Saturday, September 4, 2010

A Health Care Comparison

Well, if my previous posts haven't managed to fully alienate my slim readership, this one is sure to get people fired up on both sides of the border ! I probably field more questions about this topic from both Canadian and American friends and acquaintances than I do any other topic, so here is my attempt at a *balanced* comparison of my verisons of Canadian and American health care !

First of all I will address the rumours !

While it is POSSIBLE to die in the streets waiting for treatment in the US because you don't have any money to pay the bill, this outcome is highly unlikely for visiting Canadians no matter whether they carry a US health insurance policy or not. For a variety of reasons, this outcome is also highly unlikely for most Americans, although it can get expensive fast if one has unprotected assets, is under-insured (or not insured at all) and/or one doesn't know how to work the system.

Similarly, it's POSSIBLE to die while waiting in a queue for a doctor to show up and treat you while on holiday in Canada, but this would be an equally unlikely outcome for most Americans (and for most Canadians) in the majority of cases. Most of the time, people who need care get it in a relatively timely fashion, although in many cases the wait is considerably longer than it would be south of the border for the same treatment. When I lived there, the wait for a "routine" MRI was as long as several months, depending on the severity of one's condition and the availability and proximity of the nearest MRI machine.

Outcome for outcome, the quality of care in both countries is very good. Depending on the severity of the issue at hand, timeliness (and sometimes the degree of thoroughness) of care and reasonable access to doctors, specialists, and second opinions is (or was) probably the biggest gripe in Canada.

Conversely, so long as one has good insurance OR one knows how to work the system, timeliness of care and access to specialists in the US is generally very good. The biggest gripe down here is the cost (and sometimes the availability) of non-cancellable comprehensive health insurance.

Canadian health insurance is not "free" and it's not particularly comprehensive, either. It covers a percentage of most doctor and specialist visits, some instances of follow up care and physiotherapy as well as most care provided while a patient is actually in hospital. It does NOT cover dentistry, most ocular bills, chiropractic visits or alternative medicine, nor does it routinely cover perscription drugs for those under 65. Many Canadians carry extra insurance, often sponsored through their employers, just like here in the US, to bring their health care coverage up to a standard they feel comfortable with.

One of the few real differences that I have found between Canada and the US is the system of health care between the two countries, even if the overall outcomes are similar. Canadians, both liberal and conservative, voluntarily pay very high taxes to support their provincially run universal coverage health insurance systems; despite the griping, most of them are very happy with much so that the easiest way to never get elected again in Ontario is to suggest a return to free market health care. It is no exaggeration to say that nearly everyone in the country supports the idea that every Canadian should have equal and affordable access to health care, regardless of who they are or their ability to pay.

Interestingly, for all the rhetoric levied against various parts of the US health care system from (gasp) Socialist Canada, the US government already exercises considerable involvement in many health care situations. Medicare (and to a lesser extent Medicaid) is quite similar to the system in place in Canada right now. The biggest difference between government run health care in the US vs government run health care in Canada is that one has to be retired and 65 or below a certain income threshold to qualify for it down here as near as I can tell.

My only personal gripe is the ever escalating cost (and potentially the availability) of affordable, reasonably comprehensive health insurance in the US, especially for sole proprietorships and other small businesses that don't qualify for group health insurance. I've said for years that I would like to own (and pay out of pocket for) a family policy that mimics the coverage I had when I lived in Canada, but extensive research has shown me that such a policy really doesn't exist down here. I don't care too much about routine doctor visits or perscription drug coverage. At the end of the day, what I really want is to know that our medical bills will be fully covered and our insurance won't be cancelled in the event of a catastrophic and progressive disease or accident.

And so wraps up my post ! Any readers left out there ? :)


Daun said...

I completely agree. Unfortunately, the politics in the US, such as they are, will not allow the dissemination of facts about our already existent health care system and the startling similarity to the one our friends North of the Border share, minus of course "universal coverage". I would also gladly pay to have universal coverage in the US.

But rational discourse doesn't make the evening news.

As far as I can tell, some of the new guidelines coming out of this administration DO involve protection from being dropped. They do NOT however, cap premiums. So you may never be dropped, but you will pay for it!

You've failed to alienate me at all. A reasonable, moderate voice is always welcome in the polarizing storm. I've really enjoyed your previous posts about organic and GMO. Really made me think.

Keep it up.

Anonymous said...

I think your appraisal is fair and balanced. I think the dominance of corporate interests in our political process is the biggest impediment to change in the US - if health care costs continue to rise, they benefit. People paying for health care insurance (like me) know how incredibly expensive it is here - it's the constantly rising, uncontrolled costs that drive this.

It needs to be fixed, and we need to take care of our huge uninsured population, but I don't have all that much hope that it's going to really happen anytime soon.

Jack said...

I think you have been very objective which is something that seldon happens in the health care debate. One of the differences in escalating costs is that here in Ontario(and Canada) the cost is born by the community at large through the gov't and consequently everyone remains covered. As I understand the US system if your insurance cost becomes too high the individual will drop to a lower coverage plan or no coverage.

Jason said...


I don't pretend to understand the nuances of the health care system down here; I'm mostly reporting on things as they have happened to me. However I think it's fair to say that there are a lot of choices (and a lot of prices) when comparing insurance coverages. I don't know if this is the case in every state, but TN has a health insurance system (Tenncare) that one can potentially qualify for if one becomes uninsurable privately.

Glad to know I still have some readers ! It's a lot more interesting than writing a blog to yourself ! :)