Healthcare in Canada vs. the USA

Assumptions about the Healthcare Systems in Canada and the USA

Most Americans don't understand how the healthcare system works in Canada - and vice versa. That makes sense. Because healthcare is the most intimate of institutions. No one plans to visit a hospital or a clinic while on vacation. Most of us buy insurance to protect us from the disruption and costs that might follow an accident or a medical issue while abroad. But that doesn't stop us from conjecture and judgment. We hear people talk, see things on TV, and read things online - much of it sensationalized. Generally speaking, Canadians see American healthcare as barbaric. But some Americans share the same opinion of the Canadian system.

Before I moved to America, I only knew one sort of healthcare system. And I was grateful for it. When I moved to the USA I was at first terrified by the nightmare that I imagined would unfold when I had to interface with the healthcare system for any reason whatsoever. But that nightmare never materialized. In fact, I was - and continue to be - completely blown away by the quality of care I have been able to access as a middle-class, public-sector employee in California.

A Canadian's Experience: My Mom's Cancer

I know some Canadian peeps might find this difficult to read, but the quality of healthcare I have received in the USA has by far exceeded the care I was able to access in Canada. I think it might even help save my life.

Let me explain.

My mother developed breast cancer at an early age. She was diagnosed at 36 and passed away at 49. My mother's death due to the disease was probably inevitable, especially since hers was diagnosed as stage 3B. But she suffered in part because her doctors recommended a treatment plan based on data that was later determined falsified. She bravely lived through three rounds of chemo until her mets finally took her life, far too soon. But the family knew this well before she passed away. And we never even thought about getting a second opinion or suing anyone. In Canada, we are generally grateful for what we can get, we are proud of our socialized medicine, and we trust our doctors to help us. We don't press the needs of the individual at the expense of the many. That mostly works out well. But we also don't know any other way of interfacing with healthcare, especially if things go wrong.

And most of that Canadian pride isn't really connected to our actual experience of Canada's healthcare system (there are many complaints). Instead, it's a part of how we tend to define ourselves as a nation-- by what we are not. And we count our lucky stars that we don't have to deal with the imagined nightmare that is the healthcare system in the USA. Yet many wealthy Canadians go to America and pay out of pocket for care. There's a reason for that. Especially if you are a woman.

In Canada, my mother's early breast cancer diagnosis and death meant I was eligible for one mammogram a year, from 35 years of age. Nothing more. In the USA, my mother's medical history (reported only by me) earned the right to obtain a full genetic screening for all possible familial cancers, not just breast. Even though I am thankfully not BRCA positive, I am still eligible for yearly breast MRIs and mammograms, on an alternating six-month schedule.

I would need a letter from God to get a single baseline breast MRI in Canada - let alone a yearly one! There is no wait time for cancer treatment here. I live near one of the top research hospitals in the country and have low-cost access to the entire University of California hospital system. I am even entitled to breast reconstruction if I need a mastectomy. The most all of this care would cost me is $1000 each calendar year, and would exceed that only if I went to a hospital that was not affiliated with my health insurance. I would not need to. So I'd most likely be looking at just a few hundred, as long as my cancer therapy woudln't be bleeding-edge science. And even then, I'd still be able to receive the therapy. Not necessarily so in Canada since it takes a very long time to approve experimental therapies developed elsewhere. Not unless I were well and wealthy enough to pay to travel to the States and pay for the hospital costs out of pocket. They are astronomical by Canadian standards. (The salaries here in the USA do not make up the difference.)

In a single year of living in America, I obtained all the information I could possibly need about how I should navigate my life given my cancer risks. Information I did not know before I came to the USA 9 years ago, even though I'd been in the Canadian system for decades. Information I didn't even know was possible to obtain.

And the usual cost of American medical treatment for run-of-the-mill issues? Prescriptions cost me $60, maximum. I pay at most $20 a pop for each visit/set of tests (often I pay nothing), plus my employer-sponsored health insurance premiums -- before tax about $90 a month. Again, the most I'll pay for heatlhcare in any given year is $1000 out of pocket (without skipping my network), and that would be for a catastrophic illness. I also have extra injury insurance that will pay me $10K if I end up with one of those major health catastrophes. So I'm pretty well covered. And I feel safer knowing that if I get internal cancer here, I will be treated immediately and with the best medicine available to humankind. I don't think I could say that if I still lived on the East Coast of Canada. Not knowing what I know now. Any of my dear Canadian readers surprised yet? I was, too!

A Few Thoughts about Pre-Existing Conditions

I have a collection of common pre-existing conditions of the autoimmune variety. Most people I know here have pre-existing conditions, too. It's generally not an issue anymore in America if you're able to choose the right insurance/go through your employer. Not everyone has that option, however. Obamacare has improved things but people still suffer and go bankrupt. And I am very fortunate, I know. But again, it's not as bad as I thought before I had lived and worked in the USA.

In Canada, pre-existing conditions do not factor into coverage. Ever. And shaming people for a pre-existing condition is not a thing up north like it unfortunately is here in the States. Canadians generally understand that being a human being is a pre-existing condition. We are a more forgiving bunch. But I'm not so sure that forgiveness turns protective when it comes to treatment/outcomes -- especially if providers are forced to ration care to those who are most likely to survive.

There are many physician and care shortages across the country. This creates a serious issue with respect to access, especially for vulnerable populations and folks in rural areas. The CBC constantly runs stories about it. 

I don't think Canadian physicians lack knowledge, recklessly gamble lives, or are low on empathy -- and I'm sure they use the latest data available to make care decisions. But biases exist in Canada just as much as they do in the USA (more about that in another post).

Regardless, Canadian healthcare operates with a completely different ethos from the one in America. In Canada we tend more stoic and fatalistic when it comes to illness -- and bad luck in general. In America, we demand medical providers go to heroic lengths to save or prolong life, or prevent illness, no matter what, for as long as as medical science will permit - and as long as that life can pay. If they don't we blame. Especially if that life is deemed high status. But that bit about status is not just an American thing. I know a little about navigating the healthcare system in Canada for critical illnesses (having seen four primary relatives through end-of-life care). And I can say for certain that gender/wealth/social class matters there, too. Elder care is an entirely different issue, though! I'll have to tackle that one much later!

The Truth About Healthcare in Canada vs. the USA? It's Complicated!

I'm not here to demonize one system over the other or to convince anyone to take my point of view or paint things in black and white. The truth is that there are good and bad aspects to healthcare systems everywhere in the world, including Canada and the USA. My situation is much better than most Americans. But most Canadians who would find their way here with graduate and professional degrees (like me) would most likely have an experience similar to mine. Because I think they would tend to go for the jobs that offer the best of the best in terms of health insurance. Canadians are used to a certain level of coverage and the idea of being underinsured frightens the bejebuz out of us. And rightly so.

Having been born and raised in Canada, I know how it feels to not have to worry about medical costs, and I truly wish that all my fellow Americans could have the same level of coverage I enjoy here -- or at least what was available to me in Canada as a bare minimum (which wasn't terrible). Health care organizations can be deathly cruel to Americans who aren't as fortunate as I am. But the system is not as draconian as many in Canada might think it is. In fact, I think Canadians could gain some much needed insight from how things function here. Maybe begin to look at the healthcare system with a constructively critical eye and start asking some hard questions of their provincial health care corporations and the politicians who represent them at all levels of government. Americans deserve better health care. So do Canadians.

*Steps down from soap box* I really feel that we Canadians and Americans can learn a lot from one another - more than just what we see on TV or think we need to run away from like the dickens. So, let's get to know one another a bit! And let's start by comparing healthcare systems.

A Canadian Explains:

1. How healthcare generally works in the USA.

2. How healthcare generally works in Canada.