U.S. Health Care Reform

O.K. So there is quite the talk south of the Canadian border regarding Health Care Reform. Leaning toward Socialism like I do, I fully support the idealistic dream that would start with the creation of universal ~comprehensive~ health care with a single payer system. Many false apologies to those of you who believe that there is a place for the many private health insurers in the U.S. I do not. As long as there is a profit motive cost reduction will not occur. No citizen of the U.S. should be without health care. None. Not the poor, or the unemployed, or the families of the unemployed. No one.

On the other side of the pond, England's NHS covers all residents and visitors also receive several (free) services. Why do I mention England? Simply because the U.S. GDP in 2008 was over 14 Trillion. The GDP of England? Not even two and a half Trillion (give or take a buck or pound). With a population of roughly 61 million, the NHS covers all its residents and provides several health care services to visitors (tourists) for free. Not so the U.S. system. No free coverage for visitors and upwards of 45 million of its own residents without coverage. Of the remainder, how many are underinsured?

Now let's look across our northern border. Canada's population? Approximately 34 million. Canada's GDP? 1.5 trillion. The Provincial Health care plans that make up the Canadian system cover all citizens, permanent residents and temporary foreign workers (certain conditions apply).

Let's compare the U.S. and Canada for a moment. 303 and 34 million people respectively with nominal GDPs at over 14 Trillion and approximately 1.5 Trillion (U.S bucks). And yet, all Canadians are covered AND health statistics and outcomes for Canadians as a population are better than those of the U.S. ...Oh, yeah, Canadians are paying per capita roughly half of what the U.S. is paying; $3173. vs. $6096. Eric and I can attest to the U.S. figure (your milage may vary). As part of a spread sheet comparison of health plans offered by his previous employer, we determined our yearly monetary health care spending. Premiums, deductibles, co-pays, costs for lab tests and prescriptions (did I leave anything out?) amounted to roughly the U.S. average. All rather baseline stuff. Nothing exceptional. I have had employer provided health care like most in the U.S. I have also been an independent contractor and had to provide and purchase my own individual health care policy. I have been lucky to be covered under my partner's employer provided health care plan. In the states I had to concern myself with pre-existing condition exclusions, health care coverage gaps, and each time I changed insurance providers I had to learn the new rules; what was covered, excluded, the limits, etc. I even had the indignity of having to pay taxes on my health care benefits as if they were income. For that, thank you to the U.S. Federal Government.

Much of what is told the U.S. population about the Canadian system is myth. The debunking of such misinformation can be found in articles on my "links" resources page under health care. As with much of life, they are all a little bit true. And the deeper one investigates the more, dare I say it, understandable these myths become and the less frightening they are.

I write this post in response to a current T.V. ad that is being aired in the U.S. One where a Canadian woman speaks rather poorly of her home country's health care system. She is pissing a lot of people off up here. For you see, Canadian medical tourism to the U.S. is one of those myths. Does it happen? Sure - which makes it a little bit true. But it is rare-which is one of the reasons she, the one in the T.V. ad, has no other Canadian company in her criticism. Out of 34 million people she is the exception, not the rule-and that is being generous. She was covered under the Canadian system and would have received treatment. No one - no doctor or bureaucrat denied her treatment because that never would have happened. The system here doesn't allow it. She *chose* not to wait and to pay out-of-pocket for treatment. There are quite a few folks up here asking for more details regarding her situation. People do, indeed, wait for treatment up here but only if the situation is not critical. Medical concerns requiring immediate attention are moved to the front of the queue. She may be one that fell through the cracks of an imperfect system. If that is the case I don't begrudge her opinion. If that is the case, should she be the example given of the Canadian health care system? I think not. The jury is still out.

Watching the health care circus south of the border makes my head spin for several reasons. Firstly, that in the U.S. the population still sees the current health care system as superior despite the fact that the numbers and outcomes do not support that conclusion. That society and businesses will greatly benefit if a universal single payer system is adopted in the U.S. but that it will not happen because of one lone exception that is being paid to shout out on U.S. television. That health care bankruptcies will continue to occur, that people will continue to worry over health care and have to compare and forecast the cost and benefits of company health care plans hoping to make the correct decision. How many more insurance forms and questionnaires will have to be sweated over and completed...?

Good questions all because, you see, I had to fill out no forms or compare plans living here in Canada. I have the same coverage as the CEO next door to me and the homeless person on the street corner. I have a private doctor and I pay less for my drug prescription (same name brand drug) than I would in the states without a drug plan (yes there are, and I have a, supplemental health plan(s) that include drugs). During the time I've lived here I have received more than adequate health care from both primary and a urgent care doctors and so have several of my Canadian and U.S. expat friends-among them situations including health maintenance, emergency care, cancer, and several on-going physical and mental treatments. I have confidence in the system here and I like that all I need do is hand my "Health" card over to be treated. I am not asked to fill out a form, I am not asked to update my insurance, I am not asked about payment. There are no deductibles or co-pays. No doctor will ever deny me treatment-and the provincial gov't assumes that if we decide I need a procedure it will be paid for. I could go on...

Canadians like to bitch about it, but as mentioned in one of the articles on my "links" page, they wouldn't give it up for anything. And the rules here are the same for everyone. Health care details are the same for everyone-doctors, patients, institutions and governments. This makes it really easy to bitch about specific health care treatment and delivery problems with pin-point accuracy. Those concerns affect us all so everyone has an interest. And that interest becomes loudly apparent. For Canadians, the issue isn't health care coverage but how to maximize its delivery and control costs. How many different insurance companies, plans, rules are there to navigate and manage in the U.S.? And one can play the U.S. health care game by the rules and still be denied a pay out for a treatment. Health care insurers in the U.S. clearly have an incentive to find ways to limit how much they pay for treatment. Not so much in regard to protect their subscribers, but to maximize shareholder returns on investment.

Point is, Universal Single payer health care is not all that scary folks. The benefits definitely outweigh the risks. Once U.S. moxie is part of the Universal Single Payer Health Care formula, what is there to fear?

Candian Health Care System

Here is a re-posting of an informative opinion piece written by a Canadian living in the U.S.A. who is familiar with both countries health care systems. Thanks to L-girl for recently posting this interesting and educational article on her blog, "We Move to Canada." I thought it an excellent addition to the three articles by Sara Robinson that I have listed on my "Websites/Links" post-the link to which you can find on the right side bar under, "Immigration." One can find them on that page under, " Canadian Health Care."

While the article is written without depth, it is no simpler than the black and white fear based lies that are constantly reported to the U.S. population. It does, however, contain an honest picture of the health care system north of the border. Taken as a whole, the information in all four health care articles listed on my resource page ring true based on my current experience with the Canadian system.

One aspect which I have not yet seen compared is the relaxed ease of use the Canadian population, at least here in Toronto, experience when accessing medical treatment. Patients do not concern themselves with payment and front-line medical workers are overwhelmingly pleasant and friendly. Follow-up calls are not rushed or frustrating and the staff on the other end of the phone are genuinely helpful. These are the interactions my partner and I have had.

Neither system is perfect, but the "facts" regarding Canadian health care being reported to the U.S. population are, for the most part and at best, stilted and misleading. While the Obama administration is attempting to overhaul and improve the U.S. system, (it) they are doing so without solid conviction, allowing the spread of fear that is based on a significant amount of nonsense.

Debunking Canadian Health Care Myths -DenverPost.com

Advice - General #3

In speaking with other immigrants I continue to glean very useful information and sometimes even expand on it. New friends of ours recently raved about their health care provider and health clinic. This thrills me because I have always relied on stellar reviews and referrals in choosing a doctor and dentist. I've relocated several times and my experience told me that my buddy's enthusiasm for his and his husband's general practitioner was such that I should collect the contact information and hope the doctor and clinic were accepting new patients. 

In every new city I've moved to I've had to wait to become a patient of my future doctor. Not unexpectedly, the situation here in Toronto (as in the U.S.) is the same. Eric and I have a five to six month wait to become patients at our chosen health clinic. We are both healthy people so this situation is not problematic. 

Now, for minor and immediate concerns there are walk-in clinics, urgent care centers and, gods forbid, the hospital emergency room. During our three month waiting period to use OHIP benefits we had the "opportunity" to experience both the clinic and UCC. All puns aside, these visits were relatively painless and pleasant and the medical attention received more than adequate. And the non-provincial health care plan out-of-pocket cost for a Toronto walk-in medical clinic visit was less than half the price of a comparable uninsured visit to a doctors office in The States. Word. ...I'm just sayin'.

So, say you are immigrating to Canada from U.S. And let's say you are moving to a province like Ontario that has a three month waiting period to use the benefits of the provincial health insurance plan. And let's say that you have an immediate need for or just want to proactively avoid any additional waiting time to establish a relationship with your own physician. If you have social connections in the area in which you will be living and those folks are comfortable referring you to their health clinic or family doctor, in order to reduce further wait time I highly recommend that you collect the pertinent information and sign up with the clinic as soon as possible. This could even mean before you leave The States. Your residential area is key because certain health clinics have catchment areas and to be treated or seen you must live within those boundaries.

A good family doctor is an important part of one's support system. For those U.S. to Canada immigrants with health concerns, families or children, the information and suggestions above may help to reduce anxiety and transition time. 

Advice - General #2

Provincial Health Care Eligibility - If you are relocating to Canada, you, and possibly your family, will need to be covered by your provincial health insurance plan. In Ontario one must be issued a work permit valid for at least six months to be eligible for OHIP (Ontario Health Insurance Plan). The employer's intent to hire the main applicant must be for three years for an accompanying spouse and/or children to be eligible. Note the difference. The intent to hire can be stated easily in a job offer letter (signed on letterhead). An employer unfamiliar with hiring a non-Canadian may be hesitant to put such a statement in writing. You may reassure them that by doing so, they do not waive their future right to terminate a lousy employee. The advice here is that communicating all this beforehand avoids possible long delays re-writing or amending offer letters to include the appropriate statements or dates. You will need the original, signed offer letter when applying for OHIP at Service Ontario.

Health Care Benefits Waiting Period - Depending on the province, you may have a waiting period to use the health care insurance plan. In Ontario for example, the wait is three months beginning on the first day of your residence. To get an OHIP card and take advantage of the benefits you must apply with Service Ontario during that three month period. Apply earlier rather than later as it may take several weeks to receive the card(s).

Oh, and...

If you, like Eric and I, make the decision to risk not having any health insurance during the waiting period, please note that in case of an unexpected sniffle, there are walk-in health clinics where one can pay cash for services at very reasonable rates.

Legal Canadian Work Status for Families - Your spouse or children may also be eligible for Canadian work permits if yours is valid for six months or longer. Other restrictions apply but, if HRSDC has issued an LMO, chances are those requirements already are covered. Work permit applications are processed and issued at the appropriate Canadian Consulate or by Immigration at a border crossing. All can apply together initially on one application, or the family can wait and do so individually after landing. As the main applicant, your work permit will be tied to a specific employer. Your spouse (common law partner) and children may apply for an "open" permit that will allow them to work anywhere.

In our case...

Eric's employer applied for a three year LMO. HRSDC issued the LMO for two years stating that the job market was too uncertain for a longer period. We applied for our work permits with Canadian Immigration at the Queenston/Lewiston Bridge at the border crossing near Niagara Falls, NY. Eric's work permit was issued for two years. I obtained an "open" work permit as his "common law" partner. In regard to provincial health insurance, we both qualified; Eric based on the length of his work permit and I based on his employer's intent to hire him for three or more years. As mentioned above, the intent was stated on the original, signed job offer letter (on letterhead) which we submitted to Service Ontario along with our residential lease (as proof of residency) and my own two year work permit. 

Labor Market Opinion Issued!

Eric's Labor Market Opinion finally came back positive! Yippee! HRSDC would only issue a two year LMO instead of the requested three. Apparently the labor market is too uncertain and three year LMOs are rare. Whatev...I called OHIP to confirm I would still be eligible for Provincial health care coverage and was reassured that the determining factor is the employer's intent to hire for three plus years not the length of the LMO or the Temporary Work Permit. The customer representative was incredibly polite and helpful, too. Time to plan our trip to Buffalo/Toronto to have the work permits issued, rent a house or apartment and start setting up our lives north of the border.