For our American readers, here is a primer on how health care works in Canada. We’re going to use simple concepts and small words so the majority of you can understand the whole thing despite having voted for the Republican President and been distracted by shiny objects and blatant lies.
Canada, that big country in pink over top of your country on a map, has about 36 million people in it. We have cradle to grave healthcare for everybody. Let’s take a common, easy to understand scenario. You have a clumsy moment on the street and trip over your own two feet.
If you trip over your own two feet and break an ankle a few things happen up here in Canada. One, you get treated for a broken ankle by doctors and nurses at the hospital. That would mean an x-ray, reviewed by a real physician to determine a) is this ankle broken? b) is there anything else wrong/life threatening with this broken ankle?
Assuming yes, the ankle is broken, nothing complex and there are no other complications, a physician will write an order for a cast. It could be plaster, it could be fibreglass, it could be one of those newfangled ‘boot’ casts that are attached with velcro straps, depending on the severity and complexity of the break. In all likelihood you will get a prescription for Tylenol 3’s and some crutches. You’ll be sent on your way from the hospital along with some advice to keep your ankle up, rest, ice it and see your own physician soon.
Upon seeing your own physician, most probably they will write you orders for physiotherapy once you’re healed up, some follow up x-rays to make sure your ankle is healing correctly and anything else you might need to have a good outcome. If you don’t have your own physician, it could be a couple of outpatient visits at the hospital and outpatient physio, either at the hospital, or a physiotherapy clinic.
Cost to you? Less than $50. Hospitals do charge a nominal fee for crutches. And the cost of your Tylenol 3’s, about $11 for the Rx to take the pills at home over the next few days.
Notice that during this entire process, there has been no mention of insurance, funding, co-pays, deductibles, asks for a credit card, or other money up front. Nobody has measured your wallet. The medical decisions have been made by medical people using common, accepted, scientific methods of treatment to get the best possible outcome for the patient.
If you have supplementary insurance usually through your employer, the whole thing might not have cost you anything other than parking at the hospital while you hobbled into Emergency.
I won’t guess how much a hospital in the US would charge you for the same treatment, but according to some rudimentary web queries the prices range from $2,500 to $11,000 not including doctors’ fees, which can be $1,000 to $2,000 plus the radiologist fees to read the x-rays. Let’s go mid-way between the two and call it $6,000 to $9,000 for the same uncomplicated broken ankle, cast, physio, some Tylenol and crutches.
The first question that gets asked when you hobble into a US Emergency is “Do you have insurance and with what company?” There is the essential difference.
Now, the hard question: How do we pay for health care in Canada? Taxes. We pay more Federal and Provincial taxes than Americans pay in Federal and State taxes. In reality, perhaps 7 to 10% more, so not really a great difference. That extra money we pay in taxes goes for things like universal health care. Canada made that decision as a country in 1966 because it was the right thing to do for all our citizens.
As a closer to home example, the beloved spousal unit wound up in hospital with an abscessed tooth. She was sent, by her dentist to Emergency as things were not clearing up. There was oral surgery in Emergency on the day of. At a followup two days later, things were getting worse, not better and there was a real danger of the infection going systemic, not just in the gum or the jaw.
She was admitted to hospital and the next night was on the table, under general, being operated on to get deep down into the infection. There was bag after bag of IV antibiotics, some serious pain meds, x-rays, a CAT scan, more, different IV antibiotics as well as post-surgical care and regular hospital services. Four days later, she is finally discharged, with another two weeks of daily IV antibiotics on home care at a local community care clinic. Yes, she’s fine, on the mend, thanks for asking.
Turns out it was a Clindamycin-resistant staph infection, Clindamycin being the oral antibiotic of choice for dentists for a patient with an abscessed tooth. In this case, through simple bad luck, the infection was exactly the kind that was resistant, which is why she didn’t get better in a couple of days and the whole trip to the Emergency department over the Easter weekend.
We did a little back of the envelope calculation and figured that the cost of her treatment was not too far from either side of $20,000 to $30,000, considering about $2,500 to $4,000 a day for a hospital stay. Then general anesthesia for the second dental surgery, which ain’t cheap no matter how you calculate it, just by counting the people in the OR. Then the Infectious Diseases folks and lab techs who diagnosed the clindamycin-resistant staph, necessitating the change of medications. Nursing care, meds, meals and the usual overheads.
We’ll put it right in the middle, call it $25,000 worth of medical care.
Our biggest cost was parking. $13 a day for four days while admitted and another $13 for the first visit to Emergency. $65 bucks. (We’re certain I spent at least that on coffee while waiting with her in hospital over the course of her treatment.)
The rest of that bill was paid for by our health care system, by that 7% to 10% more income tax we pay for universal health care. No bill was presented to us. We didn’t have to mortgage the house.
Per capita, the Canadian system, fully taxpayer funded, costs about $4,000 per person, to cover everybody in the country.
That’s 11% of our Gross Domestic Product going to healthcare.
The American Medicaid system, which doesn’t cover everybody, for the barest, rudimentary coverage, only at certain hospitals, and with only certain doctors, under certain circumstances costs the America taxpayer $9,600 per.
That’s 18% of your Gross Domestic Product going to healthcare.
You tell me why.