Healthcare is always a hot topic when comparing life in Canada to life in the US. I don’t claim comprehensive knowledge of either system, but here are my thoughts after 4 years of living in Canada (and 20+ of being an adult in the US).
In the US, I was mostly on a private HMO plan, as a state employee. In Canada, we are on the Nova Scotia provincial plan and mostly had extended health benefits provided through work.
In the US
The Pros:
Unlike many people in the US, we had excellent health insurance that was very, very cheap. For ~12 years, my wife and I both worked at a large, state university. Because we were both state employees, we paid just $30 per month ($15 each) for family coverage. In other words, we were in an unusually 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. Outside of business hours, we’d use after hours clinics, where we might wait an hour or two maximum. 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 in the group. 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.
The Cons:
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 fairly 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. Shortly before we moved, 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 challenge.
The biggest con, though, was the fact that our wonderful health insurance 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 university department was shut down and both of our jobs went away. If we had stayed, could we have found other jobs within the state university system? Perhaps, but not necessarily.
In Canada
The Cons:
Compared to our admittedly extremely fortunate situation in the US, we found Canadian healthcare much more difficult to access. It took over 3 years for us to get a family doctor. I understand that COVID slowed things down, but this does not feel like an acceptable waiting period, particularly with a young child. Fortunately, none of us have major health challenges requiring regular care, but “stay healthy” doesn’t seem like a viable national healthcare strategy.
Before having a doctor, we had a few options for care:
- After hours clinics – There are a couple near us and they all require appointments. To get an appointment, we had to call repeatedly during the first 30 minutes that they were open and hope to get one before they are all gone. It wasn’t great, but we actually got in more often than not.
- Maple – After a year or two, the government launched a new initiative giving Nova Scotians without a family doctor access to free virtual care through Maple. It was good, but access was still a challenge. We weren’t able to schedule appointments in advance, and the queue was often full. Working from home it was relatively easy for me to get in, but it wasn’t a great option for my wife or daughter.
- Emergency Room – When choosing where to live, we intentionally chose a small town with a hospital. We have all used the ER a few times, and it has been pretty good. We usually get in and out fairly quickly (under 2 hours). At the same time, I have left the ER (when it wasn’t a true emergency) 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 or give prescriptions.
The Pros:
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.
When we finally did get a family doctor, we ended up with a great one. She is very accessible, and we’ve been able to get into see her very quickly whenever we’ve needed to. She offers appointments early in the morning and also does virtual care. From talking to our neighbors, though, even once you have a family doctor, access can continue to be a challenge. We feel lucky in this area.
For much of the time, I had supplemental health insurance through my job which cost me nothing. It was nice, but didn’t feel essential, largely because the benefits were capped at pretty moderate amounts. For example, it would cover 80% of PT up to $500CAD per year, or 80% of dental up to $1000 per year, etc.
I could get a similar family plan on my own for ~$270 CAD per month, but it doesn’t feel essential. Our current plan is to go without extended health insurance for awhile and see how that goes. Because of the caps, I’m comfortable trying self-insurance in this area. 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 the cost of 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 USD (with insurance) for 180 doses. The list price was over $600 USD. In Canada, I get the exact same medicine (even the same brand) for $13 CAD (with insurance) for 200 doses. Without insurance, it costs me $57 CAD.
I have no experience with health plans in other provinces, but one nice thing about Nova Scotia’s is that coverage starts right away. I know that some other provinces have waiting periods.
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 as a minimal interventionist myself, I’m happy with that approach.
In Conclusion
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 entirely dependent on both of us keeping our jobs.
In Canada, the quality of care has been excellent, and the cost has been negligible, but getting access has been a challenge at times. There is talk that more private options might be coming, but so far we haven’t seen any real developments in that area. 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’m still undecided about my opinion of the Canadian healthcare system. My experience has been largely positive, and we haven’t had to wait for anything important, even though some relatively routine tests have taken years to get. It is also very reassuring to know that our medical coverage isn’t tied to our employment.
One last note — I lived in Taiwan for 5 years, and found their healthcare system to be really great. Some providers were definitely better than others, but once I’d figured that out, both the cost and the access were 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. One difference between Taiwan and Canada is that in Taiwan there was always a copay (whereas in Canada everything is “free”). It was small (say $5 USD) but perhaps that is part of the difference.
What about you? If you’ve lived in both the US and Canada, what has your experience with healthcare been?
