Healthcare: Perspective from an American expat living in Canada

Hi Everyone! This is something I've been cooking up for a while - I hope everyone finds it interesting. If you do - feel free to share it around as you see fit. I'm writing this to consolidate a lot of the arguments I've made in comments online and discussions in person regarding healthcare and differences between the US and Canada.

I'm originally from the Southern US - I moved to Canada about a decade ago. Because of this, I often get asked about differences between the US and Canadian lifestyle. Everything from "How do you like the winters here?" and "Have you tried poutine yet?" to "Why are Americans so crazy about their guns" and "How much more are you paying in Canada for taxes (regarding healthcare)?".

I'm going to address that last question - and attempt to talk a bit about things I've come across over the years in discussions around Single Payer vs Insurance and private vs public healthcare. This might get a bit long winded - but I hope that at the end you will understand why I feel the way I do about the Canadian Healthcare system.

First off - lets talk money. Before I moved to Canada I was under the impression that Canadian taxes were so much more than I was used to paying in the US. I heard things like 50%+ on your income! Obviously they have to pay more in Canada because everyone gets free healthcare and the freeloaders cost a lot of money!

Healthcare: Perspective from an American expat living in Canada

I was so completely wrong it's not even funny. I lived in the US for the first half of my life. During this time I had employer sponsored/subsidized insurance, and I paid taxes. The insurance I had was the cheapest my employer offered. I was single, a non smoker, and young with no medical conditions.

I moved to Canada - my first job I was making roughly equal - and at the end of the day the money I paid in taxes in Canada was less then the combined amount deducted off my paycheck in the US for insurance and taxes.

I ran these numbers a few years back which means the insurance numbers below are pre-ACA. Depending on who you believe the ACA will raise or lower your premiums in some way, shape, or form. I actually think the Insurance price I quoted was low (based on what I know for my family back in the US and what they pay), but it was from an insurance provider so I went with it.

The numbers for taxes are going to be based on what I was making in the US and in Canada when they were roughly equal. I'm making a bit more now - so the real world percentages move around but only by a 1-2%..

Let's get to the money!

Healthcare: Perspective from an American expat living in Canada

My marginal tax rate (the highest percentage of tax on my highest portion of income) in Canada was about 27% - my adjusted tax rate (the total tax percentage on all my income) was 20% (and this includes both Federal income tax, and provincial income tax). (Try it yourself here!)

A quick search on Google shows me that for my income, my US federal income marginal tax rate would be 25%, and my adjusted tax rate would be 15% (Try it yourself here!). As I'm from Georgia, I'm going to add in the Georgia tax rate for my income, which is 6% for every dollar I earn (source). So my total adjusted tax rate for income tax in the US would be 21%.

At the same income level in the US and Canada my tax burden was 1% less in Canada then it was in the US. Not a huge amount - but it's still cheaper in taxes then I was paying in the US. That shocked the hell out of me.

"But wait shockwaver!" I hear you say.. "What about insurance??" - Well I'm glad you asked!

According to one health insurance provider, the average cost of a health plan for someone with a family (Say, a spouse or a spouse and child) is $414 per month (source) - that $4,968 per year. At my income that equates to about 7%. So if we add that to what we pay off our paychecks, that equates now to a total of 28% in deductions. (Again, this is a low number and it is post employer subsidy. More recent numbers show healthcare for a single person in Georgia averaging to $4,706 - family plans average a whopping $13,149. Source here)

Where are we at so far?

Canada: 20% total for tax and health care coverage.
United States: 28% total for tax and health care coverage.

Now, let me expand a bit on what my 20% gives me. I go to the doctor, I make an appointment, get my tests and what not done, and walk out. I show them my health card when I arrive and that's the end of that. It means I can go to the hospital and get treated. It means my partner can get an CT Scan, or my Father-in-law can get full chemotherapy with a team of 3 oncologists without having to worry about going bankrupt. Or being dropped from insurance because you forgot to mention a headache you had 15 years ago. No billing departments, no medical debt, being able to get preventative care instead of waiting for problems to become serious.

When I lived in the US and was paying for insurance? Well, you go to the doctor, you provide proof of insurance (if you are lucky, they will bill the company directly - otherwise you foot the bill and get reimbursed.. maybe), but you have to pay your co-pay. So the doctors offices all have a billing department (that adds to overhead). So you pay your co-pay, get your tests done. Now, you have a (on average) $3000 deductible, which means your coverage doesn't even kick in until you pay that much. Then you have to worry about non coverage, and the insurance only paying 80%, etc etc etc. If we look at some costs to things..

Brain CT Scan average (GA) - $1,250.00 (This means I'd pay the full amount since it wouldn't hit my deductable).

Chemotherapy costs vary widely but for patients without insurance it can range from $10,000 - $200,000. With insurance you'll pay your deductible and anywhere from 10%-50% of the costs. Let's assume you have good insurance and easily treated cancer - $3000 deductible + 10% of $10,000 = $4000.

This is insane. Healthcare should be a human right. People shouldn't die because they can't afford to see a doctor.

Truth be told the US system is broken. I didn't believe it until I moved though, because I came from a well off family that never had these problems. I broke my arm as a child, and I saw the bill from just the anesthesiologist was over $10,000. TEN THOUSAND DOLLARS. Sure, my parents could handle that bill, but could most families? Absolutely not. And it's not something I ever thought of until I lived on one income for two people (while I was getting a work visa in Canada) and realized just how hair raising it is to look at your bank account and see you have $50 till your next paycheck. And I've had it lucky! The fact that I could get hit by a car and go to a doctor and not have to declare bankruptcy? That's priceless. That stimulates small businesses. That stimulates people forming startups.

Single payer systems SAVE money. They will save you money, and you will get a better standard of treatment.

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Lets talk about some misconceptions that go beyond money.

Misconception #1: Wait times in Canada are insane and tons of people die every year waiting for healthcare.

Wait times -are- an issue here - especially in emergency rooms. I've been lucky in that I've never waited more then 15 minutes in an emergency room here but you can usually expect 2+ hours if you are a minor case. Triage means people with serious issues go ahead of you. But don't think for a second that doesn't happen in US hospitals too - you get triaged and if you are a minor case you get pushed to the back. Anecdotally I know people who've waiting 4+ hours in US emergency rooms.

Wait times for treatments are a different ball game. Elective treatments can take a long time - hip replacements are one of our longest and 50% of them are done within 16 weeks. Non emergency MRIs and CT scans can take a few weeks before you get a spot opened. The MRI and CT scanners in my city run 24x7. If you have an emergency though (Cancer is suspected or something else) you can get one same day. Cancer treatments often start within days of diagnosis.

People do die - but it's a healthcare system.. people are usually only in it if there is a problem and sometimes people just die. There are cases that are of major concern - but that happens in any hospital around the world.

Misconception #2: Canadians do not like the healthcare system/Canadians flock to the US for healthcare/Doctors do not like the healthcare system

Here's a video of a Canadian doctor testifying to the US senate regarding our healthcare system.

http://www.huffingtonpost.ca/2014/03/13/can...

She specifically addresses these points. Canadians here overwhelmingly support our system - in fact our most conservative parties know they can't touch the system without losing every ounce of political support.

Regarding Canadians coming to the US system:

I hate to cite Wikipedia, but read this and look at their source links: http://en.wikipedia.org/wiki/Health_ca...

I'll point you especially at: "A study by Barer, et al., indicates that the majority of Canadians who seek health care in the U.S. are already there for other reasons, including business travel or vacations. A smaller proportion seek care in the U.S. for reasons of confidentiality, including abortions, mental illness, substance abuse, and other problems that they may not wish to divulge to their local physician, family, or employer."

And the reverse of that is: "Many US citizens purchase prescription drugs from Canada, either over the Internet or by traveling there to buy them in person, because prescription drug prices in Canada are substantially lower than prescription drug prices in the United States; this cross-border purchasing has been estimated at $1 billion annually"

Note: That is not to say you can not find a Canadian who hates the system - they exist. I know several of them personally.. but everyone I know has never had to experience the American system. When I talk about costs and what you get they are completely floored.

Misconception #3: The ACA (Obamacare) is going to bankrupt Americans.

This is thrown at your face all day, every day in ads and by your politicians. It's bullshit. The ACA is not the ideal way to go (that'd be single payer) but it's a hell of a lot better then what you had before. I'll point you here - an article about one of the ads with someone who said she was going to go bankrupt but is actually saving money. From what I understand Detroit news is a fairly conservative paper - so take it as you will.

http://www.detroitnews.com/article/201403...

Misconception #4: Single Payer systems can't work/ The government can't be trusted to run healthcare

I'll point you to a list of countries with over 99% of their population covered by socialized insurance.

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Thanks for reading this long diatribe - I've tried to source anywhere I've used numbers or statistics. If I missed any please let me know and I'll grab a source.

I'm sure I've missed a few things but hopefully this helps everyone understand what's going on outside of the US and how the system could be better. I'm always happy to answer questions regarding my perspective on life coming from the US and living elsewhere if anyone is interested.