Democratic presidential candidate, U.S. Sen. Bernie Sanders (D-VT) talks about the cost of insulin in the USA versus Canada as he joins a group of people with diabetes on a trip to Canada for affordable Insulin on July 28, 2019 in Windsor, Canada Scott Eisen/Getty Images

I began reporting on healthcare at Business Insider six months go.

As a Canadian reporting on healthcare in the US, I’ve gained insight into the complicated and often misunderstood debate in the US over single-payer healthcare.

Since my arrival to the US, I have encountered certain misconceptions about the Canadian healthcare system that I would like to dispel.

There is private insurance in Canada and Canadian healthcare isn’t free, but, everyone is covered no matter their income.

Visit Business Insider’s homepage for more stories.

Growing up in Canada I never thought much about the healthcare system. When I moved to the US for graduate school, I knew it was strange to not have universal healthcare, but I had a comprehensive health insurance plan from school, so healthcare wasn’t an ever-present issue on my mind.

That changed six months ago, when I started writing about healthcare as a fellow for Business Insider and needed to choose a plan for the first time.

As a Canadian reporting on US healthcare, I’ve gained insight into the complicated and often misunderstood debate in the US over single-payer healthcare, and I think I have some of my own insights to offer.

It’s true that in Canada, every person has healthcare coverage. But not all costs are covered by the government — private or employer-based insurance pays for dental visits, eye care and prescription drugs.

Yes, Canada has private insurance.

As Medicare for All takes center stage in the 2020 Democratic presidential debates, Canada is often used as an example for what the US could be with a single-payer system. Prescription medications at a fraction of the price. No surprise billings. An ambulance ride that won’t cost you thousands of dollars. Access to providers at all times. It sounds utopian.

But even Canada’s healthcare system is not as socialized as some other systems. In the UK, the government finances healthcare and has the National Health Service (NHS) providing health services that are essentially free to citizens. The British system is even more socialized than Canada’s.

Since my arrival to the US, I have encountered certain misconceptions about the Canadian healthcare system that I would like to dispel.

clarrie feinstein photo Clarrie Feinstein

Canadian healthcare isn’t free

In general, Canadians pay higher taxes for the country’s social safety net, which includes healthcare. In the US, a significant misconception is that people think Canadian healthcare is free.

But it’s paid largely by Canadian tax dollars. While there isn’t a designated „healthcare tax,“ the latest data from the Canadian Institute for Health Information (CIHI) in 2017 found that on average a Canadian spends $6,604 in taxes for healthcare coverage. It’s important to note that number changes depending on income. People with higher incomes pay higher taxes, which ends up covering families who earn less.

This is considered to be on the higher end for what other advanced economies pay, like the UK or Australia. Americans, though, spend more than $10,000 per person on healthcare in total, on average.

Even though Canadians pay higher taxes, it ensures that the majority of health services are covered. This includes hospital stays, surgical and maternity services (childbirth, prenatal, postnatal and newborn care), and prescription drugs while in the hospital.

There are also no bills attached to seeing a physician or healthcare provider for primary care or clinic visits. And because health insurance is public, there are also no deductibles — the amount a person pays before insurance kicks in.

Canadians have private insurance options

In Canada certain medical expenses are not covered, like dental care, vision care, prescription medication, podiatry and chiropractics.

Often, employers offer supplemental private health insurance to their employees to cover some of the expenses that are not covered under the public healthcare plan.

An area of contention in Canadian healthcare is prescription drug costs — surprising considering the constant coverage in the US, which often favorably compares Canadian drug costs to American.

Earlier this year, 2020 Democratic presidential candidate Bernie Sanders went to Canada to show the inflated cost of insulin for diabetes patients, who can pay up to $300 for a vial of insulin in the US, compared to $30 in Canada.

Soaring drug prices in the US have become a major point to address in the national healthcare debate. In the US, pharmaceutical companies face little regulation over their prices, compared to Canada, contributing to high drug costs.

Canada’s biggest healthcare debate: pharmacare

Prescription drugs are cheaper in Canada because the government plays a big role in setting their prices.

But a similar battle over drug costs is taking place in Canada. A major issue in the 2019 Canadian federal election was pharmacare, a system which allows the government to help pay for Canadians‘ prescription drugs.

Pharmacare is still an undefined concept. It could mean that people who do not have private insurance options through work for prescription drug costs would then have costs covered by the government. Or the government could heavily subsidize the cost for all Canadians, Global News reported.

Recently, the Canadian government announced regulation to reduce patented drug prices which reportedly would save Canadians C$13.2 billion (US$10 billion) over a decade. The move was done with significant opposition from pharmaceutical companies, but is an example of regulating drug costs of drugmakers in Canada, the Guardian reported.

Universal healthcare is deeply engrained in Canada’s ethos

The idea of universal healthcare—that every citizen has access to healthcare—is a Canadian ethos that is deeply ingrained in the sociopolitical landscape of the country.

The private healthcare sector in the US allows for more medical innovation, but the high costs and uneven access to care contribute to the country’s socioeconomic divides.

While there are some misconceptions in the US on what Canadian healthcare is and what it covers, there is the basic idea that if one is unemployed or does not make a certain income they will have healthcare coverage. That notion is now at the forefront in America with the Medicare for All debate.