The Cost of "Free" Health Care in Canada

[annon123]

My understanding is that Canada, and other countries with government run health care, do a pretty good job with primary care that is not life threatening.

The queue problem is for more serious care . . .

https://www.cma.ca/healthcare-for-real/why-are-er-times-so-long-canada

They also have the challenge of sparsely populated areas where access to critical care is limited.

Universal health care does not mean there are no barriers. Health care everywhere is rationed. Sometimes the barrier is an affordability issue, other times the barrier is a long wait time.

Just because the patient is not expected to PAY for care does not equate to ready access.

They pay with their money or pay with delayed health care.

While the USA has fewer sparsely populated larger areas like Canada does, in this state we have several counties with no hospitals, prenatal care, few PCP's, etc. And of course we don't have the doctor shortage that Canada does. That is the biggest reason why they have longer waits - not universal health care. Would they have more doctors if they didn't have universal health care? That I do not know. But any way you look at it longer waits aren't a good thing for patient care.

That article wait times in the ER don't, unfortunately, sound all that unusual to me. We have one failing hospital that doesn't even have most specialists employed by them and no coverage for that (most physicians are employees in this town) that has a short wait time but that is because no one wants to go there, given a choice. The other three the wait times are fairly long although for a different reason than in Canada. Often local hospital ER's are diverting care, sometimes two of them are, due to being full.

Our main reason is that over half of the patients who go to the ER here have no health insurance, thus no care. I am sure that happens in Canada with patients with no PCP's if the urgent care centers are shut - however in Canada their shortage of doctors compared to us makes wait times worse regardless of other reasons.

On a cancer email list I am on with several thousand people, many from Canada, wait times are discussed on occasion (along with the USA financial ruin due to having cancer - about 1/2 of cancer patients have to declare bankruptcy after 2 years due to medical bills) and to a person who posted they preferred no financial ruin over slightly longer wait times. Those who posted indicated that wait times to get diagnosed (eventually you need a PET and some need a CT to catch the problem and be sent for a biopsy, others have visible enlarged lymph nodes that don't go away) and start chemo weren't substantially longer than in the USA. But then again likely they hit the average wait times I posted earlier for priority one, two or three depending on their symptoms. My wait times were a bit longer than Canada's average wait time - but then again I live in a place where health care sucks, we have higher doctor shortages than many places in the USA and likely the waits are shorter in other areas of the USA.

ALL medical systems have issues - they may be for different reasons, some more serious than others - but there are issues. Canada would solve most of their problems if they didn't have such a physican shortage. We'd solve some of ours in this state if the state had expanded medicaid.

 

[sman]

While the USA has fewer sparsely populated larger areas like Canada does, in this state we have several counties with no hospitals, prenatal care, few PCP's, etc. And of course we don't have the doctor shortage that Canada does. That is the biggest reason why they have longer waits - not universal health care. Would they have more doctors if they didn't have universal health care? That I do not know. But any way you look at it longer waits aren't a good thing for patient care.

That article wait times in the ER don't, unfortunately, sound all that unusual to me. We have one failing hospital that doesn't even have most specialists employed by them and no coverage for that (most physicians are employees in this town) that has a short wait time but that is because no one wants to go there, given a choice. The other three the wait times are fairly long although for a different reason than in Canada. Often local hospital ER's are diverting care, sometimes two of them are, due to being full.

Our main reason is that over half of the patients who go to the ER here have no health insurance, thus no care. I am sure that happens in Canada with patients with no PCP's if the urgent care centers are shut - however in Canada their shortage of doctors compared to us makes wait times worse regardless of other reasons.

On a cancer email list I am on with several thousand people, many from Canada, wait times are discussed on occasion (along with the USA financial ruin due to having cancer - about 1/2 of cancer patients have to declare bankruptcy after 2 years due to medical bills) and to a person who posted they preferred no financial ruin over slightly longer wait times. Those who posted indicated that wait times to get diagnosed (eventually you need a PET and some need a CT to catch the problem and be sent for a biopsy, others have visible enlarged lymph nodes that don't go away) and start chemo weren't substantially longer than in the USA. But then again likely they hit the average wait times I posted earlier for priority one, two or three depending on their symptoms. My wait times were a bit longer than Canada's average wait time - but then again I live in a place where health care sucks, we have higher doctor shortages than many places in the USA and likely the waits are shorter in other areas of the USA.

ALL medical systems have issues - they may be for different reasons, some more serious than others - but there are issues. Canada would solve most of their problems if they didn't have such a physican shortage. We'd solve some of ours in this state if the state had expanded medicaid.

You speak often of the expanded Medicaid. Are you speaking specifically to those who would have otherwise qualified for Medicaid or is it about the premium tax credit for ACA plans? If the latter, just remember, prior to ACA premiums were much less expensive and thus, more "affordable". I put that in quotations because pre-ACA when I worked that market, a family of 4 could get a decent plan for $300 per month. I can't tell you how many times I came across a self-employed person or a person whose employer didn't provide group health insurance (small company) and they'd say they couldn't afford the $300.

Now that same family of 4 can get a worse plan, have their premium reduced with tax credit (with or without expanded Medicaid) and it be much greater than $300 per month.

I'm also curious, and don't feel like you have to share this information, you mentioned your personal financial burden because of your cancer. Did you have insurance? If so, did it not cover your care? Wouldn't the insurance have limited your out of pocket costs?

I mean, I understand for those who can't work due to cancer will have lost income. But if you have insurance and it is covered, it limits your out of pocket costs.

 

[annon123]

You speak often of the expanded Medicaid. Are you speaking specifically to those who would have otherwise qualified for Medicaid or is it about the premium tax credit for ACA plans? If the latter, just remember, prior to ACA premiums were much less expensive and thus, more "affordable". I put that in quotations because pre-ACA when I worked that market, a family of 4 could get a decent plan for $300 per month. I can't tell you how many times I came across a self-employed person or a person whose employer didn't provide group health insurance (small company) and they'd say they couldn't afford the $300.

Now that same family of 4 can get a worse plan, have their premium reduced with tax credit (with or without expanded Medicaid) and it be much greater than $300 per month.

I'm also curious, and don't feel like you have to share this information, you mentioned your personal financial burden because of your cancer. Did you have insurance? If so, did it not cover your care? Wouldn't the insurance have limited your out of pocket costs?

I mean, I understand for those who can't work due to cancer will have lost income. But if you have insurance and it is covered, it limits your out of pocket costs.

I am talking about expanded medicaid. I know that with ACA some families have to pay more than they can afford which puts them in the same category (eg not enough money for health care). In this state though unless you are working 1/2 time and at or below the poverty line you can't get medicaid anyway (kids have chips regardless of parent work status). As an adult you also can't get SNAP unless reliably working 20 hours a week but your kids can get SNAP. It's called the cure for poverty. Try to kill off the poor. (not).

I was paying $1119.19/mo with $7250 MOOP which I'd hit since coverage was so poor. Had to pay that for a number of years (over half my income at that time but I had to have health insurance due to cancer). Unlimited out of pocket with meds and very poor coverage - coupons were almost always cheaper - if they had them (this was a while ago). Also had commuting costs (8 hours) to a major cancer center once very couple of months (did chemo locally). I was working part time due to the cancer crap and didn't earn enough to get ACA. We only had one plan in this area that was not ACA for those of us who missed getting that or for those who made too much for that. I had to choose between health insurance and rent. Chose health insurance and lived in a friend's very nice large shed on a golf course (so we had to be very, very careful). Fun times. Not.

 

[toolbelt]

 

[sman]

I am talking about expanded medicaid. I know that with ACA some families have to pay more than they can afford which puts them in the same category (eg not enough money for health care). In this state though unless you are working 1/2 time and at or below the poverty line you can't get medicaid anyway (kids have chips regardless of parent work status). As an adult you also can't get SNAP unless reliably working 20 hours a week but your kids can get SNAP. It's called the cure for poverty. Try to kill off the poor. (not).

I was paying $1119.19/mo with $7250 MOOP which I'd hit since coverage was so poor. Had to pay that for a number of years (over half my income at that time but I had to have health insurance due to cancer). Unlimited out of pocket with meds and very poor coverage - coupons were almost always cheaper - if they had them (this was a while ago). Also had commuting costs (8 hours) to a major cancer center once very couple of months (did chemo locally). I was working part time due to the cancer crap and didn't earn enough to get ACA. We only had one plan in this area that was not ACA for those of us who missed getting that or for those who made too much for that. I had to choose between health insurance and rent. Chose health insurance and lived in a friend's very nice large shed on a golf course (so we had to be very, very careful). Fun times. Not.

How did $25k per year income not qualify you for a substantial subsidy? I'm in a state that didn't expand Medicaid and in 2025 that income would give me (2 person household) a monthly credit of $1,809. Meaning my premium could be next to nothing. You don't have to "earn enough" to get ACA. The income level has to do with the premium tax credit. Are you saying at $25k income you didn't qualify for the tax credit?

As for the out of pocket for meds, I realize that's a challenge with some plans. But if they are brand name meds, and at that income, many patient assistance programs would cover much of the cost.

The most important thing in this scenario is fighting to live. I'm glad you were able to get to the other side of it.

 

[EckoRomeo]

How did $25k per year income not qualify you for a substantial subsidy? I'm in a state that didn't expand Medicaid and in 2025 that income would give me (2 person household) a monthly credit of $1,809. Meaning my premium could be next to nothing. You don't have to "earn enough" to get ACA. The income level has to do with the premium tax credit. Are you saying at $25k income you didn't qualify for the tax credit?

There is a minimum income required to qualify for ACA subsidies but he's above that, and should have received a substantial subsidy.

https://www.healthreformbeyondthebasics.org/wp-content/uploads/2024/08/REFERENCE_YearlyGuidelines_CY2025.pdf

 

[annon123]

How did $25k per year income not qualify you for a substantial subsidy? I'm in a state that didn't expand Medicaid and in 2025 that income would give me (2 person household) a monthly credit of $1,809. Meaning my premium could be next to nothing. You don't have to "earn enough" to get ACA. The income level has to do with the premium tax credit. Are you saying at $25k income you didn't qualify for the tax credit?

As for the out of pocket for meds, I realize that's a challenge with some plans. But if they are brand name meds, and at that income, many patient assistance programs would cover much of the cost.

The most important thing in this scenario is fighting to live. I'm glad you were able to get to the other side of it.

I am not sure where you got that I earned $25k as I never stated my income. One year I would have been able to get ACA care but I didn't know I'd make criteria until very late November. The rest of the years I didn't make enough. When you are an adjunct your contracts are "as needed" so it is nearly impossible to predict what you will earn. I was afraid I'd sign up for ACA hoping I'd meet the income guidelines by the end of the year, then be under, and then have a ton of money to pay back.

 

[sman]

I am not sure where you got that I earned $25k as I never stated my income. One year I would have been able to get ACA care but I didn't know I'd make criteria until very late November. The rest of the years I didn't make enough. When you are an adjunct your contracts are "as needed" so it is nearly impossible to predict what you will earn. I was afraid I'd sign up for ACA hoping I'd meet the income guidelines by the end of the year, then be under, and then have a ton of money to pay back.

You said your premium for your insurance was $1,119.19 and that it was over half your income. That premium is $13,430 for a year. Twice that is $26,860. I just rounded down slightly. You can enroll in an ACA plan regardless of your income. The only question is what subsidy you will get based on your income.

 

[EckoRomeo]

I am not sure where you got that I earned $25k as I never stated my income. One year I would have been able to get ACA care but I didn't know I'd make criteria until very late November. The rest of the years I didn't make enough. When you are an adjunct your contracts are "as needed" so it is nearly impossible to predict what you will earn. I was afraid I'd sign up for ACA hoping I'd meet the income guidelines by the end of the year, then be under, and then have a ton of money to pay back.

Minimum income for ACA subsidies is $15,060 FOR 2025. So, it would have been even less whenever you were on ACA.

You were sure you'd make $1255 a month?

 

[annon123]

Minimum income for ACA subsidies is $15,060 FOR 2025. So, it would have been even less whenever you were on ACA.

You were sure you'd make $1255 a month?

I had no clue how much I'd make. I'd get a contract about 3 days prior to the course starting and sometimes it was taken away if the enrollment wasn't high enough. There was no way to predict other than watch unassigned classes and keeping an eye on enrollment. But I wasn't the only one offered contracts to teach the same classes. These were 6 week classes. Some months I'd make nothing, other months all 4 weeks, some months 1-2 weeks... it would depend on when classes started.