Canadians on US Health Care reform

[DeadPoolX 9]

I think I've made it known that despite receiving far better care in the U.S. than in Canada, I don't necessarily approve of how the American system is run. It's great for those with good insurance (like I had), but for those without decent or any insurance, it's a real problem.

I do think some changes need to be made in both the American and Canadian systems. Maybe some here will disagree with my assessment on Canadian health care, but I'm far from impressed. Some of the doctors I've met are very friendly, but the system itself is just as flawed as U.S. health care.

That said, in Canada you're simply a number too. The government runs it and to them, you're "tax payer #28946" or something similar. You're not a "person" to either insurance companies or the government. Neither look at you as an individual.

[Sprailenes 47]

Though I can admit that Canada's system has flaws, I never once felt overwhelmed or burdened by it. I always felt like a person. I am speaking from my own personal experiences of course. Others have their opinions.

[Texanadian 10]

Being as I'm a Canadian living in the USA and working at a hospital, I might as well bring this thread back up.

I think this is one of those yin and yang things. Everything you like about Canadian health care, you'll dislike in the US. And everything that you like about health care in the US, you'll dislike about health care in Canada.

It's too hard to generalize an entire nation of health care. When I lived in BC, I would go to my doctor at 10:45 for my 11:00 appointment. At 11:00 SHARP, he would bring me in. Discuss what was going on. I'd be out of there by 11:15. On the other hand, my wife has waited for 4 hours at the doctor's office here. This isn't a CAN vs US health care situation. This is simply doctors overbooking appointments. Trying to find a new family doctor may or may not be easy. Depends on where you live and how many doctors live there. Remote areas like Yellowknife or Montana may not have as many doctors as Vancouver and Los Angeles.

Health care insurance needs to be separated from jobs in the US. The reason it's tied into employment in the first place is because during World War II, there were price and wage controls in the US. So one of the things companies did was provide health care for the employee since their wages couldn't be raised. After the war ended, companies kept the health care plan as a nice perk.....Fast forward to today's world and it's all about taxation. My hospital offers 4 different health care plans. Each one has a choice for employee only, employee and spouse, employee and child, or employee and family. I chose the employee and family option on the cheapest of the 4 plans offered. But get this. My health insurance costs $15,000/year in premiums for 2009 and it's going up to $19,000 in 2010. Why would my company pay that much for me? Because they can write off all that money in tax deductions. Were they to pay me 19 grand more in income a year, they'd lose the tax deduction and also have to pay FICA on that (aprox $1450 for FICA alone).....I will admit that I only pay 25% of those premiums. They pay the other 75% of the premiums.

So companies give their employers better health care plans instead of raises. Since employees don't have ownership of their health care plan, they use them more. Then the prices go up. If I could tax deduct 100% of the cost of health insurance premiums like my employer can, I'd probably go with a less covered plan and pocket the extra income (if they paid it to me). This is another reason why FICA should be a 15.3% tax on the worker rather than split 50/50 for employer and worker as it currently is. Either way, the worker pays it. They simply reduce your income by that amount and then pay the tax on it.....Now with a combined 100% tax deduction on health care for the employee and employee paying the full FICA tax (like self employed people do), employers could pay me the extra 19,000 dollars in income rather than spending it on a health insurance plan that I don't use. And I'd gladly take it.

I do agree that health insurance is too variable in the USA. Using my wife's old insurance plan last year from her job, we were out $3300 for her thyroid surgery. Know how much that would have cost on my health insurance plan? (that covers her now).....$100. One hundred freaking dollars.

As far as medical infrastructure and technology, I have to hand it to the US side. I work in the Texas Medical Center. The world's largest medical center. There are over 70,000 people working here! You can read up on it and see some pictures here: http://en.wikipedia.org/wiki/Texas_Medical_Center

I just can't see that much medical building and continual expansion in Canada. Amazingly enough, the parking at work is great. It's free. The shuttle bus picks me up 50 ft from where I park and drops me at the front door. The benefits plan is pretty good too.

• Medical insurance (family, 4 different plans)
• Dental insurance (family, 2 different plans)
• Short and long term disability (me only)
• Vision coverage (family)
• Life insurance (family)
• AD&D (family)
• 403b retirement plan (same as a 401K except that 403b is for non profit companies. It's actually a bit better than a 401K if you want to take out their contributions since they're non taxable in certain instances)
• Separate retirement plan funded solely by the employer in my name.
• 4 weeks vacation to start. It goes up to 6 weeks after you've been there awhile.
• Sick time bank
• Flexible spending account (pre tax for stuff like prescriptions, co-pays etc)
• Pre tax daycare spending account. (this alone can save a lot of money

In addition to free parking, they give you a bus card that lets you use the bus for free to get to work. Free metro rail passes. Money for carpooling. Plus I get to work in the best air conditioned and comfortable temp area of the city. There are other fringe benefits like discounted fitness club, theater tickets, museum, computers etc.

So ultimately they take care of you. All the above is non-union as well. Now I went back to BC to visit family and friends a few weeks ago. When I got there I saw signs saying "Save our paramedics." BC only has 1 ambulance group that does the ambulances in the province. They're working overtime because they're short staffed. Haven't had a raise in eons. And are without a contract. At my hospital there are about 30 different ambulance companies that show up at the emergency room. In BC, every so often they have health care strikes against the government. In the US if you don't like your employer, you simply choose a different one. They all have similar benefits plans as mine above.

I always found it ironic that health care workers in BC who were on strike against the government would also be the ones who were the most vocal against US style health care. So they were on strike against the government and also pro-government run health care. How can you be for and against it? I would casually (and sort of smart alec'ee) ask them "well why don't you just go and work for a different hospital?" The answer I'd get would be "because the government controls all the hospitals!"

I will admit that the supply/demand of health care costs is out of line. People can't afford health care. So the price goes up. Reminds me of the Ontario government about 10 years ago. They were having a problem with people smuggling cigarettes into Ontario. So what did they do? They RAISED the Ontario tax on cigarettes and put a portion of it towards anti-smuggling efforts. Yeah way to go guys.

But getting back to health care. You have to remember that Canadians for the most part like their governments. It's easy to go to the DMV or get your Social Security card. In the US, I waited for 2 hours standing up to get my SS card. The DMV wasn't much better. The Canadian government has paid down the national debt for the last decade. The US government has doubled the debt in the last decade. Doesn't matter which party is in office. Americans just flat out don't trust their government. And I can understand why.

Actual workers in health care places in both countries come down to the individual worker. You can have a nice nurse in Canada. You can have nurse Ratchet in Canada. The same goes for the USA. I have nurses I work with who are the nicest people you could imagine. Extremely kind. I also have grumpy hags who make my life miserable.

I like watching widescreen plasma TV's in the cafeteria and in patient's rooms. Easier to catch a game on TV or catch up on the news.

Our health care plans at work cost the same whether you're a nurse with a masters degree or a janitor with 2 days experience. They cover the same. On my orientation on day 1 of my job they told our group that we were already covered with health insurance even though we hadn't actually chosen which plan yet. Good to know.

Price gouging.....True, it's a problem in the US. And it completely ruins the idea of using insurance for expensive catastrophic only situations. If an MRI were $200, people would simply pay it out of pocket and save their insurance for heart attacks and cancer. But an MRI will run thousands of dollars without insurance. So you HAVE to have insurance to cover it. Same with things like a broken arm and cast. So when you combine the vastly different costs for simple procedures along with the employer/health insurance combination, it completely destroys the true costs of health care to the patient. Price gouging is something that Canadians suffer just as much from. I want to send my parents some computer speakers for Christmas. It means paying Texas sales tax here (8.25%) and then they would pay GST and PST (12%) when it gets there. Canadians pay more for books. And when I was up in BC a few weeks back, I compared the prices of new big screen TV's at Future Shop and Best Buy. EVERY SINGLE TV was on average 25-30% more in cost. The exchange rate is something like 4% right now. So why the extra cost? A new car costs thousands to tens of thousands of dollars more in Canada. I like paying $800/year for full coverage for both my vehicles in Texas. Couldn't do that in BC. If my wife wanted minimum car insurance coverage here in TX, it would cost her $10.16/month. A whopping $122/year. I will admit that you get more car insurance with basic insurance in BC compared to basic insurance in TX.

Don't be fooled about rising health care costs being a US only thing. It's a problem in Canada too. Last I checked (about 3-4 years ago) it was costing the the BC government 42% of it's operating budget to run the health care system. And that percentage was going up every year. You just don't hear about it in Canada. The provincial debt goes up. I see BC is getting rid of PST and going to HST (something that I always hated and was glad to live in the west where HST wasn't. It seemed like a maritime only tax to me). Meanwhile I have no GST and no state income tax in Texas.

So ultimately, neither country has it perfect. The cost it is too high in the US. The costs are bleeding the consumer and especially small business owner in the US. But the cost is bleeding the governments in Canada as well. Either way, the money comes from us. Canada doesn't have the medical infrastructure that the US has and Americans don't want less equipment and any sort of wait.

[Texanadian 10]

I will admit that what I pay (about $150 every two weeks for family health care coverage) is more than what I paid in BC. But it's actually the same price as we were paying ($300/month) for 3 separate plans for my wife, her son, and myself before I got the job. The difference is that we used to have a $3,000 deductible and two $2500 deductibles and then each plan paid 70%.

My work plan has a $100 deductible and then it pays 100%. And it covers everything. You can go to rehab 4 times on it. You can have gastric bypass. All the MRI's and lab work. You name it.

But as usual, the world isn't all that rosey. Before this, we had the crummy plans mentioned above. And my wife made too much for us to be eligible for any sort of medicaid programs.

[Texanadian 10]

One of the huge differences I noticed here compared to Canada was the taxes on booze and cigarettes. Texas raised the cigarette tax in 2006 for the first time in 15 years. Yep. 1991 was the last time prior to then that they went up.

BC on the other hand raises cigarette taxes about every 6 months. Even more strange was that the right wing government in TX was against raising the cig tax because "it would be hard on the poor." Yet the left wing governments in BC have no problem with raising the tax.

With alcohol taxes, Texas hasn't raised them since 1984. As such, alcohol is about 50% cheaper to buy here. Not that I'm a huge drinker. But it is nice to be able to buy a bottle of high quality micro brewary beer for $1.25 a bottle.

I thought Obama had it completely wrong when he raised the federal tobacco tax to pay for children's health care. What does smoking have to do with children's health care? This means that 20 year olds who smoke and have no children would be paying taxes for 40 year olds who have kids. Why not just tax brunettes to pay for the children's health care tax? (I'm blonde) It would have made just as much sense.

[trailmix 77]

Don't be fooled about rising health care costs being a US only thing. It's a problem in Canada too. Last I checked (about 3-4 years ago) it was costing the the BC government 42% of it's operating budget to run the health care system. And that percentage was going up every year. You just don't hear about it in Canada. The provincial debt goes up. I see BC is getting rid of PST and going to HST (something that I always hated and was glad to live in the west where HST wasn't. It seemed like a maritime only tax to me). Meanwhile I have no GST and no state income tax in Texas.

Interesting stuff there Texan, thanks for sharing that

Yes Health care is expensive, and here in Alberta we hear about it ALL the time, it is headline news in the Herald on a regular basis and we get other media reporting on it all the time - so we do know what's going on and we are very vocal about our feelings on the matter.

In fact here we are quite vocal on anything that has to do with our money - i'm sure that's not an 'only in Alberta' thing

[KnJ 0]

I understand VERY little about the US healthcare system. I'm currently having to study up on J's plan because they're changing how the PPO vs HMO works, spending accounts, etc. It's confusing.

The whole discourse on health care is so loaded with layers of values and assumptions, not just about how some other mysterious foreign system is better/worse/evil, or where the money comes from, or how expensive it is. All of those things matter, but in those debates what I hear are questions -- about what health means, about what community is, about the value of human life. Perhaps it speaks the loudest and most contentious in the rhetoric surrounding whether abortion would/should be covered under some US universal health care. no i do not want to have an abortion debate -- my point in raising it is that emotions run so high in the health care debate in general because almost every facet of this discussion cuts so close to our humanity

Last week a new study showed that 92% of Canadians would recommend their doctor to friends and family. Two-thirds have had their doctor for over five years and 85% of Canadians have a regular doctor. ~Jack Layton

J (USC) says one of the problems and differences with the american system that has stuck out is the impossibility to maintain a relationship with a health professional because every job change -- or every time an employer changes providers -- you lose your doctor. I have had a total of 3 doctors in my 32 years, including a pediatrician. My last doctor, for 17 YEARS.

Many people change jobs a lot. This is increasingly commonplace and so with care tied to employment, there is no continuity of care. I think I took for granted that I had a *relationship* with a doctor who cared for me for almost 2 decades. He knew my history, and while he was overworked and it could take a month to get into see him sometimes, if it was really urgent but non-emergent he would take me sooner.

An admitting nurse doesn't check your credit card -- she checks your pulse. ~Jack Layton

My doctor told me about a US family who came in with their son, he cut himself and required stitches. Dr was about to close for the night, but he cleaned and stitched the boy, and the family asked him how they have to pay. He said, 'don't worry about it,' and they were incredulous, they insisted on knowing what they owed him. He said, 'okay, if you really want I'll look up how much this all cost in the book'. Roughly: $15 for the visit and $5 for the materials... I don't remember exactly but it can't have cost more than $40 for the whole thing, and it took 10 minutes of his time. ON doctors don't really get paid very much. I think my dr said he gets not more than $45 for my annual physical. I think his health is suffering. I think he cares too much.

Maybe the point here is that the US care is overinflated in cost. But I'm not sure. I had to seek care here in the US previously, and called J's mom's provider, saying I wanted to see a doctor and was prepared to pay out of pocket. When I got there, the nurse -- or maybe she was just the cashier -- asked me who my referring doctor is. I said I don't have one, I called Harvard Vanguard and they told me to come here. She asked me if there was a health professional who told me to come. She asked me a couple other questions before I figured out she was trying to ask how I was going to pay. It struck me that the language being used in the system was obfuscating the fact that I was being held up at the gate, while in pretty intense pain, because I couldn't understand that she was asking for my credit card. In Canada, this is one more step removed -- instead of a credit card, it's a health card. A credit card the goverment gave me and never asks me to pay them back for charges I make.

A good health care system reflects a country's values, and each country's values are different.

But a system with 47 million uninsured, coverage denied due to pre-existing conditions and people thrown off plans when they become ill? That doesn't reflect American values. ~Jack Layton

Immensely terrifying to me is pre-existing condition, and I wish there was a bill to reform US care policy to address *only* this specific issue. I suppose I could run into this problem. What power does an insurance company in the US have to get medical records from Canada?

Some other thoughts:

It's sickness care not health care. See previous comments about preventive coverage.

Part of prevention is continuity of care. If GP sees you look gaunt since the last time she saw you, that might warrant tests. If coverage for tests were not tied to a requirement for diagnosis, then she/you wouldn't wait til you sprouted a goiter to get that gaunt look checked out.

Care tied to work is part of a culture that does not take a holistic approach to well-being. The climate at work, whether you keep your job, get a promotion, get a raise, negotiate better coverage, are able to get time off to balance stress load -- the very stress load itself -- all determine whether you are healthy or you are sick. Whether you are healthy or sick then determines how good a job you can get, whether you can keep your job, get a promotion, etc. Of course people climb all over everyone else -- your very life is at stake.

But why shouldn't it be?

an ugly truth (that I don't agree with): if you are stupid enough to break your leg or get cancer because of industrial pollution (get a better job so you can get a better house so you don't have to live by the chemical plant, cretin), you don't deserve to be treated for that if you can't afford it, because if you were smarter, you'd be able to pay for it with your better job.

The problem is circular. There is no way out.

The quagmire that is bankruptcy and pain and suffering and unemployment (ill health does cause under- and unemployment) are all tied up as well with race and gender and class and sexual orientation and disability (not the same as illness), and the systemic problems with health care are both the cause of and caused by inequality.

The right to self-determination is not a given. The ability to be truly healthy is not purely determined by an individual's choices (nor is the ability to get a good job). The monetization of *care* has created a new kind of uncaring world.

Care used to be (for hundreds of thousands of years) the domain of a community where the old and the young took care of each other and life was short and brutish -- it still is. However you define progress, MRI technology or none, people who are supported heal better.

Universal "health" care addresses widespread systemic inequality that can only partially make up for the fact that one lone human being CANNOT survive. We all need other people. North American culture has alienated us from each other in so many ways that more and more people are so painfully alone.

So I chew on that value. That is what informs my support of universal care.

Edited December 2, 2009 by KnJ

[Texanadian 10]

I have to disagree on the industrial pollution and jobs. Down here we have the ship channel, 2nd largest port in the country. With that we get bunker fueled ships idling and polluting like crazy. Due to international ship rules, we can't put emissions rules on the ships. The water in the ship channel is disgusting. 1/7th of the world's plastics are made in Houston. You got plastic, you got pollution. The Goodyear tire plant is here. And if you want to drive out to Baytown/La Porte (aka south-east Houston), you'll drive through about 45 minutes worth of factories and industrial plants (driving at highway speed the entire time)

All the jobs out there pay really well. And the housing out there is really cheap. We can't all be the university educated clean living people. Somebody has to produce oil and gas. Somebody has to be the mechanic that drains your oil. Somebody has to be the person who cleans out septic systems. Just like somebody has to brave frostbite, breakdowns, and ultimately death driving big rigs on the frozen Alaska lakes to make it from Fairbanks up to Prudhoe Bay.

I don't live in south-east Houston though. I'm in the west side. More expensive that's for sure. Although still light years cheaper than the west coast of BC where I'm from. I guess that's the benefit to living in a big city is you CAN get away from the pollution. Houston is 600 sq miles. (20% larger than Los Angeles)

Even in beautiful British Columbia, when you're out on one of the ferries admiring the view, there is still an engineer down in the engine room dealing with more grease and diesel and stinky oily lubricants than most people would ever know or think about.

One of the biggest problems with health care debates are the "scary words" that both sides promote. Anytime anybody says "bureaucrat", it comes across as saying devil. Whether that is a government or an insurance company. Then you get the S world (Socalized) along with people dying on the streets from the other side.

Jack Layton still has some explaining to do.....Mr Federal NDP guy and he got treated at a PRIVATE health care clinic rather than wait for a publicly run clinic to fix his hernia. Of course he's not unique in that regard.

http://www.canada.com/montrealgazette/news...d5-44963b8058da

Former prime ministers Paul Martin, Jean Chretien and Joe Clark also have been treated at private medical clinics, Day told the annual meeting of the Canadian Science Writers' Association.

And he said union leader Buzz Hargrove, president of the Canadian Autoworkers, proved a master at "queue jumping" when he got in for an MRI within 24 hours of injuring his leg.

Yet Layton wants to BAN private health care. Don't tell me what I can spend my money on. Especially when it comes to something concerning health.

K&J does bring up a good point about changing doctors. I had mine for over 25 years in Canada. He's still working. I moved. My wife misses her old dentist. Again, I had the same dentist for the same amount of time as my doctor. I have noticed that a lot of my Canadian friends and family support the idea of a co-pay for visiting an emergency room or clinic. Something to keep the freeloaders who go there for every sneeze and sniffle from going. But the hardcore universal people say it's a slippery slope. Fair enough.

Unfortunately my health care plan is considered a gold plated plan since it costs more than $8500. As such it would be subject to a tax (30%? Can't remember the number right now). Pre-existing clauses are a good/bad situation. On the one hand they keep people from canceling their health care for years until they need surgery. And then re-buying it right before they need it. But on the other hand, it sucks if you've had colon or breast cancer and can't get affordable coverage because of it. Or you can get coverage for everything but your colon or breasts. Most plans will waive the pre-existing mumbo jumbo if you've been continuously insured for a certain amount of time. But nothing is perfect in regards to pre-existing clauses.