A link to this article just popped up in my Facebook feed.
Officials investigating after two deaths in Châteauguay ER | Montreal Gazette
“The local health authority says the two people died at Anna-Laberge Hospital during a period of high traffic and “very high” wait times.”
Both of these countries have not insignificant proportions of people who have private insurance, IIRC it’s about 15% in Canada. And that industry is growing in both countries, for obvious reasons.
You bring up a good point; I complain about the guys with the MS in Hospital Administration, but there exists something worse! My former employer brought in a CEO with no healthcare training or experience at all. He cut the psychiatry department by 50% because its appointments were not moneymakers and because “mentally ill people contribute to a poor payer mix.” So yeah, one morning we all woke up to the news that half of our psychiatry colleagues had been laid off, and that the wait list for a psychiatric intake was now over 6 months! We, as a group, lived with this for about a year, and then got together and ousted this jerk (basically we held a secret meeting where we passed a no confidence vote, and threatened to quit en masse if they didn’t get somebody new.)
I looked up the American Society of Civil Engineers’ plans. “Real” insurance is exactly the same price per month as I can get individually. There is a very cheap option, but it seems to cover only hospital costs and part of 4 or 5 office visits a year. So if I needed to go to the ER, have lab tests, or be treated for cancer, I would be out of luck. Sigh.
I use ACA Marketplace insurance. I socked away cash so that we could limit income the two years before Medicare will kick in. Our taxable income is around $70k. I pay around $200 a month for a bronze policy. My subsidy is around $700 per month. It has a $9k deductible but I also socked away HSA money in those last years of work so I’m covered in the worst case. My policy covers all the required preventative care and I can have 3 PCP at $50 each without meeting the deductible. You should check out what the ACA Marketplace would look like for you. Yes, I am not getting lots of specialist care these years (no dermatologist checking for moles, etc) but I see my PCP yearly, have routine blood work, a mammogram, and the regular colonoscopy and bone density tests. All covered.
I plugged in my income now and I do not get any subsidy. When my husband really does retire, I will check again.
In the UK, doctors can provide healthcare for the NHS and also for a private entity that gets paid by private insurance (Bupa, Aviva, AXA, etc.). If you have a heart attack, NHS will take care of you and you will get similar care to what you would get in the US. If you want an elective surgery (total knee replacement0, NHS might make you wait years and private insurers would get you in right away.
My recollection is that in Canada, doctors can either take public insurance or private but can’t do both. The market for private insurance was more for vision, dentistry, and maybe some procedures that aren’t covered by the provincial insurance. At the time that I looked, private health insurance was not nearly as advanced as in the UK.
The hybrid of public insurance and private insurance can work reasonably well.
@TomSrOfBoston, I believe that ER nightmares like this occur in the UK as well as Canada and rarely but sometimes in the US See also this.
Yes, there are subsidies for ACA plans at lower middle incomes.
There is also Medicaid at lower incomes (though there is an income donut hole of no Medicaid or subsidy in states that did not expand Medicaid).
I have never heard anyone from Canada or the UK say they wish they had the US healthcare system. Sure they complain about their systems, which aren’t close to perfect, but absolutely no one thinks the US has a better system.
IIRC, this is what my BIL and wife have in Australia. Actually, it works sort of like Medicare does here. You get basic coverage (like parts A and B Medicare) at no cost, and can buy a supplement that bumps up your coverage. And there are several different layers of coverage. My BIL says…it works very well. And the cost is nominal.
We’re from the UK and are very glad to have US healthcare. We’ve had endless examples of relatives experiencing delays or simply being fobbed off in the UK. A family member is having to fight to get cancer treatment at the moment because the default is that chemotherapy simply isn’t offered to anyone over the age of 80.
But we are sufficiently well off to afford it and know that high quality care is a luxury that is not accessible to many in the US. Just like in many other aspects of life, there’s nowhere better to live than the US if you are wealthy and successful, but it’s worse than other developed countries if you are poor.
So are you saying you don’t have long waits/delays in the US or get fobbed off? You must live in a very different place than I do if so. There are virtually no primary care providers taking new patients where I am, and a physical will take at least 6 months to schedule (including a new patient visit, meaning you are without a PCP in the meantime). The pediatrician we used kicks kids out the day they turn 18 they have such a wait list and it is not easy to get a new PCP. I would be shocked to get into any specialist in less than 4-5 months, except for something really emergent, and I am not surprised when it’s 5-6. It’s not an insurance issue - I actually have very good insurance compared to many (i.e., no deductible) - it’s an availability issue. Maybe if you live in a major city it is different. But honestly, even when I’ve been willing to drive to the nearest major city (several hours away) it’s months before we can get in. My daughter has been supposed to see a specialist in a major city known for its health care and we originally were told in March that she could have an appointment in October. Nothing all summer. They later canceled that appointment, and we were given an appointment in December instead. It’s not an emergency but annoying not to have answers for 9+ months but I figure par for the course. Maybe your experience is different. In my case, I have to see one specialist before I am allowed to be evaluated by another for an intermittent but annoying issue and I have to wait four months for that appt., and then presumably when they find nothing I’ll wait another 4-5 months before I can see the other specialist. So at least 8-9 months before I get (or don’t get) any answers. So, again, maybe it’s different where you live, but where I am endless delays (and often being fobbed off as well) are par for the course. And the more providers who get burned out and leave the worse it gets.
My PCP here in the US is in her late 50s. I asked if she’s thinking about retiring. Fortunately she said no, but she added, “I do wonder who will be my doctors as I age”. There just aren’t enough. And as the boomers continue to age, care for the elderly is really going to decline, I fear.
Same here. My PCP just did her board renewal which is good for 10 years. She told me…it might be her last time. Ack! My goal was to have all of my new doctors in practice until I go to the great beyond!
I have been waiting since August for an appointment with a recommended rheumatologist. I made three different appointments for late December (figuring that if there were a cancellation I may get in earlier)–no such luck. But in the network I use (NYU-Langone), I can see a real doctor same day in virtual urgent care. I saw an ER doc today who prescribed a hefty dose of prednisone for five days for my issue (and told me I was taking way too much ibuprofen!).
I saw another rheumatologist in August and I learned the lesson that reviews mean something! She was awful, exactly as she had been reviewed.
But my PCP’s office (not her–she’s very much in demand) always has openings. And I can message her and she’ll squeeze me in. Much the same with specialists, especially once I’ve seen them once.
I have a cheapo Medicare Advantage plan. Almost every doctor in the network takes it and most in Brooklyn take Medicaid as well.
Our experience has not been like that at all. We live in Silicon Valley and have lots of competing providers who can fit you in without significant delay (typically within 1-2 weeks even for something that’s not deemed urgent). The main problem is simply the expense and that Stanford medicine (where we’ve had world class treatment, especially when our tiny premature baby needed major heart surgery) is not in-network for many insurance plans. We are fortunate to have a pre-Obamacare individual insurance plan that we’ve held onto, which is relatively cheap (LOL that I think $1800 per month for a family plan is cheap) and offers unrestricted network access. Shopping for insurance nowadays (as our neighbors recently found out) would be much more problematic.
Rheumatologists are really hard to get an appointment with. Once you are in, it’s better but that initial appointment is a lengthy process.
But a good rheumatologist is worth their weight in gold. 
The Canadian government and/or media has set up the US health care system as a bête noire. No matter what problems exist in the Canadian system they are conditioned to believe :Thank God we don’t live in the US". Many believe that all these big US hospitals are filled with wealthy people and people soon to be bankrupt.
@Twoin18 is in the top tier that I described. If you live in close proximity to a major medical center – could be academic like Harvard or Stanford but could be Geisinger or Mayo – and if you have good primary care, which is increasingly becoming concierge, you have access to the best health care in the world, though even there prevention is underplayed. And, even with top tier access, it can sometimes take months to get your first referral to say a pulmonologist (they are very busy as Covid created lots of new cases). The cost in the US are the insurance premiums (though most people only pay 20%) plus all of the deductibles and co-pays and co-insurance payments (20% of cost).
In the UK, NHS plus a good plan at Bupa or AXA can probably get you something similar. If you have to wait at NHS, you activate the private insurance – though I’m not up on the details.
But top tier in the UK (the NHS/private insurance) is probably a lot more affordable than being top tier in the US.
Again, @TomSrOfBoston, my information is older, but my impression is that Canadian private health insurance does not give you the same access or coverage as the private insurance in the UK. If I’m still correct, it doesn’t easily give you the same ability to step around bottlenecks from the public system. You may be more up to date.
I sense that a lot of the folks on CC, but by no means all, may be at or closer to the top tier. My observation (borne out by lots of data) is that over the past 30 years, the average person gets on average better health outcomes in Canada or the UK.