Can Americans without health insurance get all of the care they need in Canada?

“‘There’s a Perception That Canada Is Being Invaded’: Justin Trudeau’s government has started rejecting more refugee claims from migrants who cross the U.S.-Canada border on foot.” (Atlantic)

Canada has built a reputation for warmly embracing Syrians. But most of the newcomers are from elsewhere. At first, it was mostly Haitians in the U.S. who made the journey. Some said they were spooked by Trump’s anti-immigrant rhetoric and worried about losing the temporary residence status they’d been given in the U.S. following the 2010 earthquake in their native country. In recent months, Nigerians have become the most frequent border crossers. Many get visitor visas to come to the U.S., then take a bus or taxi to upstate New York, where they walk north into Quebec—straight into the arms of Canadian border guards waiting to arrest them.

The migrants are typically detained for a few hours and then bussed to an emergency shelter in Montreal, where they stay and work on their asylum applications. While they wait for their cases to be adjudicated, they can access healthcare and send their children to public school for free, just like any Canadian.

Could this be the solution to our country’s healthcare funding issues? Americans who need an expensive procedure walk across the border, ask for asylum, and then get admitted to a hospital in Montreal.

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21 thoughts on “Can Americans without health insurance get all of the care they need in Canada?

  1. I’m Canadian, and *I* can’t even get all of the care I need in Canada. Waiting times for non-emergency procedures are abysmal. Family doctors are rationed, and are in short supply in major centers. My wife blew out the meniscus in her knee last fall, and the we were scheduled for an MRI in March 2018, six months later. Insanity. We drove across the border to Buffalo and paid $400 for one. Surgery was indicated, but no specialist was able to give us a definitive date: “Get in line” is the answer. We chose to drive to the Cleveland Clinic, about five hours away from our home in Hamilton, Ontario, and had the surgery done on our schedule. Fantastic service, and the price was fair.

    There is so much propaganda about the Canadian health care system, but it’s incapable of keeping up with demand… and will only become worse. My smug left-leaning friends claim Canada is superior to the US because of universal health care. My response is that access to a waiting list is not access to health care.

  2. America spends something like twice as much per capita as Canada. In value for money terms, the Canadian system is much more efficient.

    Also, regarding the original question, it clearly wouldn’t work well for most of the population. People would have to pull their kids out of school, quit their jobs and so forth. Then the would have trouble paying the mortgage.

  3. RN friend in UK working at hospital near Gatwick a decade ago complained about endless stream of folks from Middle East with somewhat urgent health issues who had flown in to take advantage of NHS

  4. @John has no one yet sued the Canadian government for malpractice due to death or complication resulting from the long wait? Or is Canada has shortage of lawyers?

  5. Vince: Though its certainly true that the Canadian system is more effecient in money-value terms, that is not where the argument stops. Would adding more money fix all of the cited problems with Canada’s health system? Only way to tell is to try. Healthcare isn’t one thing, it’s thousands of different services. In each of those services there are trade offs between quality, cost and access/quantity. I’m not saying the American system is better, but I am saying there is no magic solution.

    Phil: I live in Buffalo, so I have some experience with this. It’s enough of a pain to get healthcare in Canada when you legitimately need it, i.e. you’re at a cottage in Ontario and break your ankle.

  6. > America spends something like twice as much per capita as Canada. In value for money terms, the Canadian system is much more efficient.

    Rationing *anything* (with sufficient enforcement) is always more efficient per unit resource. It’s practically the definition of the word: you’re limit the ability of individuals at the high end of consumption to spend the resource less effectively than if it were given to the individuals at the low end. It works because everyone generally goes after the low-hanging fruit first, so everyone gets antibiotics and heart pills but no one gets treated for joint pain.

    What this means is that Canada’s dollar-effectiveness is automatic and *not* solid evidence of a very well-run system. It might be, but this statistic isn’t sufficient.

  7. Totally agree. Same scenario in Great Britain with NHS. Wealthier UK citizens, faced with long waits for procedures and consults, pay the private physicians on Harley St and elsewhere. But their fees are moderate compared to full US rates (based on Medivac from Egypt for American personnel — State Dept funded London rather than US if it were a minor medical condition). Fees in continental Europe are also a fraction of US.

  8. John Bennett. I am sorry you have had such a bad experience with our Canadian medicare system However, my OHIP (Ontario Hospital Insurance Plan) ones have been the polar opposite of yours:
    Severe shoulder girdle tendon and cartilage damage with detached biceps tendon, etc, etc – wait for orthopedic surgeon appt 3 weeks, ensuing MRI: 2 weeks; follow up consultation w/ortho 2 weeks (second opinion @ David Braley Sport Medicine and Rehabilitation Centre at McMaster University – next day and surgery booked four weeks out from my requesting it. In fact it is 2 weeks today.

    My experience with my prostate (BPH) surgery (TURP prostate resection) late 2015 was pretty much the same. I have nothing but praise – my GP ALWAYS sees my wife and/or I the same day, without exception. I don’t know where you could get better health care.

  9. John: A friend in Toronto had a serious problem with his shoulder, requiring surgery, and he chose to pay retail at the Mayo Clinic in Minnesota rather than wait. So I’m familiar with this. But consider Americans who are “vulnerable” and, due to the cruel policies of the Trump Administration, lack health iinsurance or savings (not to be confused with the tens of millions of Americans who lacked health insurance and savings under the generous and caring policies of the Obama Administration). I think it would be kind of awesome to see them asking for asylum in Canada and receiving health care while their claims were evaluated!

  10. As someone who can “see Canada from my house” (when I watch youtube), I researched heading up there to partake of their glorious socialized health care when I had a major health woe. The standard treatment in Canada for this health woe turned out to be “cheap opiates”. I stayed in America and got a better, more effective treatment, and it cost me $100, which was reimbursed by my insurer, so I guess it was technically free for me.

    When I run into Canadians visiting our fine nation to shop, they are healthy ones who love physical exercise and being outdoors all day and they also love their health care system, but they have no direct experience with trying to use it. They are sure it is probably great if they ever needed to use it though. For some reason, similarly healthy Americans feel identically about our health care system.

  11. The Practical Conservative: read my response above. I’m here, I’ve experienced it firsthand many times. Further, I have never heard of anybody here losing his or her home (f.e.) to pay for a medical procedure

  12. z:

    Rationing *anything* (with sufficient enforcement) is always more efficient per unit resource. It’s practically the definition of the word: you’re limit the ability of individuals at the high end of consumption to spend the resource less effectively than if it were given to the individuals at the low end. It works because everyone generally goes after the low-hanging fruit first, so everyone gets antibiotics and heart pills but no one gets treated for joint pain.

    I don’t that that makes sense. In any case, rationing (i.e. providing less care) is not the reason that every other developed country spends much, much less on health care. The reason is America pays much more for every unit of care – more per pill, more per operation, more per MRI. This was well documented a few years ago in the NYT: https://www.nytimes.com/interactive/2014/health/paying-till-it-hurts.html

    There’s also research that shows that America derives no benefit from all of the extra spending.
    https://www.ncbi.nlm.nih.gov/pmc/articles/PMC1483879/

    Of course, pharma companies, insurance agencies and so forth, are quite happy for Americans to hear about “rationing” and anecdotes about Canadians crossing the border for various things. As Noam Chomsky says, “… US society is, to an unusual extent, business-run, with a highly class-conscious business community dedicated to ‘the everlasting battle for the minds of men.'”

  13. Not clear why Noam Chomsky is cited as an authority on US business when he spent his whole life in an academic institution teaching an obscure liberal arts subject and in his spare time to supporting non-market regimes in places like Cambodia, Cuba, Venezuela and so on

  14. Vince: Obviously the U.S. system is crazy expensive and wasteful. That’s why I suggested that the uninsured apply for asylum with our friendly/welcoming neighbors to the north!

    Jack: MIT has accumulated $15 billion in after-tax profit (“the endowment”) so I think that gives senior faculty some authority on the subject of business!

  15. z, the rationing used in Canada or Europe is based on ‘queueing’, not active planned rationing. That means that if you are time poor (because you have a job that is demanding, or other reason), you will go and seek medical care only when you have no alternative (personal experience, plus the experience of basically any other working person around me), which basically means you self ration your own healthcare. Waiting times are the real problem, even when care is potentially good. Waiting times are cause by overdemand, which is partly due to some people taking a lot of resources, and partly for poorly managed supply (in some cases the resources are there but the logistics are so poorly managed that they are very underused).

    As an European taxpayer I would obviously like to see competent people managing the logistics *properly* to make sure that what is available is used to capacity (if I were to need a CT scan I’d rather have it tomorrow at 3am than in 6 months at a more convenient 3pm) — this is something people do not seem to be able to grasp. I would also like to see an active and planned rationing, so that each person gets only X amount of free stuff every given year. After that care stays free if it is judged as a medical need by the physician, whereas someone going for a full body scan every month because they are time rich and hypochondriac would have to cough up money and/or face longer waiting times.

  16. Americans shouldn’t plan on being welcome up here in the future, after the way Trump has imposed tariffs.

  17. Gordon: This is all the more reason why Americans need asylum. They are being oppressed by the tariff policies of President/Dictator Trump and thus being forced to pay more for steel and aluminum.

    Fazal: From a U.S. point of view, it is NOT cheaper to fly to India and pay with a credit card than it is to walk across the border and let the Canadian taxpayer fund the treatment!

  18. Federico: Your description of queuing agrees perfectly with my scenario above. Instead of the controlling authority limiting per-person consumption they limit supply to a region and allow the queuing mechanism to prevent all the supply from “selling out” to a few fast-moving high-consumers. This is still rationing.

  19. gotbikes, I wasn’t talking about Canadians in Canada, as they were in America to go shopping.

    Americans pay more because more people in America have jobs in healthcare. LPNs and MAs don’t work for free, nor should they. Neither do billing specialists and administrative coordinators, although the question of whether those kinds of non-patient-facing jobs are so essential is an open one. There’s also a ton of healthcare money spent on advertising/marketing healthcare to people and corporations.

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