January 19, 2009

We're medicare(d) for

We’re officially part of the socialized medical system as of January 1. It took a couple of months to process the paperwork, like everything in Quebec. With all the talk about a need of a socialized medical system in the U.S., we figure we’ll be living it for the next few years and will be able to report on what works and what doesn’t from our perspective.

What we know up until now is that it is okay. That said, fortunately we have not had to use it for anything big -- just a trip to the medical clinic and a couple of prescriptions. It
seems much like the Medicare* system in the US. If people can afford it, they have supplemental insurance like what Paul’s company supplies (and deducts from his paycheck) for us. As with Medicare in the U.S., there are things covered and things not covered. For example, there is a medicine for Louis not covered and we have to contact the doctor and have them write a letter about why the medicine is necessary. The “book” of covered medicines is updated three times a year. Since the government system won't pay, we simply submit the receipt to the private insurance and get reimbursed for it. Like in the U.S., unfortunately, we do have some insurance paperwork.  So far though, not as much. There's no keeping track of deductables, co-pays, etc.

It’s still a two-tiered system in Canada, despite what is often portrayed. Each province has different components to its system. In Quebec, they don’t want to be known as having a two-tiered system (Quebec tends to be much more liberal than the rest of Canada on many, many issues). If someone plans on only using medicare, they have to find a doctor to take them on as a patient or go to a free clinic. Doctors can only accept a certain number of medicare patients at a time. If you have to go to the clinic, yes you may wait four hours or more to see a doctor. However, EVERYONE in Quebec is required to have a medicare card and therefore everyone has coverage. Our neighbor showed me a receipt for medicine for her father that would cost over $1,200 and they had to pay $8. Danielle can get the Gardasil vaccine at school for free, when it in the US it would cost us $200. Keep in mind, while people say the system in Canada is “free” – it really is not. Taxes are very high here. Over 70% of the medical expenditures come from public sources – the rest is private and out of pocket, including elective procedures like cosmetic surgery. But, every person is covered; no one is turned away at a clinic or emergency room. Kish sat next to a doctor on a flight to Montreal who told her that in Canada if someone is really sick, say with cancer, the last thing the patient needs to worry about his how to pay for it. It would be interesting to see if there are studies on how the financial stress of an illness affects the healing process.

What has become common here is a “membership” to a private clinic or doctor. There’s a fee and once you join, it works much like a private doctor in the U.S. Unfortunately, Canada has a shortage of doctors because many do not make money here and are opting to go to the states. However, it’s important to note that doctors can be educated in Canada for about $3,000 a year – so they are not incurring the debt that US doctors often do. But many doctors here are turning to private clinics because they don't want to deal with the government.

Here's a bit of trivia -- did you know that the "Father" of the public health system in Canada, Tommy Douglas, is Kiefer Sutherland's grandfather? Douglas is his mom's father.

We’re finding that the medicare card is as important as a passport these days. Below is a link to an interesting article about some of the differences between the US and Canada. It’s from 2006 so it is likely dated by now. In general, most people we have spoken to are fine with the system. As with everything, there are critics. The Pisani’s aren’t very bashful about expressing opinions – so we’ll keep you posted.


*in checking with writing style...they refer to medicare in Canada with a lower-case "m" as opposed to the US where it's Medicare.

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