Do you want health care, or do you want health insurance?

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. 


Heuristic Hagar

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By hagar

8 thoughts on “Health Care”
  1. You think the Canadians are bad, try talking with the Brits…
    Seriously though, you are correct. People do equate health care with insurance in the States. And, when Obamacare was passed, it was not about care, it was about insurance.
    The problem is people have ZERO idea what medical care costs. How much does a doctor’s visit cost? No one knows. Even the Doctor’s office does not know. So, any real healthcare reform will never happen because someone else is paying the bill.
    Granted, there are co-pays and deductibles, etc…but the majority of the cost is carried by someone else. And, that is exactly why there is this equivalency between care and insurance. It removes any incentive to care about the cost, and it limits competition as well. If you are locked into a network of doctors, you will take whomever works with your insurance, instead of the best doctor you can get.

  2. I used to hear how great canada health care is, and in the next breath they would tell how they or a family member is coming to the USA for a “procedure “….. IMO,until We the People force our “leaders” to do thier job we are going to be subject to the insurance/care nightmare. I recently got to experience it first hand. The care I received was top notch, zero complaints. Dealing with insurance and being put on leave of absence was not fun.. but Im still here and thats what counts…

  3. German healthcare is similar to Canada or UK.
    The quality is declining for the most part UNTIL you get on the table – then it is top notch. But it either takes literal years to get an operation or they want to cut you open first thing tomorrow for symptoms which do not require operations. You see: for all the talk about how great these systems are it all comes down to money.
    How much money can the hospital get for you: If you are sick with something that does not pay well for the hospital then you are out of luck and can fight for YEARS to receive an effective operation because the make more money by selling you pills than removing the problem.
    But if they can railroad you into an expensive operation you may not need then they will try and convince you to take it so they get paid a lot.

    Despite the overall good quality of medical care people are taking operations in east Europe because it’s not that expensive and it is done NOW and not in maybe 3 years.

    And all the money does not pay for nurses. The staff is overworked and more and more people are leaving.

  4. A large part of the pricing problem is driven by the Medicare/Medicaid system, whereby politicians proudly save us money by paying only a small fraction of the billed amount, while demanding that providers give the government the best price. It follows that providers that accept government payment must overbill the gov’t by a large multiple, while overbilling everyone else even more, and the quasi-private “insurance” companies negotiate discounts to almost-sane prices that are high enough that the providers stay in business.
    It further follows that if you have a high-premium Obamacare plan, with only 10% coinsurance, you’re paying the entire amount for routine / minor emergency care out of pocket while the “insurance” company has negotiated away its share.
    It’s sometimes possible to work around this and get a sane price, e.g. by arranging to have major surgery done in a way that would never, ever be billed to “insurance”, but that only works when there’s time to negotiate.
    (FOAF had a brain tumor removed at a top-rated hospital, by a top-rated surgeon who didn’t normally work there, on a strange schedule, with some other twists to ensure that everything was out-of-system. Saved about 90% relative to list price. (This is dimly recalled from 2010-ish.))

    Also, it’s worth finding a good pharmacy. After the Wasp Incident, I was prescribed an epinephrine autoinjector. The local pharmacy had a few options. Turned out that paying cash for a generic cost about half of what my out-of-pocket cost would have been with the “insurance” company pretending to pay.

  5. I’ve been saying for years health insurance is a discount club membership and is not used or treated like any other insurance by most people.
    Let’s not forget all the compassionate death being offered in Canada now because it is cheaper.
    Let’s also not forget all of the perverse covid incentives and money…
    I will also agree that living in new england my entire life, about 2022 is the first time it ever became even slightly difficult to get any appointment in a timely manner.
    But also big shocker, health care is a crazy over worked, over stressed, and understaffed field pinched for profits wherever possible and the pandemic and mandates very much broke the camels back.
    The entire system is a mess and its all so incestuous its insane.
    Many hospitals are for profit. That’s good in that I think it gives much greater chance for developing treatments and methods and experimental stuff you wouldn’t get because the profit potential is high. Its bad because its all profit. Then you have the issue that emergency rooms cannot deny care (or any place that technically qualifies such as some nursing facilities I have heard) and the hospital is on the hook for those costs if it is a someone who doesn’t pay. But then you have the gov giving money to hospitals and running itso an insurance. And so on and so forth.
    Idk the answer but the whole system needs redoing and not at the cost of care quality and the gov/insurance/private enterprise imbroglio needs to be done away with.
    I have seen favorable things said about Japan but who knows, highly socialized as well and probably has the same problems.

  6. Preaching to the choir on this one.

    Aye the fact that there is no set price nor standard is just pants on head silly bordering on malicious even before you tack on the insurance mark up.

    Nail on the head here.

  7. I will admit, I don’t know how to fix it either. There are so many moving parts that it hurts to even try to *think* about it. As an example, the medicos in my neighborhood have decided that it costs less for them to vaccinate everyone who wants a flu shot, than it does treating them when they come in with complications from not having the shot. Every October, they do a flu clinic. Anyone can come in. They take your name and info. If you have insurance, they bill it. If you don’t, they wait. They have a fund set up to cover the costs of community shots for the uninsured. As I don’t have insurance, I sometimes pay a little (under $20), but most often pay nothing. I’m never asked if I *can* pay. It’s just what they do for those without insurance.

    On a community level, that can work, and work well. Our doctors and nurses know from long experience that this is cheaper for the community. It doesn’t bother them one bit. We have a couple of big donors in town who gift money just for such things.

    On the other hand, this does NOT work well on a country wide level. It doesn’t even translate well to a state level. It can’t.

    The best system I’ve seen, for pretty much anything like this, is in the Mormon community. I’m not Mormon myself, but I have a number of friends who are, and we interact a lot on the prepper side of stuff. Their community (there’s that community word again) takes care of their own. If someone doesn’t have insurance, the community helps out. If someone doesn’t have a job, the community helps out. Each case is handled by a single person who is not overworked, and that person is in a position to look at someone and decide.

    Decide what? Well, to decide whether Walt over there is very elderly and frail, but has done his best and been a great boon to his community, and now it’s our turn to take care of him. To decide that Judy left home at 17, messed around, screwed up, and is now looking at “community” as a giant nipple to squeeze for free stuff, and should be offered a hand up, but never a hand out. To decide that Alex is going through a really rough patch because their job had to lay them off due to nothing they had power over, and offer that hand up and maybe a couple of hand outs until Alex is back on their feet.

    But again, that just cannot be done on a country wide level. It can’t. Biden doesn’t know who I am. Trump doesn’t know who you are. And frankly, the Gubbmet was never MEANT to be as big as it is now. When this country was formed, there were people within each community who absolutely were able to look at the Judy’s of the town and say, “Smarten the heck up, child, and maybe we can help. But don’t smarten up and you’re on your own.” There were people who knew that the kid down the road had a mental disorder that precluded them having a normal life, and found a way for that kid to have a job that suited them, and someone to make sure they got there, got home, and got fed. Today, even in tiny communities, you just don’t see it.

    If we can’t do it in small communities, how in the heck are we supposed to do it with something the size of the medical insurance companies of the whole country? *sigh*

    I knew this would be a “preaching to the choir” topic. Believe me when I say, there will be topics y’all don’t like my opinions on, and I won’t back down from speaking my truth. THE truth, if you wish. But on this… yeah. We’re all in the choir.

    1. Too big and too many moving parts is right and just about everyone agree with that statement.
      The unfortunate thing is the the people seeking care and the working slubs of the industry are the people caught in the center and squeezed between the profit motives of the industry and the insurance companies, the bureaucracy, and the gov being the biggest swinging dick with regulation and medicare.
      Then there is also the absolute waste and graft of the system. I had an allergy test done. The results were available online complete with little graphs and ratings to tell me if the values are good and within standards. I paid $25 to my primary care doctor for a follow up to tell me exactly what I can see online. So I waste $25 out of pocket and 2 hours or so of my time and the insurance company pays for an unnecessary visit. That is just the lowest of the most low hanging and transparent fruit. Then you have the absolutely opaque medical billing where half of these outfits runs them like invoice scam operations, the incentives and kick backs for drs to prescribe certain pharmaceuticals, etc etc.
      Also, yawn, my truth. IDK man, that phrase is just so tired to me.

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