Here's a good comparison of the Canadian and U.S. health care system by a writer who has lived in both countries and compared the benefits and liabilities of each.
Subject: Health Insurance
Date: Wed, 10 May 2000 13:21:03 -0700
Have been meaning to get this msg to you for ages...sorry, have been so swamped. I've written a rather personal note because I have had quite the medical "go round" in both countries which I trust, makes me a somewhat (reluctant) expert! If you want to cut'n paste & use info, pls do by all means but but pls delete my name! This is only Book I of xxxx's Great Saga but I think it will give you some insight into the medical systems in both the U.S. & Cda.
Cda is the best place to be for us lower income folks, with several caveats. In B.C., we pay $36. a mo. & another $35. a mo. for Extended Health Care, which pays 80% of prescriptions, dental (not all of it!) vision (not glasses) and basics, like crutches etc. It also gets you a private rm in hospital & other sundries. Yearly, all Canadians get 12 visits to a "massage therapist" (yes, if your doc writes a note, stress passes) physio, chirpor. with a co-payment of $10. or $20.per visit. Companies offer employees diff plans but basically, things like acupuncture are not covered by reg. ins., but are tax deductible. Because I have a # of health probs, once my prescription drugs exceed a total of $800. (where I am reimbursed 80% for all not under the pre-existing conditions umbrella) in a given yr., the govt. jumps in & picks up 100% of my prescription drug payments. Believe it or not, I usually break that bank by now (just did) so for the rest of the yr., unless it's a pre-existing condition, all my drugs are free. This saves me $200-300 a mo.& I am not "punished" by my ins. co. because, unlike the U.S., our premiums do not go up if we have health problems.
When I had a skull fracture awhile back I was a major bubble-head for about 6 mos. & my income was LOW for that yr. I was surprised to find the govt. paid my monthly premiums & sundry other items (physio at $10 instead of $20, free ambulance which I needed several x!) for the next yr. So, unlike the U.S., no matter how poor you are, you are covered just like everyone else.
When I lived in the U.S. I was making damn good money & had a very good plan with Prudential. However, with some chronic, not serious health probs & a nasty bout with TSS, I saw my premiums go from $125. a mo. to $404. in about 4 yrs. Last notice was a jump to $505.a mo & that was when I was writing. Even when I was consulting, that was a hell of a lot of money, plus the deductible, plus the 20% of everything. Yes, I had $ but it still hurt. It seemed like I was being penalized every time I was sick because the premiums went up every 6 mos. And the paperwork is a nightmare. I used to say, everytime you get sick, it's like you've had a car accident for all the paperwork. Here, the only paperwork is sending in my prescription receipts for 80% reimb until I break the bank. Then it's in any pharmacy database that all prescriptions are free & the pharmacist just hands it to me & I don't pay a penny.
The prob here in Cda is that the med. system has pretty much bankrupted itself. Need radiation? Last I heard, the wait was 6 mos. Heart surgery? Same thing. (My friend's father needed a bypass *desperately* yrs. ago & one of his daughters had been a head nurse in open heart surgery. She called the top heart surgeon *at home* & he moved her dad up the list. It's sort of like getting a good table at a restaurant.) An MRI takes 6 mos. to a yr. unless it's life threatening. Of course, many ppl with brain tumors are not in a life threatening sit'n when the symptoms begin. Besides the wait, the doctors *are* underpaid & they have "strike days". Last yr. all dr's closed up their offices for a full week because they didn't get raises. Other times, they just shut the doors for a day. Hospitals are very under-staffed & there is a wait for everything, including treatment for serious conditions. I remember when I lived in the U.S., a lump was discovered in my breast & it was removed the next wk. Women here wait 3-6 mos. & personally, I'd go mad waiting even a wk. for a biopsy. That's why many ppl slip down to the states to have tests or elective surgery. Elective surgery is another area where the waits are interminable. Back surgery, etc. can take yrs. A friend of mine had scar tissue from a hernia operation that was causing great distress internally but he had to wait 18 mos. for sugery. He was called, told to be in the next day or he'd have to wait. This is the norm.
There's a big brouhaha going on in Alberta where the govt is trying to introduce a 2 tier plan. Meaning, ppl could opt to pay more for "better" coverage. Personally, I think this is a great idea.
I was very ill from 96-99 with vertigo following a car accident & wonder often where I would have been better off. In the U.S., with the ins. I had, I would have rec'd much more aggressive treatment & tests. They have the technology down there not available here. I corresponded via email with some specialists I had seen on a segment on vertigo on Dateline & one of them wrote me that the technology & surgery was not available in Cda & that I might have to go the U.S. for treatment. My parents were actually looking at taking me to the Mayo Clinic as I was literally helpless & really suffering. (24 hrs. a day of vertigo with vomiting, falling, causing numerous injuries, inability to work because the screen would swim before my eyes, I lost so much weight I became malnourished, etc. I became so depressed that I eventually lost the will to live. Eventually, time, vestibular rehab that I learned about from one of the US docs & did myself helped me.) I suspect in the US, I would have recovered much faster, but at what cost? Here it was "free" but I lost 3 yrs of my life & will be bailing myself out financially for the rest of my life.
Each time you need to see a specialist here, you have to have a referral from your GP. Typical waits for a specialist are a yr. Yes, you read that right. That's an allergist, a gynecologist, an eye doctor, neurologist, psychiatrist, ENT...anything but a GP. I just saw a specialist last wk. re: my long gone vertigo & we both sort of laughed. He said. "Guess you could have really used my help 2 yrs. ago, huh? Well, somehow you managed!" I waited 14 mos. to see him. (I would have canceled but my GP said. "No, he's the best. What if it comes back?" So, I had a 3 hr. appt. & I'm on the top of the list if it ever does return. But did I need him way back when.)
Another time I was found unconscious on the street. No carotid artery, I was lights out! Rushed to hospital & they deduced I had low potassium. Filled me up with it & literally carried me out to a cab about 6 hrs later. I had gone from being quite uh...sort of dead....to getting dragged out the door when I couldn't stand. This is the way it works here. They don't have beds or time to find out what is really wrong. They just deal with the immed. "emergency" and off you go. I was so weak I couldn't get out of bed for a wk. Many black-outs later (resulting once in a skull fracture & concussion with true "head injury", another concussion & then a broken rib) they discovered I had dangerously low blood pressure, blood sugar, etc. etc. & that my adrenals were underfunctioning. This had gone on for yrs. For all the blows to my head & accidents from fainting, it's a wonder I'm still alive. The point of this story is I know (at least with the doc I had in Calif) that she would never have said, "Oh, you blacked out again....oh well!" She would have looked - fast - and got to the bottom of it. There is no time for that here because dr.'s are so overworked & you have to wait forever to get tests or see a specialist. They just deal with each problem (broken rib, skull fracture) as it occurrs. Sure, a few dr.'s ordered extra tests but I had to wait for those & just kept on blacking out. I got so I was too scared to go out the door & my mom checked up on me by phone 2x a day. We never knew if I'd fall & not wake up.
We have a saying here. "It's a great system as long as you don't get sick!"
As you know, I am anxious to return to the U.S. except I do get really scared when I think of the medical. Even if I was well, it still scares me. Even with my pre-existing conditions all well under control, I know I'd have to pay huge premiums & if anything recurred, those rates would start going up & up.
I think there are wonderful benfits to both systems & that both countries could learn something from each other & find a system somewhere in the middle. For example: There is no "user" fee here & many ppl go to the doc every time they have a sniffle. I come from a family of Dr.'s & nurses & they say a lot of elderly ppl depend on a weekly visit to the docs for companionship. I think if ppl had to pay $5. for every visit they would think twice about going every time they sneezed. No matter how broke I've been, I would never have an objection to paying a little extra for using the system more than those who don't use it at all. Also, there could always be compensations made for people truly disabled & ill (I had disability status for 2 yrs.) so co-payments aren't cauing further stress to ppl who are truly suffering & unable to work. A small user fee would truly help with the financial mess of the current system. I think the monthly premiums could go up too. I was paying $36. a mo. in '88 when I moved to Calif.! I think smokers should automatically pay a higher premium for obvious reasons.
On the U.S. side, the fact that there is no universal health care is truly frightening. Like it or not, good health care is a priviledge for the wealthy. They can receive the very best treatment while the middle-class & lower class are stuck with HMO's or nothing. I know a # of professionals who are self employed & make quite decent money but choose to forego ins. althogether. For someone who has always been healthy, this is tempting but I remember how I got Toxic Shock (from tampons) and how quickly I would have died w/out proper medical care & I am *so* grateful I had insurance. I remember being rushed into the hospital (in calif) and all they were worried about besides me being in shock was my ins. Once they called Prudential & found out my coverage I was treated like a princess. I was in for 5 days & the bill was some $40,000 (my pers. cap was $1000.). The doc told me when I was leaving that if treatment had been delayed even a few more hrs. "it would have been very bad indeed." I remember a man coming in to Emerg in the next bed. He had been in a car accident & they thought his neck was broken. He could only speak Spanish so I listened while they said not to touch him, get a translator & find out what his coverage was. When they found out his coverage, he was shipped out, presumably to a County Hospital. Even healthy ppl can have accidents & I wouldn't go a day w/out insurance.
Both sides of the border have their problems. If I was very wealthy I would choose to live in the U.S. for many reasons but having great medical insurance in a country that has incredible healthcare for those who can afford it would be paramount. But the ppl who have that kind of coverage are not poor writers - most aren't even middle class. It's for the have's, not the have not's. At least in Cda, everyone gets coverage, even those who can't afford the monthly premiums. No Canadian citizen would ever get turned away for treatment. However, with serious or complicated problems, Canada does not have the availability or advancements of the U.S.
I know the taxes here are the highest in the world (49.5% B.C. personal income tax + federal!) & prices are ridiculous compared to the U.S. Everything (from food, gasoline, liquor, clothes, etc.) is markedly higher than anywhere I've been in the U.S. Added to the high taxes we already pay, everything we buy - goods & services - is levied the GST (Goods & Services Tax) and prov tax, adding 15% onto every item purchased. So, we don't pay that whopper of a monthly premium but I *do* know we pay overall.
I have noticed since leaving here in 88 and my return in 96, there is no longer a true middle class. This has truly become the land of the have's and have nots & that makes me very sad.
Hope this helps. As a struggling freelancer, I admit I breathe a little easier living here. There isn't as much opportunity & that gets depressing but then again, we don't have guns & we *do* have universal medical care. As I approach 40, it gives me more reason to think this might be the best place to make my home. My family is here, the city is truly gorgeous & there is no reason I can't do an appt. swap or a 6 mo. sojourn with someone in Manhattan! I live 2 blks from the beach & a New Yorker here would think they had died & gone to heaven. So, that's a possible game plan!
I really think "the answer" to the medical insurance dilemma is somewhere in the middle. To provide universal care, taxes will have to go up for *everyone* & it will have to go up a lot. How will the Americans react to that? Especially the ones who receive decent medical care already? Medicine will no longer be about profit (not that it should be) and that could dissuade many doctors & researchers. Many of our brightest Canadian trained doctors bolt for the U.S. because they can make so much more $ and work in sophisticated facilities on new procedures & new technologies. Would this continue under a universal plan? Could the U.S. still afford it?
Can you imagine how pissed the Donald Trump's of the world would be if they had to wait in Emerg. for 8 hrs. like everyone else? :-)
Hope this helps. I'm happy to answer any questions. I didn't send this to the whole list because I sound like such a sickie (had a few very rough yrs.) but I'm happy to share with you because I know how interested you are in this subject.
Sorry this is so messy & all over the place! Brain drain......;-)
I should write a pc. from the perspective of someone who has lived on both sides.....hmmmm.....
Ciao for now,
>Norman Bauman wrote:
> I'm paying $3,200 a year for HIP. There's a cheaper plan at $2,800 which
> would restrict me only to the doctors that are in their pool. As far as I
> know, that's about as cheap as an individual can get health care in the NYC
> area. I once wrote an article for Printing News on the problems that
> printers in the NYC area were having getting health insurance. They
> investigated purchasing groups, etc., and nothing really helped. I also
> wrote an article about "no-frills" health plans, and it turned out they
> didn't make economic sense--in order to reduce premiums by a significant
> amount, they had to reduce benefits so much that they were useless.
> Somebody on this conference had a medical savings account and liked it, but
> I'm skeptical.
> This really is an important issue for writers *qua* writers, because of the
> way health care is tied to your work in the U.S. and because many of the
> writers' organizations provide insurance for their members--all of them
> fairly expensive.
> Writers who have lived in both the U.S. and Canada tell me that they much
> prefer the Canadian single-payer health care system. Most of the Canadian
> health care costs are paid from taxes, and the Canadian tax system seems to
> be far more progressive than the U.S. system, so writers with low incomes
> are at a great advantage in Canada (or disadvantage in the U.S.). The real
> dollar cost of Canadian health care, as best as I can figure it out, is
> about 2/3 of U.S. costs. There are problems with the Canadian system, such
> as long waiting times, but according to David Himmelstein, who reviewed the
> literature, all the published studies indicate that the outcomes of
> Canadian health care are equal to or better than the outcomes of U.S. care.
> Of course for people who can't afford health care, the outcomes in Canada
> are much better.
> I would be interested to know from Canadian writers whether they think my
> understanding of their system is correct.
> The single-payer system is actually quite popular in the polls in the U.S.,
> particularly among doctors. There was a survey in the New England Journal
> of Medicine which found that a majority of medical school doctors and
> students preferred single-payer over the other options (SR Simon et al,
> "Views of Managed Care Views of Managed Care: A Survey of Students,
> Residents, Faculty, and Deans at Medical Schools in the United States,"
> N Engl J Med 1999 Mar 25;340(12):928-36 ) "[A]ll groups
> expressed a preference for a single-payer health care system over both
> managed-care and fee-for-service systems. Overall, 57.1 percent thought
> that a single-payer system with universal coverage was the best health care
> system.... 21.7 percent favored managed care, and 18.7 percent preferred a
> fee-for-service system.") There were also quite a few letters to the
> editor. Marcia Angel also had an editorial in NEJM supporting single-payer.
> Blendon also did a survey in JAMA in which he reported that 30% of
> Democratic voters favored single-payer. I *don't* think this was reported
> in the New York Times. And I think it's a pretty good story.
> The question of *why* politicians, like for example Hillary Clinton, have
> ruled out single payer as an option is a very interesting question which I
> have been researching. Meanwhile I would suggest checking the web site of
> Physicians for a National Health Program, and
> searching the NEJM web site for "single payer". The Consumer Reports web
> site also has a lot of articles.
> There really is no way that U.S. writers can get health care at Canadian
> costs, or be guaranteed health care even when they can't afford it, under
> any existing plan that I know of. I think the best thing self-employed
> writers could do is to examine the single-payer health care system--by
> writing about it.
> At 09:31 PM 4/19/00 -0000, email@example.com wrote:
> >Does anyone know of a cheap group health insurance plan for writers?
> >I'm looking for a no-frills major medical plan with a monthly premium
> >under $200. (It looks like the monthly premium for the NWU plan would
> >be well over $200.)
> >I'm not sure if this matters for group plans, but I live in New
> >Thanks in advance for any replies.
> Post message: MAGWRITE@onelist.com