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Comment by graeme | Hacker News Reader

I'm a Canadian. I'm curious to know what it would cost to match my level of coverage in the US.

1. Public medical care. Good care, normally easy to see a doctor. Excellent quality. Can use this as much as you need. 2. Occasional use of the parallel private billing system. Costs less than $300 Canadian to see a specialist. 3. Private coverage for paramedical claims (Physio, massage, drug plan, dental, vision, etc.). Pretty comprehensive. Costs about $100 Canadian a month.

I work for myself. Is it even possible to replicate such a plan without employer coverage? What would it cost?

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I'm genuinely curious about this, particularly the "easy to see a doctor" part, because I know that quite a few Canadians travel to Thailand for non-emergency medical care mostly due to long wait times. That's according to a few statistics published by some of the private hospitals in Thailand. I've seen few outbound studies published by Canadian researchers, although here's one from last year [1]. From what I understand, out-of-pocket costs aren't that much difference between Thailand and Canada.

[1] http://www.ctvnews.ca/health/more-than-52-000-canadians-trav...

I think it varies a lot by jurisdiction, proximity to foreign centers, and type of procedure.

For instance, I live in Quebec. On the chart in the article, Quebec only had 6284 travelers, despite having a large population. Quebec's private medical system is more extensive than average, and I think you can buy more here than you can in some other provinces.

BC also has easier travel options to Asia. It would be quite a trip from Quebec, and possibly easier to buy locally.

Across the board, wait times tend to be long only for elective issues. I've generally had no trouble with them for and neither has my family.

Though some specialties seem worse off. For instance, if I needed a gastroenterologist in Montreal, I believe I'd have great difficulty finding one.

Also, in Montreal, much depends on your local hospital. Some have longer wait times than others, even within the same city. If someone doesn't know how to navigate that system, going abroad may seem simpler.

That makes sense, the variation by jurisdiction. It's kind of strange that a local person would find it simpler to go abroad than navigate the complicated workings of the local care system. Although it is pretty simple when you go to a medical tourism destination - you just get off the plane, taxi to the hospital, walk in and ask for sevice, and you get it.

I live in Arizona. My employer only offers high deductible health plans with a pre-tax health savings account. So, I pay ~350 USD per month for the plan to cover my wife and I. Then I also contribute to this health savings account, my employer kicks nothing in. For this, we get basic vision and dental completely covered. That is, routine checkups, cleanings, basic prescription eyewear. Everything is else is subject to a high deductible, ~10,000 USD. The insurance covers something like 20% of certain kinds of expenses until we hit the deductible, then it covers 80-100%, per year.

A few weeks ago I had an asthma attack and went to see a doctor. The office refused to tell me in advance what I would be charged, or even what my insurance would be charged. I ended up being charged $200 after insurance, and then an additional $100 for prescriptions.

Because I had not previously selected a primary care physician, it was difficult to see a doctor in a reasonable amount of time. The doctor I did find gave wrong instructions for one of the prescriptions, and forgot to call or even write down the other.

Should I take that to mean that there is no option to get equivalent insurance to what we have in Canada?

I think it depends on the state. We don't have a national healthcare system (disregarding a couple programs for the old or very poor). Obamacare laid down only the barest of national standards.

In California and a few other states Kaiser Permanente offers an integrated system. I signed up for it as it seemed the least complicated option.

What I want to know is, how much does it cost to provide that service to you? Not how much do you pay, but how much does it cost? If it's greater than $100 a month (how could it be less?), then someone is paying. What portion of Canada's budget is spent on the health system? Are you paying for your healthcare indirectly via taxes (in which case you're just unaware of the true cost) or is someone else paying (in which case you just won the redistribution game, congrats).

It still costs something to provide medical care. It's not like Canada doesn't need to pay their doctors. The cost in the U.S., contrary to public opinion, is not driven by insurance company greed. So, assuming the cost is about the same in Canada, how did you succeed in shifting the cost elsewhere in a manner that you're satisfied with?

And, if we were to replicate such a plan in the U.S., do you think we'd see similar results?

For cost, it varies by province, because health care is a provincial responsability.

Overall though, Canada's entire public medical system costs less per capita than America's public system (medicare + medicaid + whatever else they're including).

http://www.slate.com/blogs/moneybox/2013/01/23/chart_us_gove...

I checked the stats for my province, Quebec. In 2013, costs were a bit under $4000 per capita for the public sector. So that's about $333 per month.

Per province breakdown stats: https://secure.cihi.ca/free_products/4.0_TotalHealthExpendit...

As for replicating it....I'd wager that it couldn't be done nationally. It could possibly be done in a small state. It probably could have been done back in the 1950s, but there's been so much drift in the two systems since then that it would be difficult to imagine implementing it.

Because there'd be pretty wholesale change: no private health insurers. Also the fact that medicare + medicaid cost more than Canada spends already doesn't bode well.

But that could just be status quo pessimism.

Our employer-sponsored plan is roughly equivalent to this, and it costs the employer about $1,950 per month.

Interesting. Total private + public health care spending in my province is around $5000 per capita, per year. That covers everything I listed above.

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