The Canadian Healthcare System from an American Perspective

Canada Day 2017, Victoria, British Columbia

In 2010 my wife and I packed everything we hadn’t been able to sell or give away into a U-Haul and left the United States for Canada. After spending four years at university earning my degrees in anthropology and environmental studies, and three more living and working as legal residents, we recently returned to the United States for what we hope will be a brief stay before our planned return in mid-2018.

Though we didn’t move north because of Canada’s single-payer healthcare system, our experience with it has only strengthened our conviction that it, or something very similar, offers the US the best opportunity to move beyond the expense and administrative headaches inherent in its current system. While Obamacare represented a significant step in the right direction, its reliance on the for-profit insurance market will forever prevent America from achieving either the savings or results of a universal single-payer system.

One of the unfortunate side effects of the United States’ interminable healthcare debate is the conviction on the part of many Americans that they are experts on the Canadian healthcare experience. Critics of universal healthcare in particular often share stories of hoards of Canadians coming south for healthcare that isn’t readily available at home, or other alleged tales about the horrors of “rationing”. That these stories typically come without sources, or at best dubious ones, never seem to raise any suspicion that they might be false or exaggerated.

While there are undoubtedly examples of wealthy Canadians going abroad for various elective procedures, these cases only serve to demonstrate that those with the means to do so can, and often do, get what they want more readily than those without. American boutique healthcare clinics openly advertise their capacity to move people to the front of the healthcare line without the wait experienced by Americans of lesser means. It seems what serves as proof of unreasonable rationing in Canada can, at least in the eyes of universal coverage opponents, also serve as an example of choice in America.

Regardless, polling has shown Canadians are far more satisfied with their healthcare system than their southern neighbors. By and large, the data indicates their satisfaction is justified. In my experience when Canadians do complain about healthcare they typically express regret their government isn’t committing more resources to it rather than arguing it should stop providing health coverage altogether.

Thankfully our direct experience with Canada’s health system has so far not included hospitalization. Between my wife and I direct contact with it has involved three emergency room visits, one ride in an ambulance, periodic trips to a specialist, and regular lab work. Excluding payments for far more affordable pharmaceuticals, our use of the healthcare system has resulted in only two bills over seven years. In one of those cases, our provincial health card had expired while we were waiting for a student permit to be renewed. After the permit came through the doctor billed the province again and the expense was retroactively covered. The second bill was for $80, which is apparently the current going rate for an ambulance ride in British Columbia.

It is frequently argued that, whatever its faults, a market-based approach at least preserves patient choice. We’ve found just the opposite to be true. Because every doctor is part of the same provincial insurance network there is no chance our doctor of choice won’t be covered by the single public insurance plan. This isn’t to say finding a personal physician can’t be challenging. Just as in the US, not every doctor is taking new patients or working in private practice. Many physicians work for clinics and so aren’t considered anyone’s personal doctor no matter how often a given patient sees them. Still, the number of physicians per 1,000 people is virtually identical in Canada and the US according to the World Health Organization — 2.477 for Canada in 2012 vs. 2.554 for the US in 2013.

The unavoidable limitations imposed by a finite number of health care providers notwithstanding, no Canadian that I’m aware of has had the experience my wife and I regularly endured in the United States. A pre-existing condition made having group coverage essential to both our physical and financial security. This imposed a double restraint upon our freedom: employment decisions were often influenced/determined by the availability of group coverage, while annual changes to insurance coverage by our employers meant being forced into frequent searches for a new doctor against our will. We can honestly say that any barriers we’ve encountered in Canada can’t compare to the built-in antipathy to choice inherent to America’s healthcare system.

Statistics comparing Canadian costs and outcomes to those seen in the United States are readily available for those willing to look. However, even detailed reports by reputable independent sources showing lower infant mortality rates and longer life expectancies north of the border have, unfortunately, so far failed to have much impact. Likewise, we have seen among many of our own family and friends an unwillingness to be moved even by our own personal accounts and reassurances. This persistent cultural resistance to evidence was a primary reason for our decision to leave the United States.

That said, our direct encounters with the Canadian healthcare system, as well as our indirect experiences through Canadian friends that have been hospitalized, have so far not given us any indication the quality of care in Canada is less, on average, than a person would expect to receive under similar circumstances in the US. The major difference, which is not insignificant for individuals and families suffering through a health crisis, is the level of stress the two systems place upon patients in exchange for care. Though I would never argue that our move to Canada didn’t come at great personal expense or without any anxiety, it wouldn’t have been possible for us to make it without the many thousands we saved on health insurance over the past seven years. As one Canadian friend put it while recovering in the hospital from a heart problem, “I don’t know what I would do if I was facing a bill at the end of all of this. How do you Americans put up with it?” I couldn’t answer him.