I’m splitting this topic off here since it raises an issue I’ve often considered but have not written about. I’m thinking about the US versus Canadian health economics models. While I’ve always enjoyed very good access to things like CGM supplies with reasonable out of pocket costs, I’m starting to wonder if people in Canada might be able to finance these non-covered supplies with the huge avoided costs that I must pay.
For example, I pay about $400 USD/month for insurance premiums before I see dollar number one in benefit. I am covered by Medicare Parts A & B as well as a supplement plan that picks up copay amounts. I’m eligible and pay for a pharmacy benefit plan I earned from my former employment.
I also must fund annual deductibles and copays. In addition, none of my insurance coverage extends to alternate providers like naturopaths or any dental work.
I estimate that I pay $900-$1,000 per month for health costs, including insurance premiums. That’s about one dollar out of every four of my annual income.
On the plus side of this equation, I receive all my pump supplies, test strips, and CGM supplies without out of pocket costs. In reality, I’m already paying dearly for this “benefit.”
I suspect that many people in Canada, while they do often pay 100% for things like CGMs, are financially better off than me.
I’m not well educated about the Canadian health access model but I do know that the system varies from province to province.
What do you think of this idea, especially if you live in Canada?
So, I can only speak about the two situations I’ve been in: in Scotland in the 90s on the National Health Service, and in the U.S. on employer-subsidized health insurance. Here’s the breakdown:
When on the NHS, I never paid out of pocket for anything. Period. As a student, my taxes were verging on nothing (I paid less than $100 USD equivalent in income taxes, and the only other taxes I paid were VAT). Interestingly enough, even though I was in a large city with a sizeable population and limited NHS resources, I also never waited for care.
Now, on my solid plan from my university in the U.S., I pay:
a. My monthly premium in addition to what my employer pays (the split is about 25/75 in my “favor”)
b. My copays of $25.00 per regular visit, $50.00 per specialist visit, $400 per hospital visit, $15/25/50 for drugs by tier, and probably some others I haven’t discovered yet.
c. Of course my deductible of only $750 / $1500 (individual/family) and a drug deductible of $250 / $500
d. And after all that, I still get to pay Copay plus 20% Coinsurance on any visit until I meet the “out of pocket maximum” of $17,500 (or something).
I’ve been averaging about 33% of my pre-tax pay per year for my family’s medical expenses. Part of that is we had a very difficult C-section for my son a few years back, and somehow that was not subject to out of pocket maximums. We’ll be paying that bill for the rest of my life, and I’m willing to bet my son will have to pick up the portion of the tab I can’t pay off.
So, rhetorical question: how can Canadian or British or Danish or Japanese or Chinese or Kenyan or Indian or … healthcare not be less expensive than US healthcare? If I’m missing something here, I wish someone would tell me what that is!
Perhaps you need to be a little more granular in how you arrive at $900-$1000 per month as I believe that number can fluctuate pretty wildly depending on what you cover directly, what might be covered by a 3rd party such as current or previous employer and what your overall medical requirements may be.
I am also on Medicare Part A + Part B with Blue Cross supplemental insurance ($592 per quarter) + Part D ($12.83 per month) and my total costs for insurance is about $335 per month + my insulin + a statin. Statin copay is about $9 every 90 days and my insulin runs about $60/month (Purchased out of pocket in Canada). My Dexcom G5 subscription is 100% covered with my plans. My insurance coverage is all 100% self pay - no employer contribution except where mandatory.
My costs, therefore, if I have this right, run less than 1/2 of yours. I go through about 300 units of Humalog every 12 days and also figured in the basal Lantus I gave up 7 months ago at 250 units per month.
My part A may be understated because I asked somebody and was told Medicare was deducting $125 per month but when I go online it appears the rate is much higher than that.
I think the short answer to your question is a resounding “NO”.
There may be some exceptions for specific conditions, age brackets etc, but in general per-capita health care costs in the US are vastly higher than most ‘comparable’ countries.
I can’t comment on Canada, but in Australia with a Seniors Health Care Card:
CGM is not funded at all (Dexcom G5 works out at US$4717 full retail, using sensors & transmitters at Dexcom warrantied intervals) [NB for people under 21 CGM is fully funded ie no out of pocket costs, and there are other cheaper ways of getting it, plus obviously the ability to extend sensors & transmitters]
General prescription price is US$4.40: For insulin your typical script would be for 5 boxes of 5 penfills, i.e. 4500 units (Novorapid, Humalog, Fiasp whatever are all the same price). Some prescriptions for drugs not covered by the pharmaceutical benefits scheme can be more expensive.
Test strips are US$10 for 100
Syringes, needles, pen needles are FREE
Pump consumables: Cartridges are US$6.10/box of 10, infusion sets are US$8.10/box of 10
GP visits are usually free (some GPs may bill, you’re free to go to one who doesn’t)
Public hospital visits are free
Endo visit through a public hospital clinic or attached diabetes service are free
Pumps are not funded
Adding all that up comes to about US$5200 or less per year - and the cost doesn’t go up from there even if you need hospital stays, as long as you access that through the public system. There may be some delays in accessing specialist appointments for treatment of non-acute complications.
My costs are about $550-600 a month. My total costs so far the year are at about $4800, so maybe a max of $7200 that includes (originally pump) pump supplies, insulin, CGM and it’s sensors transmitters etc. Some dental, vision, acupuncture, chiro. That covers my copays, prescriptions costs, tests, x-rays, labs, phys therapy and any other treatments. I’ve had a lot of that this year.
That of course is not the total costs, it is subsidized by hubby’s past employer. Roughly at about another $600 a month. The longer he worked for them the higher percent of coverage he got.
In the Canada and Australia health plans the part you are not paying for up front in costs is funded by higher taxes paid, so those are added costs you are actually paying. Although Canada is supposed to be cheaper health coverage per person costs, but they have longer wait times, less benefits etc because of it.
The link I posted is for total per-capita costs, nothing to do with how they are being paid. In other words, the $10348 for the US includes the insurance, copays etc, and the $4708 for Australia includes our higher taxes.
FWIW, the Medicare Levy that pays for our health care is 2% of taxable income. A significant proportion of Australians also have some level of private health insurance which for an individual varies between $15-35 per week, with the more expensive end including things like orthodontic treatment and assisted fertility treatment. For higher income earners (over AU$90k per annum) who don’t have private health insurance, an additional medicare levy of up to 1.5% applies. ALL of these costs are included in the total system costs above.
That makes more sense. I didn’t look at the link. Because you posted syringes are free and test strips are $10 etc, I knew other parts of the cost were coming from somewhere.
Yes, I had heard the US medical costs average was over $10,000 per person. Up from over $7,000 not that long ago. It’s escalating fast.
My actual yearly cost for the past year of healthcare has been around $1,100 USD.
If I had no insurance through work (which covers Fiasp and some other medications I’m on) and if I paid out-of-pocket for the full cost of Dexcom (not stretching supplies), my healthcare costs for the year might be $7,500 USD (about $5,000 of which would be Dexcom).
If I lost my job (and insurance) tomorrow and could not find another job for hte rest of my life, I’d have to give up Fiasp and a CGM. I’d continue to be able to use my pump, rapid-acting insulin, and test as many times per day as I needed to. I’d continue to see my doctors and get blood work and could go to the hospital if I needed to. Some of my medications, such as the blood pressure medication I’m on, would need to be changed because it’s only covered by my insurance. But if there was some reason (such as side effects) that this particular medication was the only one that worked, my doctor could apply to have it covered by the government under special authorization. Since I would be someone with low income, I would likely not be paying taxes, but my out-of-pocket healthcare costs would be close to $0.
The health social safety net that catches someone in Canada who loses their job impresses me. Your system overall costs less, covers everyone and eliminates the desperation that some of us feel here.
Yet, some here still cling to the idea that we have the “best healthcare system in the world.” How many diabetics in Canada ration their insulin?
By the way, when I moved to a new city, I had to wait six months to see an endocrinologist.
This amount covers premiums for Medicare Part B, Medicare supplement and my prescription coverage. It covers my out of pocket costs for annual deductibles, copays and uncovered medical expenses like dental work, naturopaths, nutritional supplements and glasses. I consider as fair game any health expense allowed on the US Schedule A tax form including transportation costs to/from medical providers.
As someone who has been actively searching for a new job in the US for the past five months and is finally having to settle on a temp-to-hire position with no benefits so that I can save up enough money to move somewhere with better job prospects and hopefully not continue to spend more on health insurance than I do on rent (which is saying a lot because I live in downtown San Francisco) - I wholeheartedly agree! Hoping this diagnosis doesn’t end up financially crippling me for life like it has done to so many others. Stack on my $30,000 in student loan debt (from an “affordable” state school), and staggeringly low wages due to entering the job force in 2009 and I’m screwed unless something changes in this country soon. Tough to believe that my parents had a house and two kids at this age!
Yes and no. The system is great if you are in hospital or a doctor’s office, or somewhere a doctor has sent you, such as a blood lab or MRI clinic. Anything done or dispensed there (with some exceptions) will be paid for by your provincial government. Outside of that, though, you’re on your own. Private insurance, or being on a provincial public plan, is a necessity for some.
Without private insurance, for 35 years my medical costs were all out of pocket – prescriptions (easily $800 a month), pumps and pump supplies, CGM. Now that I have private insurance, and now that my province covers pumps and most of the cost of supplies, I often wonder how I managed to pay those bills. A study published last year found that almost a million Canadians cut back on food, heat or other healthcare expenses because of drug costs. So, not everything is covered for everyone, and costs for individuals can be a burden.
I don’t think you’ll get an all-encompassing answer to this question based on the personal experiences we’re sharing. Whether one system or the other is better for a given person is highly dependent on their health care needs vs. the plans available in the two countries. For an all-encompassing answer I think the link @Dylan_Sutton cited is excellent. It’s pretty clear that health care costs in the US are higher than Canada at the macro level.
To throw my personal situation into the mix, I’ve spent US$5400 so far this year, excluding premiums (I’m on my wife’s policy). That includes $1500 deductible for our high-deductible PPO plus co-pays with the 80/20 plan. Out of pocket costs for a seizure med I get from Canada that’s not of our plan’s formulary is also in this total. We’re I to pay for the seizure med out of pocket in the US, my cost would run about $35K/year. I couldn’t afford it. Clearly in my circumstances, Canada is a best for me.
Edit - should of mentioned I had a hospital stay last month including ambulance service and time in the ER. I haven’t received the bill. I’m sure it will be a pretty penny.
I lived half of my 68 years in Norway and the other half in Canada, by all accounts two of the best countries in the world to live in.
Norway like Canada (and other European countries) has universal health care. The main difference I noticed when I moved here to Canada was that I no longer had to pay $20 every time I went to a doctor, something Norwegians justify as a way to discourage hypochondriacs from overloading the health care system.
In general Norway has a cradle to grave social system unlike Canada which is somewhere between the US and Europe. Since I never worked for a company that had a pension plan for its employees I’m on basic Old Age Security which is $1200 a month. The same goes for my wife, an artist who also never had a pension plan. And I get $1200 a month from Norway for the years I worked there. Because of that we are considered low income and receive about $700 a month in guaranteed income assistance (GIS). In addition we pay nothing for our medical insurance (MSP) and medications and get $1000 in dental care every second year and two pairs of glasses every third year, and my wife was just given a $4,200 set of hearing aids she needed. To top it off, for $45 a year we get to buy a buspass that allows for unlimited travel by regional and municipal bus companies throughout the whole province.
What that amounts to is that I am glad I live in Canada and not the USA.
I agree with @beacher. I’m in BC, which has one of the better provinces in terms of diabetes coverage. But until the past year or so, pumps were not covered for people over 25 years old. There are definitely gaps.
@beacher, I am surprised to hear you say you paid for things like test strips out-of-pocket or with insurance coverage. Does Ontario not cover the basics like insulin and test strips?
Here in BC test strips are limited to 500 a year for non-insulin dependant diabetics and I believe the number is 2000 a year for people who need to inject insulin.
It’s 3,000/year for insulin users. However, if you need more, your doctor can write a letter requesting coverage for more. I’ve never heard of the government saying no to this request.
Hrmm, you aren’t looking to be a character witness for an immigrant visa, are you?
Yeah, my experience living in Europe and in the U.S. is that, from a healthcare and financial perspective, I was (and would be) far better off in Europe (or Canada). I’m sure it’s different for wealthy people who have to take into consideration progressive taxation schemes in most European countries. Realistically, I will never be in that class of wealth where it would benefit me to live in the U.S. with lower capital gains and income taxes. And, to be honest, I am philosophically committed to progressive taxation and comprehensive social safety nets, so I like to think I’d choose to live in a “more expensive” country even if I did have enough wealth to benefit from a low-tax, low-social country like the U.S.
Its public plan does, yes. For many years I wasn’t on it, and even when I was, I rarely reached my quarterly deductible, so insulin and tests strips (and everything else) were still mostly out-of-pocket.
