I spent a number of years living in Canada during my youth. I learned that guns were bad, Canadian healthcare was perfect, and that Americans were assholes. Years later, I was living in Maryland and learning more about the US healthcare system and politics, and I realized that Canada was not the utopia it pretends to be.
Most Canadians will tell you how amazing their healthcare is. If pressed, they will then explain how horrible it is to have to pay for healthcare in the States. In the same breath, they’ll laud their own experiences. This is because Canadians are indoctrinated to believe that their healthcare and schooling, and indeed their entire way of living, is vastly superior to the United States.
There are so many complexities to this topic that it’s hard to know where to start. I’ll begin with this: the Canadian healthcare system is broken, but in very different ways to the US system. The US system is also broken, but most of the breakage has to do with insurance, not actual medical care.
And therein lies the problem. It’s the problem everywhere, by the way. People in general seem to equate health CARE with health INSURANCE. While they are connected, they are not the same thing. Everyone seems to treat them as if they are the interchangeable, and there is nothing farther from the truth.
Health insurance in Canada is okay. It’s not great, and not horrible. The set-up is very similar to how HMOs are used in the United States. There are limited numbers of doctors available at any given time. No one is taking new patients, but new patients are arriving in a constant flow. Emergency rooms aren’t permitted to turn people away, but the waits range from four to twenty four hours. At the point of service, Canadians pay nothing for their medical care. They do pay for prescriptions and certain other things like some types of therapy and such. There are set fees for the majority of medical procedures that require payment, so it’s not too complicated. Most jobs include insurance that covers such things as prescription medication, eye care, and dental care. The average Canadian pays very little out of pocket, and almost nothing at all at point of service.
Canadian medical care is lacking. Doctors and other medical staff are underpaid and overworked, much moreso than here in the States. They are required to do their work under very strict guidelines. For instance, the last time I was in Canada, the length of visit allotted to a physician to diagnose you going in for flu symptoms was only ten minutes. They had ten minutes to get in, order any tests, talk to you, examine you, and come to conclusions. Specialists have different rules, of course, but they aren’t all that much better. I don’t have the actual details for current conditions, but friends in the Great White North do report that wait times have gotten even longer in the past ten years.
A woman on TikTok (don’t judge me, it’s a fun little platform) was describing her most recent visit to a Canadian emergency room. She had a problem with her calf, it being swollen, and hot to the touch in one specific area. She provided pictures. My first diagnosis, upon seeing it, was deep vein thrombosis. That’s definitely an ER trip. She waited in the ER waiting room for ten hours before being seen. She lost her leg because of the length of wait, because by the time she was seen, the damage was too severe. Complications due to the late nature of the surgery mean she may lose not just her leg, but her life.
American health care is several steps above Canadian, in my very strong opinion. I’ve never had to wait more than a couple of hours to be seen at an ER, and then only in appropriate times. America has something called Urgent Care, for things that are more emergent than seeing your family doctor tomorrow or Thursday, but not as emergent as needing the emergency room. This takes pressure off the ER and the family doctors enough to keep the system from getting gridlocked.
On the flip side, American health insurance is a complex and convoluted crapshoot. I say that in the most polite of tones. The VA and Medicare both provide some insurance coverage and medical care coverage for people, but reported care under both programs is poor. If you want to know why, look at all the commentary about Canadian socialized medicine above. For those Americans who either choose to not have insurance, or who cannot afford it, self-pay is a perfectly valid method of going through life.
The problem with self-pay is that there is no way to know how much anything costs. An office visit for a sinus infection may cost $150 this week, $300 next week, and $50 the week after that. There are no explanations, no oversight, and no way to know what is going on behind the scenes. All attempts to make medical care costs transparent have, thus far, been for naught.
The behind the scenes insurance mess is even worse than the self-pay mess. Insurance companies exist in order to make money, and that’s something many people forget. It is their job, quite literally, to turn people away for services. Doctors, dentists, ophthalmologists, and specialists of all types are required to fight tooth and nail to get paid for their services. In order to get enough money to cover their own expenses, medical practices often have to charge insurance companies outrageous amounts, because they get only pennies on the dollar in return. It’s a vicious and horrid cycle wherein the insured pay the price for their own torture.
The care in America, though, is so much better! I have had medical care in America, Canada, and Britain. America wins on the care side, by far. When I broke my ankle, I was treated quickly and compassionately. I received not only emergent care at the ER, but appointments after the fact to check on my progress, and I was given access to physical therapy to aid in my recovery. Did I pay for all of this? Yes I did. It was expensive. I winced. It hurt to open the wallet that widely. But I received excellent care. Had I been in Canada, the outcome would have been vastly different, and likely would have ended up with me having unnecessary hardware in my ankle.
When my appendix burst and ultimately dissolved (that’s a whole other story), I was rushed into the ER by my family. Every doctor and nurse there listened to what I had to say, and I was treated with gentle hands and expertise. Due to the nature of the emergency, I ended up being in hospital for five days. As someone who was paying out of pocket, that was panic inducing. I could see the dollar signs stacking up. Instead of sending a bill to me, they send a financial advisor to talk with me. She helped us to come up with a payment plan that was reasonable for us. When I had a panic attack at 2am on the third day, the night nurse came and sat with me. I managed between sobs to explain that I was still in a lot of pain (I had managed to go septic due to how my appendix committed sepuku) and I was terrified to be going home in the morning. She talked to my doctor, and it was agreed I should spend another day in care. It made all the difference. In Canada, you go home three to five hours after your surgery. Let that one sink in.
Do I wish we had a country where the insurance was as straightforward as the medical care? Yes I do. It’s a desperate wish. Forced to choose, though, I will choose good care over okay insurance every single time.
It is unfortunate that I see America quickly following in Canada’s footsteps, both in care and style of insurance. I’ve lived in New England now for over ten years. In that time, I’ve never had problems seeing a medical practitioner… until 2022. I have had four appointments canceled out from under me, because the doctors have left the practice. I have been trying to see someone in a non-emergent way, for over a year now. It’s not something worthy of going to Urgent Care, and definitely not worth a trip to the ER. All I can do is continue to wait for an appointment I hope will eventually happen.
If you want to fight for health care, fight to make insurance and medical payments clearer, more transparent. Fight for decent pay and hours for doctors (because, while doctors here get paid fairly well, they are swamped with unconscionable fees for malpractice insurance). Fight for nurses being allowed to do their jobs and not be treated like servants. And fight for private insurance to be either fixed or regulated, but NOT by the government. Fight to keep health care out of the hands of the government.