The Canadian health care system

There's been a lot of talk about the U.S. possibly implementing a "Canadian-style" health care system, and also a lot of misinformation about what a "Canadian-style" health care system actually is. So I thought I'd write a little about what it's like for me, as a Canadian with diabetes (as well as a few other chronic health conditions), under this system.

First of all, to be perfectly accurate, there is no "Canadian health care system." There are multiple systems -- one for each province and territory. I live in British Columbia, so I can really only talk about what the system is like here, though there are more similarities than there are differences between the different provincial system.

British Columbia is one of only a few provinces that charge health care premiums. These premiums are based on your yearly income. People with an income of less than $20,000 pay no premiums. The maximum premium, for people with an income of $28,000 a year or more, is $54 a month. Between those two amounts are various income levels with various levels of subsidy.

These premiums cover almost everything: doctor visits, hospitalization, lab tests, X-rays, etc. They do not cover prescription drugs. They do not cover psychotherapy. People with the highest premiums, the ones with an income over $28,000, do not get certain services covered, including physiotherapy, chiropractors or massage therapy. People who have lower premiums have these services covered, but do have to pay small "user fee" of about $10 to $15 per visit. People with higher incomes usually have these services paid for by their employers through various benefits packages.

Many of my American friends are surprised to find out that Canadian employers offer medical benefits, since the government does cover most of our health services. Benefits packages usually cover things that the government doesn't cover, like the aforementioned physio, chiropractors, and massage therapy, and prescription drugs. Some cover psychotherapy or offer "employee assistance" packages. Some pay the medical premiums for their employees.

For those who do not have employers who pay for their prescription drugs, we have what is called Pharmacare. Pharmacare is another sliding-scale plan that is based on a person's income. People whose income is less than $15,000 pay no deductible, but must pay 30 percent of their drug costs until they reach a maximum of 2 percent of their annual income spent on prescription drug costs. People whose net income is between $15,000 and $20,000 pay a deductible equivalent to 2 percent of their annual income, and then the government pays 70 percent of drug costs, until the person has spent 3 percent of their annual income on prescription drugs, at which time the government pays 100 percent of the drug costs. And people whose annual income is over $30,000 pay a deductible equivalent to 3 percent of their income, and then the second deductible is equivalent to 4 percent of annual income.

People who are on welfare or disability benefits have all their prescription drug costs covered by the government, and they don't have to pay medical premiums.

Because I am currently on disability, all of my diabetes supplies (and my other prescriptions) are covered by the government. If I go back to work, they will still be covered by the government under a program called "medical-only income assistance." This is a program that pays the costs of medication for people who have left disability assistance to go to work, but who would have trouble paying for their prescription drug costs if those costs were no longer covered by the government. The government sees this as a way to encourage people with disabilities to go to work and get off disability assistance.

What do I think of the British Columbia health care system? (As I said, there is no universal "Canadian" system.) I think it's not perfect, but I prefer it to the lack of a system in the United States. It has its flaws, certainly; the government has a tendency, in my opinion, to see health care as nothing but a big expense, and they tend to stigmatize certain diseases -- especially diabetes -- as being a "drain" on the health care system.

But I know too many Americans who have no health insurance. I know too many who are terrified of losing their jobs because if they do, they lose their health insurance. I have met people who say things like, "I think I'm having a miscarriage, but I can't go to the hospital because I have no money," or "I have diabetes, and I can't afford to pay for my insulin/syringes/test strips/etc."

There must be a better way.