The Time I Experienced Universal Healthcare as an American
The worst part of Canadian Healthcare is American Healthcare
I grew up, and still to this day hear about how awful the concept of universal healthcare is in other countries. There is always some metric a person will latch on to that may appear to be worse than the same metric in the United States and suddenly THAT metric is the most important one at the expense of all others.
“Yeah it might be cheaper/just as good/more accessible/better results, but you might wait 5% longer for a non-critical rotator cuff surgery, so nah, I’d much rather risk bankruptcy, higher prices, and worse out comes because of this one specific thing I heard about one time”
It really is that ridiculous when talking to folks about healthcare in the US vs other countries and shows just how narrow our worldview can be as Americans. Access to all this information and data and many just shrug their shoulders and think “nah someone needs to get obscenely wealthy off of this, instead”.
So I’m going to write about the time I actually had a run in with a foreign healthcare system. With two kids. On a federal Canadian holiday, no less.
Canada Day. July 1st, 2019. The biggest federal Canadian holiday where most places are closed down, tourist places are open, and outdoor activities are the thing to look forward to in the Canadian summer! My wife, my two kids (then 2 and a half and 6), and my mother-in-law were set to spend 10 days on a trip in the Great White North, going from Iowa to Winnipeg, stopping in Minneapolis for an over-night, hitting up the cool tourist places there for a few days, then camping on the shores of Lake Winnipeg for two night. After that, we were going to drive East and hit Thunder Bay on a scenic drive to Lake Superior and come back home through Duluth, see a relative in Minneapolis again, and then head home. We arrive in Canada on June 30 and begin our first day!
The first day was great! We hit the Museum of Human Rights, the Forks shopping district with the kids and crew, then that evening my wife and I celebrated our anniversary a few days early at an authentic French place in nearby St. Boniface and tried some local microbrews back at the Forks district. It was really quite nice.
The next morning, July 1st around 730 A.M. we are packed up from the hotel to move to our next location outside of town. Kids in tow, my wife has her heavy backpack on and is pulling behind her one of our large suitcases for the week. I have the kids and am with mother-in-law, holding onto the little’s hand and pulling behind a suitcase and wearing a heavy backpack of my own. I call over to my wife “hey you have a lot of stuff, come on down the handicap ramp with us, don’t deal with those stairs”. She brushes me off saying she has it, no worries, go ahead with the kids.
The next thing I hear is a scuffle, a thunk and her screams echoing across the parking lot on the backside of the hotel. The poor kids didn’t know what to do, it all happened so fast, and it was a genuinely scary moment. Mother in law took the kids close and back inside while I rushed to attend to my wife’s apparently hurt leg.
She overestimated how much she could carry, caught the tip of her foot on a step, and fell overside ways with all of the extra weight. This snapped her ankle bones in 3 separate places in the form of an open facture that needed immediate medical attention. Some kind First Nations folks were nearby, saw the damage and reactions from my wife, heard my accent that I was an American, and immediately offered to dial 911 for an ambulance. This is on a National Holiday, in a foreign country, and we’re literally 1 day into our 10 day long vacation and congratulations to use, we get to experience health care in Canada!
The first part to note about the experience is that the paramedics were kind, competent, and worked quickly. They had a trainee with them on this one and together the trainee and the head EMT took care of my wife while the 3rd EMT met with me and explained what the next steps were. Mother in law went with my wife in the ambulance, and I took the kids and met up with them at the hospital they ended up taking her to. This particular hospital was actually attached to a hotel because I believe it was the largest and most well-staffed hospital in the entire province so it was somewhat of a destination. Well lucky us, we’ll be needing that. Mother in Law saw about checking into the hotel with the kids while I waited in the lobby of the Emergency Room and this is where I saw another stark different from American healthcare.
Canadian citizens would come in, hand the receptionist their ID, take a number and wait. That was it. If some folk had questions, the security desk guys were happy to point folks in the right direction, but otherwise it could have been a lobby at any big bank. The receptionist clearly recognized some of these folks, and she would later share with me that a lot of them come in because they have no where else to go. Most of the folks waited between 5 to 10 minutes before being called in to be seen. I end up waiting over an hour after to be seen properly by the receptionist, but was able to go back and see my wife in one of the rooms she was carted into as part of triage.
When it was my turn, this is where the story takes a bit of a turn. Instead of me handing her my ID and moving right along, there was a delay. The doctors wanted to operate on my wife’s leg immediately but per hospital management, they discovered that she was an American. This meant they had to clear a few more administrative hurdles since her injury was not deemed life threatening. She had to have insurance, or at least a plan in place to facilitate the care. The doctor literally came out and asked, “Hey can we go on this” and the receptionist shook her head. We had to get preclearance from our American health insurance company before they could officially check her in.
I watched as another person handed the other receptionist their ID and walked on back, holding their wounded hand wrapped in a cloth. Canadian citizens really do just walk right in and get the help they need without many questions.
Nope, it was now time for me to call the insurance company again and explain the situation and get this operation taken care of. Yes, she needs the pain medication, YES she will need more if we can’t get this operation going now, the delay is the problem! Yes we are in Canada, YES it’s a national holiday, and Yes they will work on her leg now if you just authorize this procedure!
The worst part of Canadian healthcare was turning out to be the American healthcare system.
The delay ended up going on as the insurance rep had to “check with their manager” several times throughout these calls that the total time exhausted on this was over 3 hours. By the time they decided to authorize the procedure, it was the end of the day and the doctors were booked up. My wife ended up waiting an entire extra day in pain and uncertainty not because of extended wait times, understaffing, poorly managed healthcare systems, or incompetent staff.
My wife’s operation was delayed an entire day by the American insurance company.
Needless to say, the trip did not go as planned, we never left Winnipeg. It was a pretty harrowing 5 days as I had to figure out how to cancel all of our reservations, make sure the kids and my mother in law were taken care of, and of course, be with my wife as she goes through this traumatic situation. I ended up taking the kids out to some sights on my wife’s request so we could experience some of the cool stuff Winnipeg had to offer, but it wasn’t the same knowing she was stuck back in that hospital. During the days I’d be with the kids exploring the city, at night after visiting my wife I’d hit the bar down at the hotel restaurant.
I’d share with Canadians why I was there and the first response was “oh, so your insurance pays for this so you’re good for the year, right? You have a claim, and you don’t pay now that she’s injured, right?”. They didn’t understand that you still must pay your insurance premiums even while you’re hospitalized. That the totals for your out-of-pocket resets at the end of any given calendar year whether you use it or not. That even if it’s serious, the insurance company can – and would – refuse or delay the payment to ensure they would get paid the maximum amount or they pay the least possible rather than swooping in and just fixing everything. The Canadians really thought that at least with Americans if they must use their insurance, the company comes in and is a blanket or shield against all the extra costs and issues you may have.
This was clearly not the case.
My wife ended up spending 5 nights in the hospital at the Health Science Center in Winnipeg, Manitoba, Canada. Nights that really were much better than they could have been. She had round the clock care with at least two nurses or students working on their medical degree, alongside fully qualified doctors. This was a recurring theme, constant assistants, students, and trainees at every turn. No shortage of staff. There were games, entertainment, and full warm meals available to her. They took really good care of her and frequently commented on how thankful she was since a lot of the level of care she got was better than she received even during her time in the maternity ward in both Idaho and Iowa. Frankly, the care was as good or better than we would have received in the United States.
She has two steel rods in her leg to this day after such an egregious break and facture with a nice Canada tattoo to commemorate the occasion with socialized medicine. The hardest part of the whole ordeal wasn’t a long wait time or hearing the Canadians ask what we were “aboot” there. It was dealing with the insurance company and the uncertainty that it brought. Most of my stress after the initiate checking in that she was going to be OK was “what are we going to have to pay for this” and “can we even afford to get that operation if they charge us for it?”
While we were gearing up to leave, I asked a lot of the administration some questions on how things would have gone down if we were Canadian. I had plenty of time to hang around and get familiar with them during this week in Winnipeg. Since we were not Canadian citizens and had to leave the hospital since we both wanted to go home and the insurance company was going to stop paying for “non necessary inpatient care” we had to purchase a knee scooter. This is something that would have been rented from the equipment store, not something to purchase, so I understand that expense. I did have them run up the total it would have been though and they gave me an approximate cost.
We would have had to pay for the ambulance as that is a separate charge. However, since we are Americans and pay Full Retail rather than it being the standard $100-$200 cost, it ended up costing us $870 CN to the city of Winnipeg. Our knee scooter was another smooth $450 CN full cost, something the equipment store rented out for $25 a week, and if you were unable to work due to this cost, it would have become free. Hospital stay? Zero Canadian dollars. Our cost? $21,711.75, plus the continued insurance premiums and co pays for all other operations and needs for that year. We didn’t have to pay all of that out of pocket, but we absolutely hit our maximums and ended up spending close to that on the year. The pharmacist was cool though and charged us FULL RETAIL for our drugs though, about $19 CN for a months’ worth of hydrocodone. A similar dose in the United States WITH INSURANCE is about $97 US; for retail, we’re talking hundreds of dollars. It was $19 in Canada. All of these costs were things we had to pay as American citizens that Canadians would have enjoyed for far, far less. None of this even mentions the months of emails, calls, worry, let alone the concern and delays while we were still in Canada.
The costs are far higher than just the number on the bill.
For a Canadian citizen it would have cost about $7 for the delivery fee to their home through the mail. Probably something that would get picked up by the nurse and/or physical therapist assigned to folks that suffer a debilitating injury like this. Recovery and physical therapy would have also been covered for a certain number of weeks with extra recovery or need to be taken care of via the citizen out of pocket, with their own private insurance, or through their employer. In the United States we had to pay copays and premiums for the entire year and into the next. Out of pocket, out of our paychecks, not through our taxes, for worse and less care.
I’ve had health insurance in the United States for the entire time I’ve been an adult. I’ve also had access to the VA healthcare system since I returned from a combat deployment in Iraq. I’ve also experienced healthcare in a foreign country that has seen millions spent to demonize it. It is just a better system than ours. It isn’t perfect, but it doesn’t add the insult on top of the injury with a bill at the end of the day or a non-medical third party determining the speed and order of the care received. The biggest barrier to better health outcomes is the private insurance industry, both in the United States and abroad. Our experience in Canada seeking emergency care was made worse at every turn because of companies like United Healthcare. We are lucky that we were able to absorb it and make it work for ourselves, but how many others cannot?
It is no wonder that despising our healthcare system is a bipartisan point of agreement, but what IS a wonder is why one party is so deadset on making it worse. The story I’ve told above should be a wakeup call to republican readers that things are broken here, and they can be better. The solution isn’t more markets, it’s more public access and removing barriers to care. Its paying and supporting the expertise of medical staff as a matter of public benefit and not something to be sought out for profit. The profit motive and move towards denial of care is what is killing us in the United States, not long lines or complicated red tape.
Make no mistake, we had a worse outcome specifically because of the greedy corporate actors that make this a complicated as possible for people like us so that they can make an extra bonus on our suffering and increased costs. My wife suffered more because of people in charge of companies like United Healthcare, this is a fact that we have to reckon with as a nation and as a people.
We should start voting and acting like it.