would be a good way to lose your spot as the premier of a province, and I doubt anyone would get elected with the plan of eliminating the concept of "universality" in the Canada Health Act.
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Cathy mentions that a province is free to do what it wants. This is true but they could potentially lose out on federal funding. I think that would be a good way to lose your spot as the premier of a province, and I doubt anyone would get elected with the plan of eliminating the concept of "universality" in the Canada Health Act.
Not sure if you've noticed, but politicians tend not to campaign on the controversial; they just do those things once they are in.
Sure, they may then get voted out, but often the opposition will let it slide - if it's good for them.
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Abolish the Canada Health Act? Not likely . . .
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I'll also come in as an "et al". I'm an American living in the UK and have experienced both the US systems (with employer provided Blue Cross/Blue Shield) and the UK National Health service. I've raised four children in the UK (with births, chronic asthma etc). My ex-wife had a cancerous breast lump. I had a shoulder operation. My experience is that the National Health service was basically outstanding. Yes, my shoulder thing had a 6 month wait, but when my ex-wife had a suspicious lump they dealt with it immediately. Emergency room visits for child asthma attacks, stupid injuries etc. were dealt with right away (immediate triage). Oh, by the way, my taxes are about the same as they would be if I lived in, say California or Oregon.
I found the US health care system to be mixed. Wait times are just as long. The specialist in the US could not diagnose/treat my shoulder. I remember a doctor who wouldn't give me a prescription for Nicorette gum (to help me quit smoking) unless he could do a full "work-up" (so he can bill the insurance company for various tests).
I'll tell you why many Americans are against universal coverage. It has nothing to do with cost/efficiency etc. It is sad to write this, but the basic reason for many Americans is that they "don't want some goddamn __________ to get something I have that they don't". (I'll let you fill in the blank, boys and girls). Even in 2016, this sentiment is absolutely fundamental to much of American society.
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I'm in British Columbia Canada.
It's not really free, I get a bill every month for about $80 so I sometimes wonder why people say it's free.
If I get a prescription I have to pay 100% of the cost, if I go to the chiropractor I have to pay 100% also, same with the dentist and eyes.
Visiting the doctor has no charge, if you get in accident and go to hospital I think theres no charge.
I don't have a family doctor as theres a shortage of them here and they have a waiting list.
I looked into it once and the doctor didn't take patients with a close family member that had had cancer. Not exactly sure why, but if I remember rightly it had to do with money.
I suppose its good because everyone is covered for the heavy stuff and also the most routine stuff. Beyond that if I'm unlucky enough to get something nasty I hope I have enough money to jet down to the U.S.
This is true in BC but not in Alberta.
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As a Canadian mother of a child with a chronic health issue I have nothing but good things to say. For the first 3 years of my sons life we were at the local children's hospital every 4-6 weeks. Sometimes just a day a visit, sometimes a week. Every visit I was thankful that I didn't have to worry about what it is costing us on top of worrying about my child's health. We received outstanding care each time and waited no longer than 30-60 minutes for a doctor to see us.
My mother found a lump in her breast. In a week she had all the tests done that confirmed breast cancer, and within another week she had a double mastectomy.
Yes, taxes are higher here. In Alberta (the province with the lowest provincial income taxes) I pay approximately 23.5% in taxes on our household income after the personal deduction limit.
Also, yes we do have to pay for dental, prescriptions and paramedical services but typically employer health benefits assist you in these costs. When my husband and I are both working and we both have benefits for the family we rarely see a bill for these services and with my sons prescriptions and my use of paramedical (massage, chiro and acupuncture) for a chronic pain condition it saves us at least $2500 a year.
The negatives I have heard is that if you have condition that is extremely rare there is often no treatment available in Canada and these persons have to travel to the US for that care. Often, if the treatment is a known cure then the provincial health care will pay the cost of the treatment but if is an experimental treatment than they will not. There was a local girl with a debilitating disease (which for the life of me I can not remember name of) and there was only one doctor in North America that would operate on her brain to try and help her and this doctor was located in Texas. The surgery was $250K and the provincial health care system would not pay for it. Her parents took out the equity on their house to the tune for $100K and the community and local businesses fund raised to come up with the rest.
Also, I have heard there is typically long waits for things like hip and knee replacements.
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For the Canadians:
It seems you've all addressed the working of the national health (or whatever you guys call it). Do you have the ability to go private (to a doctor of your choice and you pay for it)? OR, is there no private health care up north?
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For the Canadians:
It seems you've all addressed the working of the national health (or whatever you guys call it). Do you have the ability to go private (to a doctor of your choice and you pay for it)? OR, is there no private health care up north?
I think your question will be hard to answer. One, because as was discussed, the specifics depend on your province. (https://en.wikipedia.org/wiki/Two-tier_healthcare#Canada)
Second, it depends on your definition of private. For example, in Ontario, if you go to see a family doctor, that provider is a private practice, a small business, who happens to bill the public health insurance. Is that private or public?
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For the Canadians:
It seems you've all addressed the working of the national health (or whatever you guys call it). Do you have the ability to go private (to a doctor of your choice and you pay for it)? OR, is there no private health care up north?
I keep drifting through this thread, hesitant to add my own experiences as someone who moved fromt he US to Canada several years ago.
As others have indicated, there is no "national health care" - but a system of provincial health care systems (see Cathy's post). As such every province has different levels of care, restrictions, etc. To get at your question, things that we'd call a 'private practice' do exist here in Canada, but since they all bill the exact same provincial health care system the line is a heck of a lot more blurry. You can choose your own doctor providing they are accepting patients; we've been on waiting lists for over a year. Smaller towns typically have only a single hospital where you to go for everything, from annual checkups to acute emergencies.
There are also (at least here in Quebec) clinics that deal with secondary insurance or out-of-pocket costs. There you typically have shorter wait times and amenities like private wait rooms and physical therapists that will work with you one-on-one. My advisor's wife went to one to get an additional post-op care that wasn't available through the bread-and-butter provincial health care system.
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I've received care in 3 different provinces. I can attest that the level of care can vary pretty widely. Here in BC we get timely care and Drs treat their patients with care and respect. Ditto for the one ER trip I had in NS.
However, the story was very different when we lived in Quebec. Crazy long wait times, overcrowded clinics and hospitals, level of care 20 years behind the standard treatment for whatever condition you had and many Drs treated their patients with callous disrespect. Though we loved living there, the awful medical care is the only reason I won't move back. In all other respects it was wonderful.
For the person who asked about what happens when Canadians need care outside their home province, the treatment is paid to the provider by the home province, at the home province's rate. If you move between provinces, your insurance switches to the new provinces plan 3 months after the move. For example, when we moved from BC to QC when I was pregnant I had to go for weekly checkups. Each visit I filled out a form allowing the Dr to bill BC for the visit. The Dr was thrilled b/c BC paid $70/visit, while he could only charge a QC resident $36/visit.
The only exception I'm aware of is that Quebec doesn't seem to pay BC for any visits their residents need. QC residents needing care in BC have to pay out of pocket.
In terms of level of care for rich/poor, the difference seems to actually be in whether you have a job that provides good extended insurance or not. Both DH and I have decent jobs with good insurance. We opted for coverage from both (we have 2 kids and expected to spend more on care than on the extra premiums) so our cost for many "extra" services (dental, vision, mental health, prescriptions, etc) is $0. Families with no, or crappy, extended health insurance have to make harder decisions about what extras they can afford.
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However, the story was very different when we lived in Quebec. Crazy long wait times, overcrowded clinics and hospitals, level of care 20 years behind the standard treatment for whatever condition you had and many Drs treated their patients with callous disrespect. Though we loved living there, the awful medical care is the only reason I won't move back. In all other respects it was wonderful.
Were you speaking English in Quebec? I've had some experience that suggests the quality of service received there depends somewhat on your demonstrated fluency in French. :P
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However, the story was very different when we lived in Quebec. Crazy long wait times, overcrowded clinics and hospitals, level of care 20 years behind the standard treatment for whatever condition you had and many Drs treated their patients with callous disrespect. Though we loved living there, the awful medical care is the only reason I won't move back. In all other respects it was wonderful.
Were you speaking English in Quebec? I've had some experience that suggests the quality of service received there depends somewhat on your demonstrated fluency in French. :P
We have had difficulties with several doctors and nurses here in Quebec because of the language barrier. We always try to speak french and normally we do ok, but when it comes to technical medical explanations we often don't understand what is precisely what is being said (after all, many of the words don't come up in daily conversations). Several times seemingly overworked and short tempered doctors and nurses have told us they can't give us an explanation in english when we don't understand the french completely, and we've been pushed out the door. Occasionally it's a nice, patient doctor, but in our experiences it's about 50/50.
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However, the story was very different when we lived in Quebec. Crazy long wait times, overcrowded clinics and hospitals, level of care 20 years behind the standard treatment for whatever condition you had and many Drs treated their patients with callous disrespect. Though we loved living there, the awful medical care is the only reason I won't move back. In all other respects it was wonderful.
Were you speaking English in Quebec? I've had some experience that suggests the quality of service received there depends somewhat on your demonstrated fluency in French. :P
We have had difficulties with several doctors and nurses here in Quebec because of the language barrier. We always try to speak french and normally we do ok, but when it comes to technical medical explanations we often don't understand what is precisely what is being said (after all, many of the words don't come up in daily conversations). Several times seemingly overworked and short tempered doctors and nurses have told us they can't give us an explanation in english when we don't understand the french completely, and we've been pushed out the door. Occasionally it's a nice, patient doctor, but in our experiences it's about 50/50.
The best part is that many of those nurses and doctors are lying and speak English fluently, they just don't like you because you're obviously an English speaker. This is a thing in Quebec.
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The best part is that many of those nurses and doctors are lying and speak English fluently, they just don't like you because you're obviously an English speaker. This is a thing in Quebec.
I'm well aware of this. Still makes it frustrating... no matter how hard I try I'll always have accented french.
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For the Canadians:
It seems you've all addressed the working of the national health (or whatever you guys call it). Do you have the ability to go private (to a doctor of your choice and you pay for it)? OR, is there no private health care up north?
Why, yes, sir. We can just drive across the border into Bellingham, WA!
In reality, Alberta is a bit more lenient about private practice for cosmetic surgeries, and optional care, but BC remains fundamentally opposed to the "slippery slope". There is a legal action right now to change it. In BC, you can join a private clinic, which provides extended care (diet / physio, etc) and consolidted administration services together with the doctors care... and pay for a bit more time with doctors team, but the doctors are paid for their medical services from the government payment program.
Everyone gets a doctor of their choice, unless they go to the ER. Like choosing a dentist in the USA, really. Your choice depends on who is taking new patients. You just need to get a referral first, before "bothering" the specialists with appointments.
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However, the story was very different when we lived in Quebec. Crazy long wait times, overcrowded clinics and hospitals, level of care 20 years behind the standard treatment for whatever condition you had and many Drs treated their patients with callous disrespect. Though we loved living there, the awful medical care is the only reason I won't move back. In all other respects it was wonderful.
Were you speaking English in Quebec? I've had some experience that suggests the quality of service received there depends somewhat on your demonstrated fluency in French. :P
We have had difficulties with several doctors and nurses here in Quebec because of the language barrier. We always try to speak french and normally we do ok, but when it comes to technical medical explanations we often don't understand what is precisely what is being said (after all, many of the words don't come up in daily conversations). Several times seemingly overworked and short tempered doctors and nurses have told us they can't give us an explanation in english when we don't understand the french completely, and we've been pushed out the door. Occasionally it's a nice, patient doctor, but in our experiences it's about 50/50.
It's false that Quebecers are rude to non-francophones. They're actually rude to everyone, including each other. Anglophones just happen to take it personally.
I speak fluent French with an English accent, and no not all the poor treatment was because of my accent. My last name is french, I look Quebecoise. Many systems are set up in a way that are disrespectful to all patients, regardless of language, color, gender, etc. For example:
- The hospital I gave birth to YDD in was seriously overcrowded. The room I was in was actually only meant to be a single room, but there were 2 beds shoved into it. The bathroom was shared with the room next door (aka 4 post partum women sharing a bathroom meant for 2). My bed didn't have a privacy curtain so I got to breastfeed in full view of the public hallway. This was the case for all the maternity rooms in that wing. There were dozens and dozens of rooms set up like this.
- We were lucky enough to find a family GP. He started his day promptly at 9am. However, he instructed his nurse to begin making appointments for him at 8am. Patients were never told about this arrangement. If you weren't there at 8am they'd threaten to give your spot away. So, no matter what you had to show up at 8am so you could save your spot for your 9am appointment. There was a 5 week wait to see him for any appointment.
- My 3yo had her tonsils out while we were there. The ENT used the same scheduling system as our GP for the recall follow up. Foolishly, I showed up for the recall appointment at the time I was told. I waited in the hallway for 2 hours with my 3yo and 1yo for a checkup to make sure she was healing properly. There were 3 other people ahead of me in line. None of them were ever called. After 2 hours I gave up and took the wild toddlers home. The nurse would never tell me how late the Dr was running and insisted we stay. No one ever called to check on us. In BC, when a Dr is running late, their receptionist will happily tell you when you'll be seen so you can go home/go for coffee/whatever instead of sitting around sharing germs with all the other sick people. If you miss an appointment for something important, the office calls you back to reschedule and check on you.
- I had 2 toddlers who were frequently sick when we lived there. It can be hard to tell on your own if your kid just has a cold and/or also has an ear infection and/or is just teething. Sometimes, when they really seemed to be in pain I'd take them to the walk in to get their ears checked. About half the time they had an ear infection. If they didn't have an infection, I'd get berated for bringing them in and wasting the Drs time with my "healthy" kids. How the fuck was I supposed to know if their ears were OK? They were screaming in pain. In BC, Drs never have this reaction.
- The nurse line advised me to stay home when my 3yo was running a 104F fever. She'd had it for 3 days and had become lethargic. Luckily we didn't listen. Turns out she had pneumonia.
- All clinics insisted on taking young children's temperature rectally. If you complained, you were told it was the only accurate way to do it. Have you ever held your 3yo down while some stranger shoved something up her butt knowing full well there's a quick non-invasive alternative?
This was in Quebec City, not some backwater. I have more examples, these are just the ones that pissed me off the most.
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The ER in Gatineau is pretty bad: http://www.cbc.ca/news/canada/ottawa/gatineau-hospital-coroners-report-1.3736927 (http://www.cbc.ca/news/canada/ottawa/gatineau-hospital-coroners-report-1.3736927)
Many of the issues in QC health care simply revolve around doctor shortages and funding. Post secondary education is pretty top notch and cheap, tons of other social service but they have let the medical system slide.
I lived in QC for about 10 years, never went to a hospital and the few times I needed to see a DR. I went to a clinic, one time with a really badly burned hand and I found if you were lucky enough to get am actual appointment you didn't wait long. I did get berated once when they had my brother's file instead of mine. Apparently I should have known to tell them I had a brother, giving my name and carte de soleil obviously wasn't enough. I actually complied and told them the next few times and they still grabbed my brother's file. This is when I burned my hand badly and needed a dressing change so nothing to serious.
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- The hospital I gave birth to YDD in was seriously overcrowded. The room I was in was actually only meant to be a single room, but there were 2 beds shoved into it. The bathroom was shared with the room next door (aka 4 post partum women sharing a bathroom meant for 2). My bed didn't have a privacy curtain so I got to breastfeed in full view of the public hallway. This was the case for all the maternity rooms in that wing. There were dozens and dozens of rooms set up like this.
I thought my experience in calgary was unusual... It was about 5 years after the peak of the oil boom, and they had a "baby boom".
Not quite your experience, but I was sent home form the hospital twice (with apointment to be induced) due to overcrowding. On the third time, I was 14 days overdue, so they weren't allowed to turn me away anymore.
Although I asked for a private recovery room (the birthing room was private), none were left, so I shared a room with a woman from the nearby reservation, her husband and kids until 9pm at night, sometimes later... (visitor hours were supposed to end at 7 or something...) Yet my husband was only allowed in to see me for a couple of hours a day, it seemed.
For the second, I had some birthing complications, (large / stuck baby) the doctor was busy with a emergency c-section for another woman, so I delivered an 11 lb baby vaginally, with only a nurse. Baby ended up in ICU for 3-4 days, then was on oxygen at home for the next 6 weeks. Sometimes I wonder if I should have had a c-section (but no doctor available).
BUT -- all that was due to sudden population boom, and I did not pay a single dime, not even for the oxygen / home care.
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For the Canadians:
It seems you've all addressed the working of the national health (or whatever you guys call it). Do you have the ability to go private (to a doctor of your choice and you pay for it)? OR, is there no private health care up north?
I keep drifting through this thread, hesitant to add my own experiences as someone who moved fromt he US to Canada several years ago.
As others have indicated, there is no "national health care" - but a system of provincial health care systems (see Cathy's post). As such every province has different levels of care, restrictions, etc. To get at your question, things that we'd call a 'private practice' do exist here in Canada, but since they all bill the exact same provincial health care system the line is a heck of a lot more blurry. You can choose your own doctor providing they are accepting patients; we've been on waiting lists for over a year. Smaller towns typically have only a single hospital where you to go for everything, from annual checkups to acute emergencies.
There are also (at least here in Quebec) clinics that deal with secondary insurance or out-of-pocket costs. There you typically have shorter wait times and amenities like private wait rooms and physical therapists that will work with you one-on-one. My advisor's wife went to one to get an additional post-op care that wasn't available through the bread-and-butter provincial health care system.
This is what I mean by private. Outside the system where cash is king.
I can go to a provider inside my plan, I can go to one outside my plan and pay more out of pocket, I can go to one who does not take my insurance or any insurance and pay out of pocket.