Many people are curious about the pros and cons of the American and Canadian healthcare systems. These are my thoughts after approximately 3 years living in Canada. I claim no expertise other than my personal experience. For context, in the US, we were on a private HMO plan, as state employees. In Canada, we are on the Nova Scotia provincial plan. I have no experience with health plans in other provinces, but one nice things about Nova Scotia’s is that coverage starts right away. My understanding is that some other provinces have waiting periods.
In the US
Unlike many people in the US, we had excellent health insurance that was very, very cheap. For ~12 years, we both worked at a large, state university. As state employees, we had fantastic health insurance and, because we were BOTH state employees, we paid almost nothing for it. At the time, in the state of Florida, married couples who both worked for the state paid just $30 per month ($15 each) for family coverage. In other words, we were in an extremely good insurance situation in the US. With insurance, we paid $20 per appointment for general physicians, and $40 per appointment for specialists.
We were also happy with the providers we had access to. We had a pediatrician that we really liked and were typically able to get in the same or next day for illnesses. We’d use after hours clinics, where we might wait an hour or two maximum, to fill in the gaps. We had an extremely positive childbirth experience at the big hospital where they were very supportive of natural birth and it cost us $250 out of pocket. We had a large medical clinic on campus where both my wife and I went for our primary care. It was easy to get primary care appointments, although if we wanted something same or next day we might see a different doctor. Specialist appointments could take a long time — I waited 4 or 5 months to see a hematologist at one point. Prescriptions were well covered (by US standards). My asthma medicine cost $60 for 180 doses, with a list price of ~$600.
We didn’t really have any mental health coverage, aside from 3 free meetings covered by our EAP program. Dental insurance was separate from our health insurance, and was quite expensive. It was also complicated, and changed every year, so we were often changing between programs and, as a result, changing our dentists. We typically paid between $75 and $110 per month for a family plan, plus another $20-$50 per visit. My teeth are kind of a mess, so I had all sorts of extra treatments. We never really found a dentist that we liked — they were fine, but my wife had a terrible experience getting her wisdom teeth extracted and figuring out an overlap between our dental insurance and our health insurance (for an oral surgeon) was a real pain.
The biggest con, though, was the fact that our wonderful health insurance situation was entirely depended on both of us keeping our jobs with the state of Florida. If we were to lose or change our jobs, we’d lose these benefits. And the people we knew that were not working for the state had VERY different health insurance experiences. We didn’t know it was going to happen at the time, but since leaving Florida our department was shut down and both of our jobs went away. If we had stayed, could we have found other jobs within the university? Perhaps, but not necessarily.
I’m going to start with the cons. Again, this is based solely on our personal experience and (as expressed above) we were coming from a very good (albeit job-dependent) situation in Florida. Thus, by comparison, our situation in Canada has felt significantly worse.
The big problem is access. None of us have a family doctor. We have been on the waiting list for almost 3 years. I understand that COVID slowed things down, but this is clearly not a functional system.
So what do we do if we need care? We have a few options:
- Afterhours clinics — There are a couple near us and they all require appointments. To get an appointment, you have to call repeatedly during the first 30 minutes that they’re open and hope you get in before the appointments fill up. It isn’t great, but we’ve typically gotten in.
- Maple – Also, for the last year or so we’ve had access to free virtual care through Maple. Again, getting into it is challenging. As free customers, we can’t schedule appointments, and the queue is often full. Since I work from home, it’s easy for me to try repeatedly, but that isn’t a good option for lots of people.
- Emergency Room – There’s a hospital right in town. I’ve used the ER a couple of times, as have my wife and daughter, and it has been pretty good. Usually, we’ve gotten in and our fairly quickly (under 2 hours). At the same time, there was at least one time when I took my daughter and we left after 2 hours because it was simply going to be too long of a wait.
- Dial-a-Nurse – We have a dial-a-nurse program that is free and is fine if you just need advice, but they can’t treat anything.
There’s a saying I’ve heard here in Canada — “the healthcare is great, you just can’t get it” and that jibes with my experience. Aside from the access issue, everything has been good. I’ve gotten a number of referrals from Maple, and while some have taken a while to schedule, the quality of care has been great. Every doctor and nurse I’ve met with has been knowledgeable and professional, and my appointments haven’t felt rushed. And everything has been 100% covered by my taxes (aka “free”) which, even after 3 years, still feels strange. I always feel when I leave like someone is going to run out after me and ask me to pay.
I have supplemental health insurance through my job which costs me nothing. I could probably get a similar family plan if I were unemployed for ~$200 CAD per month, but it doesn’t feel essential. My insurance covers 80% of PT or mental health up to $500 CAD per year, per member of my family. That gets me ~4 or 5 sessions, depending on the provider. Similarly, it covers 80% of dental, up to a max of $1000 per person, per year. Plus, Nova Scotia has a children’s oral health program that covers basic dental work for kids up to age 14, so we don’t pay anything for our daughter. We have a dentist in town that we really like but, again, getting an appointment can take a while.
Before we moved, I was nervous about prescriptions. I knew they were not covered by provincial health insurance, so I stockpiled some of my asthma medicine before the move. That has totally turned out to be a non-issue. In the US, I would pay $60 (with insurance) for 180 doses. The list price of this medicine was over $600 USD. In Canada, I get the same medicine for $13 CAD (with insurance) for 200 doses. Without insurance, it will cost me $50 CAD. It’s the same exact medicine from the same brand. Seems crazy.
One last thing I like about Canada — it’s much less of an interventionist culture. Some of that is undoubtedly tied to the lack of access, but I think it also has to do with incentives. I don’t think doctors here are incentivized in the same way to schedule follow-up appointments or tests. And, personally, I’m pro-minimal-intervention in healthcare, so I’m happy with that approach.
Our experience in the US was much better in terms of access, and similar in terms of cost, but that is a very atypical experience in the US. Plus, it was dependent on both of us keeping our jobs, and needing insurance certainly adds a layer of complexity to early retirement.
In Canada, the quality of care has been excellent, and the cost has been negligible, but getting access has been a real challenge. One thing that we’re interested in exploring further is some of the private options that may be coming. Coming from the US, if we could pay $50-$100 per month to have better access to healthcare, I think we’d be open to that.
Ultimately, I’d say we’re still undecided about our opinion of the Canadian healthcare system. We haven’t needed it for anything serious, and (despite the access challenges) we’ve been able to get it when necessary. Plus, we really like the fact that we can count on it being there even if our work situations change.
(One last note that doesn’t really fit in here but that I wanted to mention — I lived in Taiwan for 5 years, and found their healthcare system to be really great. It took some time to find good providers as some weren’t up to the standards I was used to, but once I did, both the cost and the access was excellent. Years later, my wife took some public health courses and Taiwan was often held up as a success story in terms of universal healthcare. Based on my experience, I can totally see why.)
What about you? If you’ve lived in both the US and Canada, what has your experience with healthcare been?