Canadian Health Care opinions wanted (from Canadians)

[Sabatini]

Health care in the United States, where I live, continues to rise in cost rapidly.  So, of course, health insurance costs also go up, companies cut back employee coverage, government agencies cut back benefits provided by government programs, etc.

We continue to discuss how best to attack this problem.  In our talks, the Canadian system always comes up, with many of us expressing opinions and beliefs based primarily, if not entirely, on hearsay and anecdotal "evidence."

So, dear Canadian friends, and I know there are many of you on this forum, please give me some information based on your reality.  As a starting point for discussion, tell me if some of these are myth or fact:

1.  It takes weeks to get in to see a doctor for a sore throat/flu/ache/pain/leprosy

2.  It takes months to get knee replacement/heart bypass/any surgery considered elective

3.  If you reach a certain age, you are no longer eligible for a lot of treatments, because demand for them exceeds supply and you are not considered worth fixing at that age.

There is a good chance I'll be 60 in just over 2 weeks, so these things are on my mind, especially since I'm in the "If I'd known I was going to live this long, I'd have taken better care of myself" category.

[expatCanuck]

... tell me if some of these are myth or fact:

1.  It takes weeks to get in to see a doctor for a sore throat/flu/ache/pain/leprosy

2.  It takes months to get knee replacement/heart bypass/any surgery considered elective

3.  If you reach a certain age, you are no longer eligible for a lot of treatments, because demand for them exceeds supply and you are not considered worth fixing at that age.

Born & raised in Toronto -- have been living in MA for the past 7 years ... so I'm not overly current, but have no reason to believe that the system has degenerated significantly.

> 1.  It takes weeks to get in to see a doctor for a sore throat/flu/ache/pain/leprosy
No, no, no, no & possibly (leprosy -- 'cause that sounds like you might want a specialist). 
Just as in the common U.S. model, you've got a family physician (i.e. - PCP).
Obtaining a meeting with a specialist can entail a significant wait -- you're typically queued based on urgency, risk,
expected benefits, and probably some other factors.

> 2.  It takes months to get knee replacement/heart bypass/any surgery considered elective
Quite possibly.  Depends in part on to whom you're referred to and how long the wait list is.

> 3. If you reach a certain age, you are no longer eligible for a lot of treatments,
> because demand for them exceeds supply and you are not considered worth fixing at that age.
There's an element of truth here, but I wouldn't phrase it quite that way ('not worth fixing').
Rather, it's a matter of how to equitably allocate finite resources in a universally available system.
If demand for a procedure exceeds supply,and both a 40-year-old and an 80-year-old are vying for the spot,
what would you say is the most equitable allocation of the spot, from a societal standpoint?
(See my answer to Q1 -- keeping in mind urgency, risk and expected benefits.)

One last (important) thing to keep in mind is that (as far as I'm aware) the health care systems are not equal across provinces.
Constitutionally, health care is a provincial responsibility.  My experience is base on my life in Ontario.

I've found the US system to be different -- I wouldn't necessarily say better or worse.  At the end of the day, it depends upon your insurance.  We've been relatively fortunate, but there's no question that:
1) it has been more expensive out-of-pocket down here
2) wait lists haven't been an issue (just so long as your insurance covers what you need).

Best of luck,

- Richard

[BrownNote]

Opinions differ, but here's my take based on recent experiences.

Ten years ago my mother was diagnosed with late stage colon cancer.  Within a week of diagnosis she was given the usual round of chemotherapy (surgery/radiation was not an option).  Initially the put her on the "gold standard" as they called it.  She was unable to tolerate the side effects and eventually opted for a "lower" type.  Unfortunately the cancer had spread to her liver and kidney's.  She passed away 6 month to the day of her diagnosis She was 72.  I asked my father about the costs as she did have some in home nursing care near the end.  He said that most of what was not covered by Medicare was covered by his private policy he kept since retirement (he was a pilot for a major airline).  Essentially out-of-pocket costs were small.


Two years ago my father, having suffered from angina for several years when for an angiogram to determine just how bad his blockages were.  His test was at 09:00 on a Friday.  He called me at the office at around noon to let me know that he had been ordered to check in to the cardiac ward immediately for a quintuple bypass.  It happened 9 days later.   Again there we no significant costs (His semi private room covered by his insuance:  Medicare does not cover it).  He was 77.  Had the surgery been deemed elective, he would had a 3 - 6 month wait.

About this time last year I went to a local clinic at about 08:00 complaining of an irritation around my left lung and some shortness of breath.  They took an x-ray and sent me to the emergency ward of a local hospital for futher tests "in case of a lung aneurysm".  I expected to be there about 8 hours it only took 6!  It turned out to be as muscular skeletal issue.

In May of 2005 one of my sisters had two very small lumps detected in each of her breasts during a routine mammogram.  Futher tests (which took about two months to complete) determined that they were cancerous.  They were removed (the lumps) about a month later, followed by several rounds of radiation.  During the process she sat down with a panel of doctors to discuss her options.  As the tumors were at an early stage and of a low grade all agreed to bypass cemo.  Shortly after her diagnosis we manage to convince my other sister (her twin) to go for a mammogram (she is not prone to see doctors!).  She too had a cancerous lump.  Again it was removed followed by radiation.   Last January the first sister was informed that they had also found cancerous cells in her uterus a couple of months earlier.  She was told that it was not unexpected given that both sisters had a "breast cancer gene" which is also related to Uterine and ovarian Cancer.  They hadn't told her earlier since she had to finish her radiation first.  As the Oncologist said "you have enough to worry about"  She had a full hysterectomy last May.  So far all is well with both although sister two has an eating disorder (and a pack a day habit) that has left her  so weak she cannot walk up the four flights of stairs to my place.  This has been going on for many years.  She has accepted some counseling from the hospital (they have excellent psychological services available for cancer patients).

During all of this my first sister mentioned to her surgeon that her brother (me) was having a hard time finding a family doctor (I was not really trying that hard) and that he had not had a colonoscopy even after my mothers death.  She, right there and then, scheduled me for one without the usual referral from a G.P.   (meaning she would get paid less).  She also had her secretary get a list of doctors who may be taking patients.  Imagine my surprise when my sister called to tell me that my 50th birthday present from her was a colonoscopy!.  I had it in July.  Total cost ot me 19.99 (I had to pay for the picosalex).  I found a family doctor and will go for annual checkups.

In all of the  above there have been no significant personal costs.  Both sisters will be going for twice yearly tests for the rest of ther lives.  

The best that I can conclude is that around here (Montreal) if a serious problem develops you will get immediate treatment.  If its elective you can wait.  Hip and knee replacements can take several months.  Family doctors are hard to find, but you can always go to a walk in clinic.  

What's better, you be the judge.  I've always lived here and have paid very little for medical services.  Although basic eye exams are no longer covered ($ 45.00) I do go for an eye exam every 6 month due to a family history of glaucoma (that parts covered).   Dental and drugs are covered by my office group insurance.  You must have drug insurance in Québec.  If not available through your office yo have to enroll in the government's plan (and pay).  

Over the years I have had a few friends have accidents acorss the border (i.e break a leg skiing at Jay Peak in Vermont).   At the end of the day it cost them around 2,500.  Although they all had insurance coverage.  I assume you get a "discount" if you aren't covered.  By discount I imagine that they run fewer tests.  

[Atlanta_Mark]

I am an American who has been living in Toronto for over a year now.

I agree with BrownNote -- the serious stuff gets taken care of quickly, and the quality of care seems to be as good as in the states. I have friends who have been treated for cancer, and another friend who is an expat American who was treated here for Parkinson's, and these seems seem to be handled quite well. Although I have not personally needed any elective surgery, I have heard horror stories about how long it takes.

I know two things for sure:
1) Most of the Canadians I talk to complain about the system, and most seem to think it has gotten worse.
2) Every one is covered, no problems.

I have so many friends in the States who either are stuck in lousy jobs that they hate because they have kids with serious health problems and are afriad to lose the coverage, or else who are not covered (one of who had a kid come down with cancer) that I would vote for the Canadian system.

[BrownNote]

I have a question for my American friends who have health coverage through their employer.  How much do you pay, and what does it cover?  And just what do yo do if you have no coverage and something serious happens (i.e. you are diagnosed with cancer, or need a bypass) and don't have the money? 

[Caleb]

I have a question for my American friends who have health coverage through their employer.  How much do you pay, and what does it cover?  And just what do yo do if you have no coverage and something serious happens (i.e. you are diagnosed with cancer, or need a bypass) and don't have the money? 

Well, I work for a great company and my job is union covered, so my benefits are not typical of most Americans.  I pay $20 each week for my insurance coverage.  There is no limit as to what is covered.  All of my children have been born since I've been at this job and my coverage paid for all but $10, which was my only out-of-pocket expense.  My dental plan is not quite as good, but it is still very good, as is my optical plan. 

Now, "most" Americans pay something each pay period for their insurance depending on their dependants.  My father-in-law works for a pretty old company that still offers decent benefits and he pays near $400 a month for just he and my mother-in-law's insurance.  That is considered pretty cheap, actually. 

I have friends who work for not-so-great companies that pay up to $1k a month for insurance, but most of them have to decline some of it to still make a living.  Lots of families have their coverage split up between the spouses insurance plans to make it all work.  It's not so much that the cost of health care is rising....which is an issue....but the MAIN issue is corporate greed in America these days.  The CEOs at the top of these companies take all they can and put the screws to the poor schlubs at the bottom.  This is why more unions are needed IMO. Greed has not gone away....in fact, it's gotten worse.  CEOs today make more than CEOs EVERY HAVE in American history....while the guy at the bottom fights for breathing room.  Pathetic!!!

And....regarding when people have no coverage.  In most major cities there are Government run hospitals that will admit anyone regardless.  The care is not the best and your waiting room experience is sure to be one not soon forgotten, but they'll take care of you.

[Sabatini]

I have a question for my American friends who have health coverage through their employer.  How much do you pay, and what does it cover?  And just what do yo do if you have no coverage and something serious happens (i.e. you are diagnosed with cancer, or need a bypass) and don't have the money? 

BrownNote,  Thank you for your reply to my post.  Here is some info on your question.

When I was "down-sized" from my job of 25 years at age 56.  I was able to buy "retiree" health insurance thru my former employer's plan.  My cost was about $200 US per month, plus I had a deductible of $1200 per year which had to be satisfied before insurance paid anything, then they paid about 80 percent.  I had to use "in-plan" doctors and hospitals or my cost went up significantly.  So, with some ongoing conditions (diabetes, high blood pressure, etc.) I am going to pay at least $3600 per year for my health care, including insurance.  This is for myself.  My wife and stepdaughters are covered under other plans.

When I become eligible for US Medicare at age 65, my current insurance ends and Medicare becomes my primary insurance, along with any supplemental insurance I can buy.

Most of us, if working, are eligible for some employer-supplemented health plan.  Whether we find the program affordable is a decision each of us must make.  Many lower income people opt out because of tight budgets.

Thanks to all who responded.

Rob