random thoughts on ontario health insurance
I recently linked to Sara Robinson's excellent posts on Campaign for America's Future: Canadian Health Care Myths Debunked, Part One and Part Two.
Discussions that follow these types of posts inevitably bring up some of the flaws in the Canadian health care system. These flaws should be addressed, and Canadians are constantly debating how to do that. But to an American, this alone is a wonderful thing. Sara notes:
Small wonder, then, that the US-to-Canada emigrants I know all think the system is brilliant. This includes people who use it for maintenance of chronic conditions, as I do, several people who have had surgery, a few emergency-rooms visits (yes, there was a wait! shock and horror! and in the States? no wait there?) - a range of services. I don't mean to deny anyone's negative experience, and I realize those stories are out there. But for people who come from a profit-driven system, Canada's universal coverage is something just short of miraculous.
When American immigrants in Canada talk about health care, one subject that inevitably comes up is preventative care. In a profit-driven system, prevention is counter-productive. In a publicly-funded system, there are incentives to keep costs down, which means to keep health up. I can't speak for other provinces' plans, but Ontario residents are entitled to:
a session with a registered dietitian,
if they are taking more than three prescription medications, a half-hour with a pharmacist,
after giving birth or adopting a baby, a visiting nurse for six months,
a doctor's visit in your own home, for emergencies when travel is not possible or advised,
psychiatry (psychiatrists are medical doctors),
treatment for substance abuse,
for children, full immunization, a healthy babies program, and a range of services for children with special needs, such as language or hearing issues,
flu shots.
If anyone knows any other interesting "extras" that are covered, let me know and I'll add them in. [Update: I've added a few from a comment below, and revised some of the following paragraphs accordingly.]
Public health information is much more accessible in Canada. In the US, you're bombarded with advertising from pharmaceutical companies trying to sell their products. In Canada, you're more likely to be bombarded with advice on nutrition, exercise, quitting smoking and wearing seat belts.
Canadians who are well employed generally have supplemental insurance through their employers. Supplemental health covers: dental, prescription, physiotherapy (called physical therapy in the US), chiropractic, massage, podiatry, travel vaccinations, medical equipment (such as orthotics), even acupuncture.
Seniors get prescription care through their provincial plans, as do recipients of social assistance (welfare). There is also a provincially-sponsored drug plan to help residents who have extremely high drug costs, or if the cost of your prescription drugs amount to a certain percentage of your income. Children and seniors get vision care, as do people with vision diseases such as glaucoma, or people who need eye exams related to other conditions, such as diabetes. [Insert inevitable comment that everyone in Ontario used to receive vision care, but that was de-listed, thanks to Ontario Premier Dalton McGuinty.] Physiotherapy after any surgery is also covered by the province.
If you don't have supplemental insurance this through your employer, you can purchase it. Coming from the US, I consider the cost of this insurance very low; Canadians do not. Also, if you purchase supplemental health insurance on your own, I believe - although I'm not completely sure - you cannot be turned down because of pre-existing conditions. If that's wrong, I'm sure someone will correct me.
What's more, my experience with the private insurers has been uniformly positive. Using three different companies over our different employment here, I have found all the representatives to be knowledge, polite and helpful. Reimbursement generally arrives promptly, and if it doesn't, someone will find out why. In other words, no one is trying to deny you coverage. The coverage is considered yours to use. You've all seen "Sicko", so you know how different this is from private insurers in the US.
In general, I've noticed that Canadians are extremely reluctant to pay for any health care out-of-pocket. They're just not used to it. For example, my co-workers will generally get as many massages as their insurance will cover, and no more. I need regular massage to prevent a range of painful and debilitating conditions - basically, in order to stay employed - and getting reimbursed for any of it feels like an incredible luxury.
Canadians are also very likely to purchase travel health insurance when they travel outside of Canada. Even without supplemental coverage, I've never done this, and I doubt I ever will. I feel I can take that small risk, and on the off-chance that I need medical care while I'm away, I'll pay for it myself. Ontario will reimburse me for what the service would have cost in Ontario, which is an added bonus. Many Canadians would find that idea shocking.
We should note that this insurance situation constitutes a mix of public and private insurance, at work side-by-side in Canada, something generally not recognized when Canadians debate privately funded care. I'm not necessarily in favour of a two-tiered system, but I do think we should acknowledge that Canadians already have a measure of private insurance in the mix.
Another topic that often comes up when Canadians talk about their health care plans are the relative costs among the provinces. Some provinces have premiums, some do not.
In Ontario, your premium is paid when you file your income tax returns, and it's calculated on a sliding scale. If you earn less than $20,000, there is no premium. It progresses from there by small increments, up to $900 for a person earning more than $260,000 a year.
Ours would normally come to $600 per year each, but since I was unemployed for some of last year, my premium was reduced to about $350. Of course we are all still entitled to the same care. While I was unemployed, I had no added concerns about my health care. Think about that.
Two of my earliest posts about health care, way back in 2004 (before we moved), were prompted by screaming headlines in the New York Times declaring the death of Canada's publicly-funded system. The Supreme Court of Canada had ruled that a Quebec law banning private medical insurance was unconstitutional. I asked readers what this meant; my questions and readers' answers are here and here.
Today there was more news about health care in Quebec, although, once again, the details might not be as drastic as the headlines imply. Quebec Health Minister Philippe Couillard proposed that doctors in that province could practice in both the public and the private systems, under strictly controlled conditions. He also proposed that private insurance companies could cover services currently covered by the public-health plan. Let's see what the New York Times calls this tomorrow. The death of Canadian health care?
Discussions that follow these types of posts inevitably bring up some of the flaws in the Canadian health care system. These flaws should be addressed, and Canadians are constantly debating how to do that. But to an American, this alone is a wonderful thing. Sara notes:
You are complaining about stopped drains, faulty wiring, and leaky roofs in front of people who are living full-time under an underpass because they have no hope of ever owning a house.
Small wonder, then, that the US-to-Canada emigrants I know all think the system is brilliant. This includes people who use it for maintenance of chronic conditions, as I do, several people who have had surgery, a few emergency-rooms visits (yes, there was a wait! shock and horror! and in the States? no wait there?) - a range of services. I don't mean to deny anyone's negative experience, and I realize those stories are out there. But for people who come from a profit-driven system, Canada's universal coverage is something just short of miraculous.
When American immigrants in Canada talk about health care, one subject that inevitably comes up is preventative care. In a profit-driven system, prevention is counter-productive. In a publicly-funded system, there are incentives to keep costs down, which means to keep health up. I can't speak for other provinces' plans, but Ontario residents are entitled to:
If anyone knows any other interesting "extras" that are covered, let me know and I'll add them in. [Update: I've added a few from a comment below, and revised some of the following paragraphs accordingly.]
Public health information is much more accessible in Canada. In the US, you're bombarded with advertising from pharmaceutical companies trying to sell their products. In Canada, you're more likely to be bombarded with advice on nutrition, exercise, quitting smoking and wearing seat belts.
Canadians who are well employed generally have supplemental insurance through their employers. Supplemental health covers: dental, prescription, physiotherapy (called physical therapy in the US), chiropractic, massage, podiatry, travel vaccinations, medical equipment (such as orthotics), even acupuncture.
Seniors get prescription care through their provincial plans, as do recipients of social assistance (welfare). There is also a provincially-sponsored drug plan to help residents who have extremely high drug costs, or if the cost of your prescription drugs amount to a certain percentage of your income. Children and seniors get vision care, as do people with vision diseases such as glaucoma, or people who need eye exams related to other conditions, such as diabetes. [Insert inevitable comment that everyone in Ontario used to receive vision care, but that was de-listed, thanks to Ontario Premier Dalton McGuinty.] Physiotherapy after any surgery is also covered by the province.
If you don't have supplemental insurance this through your employer, you can purchase it. Coming from the US, I consider the cost of this insurance very low; Canadians do not. Also, if you purchase supplemental health insurance on your own, I believe - although I'm not completely sure - you cannot be turned down because of pre-existing conditions. If that's wrong, I'm sure someone will correct me.
What's more, my experience with the private insurers has been uniformly positive. Using three different companies over our different employment here, I have found all the representatives to be knowledge, polite and helpful. Reimbursement generally arrives promptly, and if it doesn't, someone will find out why. In other words, no one is trying to deny you coverage. The coverage is considered yours to use. You've all seen "Sicko", so you know how different this is from private insurers in the US.
In general, I've noticed that Canadians are extremely reluctant to pay for any health care out-of-pocket. They're just not used to it. For example, my co-workers will generally get as many massages as their insurance will cover, and no more. I need regular massage to prevent a range of painful and debilitating conditions - basically, in order to stay employed - and getting reimbursed for any of it feels like an incredible luxury.
Canadians are also very likely to purchase travel health insurance when they travel outside of Canada. Even without supplemental coverage, I've never done this, and I doubt I ever will. I feel I can take that small risk, and on the off-chance that I need medical care while I'm away, I'll pay for it myself. Ontario will reimburse me for what the service would have cost in Ontario, which is an added bonus. Many Canadians would find that idea shocking.
We should note that this insurance situation constitutes a mix of public and private insurance, at work side-by-side in Canada, something generally not recognized when Canadians debate privately funded care. I'm not necessarily in favour of a two-tiered system, but I do think we should acknowledge that Canadians already have a measure of private insurance in the mix.
Another topic that often comes up when Canadians talk about their health care plans are the relative costs among the provinces. Some provinces have premiums, some do not.
In Ontario, your premium is paid when you file your income tax returns, and it's calculated on a sliding scale. If you earn less than $20,000, there is no premium. It progresses from there by small increments, up to $900 for a person earning more than $260,000 a year.
Ours would normally come to $600 per year each, but since I was unemployed for some of last year, my premium was reduced to about $350. Of course we are all still entitled to the same care. While I was unemployed, I had no added concerns about my health care. Think about that.
Two of my earliest posts about health care, way back in 2004 (before we moved), were prompted by screaming headlines in the New York Times declaring the death of Canada's publicly-funded system. The Supreme Court of Canada had ruled that a Quebec law banning private medical insurance was unconstitutional. I asked readers what this meant; my questions and readers' answers are here and here.
Today there was more news about health care in Quebec, although, once again, the details might not be as drastic as the headlines imply. Quebec Health Minister Philippe Couillard proposed that doctors in that province could practice in both the public and the private systems, under strictly controlled conditions. He also proposed that private insurance companies could cover services currently covered by the public-health plan. Let's see what the New York Times calls this tomorrow. The death of Canadian health care?
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