A Conversation With a Canadian About Health Care
Regardless of where you fall on the political spectrum, I think we can all agree that our system of health care in the United States has gone a bit sideways. Access to care and the prices paid for care are at the heart of our national discussion. I don’t think that anyone can dispute that the United States has the best doctors, nurses and support staff anywhere. But, the way we get the people who need together with those that provide is at best inefficient and needlessly expensive; and at worse broken and harmful.
As efforts to address the issue are argued over, built, and modified; I want to know how it’s done other places. It’s basic problem solving, if you see that someone else is doing a better job than you, then maybe you need to take those ideas and make yourself better. That’s how you continue to be the best in the world. Not with denial.
Canada, our neighbor to the north, is a county very similar to the United States. We both were English colonies and our populations are made-up of immigrants from all over the world. Both nations have big population centers on each coast and a vibrant rural heartland. Our economies are very similar, made up of the same sectors. Drop a person from Omaha, Nebraska in Calgary, Alberta and they’d feel at home. Well, the French thing would need some getting used to. Life in small town Saskatoon isn’t much different than life in small town South Dakota. But, I’ve heard a lot about their very different health care system. I’ve, of course, heard horror stories about their system, usually from people with an interest in the US’s status quo; and I’ve heard the praises sung by those on the other ideological side.
Before we get too deep into this, I want to be clear that we are discussing access and payment, not the professional quality of the personal or the quality of the science. It’s the system, not the people or the medicine. We have the best of the best doctors, nurses, scientists, and other medical technicians, but their skills go to waste if we can’t pair them with the people that need them.
What’s the real story? I want to know more. Luckily I have a very good friend who lives in Canada. Not in the ‘I have a friend who lives in Canada’ way. She is a real person that I have known for a long time, I’ve even been to her family’s home. So I talked to her about Canada’s health care system and her experiences.
First some background.
My friend: She’s a teacher in her early 30’s (OK, sorry. Verrrry early 30’s). She’s married with a young child. She was born and raised in Vancouver, British Colombia.
Canada’s Health Care System: In broad terms it is a single-payer system where medical insurance is paid for through taxes and administered by private medical professionals. When care is received, the provider, instead of billing the patient, bills the government. The system is called Medicare. There isn’t one national plan, each of the providences (the equivalent of states in the USA) in Canada administer their own health insurance plan based on national standards. The plans have to cover medically necessary expenses of every citizen regardless of employment, age, ethnicity, or gender.
How does the Canadian system work for you, for a person? Do you get a card that you use when you seek care?
“You are issued a health card (or Personal Health Number) at birth. This is a requirement for all residents. In BC [British Colombia], you pay a monthly fee levy depending on your income and family size. Now, just this January those fees were slashed by 50%. If you or your family makes less than $20,000 a year, those fees are waved. If you or your family makes over $45,000 (approx.) then you pay the maximum fee of about $75 a month. These fees can often be covered by your employer though. I can say for myself personally, I cannot remember the last time I received an MSP (Medical Service Plan) bill.”
Is the health care system connected to your jobs in anyway?
“All the basic care is covered by the province, no matter what, no matter who you are as long as you are a resident.”
The system is administered by the provinces, correct? Are there big differences between say British Colombia and Alberta?
“Yes, there are differences. As far as I know, Ontario and Quebec take medical fees directly from your income tax, so there are no levies. But if you say, need emergency care in Alberta even though you are a BC resident, those fees will be covered by your home province.”
What is covered in the system? Medical care, prescriptions, dental, vision?
“The basic medical care that everyone receives no matter what include doctor’s visits, emergency care, medical treatments, surgery etc. that is ordered by a doctor, diagnostic services (x-rays, MRIs, etc.), maternity care from a doctor or midwife, and oral or eye surgery performed in a hospital.”
What isn’t covered by the system? What do you do then?
“Primarily dental, vision, and prescriptions. This is where extended medical comes in, which often you receive through work. I work part-time at the moment, so I do not have extended coverage, but I do get it through my husband’s employer, and so does my child. This coverage typically includes dental, vision, and prescription medicine among other things (nutritionists, naturopaths, massage etc). For dental, your extended medical may cover 80% of all treatment, and then you pay the rest, up to say $5000 a year (this is just an example). So say if your child needs braces, this is something you’re probably going to have to pay most of yourself. For something like massages you may get treatment by a registered massage technician covered at 80% up to $500 a year, and after that you pay out of pocket. If your work does not offer benefits, you can get insurance through a private company. That I think would typically run you a few thousand a year maybe more.”
“There were some years in my 20s where I just never went to a dentist because I didn’t get benefits through my job, and couldn’t afford to pay out of pocket, or pay for private insurance. I also had to pay for my own birth control and other random prescriptions because those are not covered under MSP. Of course if you have benefits all prescriptions are covered no matter what they are (your employer is not allowed to discriminate). I’ll also point that both universities I went to provide extended medical care for students, which is such an amazing service.”
You had a child recently, what was that like? Specifically how much did you pay; cash money, out of your pocket, bill sent to you from the hospital?
“Closer to the end of my pregnancy I had quite high blood pressure, so I spent a lot of time in and out of the hospital for tests, monitoring, and eventually an induction with a birth that required medical intervention. Because maternity care is fully covered in Canada, we never saw a bill. They did charge us I think $20 for cable in the room, but this was covered by our extended medical coverage through work.”
If you have a medical issue, like appendicitis or a broken bone what do you do? Would you worry about the finances?
“You would go straight to a hospital for something like this and show your medical card upon check in. Go in, get care, go home.”
“One of the very few downsides of medical care here is that emergency wait times can be very long. When I was delivering my son, I waited 9 hours for a room to become available. Now this isn’t always the case. If you bring a little baby in to emergency for example, you are seen right away. I will also mention here that there can be very long wait times to see specialists. For example, the average wait time in BC for a pediatric speech pathologist is I think 6 months, and there’s no way to skip this line.”
Is medical debt a huge issue there? Do you see lots of social media posts or flyers from people raising money to pay medical expenses?
“It depends. For example my father in law was very sick a few years ago. He was in the hospital for a month maybe, without extended medical. All his care was covered but he did get a bill for his hospital stay. This I believe is specific to his province though. I don’t know for how much it was, but I imagine that could be a problem for some. Also a few years ago the brother of a friend of mine had cancer, and his family was raising money online for him to get experimental care in the States, but as a general rule, no, you would never see people raising money for care in Canada. I see so many of these posts coming from my American family and I’m always shocked.”
Do you, as a Canadian, fell like you get your tax moneys worth?
“I do feel this way. BC residents pay anywhere from 5% to 15% of our income to provincial taxes and then anywhere between about 15% to 30% on federal tax. It’s a decent amount of money. But honestly, there’s such a comfort in knowing that I do not have to worry about whether or not I will be able to afford medical care for my family. My child was quite sick a few months ago and I swear I was sitting in that doctor’s office every day for a week, really just for peace of mind (it was just a virus but I was a freaked out first time mom). I was grateful that I never had to weigh his care against what it would cost.”
As someone who has experienced the health care system with good insurance, bad insurance, Medicaid, and uninsured; the Canadian system as described above and through additional readings seems very preferable.
A criticism that is often trotted out in this discussion is the question of doctor choice. But, in my adult life I have never chosen a doctor. I see whoever will see me. My family has seen the same doctor that is at the clinic near our home for years. However, if he left to work somewhere else, we’d see whatever doc that was there. When we discovered that my wife’s insurance (at the time) didn’t include that doc’s health company in its coverage, she had to stop going to him. When there is a medical emergency after hours, from dislocated fingers to strep throat, we see the doc that’s at urgent care.
Additionally, if you live in a rural area or a small town, you also see whoever is available.
The myth of the house call country doc that is available to you 27-7 only exists in stories about how people wished things were in olden days they saw on TV. It may be different if you are super rich, I guess.
I also think that people that complain about ‘doctor choice’ are bitter because the medical professionals they have seen in the past didn’t give them the answers they wanted. Instead they told them the truth about their medical issue and that they’d have to do things they didn’t want to; eat better, don’t smoke, get exercise, take the medicine as directed, ECT….
The often cited concern about wait times is also problematic when compared to my experiences in our system. Like my Canadian friend said, there can be a wait for specialist or non-blood dripping urgent care, but in an emergency (blood-dripping) there’s usually not. That sounds exactly like my experiences in the US.
When my wife went into labor with our daughter, by surprise two weeks early, we had to go to the emergency room at midnight. And we had to wait, a long time. She was very well taken care of and the staff was great, but we were triaged. We had to wait our turn.
Another example, about five or so years ago, I started falling asleep almost every time I sat down, it was getting really bad. Plus, I was getting terrible headaches and not sleeping through the night. It was pretty clearly a very bad case of sleep apnea. Went to the doc (paid a copay before I was allowed to do so), told him my symptoms, he agreed that that is what was going on and that I’d need a CPAP machine to treat it. Did I walk out with the tools of treatment? No. I had to make an appointment with a specialist, in three weeks. After that I had to do a sleep study, another specialist, in another week. Two weeks after that I had to go back to the first specialist and then I could get my treatment.
As for the tax question, we need to get over the idea that taxes are inherently evil. If there is no investment and bad management, any enterprise will fail. That is true in the private and the public sector. If there are no funds to operate and the people in charge are unqualified cronies, whatever it is will not be good. Whether it’s the bosses buddy or a bad political appointee. Garbage in, garbage out and you get what you pay for. I will happily pay extra taxes if I could know that my family will get medical care when we need it and that it will not bankrupt us. The same goes for education by the way; I’m willing to pay for good public schools and colleges. I’m not willing to pay for shady business deals and other questionable uses for our tax dollars.
I’m not saying that the United States needs to straight-up copy Canada. But, we are the best in the history of the world. The strongest and richest nation that has ever stood. I’m not being silly or sarcastic. The United States is the best. We should act like it. There is no reason that our nation cannot take the best parts of systems that have been beta tested around the world in the decades since the Second World War. There are very few mysteries when it comes to ensuring care for everyone. There are just organizations and weak politicians in the way.
Disclaimer: The views and opinions expressed in this article are solely those of the author and do not necessarily reflect the official policy or position of Results Radio, Townsquare Media, its staff, contributors, affiliates or advertisers.