Myths and realities about Canada's healthcare system

A fair and balanced discussion of the facts and controversies about Canadian public healthcare.

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[Will]

Everytime I’ve taken the ferry from Port Angeles, WA to Victoria, BC I’ve had conversations with Canadians who are coming to the US to escape the long wait times in Canadian hospitals. I’ve also talked to Americans who are going to Canada to get cheaper medicines.

[mg]

I live in Germany and we have a mix of public and private healthcare that works just fine. Healthcare is still universal but you have a choice between publicly funded and privately funded coverage. The public health coverage is also not run by the government but by independent non-profit insurance houses. You can choose between different providers both within the public and private system. The private hospitals work with public providers as well. It's a lot more decentralized than the Canadian or (especially) UK system but still manages to provide a very high level of care.

[EveryCrazyDay]

As a type 1 diabetic my anger for the US system and emphasis of profits over patients. I’m okay with paying for my insulin but I’m tired of being charged $400 (up from $150 when I was diagnosed) for a drug that cost $1 to make and hasn’t changed. Canada isn’t perfect clearly. But I wouldn’t be broke because of my lifelong illness.

[ztl]

In the US, there seems to be an inverse problem where many people assume every other country has an NHS style system of almost entirely government run healthcare, which I find tends to erase a lot of nuance out of discussions on how to improve American healthcare going forward.

[microcolonel]

A supply issue with surgeons in a country like Canada, is primarily a price controls issue.
Going to the ER for non-emergencies is exacerbated by the generally poor service schedules of clinics: Canada's health insurance systems have failed to enable the much more efficient surgery centers and urgent care centers that are common in more functional systems. If you are scheduled for a surgery, you end up in an emergency hospital. If you need a doctor to write you a prescription for an ear antibiotic because you got a double ear infection in Lake Huron... but it's the weekend, or it's after about 6PM, too bad, you end up at an emergency department.

[arina]

Specialized doctors in Canada can also decline your referral if they deem your problem “not serious enough”. Imagine waiting for months to hear back from a clinic after your GP referred you, only to learn that they are not going to see you. Happened to me twice

[SpektakOne]

Two anecdotal stories as a Canadian citizen living and working in the US.

1) Until my insurance from my employer kicked in, it was slightly cheaper for me to fly back to Canada, pay out of pocket to see my old doctor, take my prescription for an asthma inhaler over to Shoppers Drug Mart, pay for it and to fly back, than it was to pay a local doctor and fill that prescription around the corner from my NYC apartment. Taking the exchange rate into account, it was about $10 cheaper. And I got to see my parents, so there’s that.

2) I have some school friends who are doctors in Canada, and they wish the Canadian system had the co-pays that I now dish out in the US. They feel that too many Canadians take the “free” in “free health care” and will go to the doctor for any minor or even imagined thing, even after they themselves have told patients that they’re fine and don’t need to come back. They feel that if Canadians had to pay something — even if it were reimbursed in the case of lower income people — it would give patients pause.

[KingUnKaged]

Canada really loves to adopt this sort of 'ride or die' pessimism, where the statue quo in everything from real estate to telecom to healthcare is defended no matter how bad they get on the assumption that whatever alternative we came up with would certainly be worse.

[EnbyFish]

In America there’s this perception that Canadians have it much better because of the “free health care”. Didn’t realize you still need private insurance for stuff like dentistry and optometrists.

[Noah_Levi]

I work at a private diagnostic clinic in BC and over time it’s been interesting to see the severity of patients as wait times increase. There are people with critical heart blockages that are on 9 month wait lists for a 15 min CT in a public facility. As well we do pain injections for peoples backs. They are supposed to get them every 3 months and at the hospital there is a 6 month wait list. The result is that some people end up being disabled while they are on this list to simply get an injection in their back. Our system has bottle necks all over the place and it hard to know where is best to focus to relieve it.

[Kyotosomo]

I had a Canadian family member who contracted an easily preventable cancer due to how slow the wait times are. What's worse is the government then refused to treat the cancer (that they essentially gave her) because it was too expensive. For what it's worth she was able to prolong her life by flying to America for private treatment, however she did still eventually die from it. People need to grow up and acknowledge that there's no "perfect" modern healthcare system. All you can do is prioritize certain things at the cost of others.

[chris]

I, an American, found a breast lump in January 2021. I didn’t have insurance at the time, so I was afraid to get it checked out—I’d only just finished paying off my student loans, I was more afraid of another 10 years of life-crippling debt than of having cancer. Still, I definitely was also afraid of having cancer, so I set myself to the task of getting a job with healthcare so I could go check it out—as soon as my temporary work contract ended, 3 months later. But the first job I got (in a rush) was really exhausting, and after the 3 months of waiting for the healthcare to kick in I was like “I could not do this job on chemo, it would kill me, ” so I had to quit and go find a different job and wait another 3 months for the new healthcare to kick in. But then at the new job, my role was not well defined and I didn’t feel settled and confident the job was going to last. I really needed to be in a good, stable situation to take the hit, to handle both the cost and the treatment itself if it came to that… Ultimately I didn’t get it checked out until over a year and a half after I first worried there was something wrong. Fortunately I finally did get it checked, and I don’t have cancer, yay! Now I just have to pay off the $3700 bill for all the tests, because almost nothing on my terrible insurance is covered until you hit the $4300 deductible. So like, a 27-week wait-time seems *pretty tame* to me.

[connorspiech]

I think it's a bit of a strawman to assume you can only get hit with outrageous medical bills in the US if you're uninsured. As you hint at in the video, most Americans ARE insured, yet loads of Americans have or have had medical debt which is a foreign concept to people in most developed nations. As an American who lived in Europe for about six and a half years, I can assure you that, by comparison, it is a terrible system even when you have good insurance because of the unnecessary hassles like high co-pays, deductibles, and "in-network" healthcare providers. Everyone I know in America has either had an awful experience themselves or knows someone that's had an awful experience with their insurer charging them ludicrous amounts of money or otherwise fighting them on what they'll cover. I just moved to Quebec so I can't speak on the problems with the Canuck system yet, but I can't imagine it being worse than what I experienced in America.

[jbejaran]

Comedian Emo Philips had a bit that went roughly: "My father had a heart attack recently, and it's sad. Under the American Health Care System, we ended up losing the house. Whereas under the Canadian Health Care System, we would have inherited it."

[graylucas]

I'm an oncologist. A specific absudity to highlight one of the many ineffeciencies of our system:
For certain cancers (certain scenarios in colorectal in particular), there are two chemotherapies that are roughly equivalent in efficacy. One is a pill (capecitabine), the other is an iv infusion (5-fluorouracil).
The iv requires a small procedure to insert a large Iv into the chest wall for administration, requires visits to the oncologist every 2 weeks instead of three, requires more "chair time" where a nurse supervises the injection, and in some cases takes 6 months instead of 3.
The pill has slightly more side effects, and the drug itself costs slightly more, but not when all the extra resources are factored in.
Many provinces only cover the iv, not the pill.
Why? Because they administer it "in a hospital", and therefore its paid for. The pill is from a pharmacy, so its not. Even though them just paying for the drug would save them money.
Worse for patients, worse for the system.

[marcberm]

The use of Dr Mario sound effects and visual styles in a video about healthcare does not go unnoticed or unappreciated. 😀

[michaeleaster]

I'm a Canadian who has lived in the USA and is fairly familiar with both healthcare systems. This video is good, though it seems light on the issue of choice and competition, regarding routine healthcare. In Canada, you are often fortunate to "get" (i.e. be assigned) a family doctor in smaller provinces: there is no sense of choosing among doctors. In the USA (_provided you have health insurance_, and live in an urban area), staff are well aware of the competition of the marketplace: you can "fire" your family doctor and get another one. This is just an observation. I am very happy to be back in Canada and mostly happy with the system, but this was a noticeable difference between the two.

[MrMultiPat]

I think your characterization of the American healthcare system really glossed over its horrific outcomes, by not mentioning that people who are insured still end up with egregious bills in their co-pays and deductibles. Canadians do overreact to any mention of privatization, but they overreact to that because of the horrors they constantly hear about in the American system.

[johnhargreaves]

As a Brit, I think the Canadian system works very similarly to the NHS so this is an interesting video
I also think a lot of the ‘boogeyman stereotypes’ of American healthcare being widely inaccessible are quite common in the UK as people don’t really understand the US system

[philipmcniel]

As an American (and particularly one from an economically-depressed rural area where MANY people are on Medicaid), I have two thoughts about this topic:

-First, the "medically-necessary" thing is _very_ open to interpretation by bureaucrats. I personally know someone who was on Medicaid and had an impacted wisdom tooth (meaning that it was growing sideways into one of his other teeth, and--in the professional opinion of his dentist--would become infected if not removed in time). Yes, Medicaid can have programs for dental and vision coverage "on the side, " as I understand it, since it's designed for the poor who might not be able to afford such things. Anyway, this person was told by Medicaid that the extraction was not considered medically necessary because he wasn't infected, so he would have to wait until it got infected--which was inevitable according to his dentist, remember?--before having it removed. He consulted the office of the oral surgeon to whom he'd been referred, and asked about paying out-of-pocket (he had some kind and generous people in his life who were willing to help him do so), and they said they couldn't let people on his state's Medicaid program do that. (I presume this is because they don't want to pay for the medically-necessary treatment of complications caused by medically-unnecessary procedures, e.g. if you get an infection following cosmetic surgery.) Anyway, this guy had to go off Medicaid, and only after that paperwork was approved was he able to get his wisdom tooth removed, by which point it had been bothering him for awhile.

-Second, about the first critique mentioned in Part 5, about private providers charging the government more than publically-owned providers: *_That's kind of the point!_* Anyone who has taken a basic macroeconomics class has seen a supply curve, which is a visual representation of how the higher-priced something is, the more suppliers will be incentivized to exist. If the government artificially sets a price cap, that artificially also caps the number of suppliers to the number who are willing to provide a service for the government-decreed price. I would argue that Canada's wait times may, at least in part, be a result of this inelasticity of supply (though I can't say for certain with my limited knowledge of the situation of Canadian healthcare). Paying a bit more for private providers, in this model, is simply the price of moving up to a higher point on the supply curve.