US versus Canada healthcare

Barack Obama signing the Patient Protection an...

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I recently learned that a family member in Ontario is undergoing testing for shortness of breath (SOB). When I heard that, I decided that I would write this post comparing and contrasting healthcare in Canada with healthcare in the US. If you listen to the GOP critics of Obamacare, you would believe that most Canadians would travel to the US for care if they could. That is NOT true.

Details vary from one province to another, but the basic fact is that Canadian medicine is almost totally free to Canadian patients. Elective surgery is not covered, but almost everything else falls under the government plan or is covered by supplemental private insurance that is much less costly than private insurance here in the US. Sometimes there is a wait for service. Then it is possible to receive service from a private clinic or other source, and private insurance will cover the expense. When my relatives turned 65, they no longer had to pay for the private insurance; it is now covered by their retirement plan.

Here in the US, if you are not employed, you likely cannot afford health insurance of any sort. When my wife and I were between jobs because of a move from one state to another, we continued our health insurance from previous employment using the COBRA plan which cost approximately $900 per month for the two of us. COBRA is available for only 18 months if you can afford it. And COBRA is just an extension of your previous private employer’s heath insurance; the private insurer will try to pay as little as possible. Even though we moved from a high cost state, California, to a less costly state, Utah, the insurer continued to deny the payment we expected under the plan by saying that the charges were more than customary. Rather than pay 60 or 80% of the bill, they would only pay a percentage of the lower, customary amount, which  they established arbitrarily.

In Canada, if you are ill, you need only worry about getting well. In the US, you must worry about your illness and also about how to pay for care, even if you have insurance. The effect of the doubled source of worry is that many people put off needed care due to the prospective cost. Both my wife and I are delaying surgeries because we know the risks of surgeries (we are retired healthcare professionals) and we know that the surgeries will cost significant sums, even though we are covered by Medicare and have supplemental insurance. Based on past performance, I expect good service and no arguments from Medicare, and I expect the supplemental insurer to try to weasel out of paying as much as possible.

Good health is partly a mental attitude. A good mental attitude can affect the body positively while a poor attitude can lead to illness. Here in the US, not only do we make healthcare too costly for many, we encourage poor health by stressing many of us with unnecessary worries about how to pay for care. I would expand Medicare to cover everyone. The politicians on TV denouncing Obamacare are covered by government provided healthcare that we as taxpayers pay for, or many of them are wealthy enough not to need any insurance whatsoever.

Senator Orrin Hatch recently penned an article endorsing the states providing healthcare coverage. This would produce a race to the bottom, states competing to offer the least coverage, particularly in times like now, during the Great Recession. The states could not or would not regulate the predatory lenders who were largely responsible for the severity of the housing bubble and the resulting crash. I have no confidence that the states could resist the healthcare insurers.

Please see Death and budgets