Tax season. I had a chat with a Canadian accountant about how I would deduct all expenses when I lived in the USA so I would pay, effectively, as little tax as possible to the state and federal governments. She looked at me askance and said, “In Canada, we pay our taxes. It benefits our friends and neighbours.” And then I thought about how paying tax is one of the most patriotic things you can do. I will add that it’s an easier justification when I know I’m getting a lot for my tax dollars in the form of strong public schools and healthcare.
Yes, we moved to Canada.
And as the representative for all things Canadian now the discussion of healthcare comes up. What I find most astounding is how difficult it is to even discuss this topic with my friends in the USA. So much of what we experience as “normal” in the USA is unfathomably awful by the standards of other countries I’ve lived in. I kind of hate to even bring it up or talk about it because I feel bad for my friends. What can they do? But then I also get angry when I hear about a good system getting criticized. Some Canadians will complain about their system but when I do a bit of digging it becomes quite obvious that the same problems exist in the USA except in that country you’re paying a lot of money to feel frustrated.
In a related topic, I wrote about how I think healthcare has an impact on art. In the coming years I suspect we’ll see more movies and shows starring Canadians, Britons, Kiwis, etc., passing as Americans. It’s not hard to see why they would be able to achieve their dreams more easily than someone starting out in the USA.
So here’s how it stacks up for us, as a typical middle-class family of four in an expensive Canadian city. I do not have first-hand experience for the private insurance coverage available here (you can pay extra to have a private room at a hospital, for example), nor for the very downtrodden (but I understand that walk-in clinics will see you for free if you’re willing to wait).
tl;dr We have exactly the same level of care as people in the USA with good insurance but we pay almost nothing for it and our taxes are only slightly higher than the average US state. Our healthcare system is not-for-profit and the tax system takes it’s fair share from corporations and the mega wealthy to help pay for the system.
As a family, we pay $1,800 total per year for almost total coverage — this is considered high for Canada as I understand our province pays the most. There are no co-pays or extra charges or deductibles.
I’ve never waited longer than 6 weeks to see a specialist. I did have to wait a year for non-essential surgery as people with cancer kept jumping ahead of me in the queue. As in the USA, there is a shortage of certain doctors available and that causes some delays. The US has a huge number of physicians who are immigrants as they do not have enough home-grown doctors. Canada deals with a similar shortage with immigration as well as keeping the cost of higher education low.
We’re also covered for extras like dental and vision or special medication or massage through my man’s work “extended benefit”; everything is covered 80% per person per calendar year; in the case of massage we get one per person per month, for example. Or glasses, we get $450 every two years toward a new pair and exams, etc.
I just spent two hours on the phone updating our extended benefit due to a job change and it was a hassle and I was reminded how I used to do that sort of phone call every single week when I lived in the USA. And I paid a hell of a lot more than $150 per month for the privilege and often got declined for coverage by my supposedly great insurance plan.
I’ve only had to get “prior approval” on one medication one time in Canada because it’s new and unusual and I wanted the non-generic. The doctor signed a form and I mailed it in and it was approved. Prior approval for services is simply not a regular thing in places like Canada.
The other day I went to a specialist who ordered X-rays and bloodwork. I went to the nearby walk-in clinic with forms he gave me at the appointment and they did all of the tests and it was done in less than an hour. The results were back five days later and the doctor called me to discuss it. Apparently, the results were available online the following day if I wanted to have a look at it. So efficient!
When I wasn’t covered I had to pay for some medications out of pocket. They were unbelievably cheap compared to what I paid in the USA. For example, a standard asthma medication that I remember cost me $300 in the USA cost $26 out of pocket here.
Canada could always improve but yeah, it’s good.
By comparison, I have a single male friend in Florida who pays five times as much as we do as a family and his coverage includes expenses we do not have to worry about. He pays $2,000 a year out of pocket maximum. No deductible. And in-network doctors and prescriptions are $20 a pop. ER visits are $175 all inclusive, and imaging tests are the same. This is very good coverage, but again, he’s a single male paying five times what I pay for a family of four to achieve similar coverage and he still pays more than I do for prescriptions, doctor visits, and ER / tests. Again, I pay $0 for those things.
Another young and healthy friend in Alabama I know pays a monthly premium of just under $100 per month but has a deductible of $4,000 and must first pay out of pocket $10,000. She also worries that when a doctor orders tests or a follow-up appointment if it’s so they can pad their own bottom line. She has to pay $140 every time she sees her doctor even though she has insurance. Meanwhile, when I had a C-section while living in New Zealand I didn’t have to ask myself, “Does the doctor want to do this procedure so they can make more money?”
There are still some amazing conveniences to the system in Canada that astound me. For example, when the kids were very young I was too overwhelmed to get myself to the doctor to have a rash examined. We were at the mall one Saturday and I noticed one of the many walk-in health clinics. I popped by and they confirmed that my care card would get me in. In fact, they were able to pull up my entire history from the centralized computer system and I had seen a doctor and filled a prescription all in under 15 minutes. Total cost: $0.00.
Contrast this to the time in NYC I was charged $360 for a flu shot my doctor administered because the insurance said I “did not get prior approval.”
An American friend mentioned that he was worried about amputations due to diabetes and talked about it at a hospital in Canada. People losing body parts to diabetes is strikingly common in the USA. The Canadian doctor explained to him that that just doesn’t happen in Canada because citizens gets proper preventive care.
Conservatives in the USA seem to all be of a similar bent. When they themselves have good healthcare coverage and like their physician they do not want the overall system to change. They are fearful that they will lose their own good coverage. This is despite the fact that the system is clearly wasteful and frustrating for many users. By moving to nations with socialized healthcare my paperwork and bureaucratic busywork dropped by 40%. The GOP talks about “access to a plan” but they don’t mention if it will be affordable. Most of the Americans I know who have good coverage get it at a low cost through systems like their background in the military, their work pension, or other union-based negotiated benefits. To be honest, I have lost several friends who will be listed as having died of infection or what-have-you, but the real cause of death for these people in their 30s and 40s was lack of preventive care or fear of getting fleeced by a doctor bill and waiting too long to get seen.
Some of the benefits we receive through my partner’s job can be achieved by other people in Canada in another way: they can claim it as a deduction on their taxes. So, those higher Canadian taxes you hear so much about? They can be effectively lowered by claiming all sorts of expenses, even some that I am unsure would be permitted in the USA. For example, if your kids do physical activities and you pay a fee for that, you can deduct it on your taxes in Canada. You can deduct the cost of camps, daycare, medical expenses not covered, etc.
Meanwhile, people in the USA are angry that the ACA imposes a fee on people who decline insurance, but of course this is rarely levied on those who can’t afford the fee. And what they should be angry about are the wealthy who escape paying their fair share of taxes and impoverishing their nation. So-called patriots who hide their money overseas and send their children to private school instead of paying taxes toward the common public good.