By Craig Axford | United States

Photo by rawpixel.com on Unsplash

Perhaps my problem is that having just spent seven years in Canada, single-payer universal healthcare ruined any possibility I would ever accept the Obamacare model. Be that as it may, after just a few minutes reviewing my employer’s healthcare package, I couldn’t help but feel I would be better off financially going without coverage in the US, at least in the short-term.

Paying $256 a month for a high deductible plan means that during the four months or so we have left until hopefully returning to Canada, we will need to spend more than $3,000 on healthcare before most services either my wife or I could possibly need even begin to receive coverage. For insurance to kick in for both of us, we must meet the family deductible. This pushes our total figure to somewhere just north of $5,000. Welcome back to the United States, where healthcare costs and in network/out of network headaches just might cause more strokes and heart attacks than the system prevents.

Even if we were staying full-time in the US, our plan would be a disaster. With it, our annual healthcare spending would have to be extraordinary for it to make any sense. We are unlikely to reach the $2000 individual/$4,000 family deductible alone, never mind the $5,000 to $7,000 in health related costs we would need to incur over the course of the year before this insurance plan finally began saving us money (deductible plus nearly $3000 in premiums). As people are fond of saying when stark financial realities confront them, just do the math.

In addition, it’s important to keep in mind the expenses described above represent a huge percentage of annual income for anyone doing the job I’m currently doing. Because we don’t plan on remaining in the United States for long, I haven’t sought jobs in my field here. I’ve just taken a temporary job at a convenience store to hopefully save up a little money before returning north. At that point, I will pursue a master’s degree and permanent residence in Canada. However, for many of my co-workers, the job is much more vital in both the near and long term.

I suppose some would say I should feel lucky to have any insurance at all under the circumstances (a very American response). As you might expect, working in retail doesn’t pay well. Frequently, it doesn’t come with any benefits at all.

I would argue that for all practical purposes, my job still doesn’t come with benefits. The insurance premiums alone knock roughly 15% off the earnings of a typical convenience store clerk. If that clerk or a family member were to experience serious health issues, the $2000 minimum they will have to pay out of pocket before the insurance even begins to provide some relief will quickly bump the cost of this “insurance” into the 25% of annual income range. This amounts to an extremely regressive tax on low income workers. There’s nothing economical, let alone right, from either an individual or social perspective about any of it.

Obamacare provides health insurance subsidies to those purchasing individual coverage through the marketplace created by the Affordable Care Act (ACA), but not to those receiving health insurance through their employer. It did, however, require people to sign up for their employer’s insurance to avoid paying a tax penalty. However, even taking the tax penalty into account (about $695 in our case, assuming we’re in the US all year), the hit to a low income worker, making what I earn, is far greater. Regardless, the so called “affordable” plans offered via the ACA tend to also have high deductible policies. It’s difficult to justify huge government subsidies for plans that don’t really provide true coverage.

As was the case with the uninsured before healthcare reform, high deductible plans still often leave low-income workers choosing between food, shelter, and healthcare. No one in a nation as wealthy as the US should have to face those kinds of decisions. Medicaid might pick up some of the slack in many cases, but this imposes yet another layer of bureaucracy onto American healthcare that the poor are required to navigate and that healthcare providers must bill. This alphabet soup of private and public plans is primarily responsible for the high administrative costs of the US healthcare system. Yet, it just leaves patients feeling frustrated and confused.

Before my employer took it over, health coverage in Canada for my wife and I totaled $135. Enrollment, as I recall, involved a single double sided page of paperwork. Then, we got the same healthcare card that everyone gets, rich or poor. We also got the same benefits. There was no monthly, quarterly, or annual renewal. Our healthcare provider just swiped the card at the front desk and that was that.

Our monthly premium was high by Canadian standards. Because we lacked permanent residency or citizenship, we didn’t qualify for lower cost options. However, we did still qualify for Pharmacare, a benefit which reduced the expense of Canada’s already relatively cheap prescription drugs. Supplemental insurance, provided through my job, picked up whatever drug costs that remained.

As for hospital bills, while living in Canada I paid three visits to the emergency room and never saw a single bill. My wife had a specialist to help facilitate the best management of her Type I diabetes. We likewise never had to pay a dime for her doctor visits. In other words, that $135 a month was for a zero deductible plan, which is the only plan in Canada.

I did have to pay $80 for one ambulance ride, the maximum that a hospital can charge for this in British Columbia. It took them six months to get around to sending that bill, and there appeared to be no urgency on their part about seeing it paid. That said, we were happy to pay, given that we knew a similar ride south of the border would likely run over $1000.

For obvious reasons, and contrary to popular belief, Canadians aren’t exactly flocking to the US for non-essential services they might have to wait a little longer for at home. Even the single-payer system’s harshest critics estimate that only tens of thousands off Canadians come south to receive treatment. This amounts to a fraction of 1% of the entire Canadian population. Of course, no critic of the single-payer model ever cites the number of Americans that have moved to Canada at least in part because they find its system of universal coverage far preferable to the balkanized and expensive US alternative.

Regardless, virtually every Canadian we spoke with about healthcare during our time in their country could not grasp why so many Americans favor the right to go without health insurance altogether. It’s possible some of them insist on that right for the same reasons we’re exercising it, but most seem opposed to health insurance mandates on ideological grounds rather than out of financial necessity or practical budgetary reasons. Canadians, in our experience, were equally puzzled by the apparent willingness of so many of their southern neighbors to pay so much for coverage that provides so little in return. Indeed, government has told us the plan we’re being offered is “normal” both in terms of monthly premiums and benefits received in return, and that we should accept it. Again, having experienced Canadian healthcare, normal to me has become something quite different.

Sometimes it was necessary to explain what a co-payment was to our friends up north. The whole idea of networks was something of an enigma to them as well, given that Canada as a whole is just one big healthcare network. Explaining the benefit of a healthcare network to a Canadian is like trying to explain the benefit of a fish tank to a creature that’s spent their entire life swimming in the ocean. Why you and your neighbor should each have to choose different doctors because you have different insurance plans makes no sense at all from a Canadian perspective?—?or really from any serious perspective for that matter.

For all the talk about maintaining the right to choose your own doctor in the United States, it’s in America, not Canada, where your choice of doctor is limited by your insurance provider. In fact, unless you’re buying individual coverage, even your insurance provider is likely to have been chosen by your employer instead of by you. In other words, among the world’s developed countries, America probably offers patients the least freedom of all when it comes to choosing a physician.

So, it’s official: we’ll be keeping our fingers crossed until we return to our adopted home and resume following our chosen path to permanent residence and ultimately citizenship in Canada. It simply makes no financial sense to pay an arm and a leg for both health insurance AND visits to the doctor at the same time. As with millions of other Americans, the healthcare options for us seem little changed since our initial departure in 2010 before Obamacare had taken effect. Given the kind of choices US health policy still forces tens of millions of citizens to confront daily, I’ll take the “lack of choice” Canadians enjoy any day and look forward to getting back to not having it again very soon.

Other stories by Craig include: Equality: The Yeast That Makes Liberty Rise & Who Are The Undeserving Poor? When I Meet One I’ll Let You Know

Follow Craig on Twitter or read him at Medium.com