# Moved to US, but I was better off in Canada



## james4beach

I accepted a new job in the U.S. (west coast) and moved there. The gross income was much higher than what I could find in Ontario, but as more details emerge I actually think I was better off in Canada, financially.

For one, I'm going to miss paying Ontario taxes. *My taxes were lower in Ontario than they are here in the U.S.*, though this is somewhat balanced by less sales tax in the U.S.

My gross income increased $13,000 by going to the U.S. But the net income on my paycheque is identical to what I paid in Ontario! It's a bit disappointing to see my paycheque stay the same, after what I thought was a 13k raise. I'm in one of the highest tax states (CA, OR). This comparison is done with no RRSP/401k enrollment.

Here's a neat graph from a nytimes article. Notice how median incomes in Canada have totally caught up to U.S. incomes. Look how the gap has closed since 1980 !









But it's the health care on top of that which really tips the scales towards Canada. My employer does offer a health plan that's considered quite good, but of course it doesn't cover everything. And it's extremely complex to unwind the details of it (this is a big thing I learned in the US... health coverages are convoluted, tricky, extremely difficult to figure out). Talking to other employees, it turns out that under normal situations I don't pay anything for my health coverage. Regular doctor visits, minor emergencies would all be fully covered. But there are certain complications and serious procedures where I may pay out of pocket. One of the ladies in the office had a pregnancy complication and paid around $10,000 of her own money.

So that's what you get in the U.S.A. Even if you have a good health plan, you could still pay _thousands_ of your own money for some situations.

These comparisons are done by treating 1 CAD == 1 USD. Currently I'm better off in the U.S. due to the weak Canadian dollar, but I try not to count on forex.

Let me tell you this though. If I go back to running my own business, the first thing I'm doing is leaving the U.S.A. Just about any province in Canada would be a superior place to operate my small business from, especially with healthcare in the mix. On top of that health care would be less stressful (even if you buy supplementary coverage, it's better in Canada).


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## james4beach

Also I don't want to lose this point, which is huge. The Canadian middle class may now be the best off in the whole world.

From NYT article: *"After-tax middle-class incomes in Canada — substantially behind in 2000 — now appear to be higher than in the United States."*

And if you look at the ranking, we're basically at the top of the world. I'm seeing it first hand myself. I was "richer" in Ontario, even though I've now moved to a high salary job in a wealthy American city.


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## andrewf

Thanks for sharing, james. Interesting that so many people are adamant that taxes are far higher in Canada than elsewhere. I personally think that taxes are pretty reasonable, given the level of services we receive. Not to say there isn't waste and things I would rather see money spent on.


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## AltaRed

The proper comparison would be 'purchasing power' where living costs (other than health care) are considerably less in much of the USA.... from food to consumer goods and services .


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## Eclectic12

This is where based on articles I've read, I cautioned my relative who was a VP for a Canadian company which was bought out by an American one and being moved to Chicago to make sure he took all of the numbers/needs into account.

Despite his insistence that there was no extras to worry about, the end result was that he came back to Canada about 13 months later.


The part I found interesting was that over and above the money discrepancy (i.e. looks like there will be more cash and after all the additional stuff is added, it is relatively similar) - he said the thing that drove him nuts was that he had to interview twice as many people to get down to a "so-so" hire compared to how simple it was to end up with a good to great candidate in Canada.


Cheers


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## Edgar

AltaRed said:


> The proper comparison would be 'purchasing power' where living costs (other than health care) are considerably less in much of the USA.... from food to consumer goods and services .


This is spot on. The price we pay for cable, to cell-phone contracts, to even Mars bars are drastically higher than in the States. I dont know how long youve been there j4b, but Im sure you will see the benefits from their consumer-based lifestyle shortly


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## james4beach

Agree that one has to look at purchasing power, cost of living, etc.

I haven't lived in this U.S. city long enough to get a good grasp on my cost of living. Groceries are more expensive than in Canada, sometimes dramatically more expensive especially for fruits & vegetables. This is counterintuitive and people don't believe me when I say that groceries were a lot cheaper in Canada.

Yes I agree some things are cheaper in the US. Candy is way, way cheaper. You can walk into a drug store and there are bins of candy bars for $1, stuff like that ... I have no interest and it does not enter my cost-of-living equation.

There are many consumer goods on Amazon that are a lot cheaper than what you can find in Canada. I don't buy many consumer goods, I won't be purchasing cable, so this doesn't really benefit me.


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## HaroldCrump

james4beach, if the health plan you have from your employer is a PPO plan, then that is a huge benefit.
You say it is a good plan and you often have zero co-pay in most cases, so sounds like a PPO plan.
A good PPO plan, such as with Blue Cross Blue Shield, is worth its weight in gold.

You could, in fact, compare it to having a govt. gold-plated defined benefit pension plan here in Canada.
Older folks in the US often choose jobs based purely on the presence/absence of a PPO health plan - just like here in Canada, the presence/absence of pensions is a big driving factor.

You, incidentally, ended up in one of the highest tax jurisdictions in the US.
California is not representative of the entre US, esp. the heartland.
California is very similar to Ontario, in fact.
It is plagued by very similar chronic problems as Ontario, including terrible state of public finances, expensive housing, strong presence of entitled unions, bankrupt municipalities and counties, a carbon tax, etc.

I can assure you this is not the case in many other parts of the US.
You may find that the heartland, often derogatorily called the _flyover states_, have very low cost of living, low state and municipal taxes, cheaper housing, and friendly, small-town dispositions.

And yes, I do know what I am talking about...I have worked in the United States for many years (although not in the state of California).


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## heyjude

I've lived in both countries and I can attest to the fact that the grass, while it may appear greener on the other side, is not always so on closer inspection.


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## Eclectic12

james4beach said:


> I haven't lived in this U.S. city long enough to get a good grasp on my cost of living. Groceries are more expensive than in Canada, sometimes dramatically more expensive especially for fruits & vegetables. This is counterintuitive and people don't believe me when I say that groceries were a lot cheaper in Canada.


Don't feel bad ... I've seen the same thing in places like Niagara Falls NY, San Francisco CA, Los Angeles CA, Syracuse NY, Tampa Bay FA & Rockville MD to name a few. 

Not many Canadians believe me either ... something about being dazzled by the items that are cheaper, I think ... :rolleyes2:

Gas is cheaper, sometime cheese, usually milk, spark plugs and tires.
For the first time in thirty years, I managed to find a laptop that was $200 cheaper but it was a clearout item for a store that was closing.


And assuming there is a public transportation system - that can be cheaper as well. For the week I was in LA to take a course in Irvine CA, I paid something like $3 a day to ride all Metro lines and buses for 24 hours. Since everyone sees public transportation as being for the poor, the busiest was getting on at 1am at Universal Studios in Culver City where the Metro car was 3/4 full.

Mentioning in bars that I was riding the Metro was hilarious as the responses would go:

"LA has a Metro? .... oh yah, it celebrated it's anniversary five or six years ago ... How is the Metro? I've never ridden it."


Cheers

*PS*

How could I forget booze?
That is definitely cheaper.


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## james4beach

I agree that some US states would offer an enormous tax savings vs working anywhere in Canada

My company has an "HSA" health plan, it's a Blue Cross HSA. There's a high deductible ($3500) but my company pays me $3500 which goes into an HSA bank account. I don't understand all the ins and outs of it.

Yes booze is much cheaper.


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## Eclectic12

HaroldCrump said:


> ... I can assure you this is not the case in many other parts of the US.
> You may find that the heartland, often derogatorily called the _flyover states_, have very low cost of living, low state and municipal taxes, cheaper housing, and friendly, small-town dispositions.


Agreed ... but then the question becomes how many suitable jobs are available in the heartland.

I don't know if it's bias by the media but I can't recall many being interviewed who had moved to the heartland (is Texas considered heartland?).


I know the Egyptian born programmer, lured to Florida was making peanuts for his work compared to just about anywhere else. His costs however, were much better (ex. no individual income tax, lots of local things being paid for by tourist taxes).


As always, it's best to compare to what you are likely to need. My parents were shocked when they went to the Florida library that matched their mailing address, were asked the lot number and told "your lot is the other side of the creek which is Dunedin ... to get a library card from Clearwater, you will have to pay $60. We recommend you go to the Dunedin Library as it will be free."


Cheers


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## HaroldCrump

Eclectic12 said:


> Agreed ... but then the question becomes how many suitable jobs are available in the heartland.
> I don't know if it's bias by the media but I can't recall many being interviewed who had moved to the heartland (is Texas considered heartland?).


There are lots of jobs in Texas.
Some may not _want _those jobs, but that's a different matter.
I personally know of several folks from Alberta (engineers, oil field specialists, etc.) that got very high paying jobs in Texas and moved from Edmonton, Fort Mac, Grand Prairie, to Texas, Oklahoma, etc.

James4Beach's question is about relative taxes, right? Not nominal salaries and tax amounts.
Therefore, relatively speaking, the heartland states have a lower after-tax disposable income than California or the east coasts hubs of Boston , NY/NJ & DC/MD.

If tax and disposable income were the only criteria, I'd say California is one of the worst places to be in.


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## MoneyGal

Eclectic12 said:


> The part I found interesting was that over and above the money discrepancy (i.e. looks like there will be more cash and after all the additional stuff is added, it is relatively similar) - he said the thing that drove him nuts was that he had to interview twice as many people to get down to a "so-so" hire compared to how simple it was to end up with a good to great candidate in Canada.


I have heard this over and over from U.S. companies associated with Canadian companies who are able to hire from Canada to meet needs.


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## Eclectic12

HaroldCrump said:


> There are lots of jobs in Texas.
> Some may not _want _those jobs, but that's a different matter.


Interesting ... 




HaroldCrump said:


> James4Beach's question is about relative taxes, right?


As I read it ... he was indicating that *after moving* the much higher gross salary that looked like it would be a better situation is translating to a similar or more expensive situation than Ontario.

I didn't see any question in the OP ... just statements.




HaroldCrump said:


> ... Therefore, relatively speaking, the heartland states have a lower after-tax disposable income than California or the east coasts hubs of Boston , NY/NJ & DC/MD.
> 
> If tax and disposable income were the only criteria, I'd say California is one of the worst places to be in.


Has Texas changed their tax rates?

One of the articles during the "does or doesn't Canada have a brain drain issue" time frame was a doctor's assistant who moved with her doctor husband to Texas. Her final analysis was that it was similar to what they'd left in Ontario. The swing factor for her was that lots of family was close in Texas and he had almost no one in Canada. Her message was do your homework and make sure all the extras were factored in.

This is a while ago though.


Cheers


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## Eclectic12

MoneyGal said:


> I have heard this over and over from U.S. companies associated with Canadian companies who are able to hire from Canada to meet needs.


It was the same when I was loaned out from the Toronto firm to the US firm to work in Rockville, Maryland.

Canada's group was so small that in seven years, we'd hired two students ... everyone else came from industry and had done two or three aspects of the software. The technical team lead introduced the three US guys to the three Canadians with "I know we have a strong team. I've worked with your three before so I know you've done the work instead of power points for the project management office. You three Canadians handled my toughest technical questions with ease."

Later on in the project when I asked him about it, he indicated most of the US firm resumes were outright lies or exaggeration.

I assumed this was specific to that firm instead of in general.


I mention the hiring students as most of my classmates on a training course were straight out of US university and complaining "I've had six months of training - how do I get on a project and do work?". 


Cheers


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## MoneyGal

I spent a signficant fraction of the last five years working in the U.S. The concern is not company-specific...The typical rationale I heard from U.S. counterparts is that the Canadian public education system is stronger. I don't know whether this is true or not, but I heard that "Canadians [as a group] are better-educated and easier to work with."


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## andrewf

Canadians do have a higher rate of tertiary education, depending on how it is measured. Canadians are lacking in management expertise. The US has proportionately significantly more MBAs/trained managers. It's one area that Roger Martin has suggested is holding back Ontario economically. Of course, he is a former head of a biz skool, so maybe he is just talking his book.


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## HaroldCrump

MoneyGal said:


> The typical rationale I heard from U.S. counterparts is that the Canadian public education system is stronger.
> I don't know whether this is true or not


It is most certainly the case, IMO.
As it stands now, the Canadian public school system is very superior to the US.
Esp. since the 2008 recession, the condition of the US public schools are very bad.
Some states are worse than others (Mississippi, West Virginia, Nevada, etc.), but overall, it is inferior to the Canadian situation by a wide margin.

In fact, the US public education system is closer to third-world levels at this point.
Many middle class parents are choosing to home school.


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## Eclectic12

Part of it (at least from the software project perspective) was also that the entire Canadian group was just under ninety people. For the US firm, this would be about a small satellite office.

So when on projects, we had to cover more areas than our US counterparts were asked to cover. 

For example, one of the bigger projects was for the Ontario provincial gov't where the PMO office was a client PMO, our PMO and one assistant who had to handle *everything*. From what our US counterparts said, it wasn't unusual to have five or six people as assistants in their PMO, where one assistant might be responsible for the power points relating to the financial software and that's pretty much it, despite the project covering HRM, CRM and Financials.

So they'd be amazed when an non-DBA would be able go beyond "it's a database error code, let's get a DBA" when reading the error logs. The idea that a non-DBA could diagnose a lot of common database error codes was foreign to them.


Cheers


*PS*

One of the senior Canadians caught on quickly that though it was an upgrade, few of the Americans had any experience or idea of what was involved. So she ran a quick tutorial for the Americans and some of the Canadians so that everyone would understand the tasks and be able to function more effectively. As I recall, she said she'd had to do this on Canadian projects for one or maybe two people, never on such a broad scale.


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## Eclectic12

james4beach said:


> ... I was "richer" in Ontario, even though I've now moved to a high salary job in a wealthy American city.


I can recall at least ten or twelve articles talking to Canadians who moved down the US, particularly when there was a concern about a "brain drain" to the US. The common theme was that it wasn't good enough to compare tax rates.

I seem to recall about sixty percent staying in the US for various reasons. Some of the reasons to stay were that there more family than in Canada, more profits were kept as a business person and thousands more job opportunities were available if they wished to shift companies.

Some of the reasons for returning to Canada were not wanting to raise children in this environment, the company stock/options had granted a nice nest egg so they wanted return to a slower paced work environment and my relative who hated having to spend so much time on the hiring process to consistently end up with lower quality staff.


Cheers


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## steve41

You forgot..... you can get a 'carry permit' in the USA. Not so for Canada.:encouragement:


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## Eclectic12

If that's the priority, why wouldn't I choose a state that allows carrying without a permit? :biggrin:

(Or with needing any sort of permit or license or registration for that matter .... ) 


Cheers


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## kcowan

AltaRed said:


> The proper comparison would be 'purchasing power' where living costs (other than health care) are considerably less in much of the USA.... from food to consumer goods and services .


There are sites that help prepare you.

Here is one that gives some guidance:
COL Comparison LA/Toronto
It isn't perfect but when you dig into the categories, you get some good guidance. Just enter the two cities.


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## HaroldCrump

Eclectic12 said:


> I didn't see any question in the OP ... just statements.


Fine, not a question per se, but his statement or matter at hand.



> Has Texas changed their tax rates?


I don't know what year to compare against.
Texas doesn't have state income taxes.
Many California cities has some of the highest local/municipal tax rates in the country, such as Los Angeles, San Francisco, Fremont, Long Beach, etc. (over 9% each, I believe).

Texas does have high property taxes, but that doesn't affect our OP (at least not yet). 

All I am saying is that there are wide variations in taxation (of various types) from state to state in the US, and from province to province in Canada (such as between Alberta on one extreme, and Quebec on the other).
What James4Beach is saying would essentially be the same as an American moving from South Carolina or Texas to Quebec and saying his tax rates went up.
Well, of course it did !


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## Eclectic12

HaroldCrump said:


> Fine, not a question per se, but his statement or matter at hand.


It is location specific and there is lots of variation ... which doesn't change that it is his situation in a west coast (I presume California but don't remember) to Ontario comparison. 




HaroldCrump said:


> I don't know what year to compare against.
> Texas doesn't have state income taxes.


This is pre-"everything online" days so I can only use my suspect memory to come close. :biggrin:
That said, I'd guess 1997 or 1998.


As for no state income taxes in Texas ... that makes it all the more fascinating that the she was saying that when it all was factored it, the Ontario situation was pretty much was the Texas situation was.




HaroldCrump said:


> Many California cities has some of the highest local/municipal tax rates in the country, such as Los Angeles, San Francisco, Fremont, Long Beach, etc. (over 9% each, I believe).


Be that as it may ... it does get murky.

My relative in LA was commenting that part of the reason for the financial troubles was the silly property tax rules.
If you buy a small first house and do not have a period without owning a house (i.e. sell the smaller old house on the same day as buying the bigger new one), your property taxes don't go up.

So newcomers that never up size their house are the ones that are paying closer to what the services they are consuming cost.




HaroldCrump said:


> Texas does have high property taxes, but that doesn't affect our OP (at least not yet).


True ... though it doesn't sound like he had a competing offer from a Texas company (and I'm not sure I'd want that climate for my full time residence/job) but YMMV.




HaroldCrump said:


> All I am saying is that there are wide variations in taxation (of various types) from state to state in the US, and from province to province in Canada (such as between Alberta on one extreme, and Quebec on the other).
> 
> What James4Beach is saying would essentially be the same as an American moving from South Carolina or Texas to Quebec and saying his tax rates went up ...


Agreed ... though with the number of article from former Canadians indicating they were surprised, I have a sneaking suspicion that the costs are far clearer or easier to research when moving to Canada.


*Sidenote;*
The American working with me in Rockville, Maryland was shocked at the income taxes us Canadians were paying. 
Then when he heard about the maternity leave (which he was privately saving for so that his wife could stay home a while), he had something new to be shocked about that knocked the income tax off his radar.


Cheers


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## HaroldCrump

Eclectic12 said:


> It is location specific and there is lots of variation ... which doesn't change that it is his situation in a west coast (I presume California but don't remember) to Ontario comparison.


Yes, James4B is talking about California.



> This is pre-"everything online" days so I can only use my suspect memory to come close. :biggrin:
> That said, I'd guess 1997 or 1998.


I don't know if Texas or California taxes have changed since then, a Google search will probably bring it up.
Anyhow, historical tax rates don't matter for the issue at hand.
J4B is speaking of present day.
Present day Ontario taxes (post HST) vis-à-vis present day California vis-à-vis present day heartland states like Texas, etc.



> As for no state income taxes in Texas ... that makes it all the more fascinating that the she was saying that when it all was factored it, the Ontario situation was pretty much was the Texas situation was.


James4B didn't compare against Texas.
He was comparing against California.
I brought up Texas as an example of the wide variations in taxations within the United States (various kinds of taxes).



> Then when he heard about the maternity leave (which he was privately saving for so that his wife could stay home a while), he had something new to be shocked about that knocked the income tax off his radar.


Yeah well, guess where the maternity leave comes from...someone's gotta pay for it.
Just like health care in the US.

Canadians balk at the health care costs in the US.
Well, it is no more outrageous than the social programs' and social health care costs in Canada, all of which are funded out of taxes.


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## andrewf

Actually, health care is more ridiculous in the US. They spend nearly twice as much in terms of share of GDP and get worse outcomes.


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## Brian Weatherdon CFP

Let's celebrate a bit of bias on this subject (being Canadians, I mean). 
And James I've thoroughly enjoyed your post -- thank you for sharing your experience and observations.

The point on healthcare is possibly worse than most realize or are willing to discuss. Put together the following points. 85% of health expenses occur in the last 5 (or so) years of our lives. In 2009 the IMF forecast that Health costs of Aging will hit developed countries with 10-times the force of the 2008 global financial meltdown. Some have estimated that the future costs of healthcare for baby boomers will range between $46Trillion and $92Trillion (though sorry I have no references for these #s) thus dwarfing all other govt administrations except military/security. So what gives? Health costs (and taxes) will rise in every aging country, and US ingenuity will certainly be put to the test! 

For me, I'm staying here in Canada, the true north, strong and free.


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## Causalien

As someone who've been both side, I can really relate to this feeling. What is amazing in USA is consumer related services. Amazing return policy that can be abused. Great Amazon itself is a plus for the whole country.

What I do not like is that there are certain pockets of population that needs to be avoided. Whereas canadians are more homogeneous in behavior, in usa, you never know if the next person you meet is going to be crazy. I think this is a result of the large rich/poor divide.

It comes down to USA being great for earning money, but for living, I prefer Canada. The bureaucracy and bullshit you have to go through for permanent resudency fidn't help their case either. So once You made enough, it is time to get out. Of course provided you haven't found a wife by then.

One thing I find interesting though is that people enjoys small talk a lot more in US. I get a lot more random chat with strangers on the street there.


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## capricorn

I moved to southern California around the same time as james4beach.

Prices for fruits and vegetables really has been a big shocker ( with me naively thinking how much grows in California and so prices should be low: it is like gas prices in Canada)

I have found the health care plan from my employer to be very good. Much better than I had in Ontario. Even though I have not had an occasion to use the health care yet, the ability to see medical specialists at your discretion seems very nice. I remember knowing people waiting for months in Ontario for their next appointment with a specialist. Vision plan is better than what was provided by the employer in Ontario (and it was not some small employer in Ontario. They had 15K+ employees last year).


Overall, I think the quality of life was much better in Eastern Ontario. But, having taken the plunge to move, I do plan to enjoy the sunshine till it is time to head back home.


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## HaroldCrump

andrewf said:


> Actually, health care is more ridiculous in the US. They spend nearly twice as much in terms of share of GDP and get worse outcomes.


Ergo, the higher is the value of the health plan being provided by the employer.

The health plan is part of total compensation.
That benefit cannot be ignored when calculating after-tax compensation.


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## Eclectic12

capricorn said:


> I moved to southern California around the same time as james4beach.
> 
> Prices for fruits and vegetables really has been a big shocker ( with me naively thinking how much grows in California and so prices should be low: it is like gas prices in Canada)


I noticed similar in Florida .... unless I was visiting outside the tourist season, then it was a bit better. I also found it weird as in Canada, if I bought at a roadside stand, the produce usually tastes far better. The strawberries from the road side stand in Florida were just as wood/tasteless as what was in the grocery store.

Now picking off the tree in the trailer park was totally different! :biggrin:




capricorn said:


> I have found the health care plan from my employer to be very good. Much better than I had in Ontario.


That's good news ... is it a HMO? Are there restrictions on the test the doctors can order? (just curious)


Cheers


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## Longwinston

Healthcare in the USA is not the answer, but neither is it in Canada. I have to wait 8 months to see a gastro specialist and over a month to have a CAT Scan. 

It's crazy. I think France and a couple of other countries have it right. 
Private and public compete against each other. Without competition you will not get good service. 

We are viewed as costs in Canada, not patients. 
It's terrible really. 

Worst thing about living in Canada in my opinion. For some strange reason a large proportion of the population is PROUD of this insane healthcare system.


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## Eder

I disagree , our health care in Canada is very good. My wife has had a few life threatening incidents over the years....in each case she swiftly saw specialists ranging from rheumatologist, dermatologist, oncologists, whatever was required.

The biggest problem in Canada is people that have very little wrong with them and demand service but are triaged and put on a waiting list so patients with real needs can be looked after. 

I know many of my friends constantly think something is wrong with them and tax our health care system with useless visits.


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## Ihatetaxes

Longwinston said:


> Worst thing about living in Canada in my opinion. For some strange reason a large proportion of the population is PROUD of this insane healthcare system.


Completely and wholeheartedly disagree with you. I have nothing but great things to say about our healthcare system and have a lot of examples including incredible care of one of my kids who had some serious health issues in the first weeks of life. One of very few things my tax dollars go towards that I don't ***** about (along with police and fire). I would guess 99% of the worlds population would give pretty much anything to have the care we do in Canada.

I love the US and spend a lot of time at our vacation home there but always look forward to getting back to Canada.


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## financialuproar

A little off topic, but I was in Las Vegas a couple of weeks ago, and decided to venture a few miles off The Strip and venture over to U.S. Walmart. Granted, this is just me observing one store in one place, but I didn't think prices were that good.

Junk food was really cheap, especially cookies, crackers, chips, etc. And as others have mentioned, booze is really cheap too. So was soda. But the staples were all pretty much the same as in Alberta. Even stuff like clothes and shoes were pretty much the same price as up here. 

Again, small sample size. But based on that, I'd say the cheaper food costs in the states is largely overstated.


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## Jon_Snow

And thus is the problem of American obesity at least partially explained.


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## fraser

Over the years I bought quite a few better quality suits and cotton dress shirts in the US. I found them to be a much better value.


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## Longwinston

Ihatetaxes said:


> Completely and wholeheartedly disagree with you. I have nothing but great things to say about our healthcare system and have a lot of examples including incredible care of one of my kids who had some serious health issues in the first weeks of life. One of very few things my tax dollars go towards that I don't ***** about (along with police and fire). I would guess 99% of the worlds population would give pretty much anything to have the care we do in Canada.
> 
> I love the US and spend a lot of time at our vacation home there but always look forward to getting back to Canada.


Glad you have had good experiences with it. You are lucky. You got good service despite the system. Our system is not set up for success. Until we have private delivery within the Medicare system, we will not have a competitive situation in healthcare. Without competition, tales of great service are nothing more than heart warming anecdotes. 

I can tell you that 99% of the people in the world most certainly do not wish for our healthcare system. This is nothing but a nationalistic myth with no bearing in reality. If our system was so great we would have people from other countries asking for superior treatment here from other developed countries. With a few exceptions we do not. Instead people who are relegated to suffering are forced to spend thousands out of pocket to go somewhere else for treatment.

This is an absurd reality of our country. We have the education, wealth and know how to deliver a world class healthcare system. Our only barrier is an absurd idealogical orthodoxy draped in nationalism that is holding us back. 

It's both sad and maddening.


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## nathan79

Longwinston said:


> Healthcare in the USA is not the answer, but neither is it in Canada. I have to wait 8 months to see a gastro specialist and over a month to have a CAT Scan.


Same experience here. Actually, it's been a total of 10 months for me... 2 months to see a specialist and another 8 months wait for a gastroscopy. Of course, the doctors don't mind presribing meds while I'm waiting... at my own expense, of course.


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## uptoolate

Ihatetaxes said:


> Completely and wholeheartedly disagree with you. I have nothing but great things to say about our healthcare system and have a lot of examples including incredible care of one of my kids who had some serious health issues in the first weeks of life. One of very few things my tax dollars go towards that I don't ***** about (along with police and fire). I would guess 99% of the worlds population would give pretty much anything to have the care we do in Canada.
> 
> I love the US and spend a lot of time at our vacation home there but always look forward to getting back to Canada.


Agree with these sentiments, as a provider, educator and a consumer with 4 children. Could things be better, of course they could. Perhaps one day people won't get ill with diseases that medicine can do very little to treat. One of our problems is, and here I very much agree with Longwinston, that we are too often using the wrong yardstick. Medicine in the US is a mess and even those who have money to afford the 'best' don't in fact get the most effective care. I think most caregivers and politicians in the US 'know' what is 'wrong' with the system there but there will never be the will to change it as long as special interests direct healthcare policy. Some European countries are doing pretty well but there is no perfect delivery system. Much of the perceived 'problem' is the now, now, now Society that we live in and (as Eder pointed out) the perception that people need a non-indicated MRI today for a sore knee just because they heard some pro-athlete got one right away (he/she probably didn't need it either!). I'm always nervous when traveling in the US re: healthcare and strongly stress to all patients that they must absolutely get healthcare coverage when they travel to the US. I don't worry nearly as much when it comes to Europe or the rest of the world.


----------



## Longwinston

Yes, agreed. The biggest issue in Canada, by my estimation, is that as soon as we enter the system we are viewed as a cost. Little wonder we have the treatment we do when that is how the system views us. 

In France, Spain and Switzerland for example, you are viewed as a source of revenue and they compete for your service.

That is the key but no one talks about it.


----------



## AltaRed

During the 3.5 years I spent in Texas early in the last decade, I found the cost of living (outside of healthcare) to be considerably less than in Alberta. Granted I rented so I got the benefit of no state income tax and no property taxes (in Texas, the state tends to tax property rather than income). I don't know why that would not still be the case. 

Healthcare is the main bugaboo down there and without a generous employer sponsored healthcare plan, people are generally hooped. Those costs are going to continue to rise unabated until employers balk more and more on sponsoring health care plans and more of the burden is on the individual. When that happens in a significant way, the supply/demand balance will start to check the prices of health care... because otherwise, only the upper class will have access to good quality healthcare.


----------



## uptoolate

Longwinston said:


> Yes, agreed. The biggest issue in Canada, by my estimation, is that as soon as we enter the system we are viewed as a cost. Little wonder we have the treatment we do when that is how the system views us.


There is something to this. We joke that as far as hospital administrators go, the perfect hospital is one with no patients.


----------



## Eclectic12

Longwinston said:


> Healthcare in the USA is not the answer, but neither is it in Canada ...
> Worst thing about living in Canada in my opinion. For some strange reason a large proportion of the population is PROUD of this insane healthcare system.


Several Americans who have moved to Canada and are sticking around because of the healthcare so YMMV.

Then too, I can recall my classmate from Idaho injuring herself at volleyball, tears streaming down her face from the pain but "don't take me to a doctor/hospital, I can't afford it".




Eder said:


> ... The biggest problem in Canada is people that have very little wrong with them and demand service but are triaged and put on a waiting list so patients with real needs can be looked after.
> 
> I know many of my friends constantly think something is wrong with them and tax our health care system with useless visits.


I can recall my aunt commenting that when her doctor took a vacation, he'd advise his patients to go to Emergency. She thought this was an abuse of the system and would either wait or go to a walk-in clinic.


Cheers


----------



## Eclectic12

Causalien said:


> ... What I do not like is that there are certain pockets of population that needs to be avoided. Whereas canadians are more homogeneous in behavior, in usa, you never know if the next person you meet is going to be crazy. I think this is a result of the large rich/poor divide.


It was depressing to drive through Alabama and see house trailers with the front caved in and a truck parked out front showing that people were still living there.




Causalien said:


> ... One thing I find interesting though is that people enjoys small talk a lot more in US. I get a lot more random chat with strangers on the street there.


Was it an exchange of information though?

Some of the "conversation" at the trailer park coffee hour was more about the viewpoint being expressed instead of exchange of information. One on one seemed to be a better forum than in public.


Cheers


----------



## Eclectic12

financialuproar said:


> ... Junk food was really cheap, especially cookies, crackers, chips, etc. And as others have mentioned, booze is really cheap too. So was soda. But the staples were all pretty much the same as in Alberta. Even stuff like clothes and shoes were pretty much the same price as up here.
> 
> Again, small sample size. But based on that, I'd say the cheaper food costs in the states is largely overstated.


That's why I shake my head when Canadians around me talk as if everything is pennies on the dollar by going to the US. Some things are and a lot isn't.

Cheers


----------



## Eclectic12

Longwinston said:


> ... Our system is not set up for success. Until we have private delivery within the Medicare system, we will not have a competitive situation in healthcare. Without competition, tales of great service are nothing more than heart warming anecdotes.


I'd want more statistics before I'd draw any conclusions.

The Tampa paper was claiming horrendous delays for Emergency visits in Canada and when my brother needed on in Tampa, it was pretty much the same delay except for the $800 bill for two Xrays.

Then too ... the question is how to setup competition and avoid problems such as the US.
The front page of the Tampa paper had an article about the guy who had a letter from the hospital saying it was their mistake prescribing what they did and how they directed him ... but the financial section was still going after him for his $5K bill.


After retiring as surgeon general, Everett Koop did a series on healthcare for PBS. According to conservative estimates - going to a standard form instead of allowing all the different health care facilities using their own would save the US system $7 billion. That's without privatizing or anything else.





Longwinston said:


> ... I can tell you that 99% of the people in the world most certainly do not wish for our healthcare system. This is nothing but a nationalistic myth with no bearing in reality. If our system was so great we would have people from other countries asking for superior treatment here from other developed countries. With a few exceptions we do not.


I think you are letting your angst about the delays push you into hyperbole.

Do you really believe that the Indian beggar who went blind because as he couldn't pay $3 to get treated for something our system detects in childhood would agree?

Do you think the people in El Salvador where minimum wage is $244 a month and living expenses are published by the gov't at $189 a month would agree?



> The privileged few in Africa who have big budgets, usually go to Europe for treatment. Those with a little less often go to India for higher quality healthcare at relatively affordable prices in private hospitals. (Ironically, India spends just 4.2% of its GDP on health, well below several countries in Africa, and its state-of-the-art private hospitals are unaffordable for the majority of Indians.)
> 
> But most in Africa cannot afford expensive treatment in Europe, India, or elsewhere. And they cannot even afford decent medical treatment – if and when it is available – in their own countries.


http://thinkafricapress.com/health/african-healthcare-desperately-needs-shot-arm


The photo health cards were brought in for Ontario " ... in response to physicians saying, `Look, I have families that come once a year from overseas to have all their health care here and I know that it's not a valid health card -- what I am supposed to do?"



> The fraud problem was particularly acute in cities close to the US, where 37 million people have no health insurance. According to Ontario doctors who work in these cities, many former residents who moved to the US kept a mailing address in Canada in order to obtain a health card. Some Americans who own cottages in Ontario form another group of abusers: because they have an Ontario address, they can obtain a health card. Other cases involve out-of-country visitors borrowing valid OHIP cards from friends and family members for medical treatment in Canadian emergency wards.
> 
> Police say that Ontario health cards sell for about $1000 in Toronto's black market


http://www.collectionscanada.gc.ca/...cdn_medical_association/cmaj/vol-154/1412.htm


My brother-in-laws chemistry prof who is originally from the US commented that he will never move back as he can't afford what he would have to pay out of pocket that Canada is covering for him.




Longwinston said:


> ... Instead people who are relegated to suffering are forced to spend thousands out of pocket to go somewhere else for treatment.
> 
> This is an absurd reality of our country. We have the education, wealth and know how to deliver a world class healthcare system. Our only barrier is an absurd idealogical orthodoxy draped in nationalism that is holding us back.


Are there problems and delays?

Yes ... but not to the point of 99% of the world don't want our system. 


Hmmm ... so going back to the old days where it was 100% private is going to fix everything?
And here I thought medicare came in because the private system *wasn't* covering everyone.


Cheers


----------



## Longwinston

"' _Originally Posted by Longwinston 
Healthcare in the USA is not the answer, but neither is it in Canada ... 
Worst thing about living in Canada in my opinion. For some strange reason a large proportion of the population is PROUD of this insane healthcare system.'

Several Americans who have moved to Canada and are sticking around because of the healthcare so YMMV.

Then too, I can recall my classmate from Idaho injuring herself at volleyball, tears streaming down her face from the pain but "don't take me to a doctor/hospital, I can't afford it"."_

------------------------

We need to move beyond the dichotomy of healthcare comparisons between Canada and the USA. I clearly stated that the USAs system isn't the answer, which you even quoted, but the urge to compare our system to the USA is irresistible. 

Pointing out the weaknesses of the American system doesn't excuse the many weaknesses of ours.

It's a big world out there. 

We need competition in the healthcare system so providers fight for our service rather deliver it hesitantly.


----------



## BC Eddie

My wife and I moved to the US on the advise of our accountant and lived in the mid-west (Illinois) from 2000 to 2006. That was some time ago so things may have changed, but for us, it was a lucrative move. I keep very accurate records of costs (Quicken)and just compared what we spent in Toronto prior to the move and Illinois after we were settled for a while. I compared 1998 to 2002 and even taking inflation into account we had huge cost savings in the US for things like food( $9800/$3500 Canada/US) and dining out($8000/$5000). The main reason for the move was to reduce income tax and over the six years we were there we saved about 20% on our total income. I recall, during this period there was criticism that Canadian taxes were too high relative to US and I believe serious effort was made to adjust them over the years.

But we did it for the money and were glad to come home to Canada. While the food was much cheaper we were surprised that even though we were living in what seemed like a farming area the vegetables were terrible compared to what we got in Canada. We later learned that while there was a lot of framing, none of it was for table vegetables but rather corn and soy beans.

We had access to a Blue Cross health plan and never had to wait for a doctor or pay much out of pocket . But I feel that I got much better care from all my Canadian doctors than I ever got from any doctor in the US. Yes, in the US they were happy to authorize any test/procedure that I wanted and they all had the latest technology but in terms of their expertise and "bedside manner" I get more personal service when I take my car in. 

I agree the Canadian system is not perfect but we worked beside many Americans who would not change jobs for fear of losing their health plan. In the US a serious illness is the number one reason for personal bankruptcy.


----------



## Longwinston

"Hmmm ... so going back to the old days where it was 100% private is going to fix everything?
And here I thought medicare came in because the private system *wasn't* covering everyone."

You can have private delivery of Medicare. They even do it in the USA, see Medicare.
We can introduce private delivery of care here within the Canada health act.

Seriously, you need to look outside of the USA, which I clearly stated was not the answer here. It doesn't mean our system is working.

Also, I never said anything about someone in El Savador or India. Another poster said that 99% of the world would prefer our system which I disagreed with. That doesn't mean that the worlds poorest wouldn't be better served in Canada.

Is there room for nuance in our discussion or should I just move on?


----------



## Eclectic12

uptoolate said:


> ... Medicine in the US is a mess and even those who have money to afford the 'best' don't in fact get the most effective care.


An example of this is the two Tampa businessmen who were diagnosed with cancer two years later than they should have been. They were suing because the plan they paid for was advertised as top of the line (with a top cost) when in fact, the doctor was prohibited from requesting the test that would have confirmed the cancer as the healthcare company deemed it too expensive.

The part that blew me away was that instead of suing for damages etc. as is often the case, they where suing to have the "this plan covers everything" changed to a more accurate wording. I'm not sure I'd have been that generous.




uptoolate said:


> ... I think most caregivers and politicians in the US 'know' what is 'wrong' with the system there but there will never be the will to change it as long as special interests direct healthcare policy.


From what I can see, some of the problem is this but there are a lot of factors. Some of the problem is that it is fairly common for people to associate the inability to pay for medical coverage as being the result of laziness.

Then too, a lot of the problem is sticking to a factual dialogue.

The Tampa paper in it's Q&A column published that Canadians don't get to pick their doctor and that the Canadian medical system was in such rough shape that all but emergency surgery was cancelled for three weeks in Dec in Toronto. My dad snorted in derision as he worked the admitting desk in Toronto General when it was private and the hospital did the same for two weeks as both doctors and patients wanted to take holidays at that time of year.



uptoolate said:


> ... I'm always nervous when traveling in the US re: healthcare and strongly stress to all patients that they must absolutely get healthcare coverage when they travel to the US. I don't worry nearly as much when it comes to Europe or the rest of the world.


My brother's experience with US emergency was a four hour wait to see a doctor, two xrays were done and he was handed an $800 bill.

The American next door said her husband went into critical care for a heart attack before dying. She was flabbergasted that her husband wasn't eating but there was around $7K added to the bill for meals. Her lawyer was able to get $35K knocked off the bill but she was still working off the $278K owing.


Cheers


----------



## Eclectic12

Longwinston said:


> ... We need to move beyond the dichotomy of healthcare comparisons between Canada and the USA. I clearly stated that the USAs system isn't the answer, which you even quoted, but the urge to compare our system to the USA is irresistible.


So to be clear, Americans aren't in the "... 99% of the people in the world most certainly do not wish for our healthcare system." then?




Longwinston said:


> ... Pointing out the weaknesses of the American system doesn't excuse the many weaknesses of ours.
> 
> It's a big world out there.


Yes ... and there's millions with no medical coverage or who are dying for problems that no longer exist in Canada as they can't afford it.




Longwinston said:


> ... We need competition in the healthcare system so providers fight for our service rather deliver it hesitantly.


And my understanding is that there was competition before medicare was started, where many people couldn't afford it or were not getting treated.

So what are the features that you envision to build into the system to avoid going back to this type of situation?


Cheers


----------



## BC Eddie

I read this post some time ago but I enjoyed it so much I wanted to share. It was published in the Wall Street Journal and is by a highly qualified expect on Canadian health care (Suzanne Somers) (I joke of course). It just shows you the kind of propaganda BS the US media will try and spread to discredit "socialized medicine" - scary, scary.

http://blogs.wsj.com/experts/2013/1...ordable-care-act-is-a-socialist-ponzi-scheme/


Make sure to read the comments on this site - they are where the real facts lie.


----------



## Longwinston

Eclectic, if you are truly interested in learning, look up France's medical system for an example.


----------



## Eclectic12

Odd ... I'm seeing mixed reviews as well as similar stresses to Canada's healthcare system.



> Like health insurance schemes everywhere, the French state health insurance program has difficulty making ends meet, and relies increasingly on topups from the general budget of the state. An ageing population and the explosion of health care costs due to increasing expectations and the development of expensive new processes and medicines, have put enormous strains on the system.


http://about-france.com/health-care.htm



> A GP needs to see many many patients to make a decent living on 23 euros a visit and they don’t care for you as well as a 250 euros doctor.
> Since they are overwhelmed by patients, for a routine checkup you may have to wait several weeks, and several hours for them to squeeze you in between patients if you show up for an emergency. The same goes for the ER, hospitals are generally under staffed ...
> Rare are the doctors who train for more, learn new acts over the course of their careers, try new products or buy new equipment. Many practice a medicine from 50 years ago, for lack of means to make it quicker and less invasive for the patient ...
> That system had a huge deficit, due to poor administration and abuse from patients who were seeking treatment and pills all the time.


http://reachfinancialindependence.com/french-healthcare/




> Yet France’s looming recession and a steady increase in chronic diseases including diabetes threaten to change that, says Willy Hodin, who heads Groupe PHR, an umbrella organization for 2,200 French pharmacies. The health system exceeds its budget by billions of euros each year, and in the face of rising costs, taxpayer-funded benefits such as spa treatments, which the French have long justified as preventive care, now look more like expendable luxuries.


http://www.businessweek.com/articles/2013-01-03/frances-health-care-system-is-going-broke


Cheers


----------



## Longwinston

Eclectic, that was your unbiased view of the French healthcare system? Nothing for us to learn to improve our system eh?

You see, it is this rabid adherence to the Canadian Medicare Myth that prevents us from getting better Medicare. 
When you wonder why we can't have better health system, you will need only look in the mirror.

France is the highest rated healthcare system in the world.
Canada ranks 30th.

According to the world health organization. Perhaps you have heard of it?

http://www.businessinsider.com/best-healthcare-systems-in-the-world-2012-6?op=1

Cheers


----------



## Eclectic12

Longwinston said:


> Eclectic12 said:
> 
> 
> 
> "Hmmm ... so going back to the old days where it was 100% private is going to fix everything?
> And here I thought medicare came in because the private system *wasn't* covering everyone."
> 
> 
> 
> You can have private delivery of Medicare. They even do it in the USA, see Medicare.
> We can introduce private delivery of care here within the Canada health act.
Click to expand...

Okay ... let's put it a different way ... what measures do you see that would prevent the private parts from maximising their profits and eventually returning to what Canada started with ... a private system that wasn't covering everyone?




Longwinston said:


> Seriously, you need to look outside of the USA, which I clearly stated was not the answer here. It doesn't mean our system is working.


Which is why I was mentioning El Salvador etc. ... though I'm guessing you'd prefer to look at Sweden or France who have a broad based health care system.

I'd argue it is, by and large working ... but is facing challenges and does need improvements.




Longwinston said:


> Also, I never said anything about someone in El Savador or India. Another poster said that 99% of the world would prefer our system which I disagreed with. That doesn't mean that the worlds poorest wouldn't be better served in Canada.


Mea culpa ... that's what I get for reading too fast. My apologies.

However, at the same time ... there is a significant number who would like our system. At an estimated 7 billion population, I've seen estimates of 3+ billion who have to choose between paying for medical treatment and basic necessities such as food.




Longwinston said:


> Is there room for nuance in our discussion or should I just move on?


Lots of room .... :biggrin:


Cheers


----------



## Eclectic12

Longwinston said:


> Eclectic, that was your unbiased view of the French healthcare system? Nothing for us to learn to improve our system eh?


It's ten minutes with Google so at this point I'll reserve judgement about how biased or not the info is ... more detailed research will have to wait. 

I did say mixed ... did I not? There was some good, some bad and concerns about growing costs plus the possible need to adjust benefits.




Longwinston said:


> You see, it is this rabid adherence to the Canadian Medicare Myth that prevents us from getting better Medicare.
> When you wonder why we can't have better health system, you will need only look in the mirror.


I think you are seeing myths around every corner. 

As I say, it's ten minutes or so with Google ... but if you prefer to believe it's an attachment to myths, I'm not sure what else to say.




Longwinston said:


> France is the highest rated healthcare system in the world.
> Canada ranks 30th.


Good to know ... but do they tell you anything about how to structure the system/improve the system?


Cheers

*PS*

I'm not finding numbers but I did find this web site that is promoting medical tourism to Canada.
http://www.findprivateclinics.ca/resources/general/medical-tourism.php


Plus I did find bulletin board postings of Americans saying they'd come into Canada for medical procedures.


----------



## uptoolate

Actually the WHO ratings are from 2000 and they refused to rank countries in 2010 (when they undertook another study and produced another report). Other organizations have produced different rankings and it is probably fair to say that there isn't a marked difference from country to country in the group ranked at the top. One thing that seems fairly consistent is that the US spends the most and is far down the rankings when it comes to most indicies of well-being. In Canada, we seem to be getting pretty good bang for our buck but of course there is always room for improvement. The question is how to improve while maintaining coverage for all and equitable access to care.


----------



## andrewf

Longwinston said:


> "Hmmm ... so going back to the old days where it was 100% private is going to fix everything?
> And here I thought medicare came in because the private system *wasn't* covering everyone."
> 
> You can have private delivery of Medicare. They even do it in the USA, see Medicare.
> We can introduce private delivery of care here within the Canada health act.
> 
> Seriously, you need to look outside of the USA, which I clearly stated was not the answer here. It doesn't mean our system is working.
> 
> Also, I never said anything about someone in El Savador or India. Another poster said that 99% of the world would prefer our system which I disagreed with. That doesn't mean that the worlds poorest wouldn't be better served in Canada.
> 
> Is there room for nuance in our discussion or should I just move on?


We already have private delivery in Canada. Most GPs work in private practice. I don't think there is a problem per se with private delivery, as it encourages innovation and efficient delivery of care. So long as there is robust public insurance and standards of care are maintained, private provision should not be villified.


----------



## capricorn

Eclectic12 said:


> That's good news ... is it a HMO? Are there restrictions on the test the doctors can order? (just curious)


Glad you asked. Till now I had not bothered to check. Just found out that mine is a PPO. Now, I am reading the fine print on restrictions. Hopefully no surprises.

we raised our kids in Canada. In our experience the health care we got was among the best in world. 

For me, this detour to USA is for work. The family is staying back in Canada as we found life there to be much less stressful for kids (and good education is much cheaper).


----------



## Karen

My late American husband was diagnosed with very late stage pancreatic cancer while we were spending a few months in Anchorage, Alaska, which had been his home for 30 years until he moved to Canada to marry me. He had medical coverage in both Alaska and in B.C., but, for my sake, he chose to return to B.C. so that I would have my friends and family for support when he died. The point I want to make is that we experienced both medical systems over the next few months, and there were advantages to each. When he first went to an orthopedic doctor in Anchorage with what we thought was his long-standing back trouble acting up again, he was sent for an MRI and a CAT scan within two days - it would probably have taken months here in B.C. In fact, he wouldn't have lived long enough to have the scans done. The results not being good, he had a biopsy the day after that and was then referred immediately to an oncologist. So he had a diagnosis within three days, and we flew home. I had phoned his family doctor here in B.C., explained the situation, and asked if it would take long for him to see an oncologist if we came home. The doctor said "No"; since he had already had the diagnosis confirmed with a biopsy, we should bring his medical records from Anchorage and he would be able to get him in to see an oncologist immediately. As things turned out, he never did see an oncologist; his cancer was too far advanced and he was referred immediately to a palliative care specialist who oversaw his home care until his death. The daily visits from the palliative care nurses were absolutely incredible; it would have been impossible to have any more caring and empathetic nursing - and yet down-to-earth and realistic - than he had over those few weeks, and I was very grateful that we had returned home when we did since the Anchorage doctors were not very complimentary about the palliative care situation there. So, looking back on it, I think we had the better of both worlds.


----------



## rikk

My current experience here in Ottawa ... on 17 April my left foot became badly swollen/infected, went to Queensway Carleton Emergency ... within hours I'd had bloodwork and xrays done, had the wound treated, and was on intravenous antibiotics. Was released to come back in 8 hours (2:00 in the morning) for another IV. I was directed to Saint Elizabeth Health Care (non-for profit care) where I was given an IV pump and meds ... the pump administered the antibiotics every 8 hours, just had to change the antibiotics bag once a day. The IV went bad, started injecting the antibiotics into the soft tissue in my arm ... ouch ... called SE, met a nurse there in about 30 minutes, and had a new IV inserted. At about the same time went to QC for soft tissue expert appointment, he put me on a different antibiotic, gravity IV, and scheduled installation of a PICC line (a line from the arm to the heart meant for longer term IV), still waiting for that. In the meantime I became aware I could do the gravity IV at home (versus daily appointments at SE) and I've been shown how to do the IV (one bag antibiotics, one bag saline solution in a piggy back configuration it's called). I am as I'm writing self-administering the IV ... takes about 30 minutes. I'm scheduled every 2nd day appointments at the SE for wound care and have an appointment with the soft tissue guy 30 April. I've been given all the materials to treat the wound and do the IV, I know that if there is a problem, help is about 30 minutes away ... I am very very happy with and thankful for the excellent care I'm receiving here in Canada ...


----------



## Eclectic12

Good to hear that for some it is working ... and that has matched my family's experience, by and large.

However there wait times for gastro have been a problem for quite a while, with Manitoba having a significantly longer wait.
http://www.winnipegfreepress.com/lo...bowel-specialist-159683885.html?device=mobile

which is a shift from when Alberta was the laggard.
http://www.marketwired.com/press-re...longest-wait-times-canada-patients-581783.htm


Cheers


----------



## PoolAndRapid

..


----------



## rikk

PoolAndRapid said:


> From the discussion it seems for most it comes down to the cost of health care. What about the cost of lost opportunity? I look at some of my family members, lifelong overachievers and part of the brain-drain demographic, who left Canada immediately after their undergraduate studies were complete because the best graduate schools in the world for their chosen fields were (and still are) in the US. The environment to foster innovation combined with the ability to reap the economic rewards doesn't exist in their fields in Canada. The level of success they have achieved, both financially and professionally, wouldn't have been possible had they not left. The only consideration they give to health care costs is from the perspective of what is good for society, not their own personal situation.


Well, I enjoyed an excellent career here in Canada ... but then I'm not a "lifelong overachiever" ... had I been, sure, I would have gone where I was driven to go ... and until recently, or as a young person, I never gave any thought to healthcare because I had no need of it. Just saying for most young people at least, my opinion, the cost of healthcare is not keeping them in Canada.


----------



## Eclectic12

PoolAndRapid said:


> From the discussion it seems for most it comes down to the cost of health care.
> 
> What about the cost of lost opportunity?
> 
> ... The environment to foster innovation combined with the ability to reap the economic rewards doesn't exist in their fields in Canada...


I'm not sure this should be taken in isolation.

If the main place or innovation/job opportunity is elsewhere and one wants that opportunity ... then one will go there. 

(Like the article I read years ago who commented the similarly to the OP but he stayed in California at there were hundreds of jobs in Ontario versus thousands being head hunted in California ... though his conclusion was that it was the same, the OP seems to be saying he's behind).


The flip sides I am aware of for this coin are:

a) my co-worker who was fed up having to learn the new healthcare provider rules as his company was changing providers every six to nine months to save money on the health care provided.

b) the people I am aware of who are working from home for US companies but still covered under the Canadian system. For some professions ... location is no longer a barrier.


IAC - the key point is YMMV dramatically as it involves a lot more variables that strictly healthcare or income tax rates. 

My relative went for what he thought was an opportunity and decided this wasn't the case. 
I would have to ask to confirm but he made no mention of healthcare being an issue for him, which is hardly as surprise at the VP level.


Cheers


----------



## fatcat

> And it's extremely complex to unwind the details of it (this is a big thing I learned in the US... health coverages are convoluted, tricky, extremely difficult to figure out).


:biggrin: ... you could could do stand up comedy james, that's hilarious ... "complex" ? ... it's _impenetrable_ and you are entirely at the mercy of the health insurers



> Yes booze is much cheaper.


indeed, _and you are going to need it _when you start getting bills for health care co-pays that are a) indecipherable gibberish and b) routinely (and i am not speaking figuratively here, i am am talking literally) delivered 9 months after the health care event, so you actually have trouble remembering what took place

james, honestly, you are an innocent, health care in the usa is delivered with the following priorities ranked in order 1) profit for large vested interest groups, like medical device companies, insurers, doctors and hospitals and 2) patient care

seriously get yourself down to the laugh factory in los angles and work up a routine

you expected _what_ from american healthcare ?


----------



## brad

fatcat said:


> indeed, _and you are going to need it _when you start getting bills for health care co-pays that are a) indecipherable gibberish and b) routinely (and i am not speaking figuratively here, i am am talking literally) delivered 9 months after the health care event, so you actually have trouble remembering what took place


Well, just a slight exaggeration, I think. 

I lived in the US for 40 years and never experienced anything like what you describe. I've been with HMOs and PPOs, and while HMOs were simpler (you have a nominal co-pay, and that's it; a friend of mine had her baby for $3), my experience with PPOs wasn't so bad. I haven't lived in the US for 12 years now, so maybe things are different, but all my siblings live there and I don't hear them complaining about it. Just as in Canada, much depends on where you live and who you're served by.


----------



## Islenska

Been on the front lines in Manitoba healthcare for dare I say since 1977, involved in retail and hospital angle of the system, mostly with pharmacy but also recruiting doctors and part owner of a clinic.

Financially it has been good for me and I still enjoy part time work,also a long time resident of the small town system, never felt the urge to check out other green grass!

In Canada we have really top notch healthcare people, my main ongoing problem is the inertia of mid-government lifers that can suck your healthcare dollars dry. (they can arrange meetings and conference calls till the cows come home!)

But I digress, sure this applies to RCMP. ambulance,education-----the Canadian way. Just a lot of your taxpayer dollars pissed away.


----------



## fraser

Over the years a number of my colleagues have gone south. The primary driver was enhanced career opportunities, and in some cases opportunities that did not exist in Canada. Most of them stayed in the US and plan to retire there.


----------



## smihaila

OP, are you single by any chance?

I did the same move as you, but my residence is in Colorado. With the wife and kids, my overall tax rate is pretty low (25%), comparing to Ontario/Canada. If I were to file as single (or the third option - house breadwinner or whatever name it has), I would definitely be paying more taxes.


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## fatcat

brad said:


> Well, just a slight exaggeration, I think.
> 
> I lived in the US for 40 years and never experienced anything like what you describe. I've been with HMOs and PPOs, and while HMOs were simpler (you have a nominal co-pay, and that's it; a friend of mine had her baby for $3), my experience with PPOs wasn't so bad. I haven't lived in the US for 12 years now, so maybe things are different, but all my siblings live there and I don't hear them complaining about it. Just as in Canada, much depends on where you live and who you're served by.


not really, i used to get bills from blue cross that were at least as old as 9 months sometimes ... not to mention that they were indecipherable since they display retail prices and insurers never pay retail

much of this depends on who you work for

i was self-employed and in the individual market which is a different world from the coverage you received by working for a company ... a different and much harsher and more difficult world to navigate

the individual market is actually where much of the problems have taken place, like denial for pre-existing conditions for example (i was denied coverage because i reported use of a drug for a condition that i didn't report on my application even though i didn't have the condition in question and was using the drug "off label" for something else which i did report)

the american system is very good until you get sick, then you have big problems


----------



## brad

fatcat said:


> much of this depends on who you work for


But as I said above, it also depends on where you live. I was also self-employed, when I had the PPO coverage, but I lived in Vermont where it was illegal for insurers to deny coverage based on pre-existing conditions. That was good on one hand but bad on the other, because very few insurers wanted to offer coverage in Vermont for that reason -- choice was limited. But I got a pretty affordable package and had no complaints, it all worked well for me.


----------



## fatcat

brad said:


> But as I said above, it also depends on where you live. I was also self-employed, when I had the PPO coverage, but I lived in Vermont where it was illegal for insurers to deny coverage based on pre-existing conditions. That was good on one hand but bad on the other, because very few insurers wanted to offer coverage in Vermont for that reason -- choice was limited. But I got a pretty affordable package and had no complaints, it all worked well for me.


navigating the american healthcare system, especially if you have any kind of ongoing health problem is like crossing a river on the heads of crocodiles ... you might make it through but you better not stumble or you are toast ... once the system redlines you, you are finished and left begging for coverage ...

the system persists based on a massive, coordinated lobbying process undertaken by hospitals, insurers, doctors and medical device companies ... the hopeless mess that is obamacare is proof of that ..

american healthcare eats up 16-17% of gdp (when other countries deliver universal coverage for 8%), it doesn't cover 50-60 million people and it performs badly on many healthcare metrics 

it is possible to have a good experience in the american healthcare system but overall it is a wasteful, uneven and immoral system

having used both systems, i will take the canadian system any day

ps. what we really need is system that takes the best of both countries and leaves the worst behind


----------



## SpIcEz

Considering J4B's original post. When I was reading it and saw the considerable increase, I was shocked. 

Now, to make things clear, James I dont claim to know your situation so I cant put myself in your shoes as to your decision to move.

However, I would have never considered 13 000$ pay increase a good reason to move to the US especially California.

About 8 years ago I was offered about a 10k increase, plus company car and gas card to move from Montreal to Missasauga (or Toronto).
After factoring everything in, it was basically a wash. And thats within the same country. I couldnt even imagine moving to California for the same amount.

I used to work for Tyco, a multinational most of you know,with offices all over the USA and Canada. On thing to keep into perspective, if J4B was a Tyco or any large corporation employee, moving to CA was worth 13 000$ increase, but for the same job in one of the heartland states he might have been paid less than what he was doing in Canada. 

Salaries are not the same in different major cities. So even though the cost of living is cheaper, your pay would be less as well.


----------



## Eclectic12

fatcat said:


> not really, i used to get bills from blue cross that were at least as old as 9 months sometimes ... not to mention that they were indecipherable since they display retail prices and insurers never pay retail


Not that it's the same ... or that I recall my brother commenting on clear the bill was ... but he was getting repeats of the same $800 xray bill up to a year later. The company he bought extra coverage from was adamant they had already paid the bill but I recall him saying he received five or so of them.

Maybe the hospital was hoping there's be a miscommunication and the bill would get paid multiple times? Or maybe the payment didn't cross the border all that quickly?

Anyway ... the bills stopped coming so the payment by the travel insurance company must have been acknowledged.




fatcat said:


> ... much of this depends on who you work for
> 
> i was self-employed and in the individual market which is a different world from the coverage you received by working for a company ... a different and much harsher and more difficult world to navigate
> 
> the individual market is actually where much of the problems have taken place, like denial for pre-existing conditions for example ...


I'm not quite sure how broadly this is true ... especially the "pre-existing condition" part.

As I mentioned in a thread (maybe this one?), my co-worker said he spent a ton of time reviewing the limits/forms/exclusions etc. for his healthcare coverage as the companies he worked for would change providers after six to nine months as they'd been able to negotiate a cheaper deal.

Then too, in one of the PBS medical care shows that Everett Koop was involved in, a family with two sons needing a lot of medical care were sticking with the old provider when the company changed. They said they were doing this as a co-worker had been turned down for coverage due to a much milder pre-existing condition than their sons had.


Of course ... without stats or a more thorough review, I have no way of confirming this beyond the examples I've seen.


Cheers


----------



## Eclectic12

SpIcEz said:


> ... Salaries are not the same in different major cities. So even though the cost of living is cheaper, your pay would be less as well.


A lot depends on the company and it's policies. 

Being a traveling consultant that lived in Waterloo, ON but based in Toronto with a Toronto sized salary (plus reduced costs when hotel/food/travel was paid when working outside Toronto) meant I was much farther ahead than those living/assigned to work in the GTA. At times, those based in the bigger cities would grumble that it wasn't fair.


Now with the focus on profits, I'd expect the US companies to look at this but for the firm I worked for, I was hearing the same grumbling as I was for the Canadian firm so there were at least some that weren't adjusting the salary.


Cheers


----------



## BC Eddie

I did many SAP HR implementations for a variety of large companies in both Canada and the US and the norm was to have different salary scales related to the local cost of living for the different company/plant locations.


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## fraser

There will always be both good and bad stories about healthcare-in Canada and in the US. 

Many of my work colleagues in the US were very concerned about being laid off in their late 50's. Not because of the financial burden, many were ready to retire, but because of the health care burden between early retirement and age 65 when they were eligible for medicare.

A growing trend in the US, especially with large corporations, is to provide private health care insurance but to LIMIT the lifetime values-some at $3M, others as low as $1M. The latter may seem large but it is not when an employee or dependent is confronted with a major health challenge that spans several years. Just one more reason why the major cause of personal bankruptcy in the US (something like 60 percent) is health care costs.

The other issue is GDP. The latest numbers that I have seen suggest that most western nations spend 11-12 percent of GDP on health care costs-Canada, France, Switz. etc. The US is at about 13-14 percent. The kicker is that US healthcare costs are rising at 5-10 percent, well above the rate of inflation-and much faster than other western nations. They are well on their way to having health care consume 18 percent of GDP. This is a significant gap and a tipping point that will make the US uncompetitive in many areas.


----------



## fatcat

> Not that it's the same ... or that I recall my brother commenting on clear the bill was ... but he was getting repeats of the same $800 xray bill up to a year later. The company he bought extra coverage from was adamant they had already paid the bill but I recall him saying he received five or so of them.


precisely, this happens all the time down there, you have to be constantly vigilant and keep records of everything

canadians that complain about the heavy hand of the government in administering medicare don't realize how heavy the insurers hand is in the usa ... if you get sick, like really sick, you are entering in to a war with the insurance companies and will have to not only fight your illness but the insurers as well



> I'm not quite sure how broadly this is true ... especially the "pre-existing condition" part.


i speak from direct experience, it's broadly true as hell ... the insurers are ever ready to find a reason to throw you off the coverage especially if you start showing signs of any kind of ongoing illness .. make a mistake on an application and you are screwed ... the applications are complex and hard to understand and so when a big claim comes in the insurers comb through them to try and find errors and use it to deny coverage



> The other issue is GDP. The latest numbers that I have seen suggest that most western nations spend 11-12 percent of GDP on health care costs-Canada, France, Switz. etc. The US is at about 13-14 percent.


13-14% ?? .... not even close, try 17.9% ... http://data.worldbank.org/indicator/SH.XPD.TOTL.ZS

17.9 and they don't even cover 50-60 million people ... canada delivers 100% coverage for 10.9%

you can't even speak about the canadian and american systems in the same context, they are not even _close_


----------



## fraser

The other issue that is facing people employed by large corporations in the US is the sophisticated software programs that have been developed by global HR firms such as Towers Watson. They are referred to as employee maximization programs.

All kinds of data is included-salary, salary band,age, seniority, vacation costs, sick time, HEALTH CARE claims, pension costs, outstanding employee options, applicable management incentives, etc. This is done for a 2 or three year history. The result is a projected future employee cost. This data is used to 'rightsize' organizations. When it comes to lay offs, they select the person who will cost them most in the future. It works because many employers in the US actually self insure for medical but they hire health insurance companies to manage the process.

I can clearly remember the comment of a former colleague in the US prior to my leaving the company. In past downsizings the target reduction was always in terms of headcount and target employee/manager ratios. For the first time ever in years of downsizing he had been told to downsize and was given a list of those who had to be included in the HR actions. Typically, as a General Manager, this was left to his discretion, and the discretion of his management team.


----------



## Pluto

Longwinston said:


> Healthcare in the USA is not the answer, but neither is it in Canada. I have to wait 8 months to see a gastro specialist and over a month to have a CAT Scan.
> 
> It's crazy. I think France and a couple of other countries have it right.
> Private and public compete against each other. Without competition you will not get good service.
> 
> We are viewed as costs in Canada, not patients.
> It's terrible really.
> 
> Worst thing about living in Canada in my opinion. For some strange reason a large proportion of the population is PROUD of this insane healthcare system.


I have concerns about wait times in Canada. There have been some wait times for people that is concerning. One woman needed a hip replacement and was going to have to wait many years. Finally she went to the US and got the operation for about 30,000, or something like that. She didn't even get any financial assistance from the Prov health plan. that was back in th e 90's, I think. I hope wait times have been improved, or our health plan will defray the cost for people who go south for the operation. Too there were other cases in which Canadians were allegedly misdiagnosed. The provincial doctors refused to admit a mistake. So the patient went to the US, got a proper diagnosis, and paid out of pocket for treatment. The got no compensation from the provincial plans. These are stories I read in newspapers so I am relying on them for veracity. 

The point is I share your concerns. Too, because we have a monopoly on health care in Canada, these people have to go to another country. I have nothing against the policy of universal health care, but does it have to be a monopoly? Why does it have to be a monopoly? If the provincial health care is so good, and maybe it is, why would they be worried about a parallel private system too? If the government system is so good, a parallel private system wouldn't make any money and would go away. It's possible that the only reason for a monopoly, is they are worried the government system is not as good as they claim.


----------



## Eclectic12

Pluto said:


> I have concerns about wait times in Canada.
> 
> ... I hope wait times have been improved, or our health plan will defray the cost for people who go south for the operation.


Some items have improved ... unfortunately, as posted up thread, the wait times are going the wrong way for digestive diseases.




Pluto said:


> ... The point is I share your concerns.
> 
> Too, because we have a monopoly on health care in Canada, these people have to go to another country. I have nothing against the policy of universal health care, but does it have to be a monopoly? Why does it have to be a monopoly? ...


Part of being a monopoly is the payments paid and other cost affecting things like requiring the use of the cheaper generic version of drugs can be dictated. As everyone is on the same playing field, there is little room for variation.

This has both good and bad sides ... for example, I can recall the doctor who wrote to the local paper saying ... "yes, my fees are dictated but at the same time, I don't have have to decide whether I'm willing to accept a bushel of apples instead of cash for my services".


Then too ... before medicare, it was 100% private where large numbers of people had no coverage unless their community raised money for them or those providing treatment decided to accept alternative payment or waive the fees.


So the question becomes how to introduce the competition, without reverting back to the way it used to be.


Then too, I found it though provoking that around the early 2000's, it was estimated that allowing US healthcare companies to use their own forms was costing over $6 billion a year in mistakes, missing information and administration compared to standardizing on a single form.


Cheers


----------



## BC Eddie

NPR radio in the US reported that the healthcare company paperwork alone (nothing to do with treatment - just paper pushing) added $1000 a year per person to US health care costs. 

When we lived in the US the Blue Cross form was printed on a huge, fold-out piece of paper that had to be at least 15 X 20 inches. The details were always wrong and we always had to follow-up with BC several times to get it corrected.


----------



## fatcat

Eclectic12 said:


> Then too, I found it though provoking that around the early 2000's, it was estimated that allowing US healthcare companies to use their own forms was costing over $6 billion a year in mistakes, missing information and administration compared to standardizing on a single form.
> Cheers


in the usa group practices that have say 5-6 physicians will have several full time staff just to handle paperwork since every insurer has it's own set of forms ... similar canadian practices often have a single person handling paperwork

the patient / customers pays for all this, it is all passed on to the patient

it is a wasteful, expensive system



> I have concerns about wait times in Canada.


 i have never waited more than 2-3 months for non-urgent tests ... that is the price we pay for having a universal system and it is well worth it

the us system works extremely well for the healthy or wealthy but badly for everyone else ...


----------



## financialuproar

AltaRed said:


> During the 3.5 years I spent in Texas early in the last decade, I found the cost of living (outside of healthcare) to be considerably less than in Alberta. Granted I rented so I got the benefit of no state income tax and no property taxes (in Texas, the state tends to tax property rather than income). I don't know why that would not still be the case.
> 
> Healthcare is the main bugaboo down there and without a generous employer sponsored healthcare plan, people are generally hooped. Those costs are going to continue to rise unabated until employers balk more and more on sponsoring health care plans and more of the burden is on the individual. When that happens in a significant way, the supply/demand balance will start to check the prices of health care... because otherwise, only the upper class will have access to good quality healthcare.


I think Texas is still fairly cheap, especially the Houston area. It amazes me what you can get for $150k down there.

As for Vegas, my understanding is real estate is a little less than half of Calgary. It also has no state income tax, but does have a sales tax of more than 8%. Lots of cheap American restaurants with their ultra large portions... Health care is the only kicker, like AltaRed mentioned. I like Canada's system. I just hate being cold for 6 months of the year to get it.


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## Eclectic12

financialuproar said:


> ... Health care is the only kicker, like AltaRed mentioned. I like Canada's system. I just hate being cold for 6 months of the year to get it.


You don't have the "go south for two months, return for a day, go south for two months" healthcare plan? :biggrin:


Though while you are south, watch out for the upsell by the dentist ... I think Dad was sixty five or so when he went into the Florida dentist to get a temporary cap for his tooth. 

The dentist told him "you are going to be around a while so I'd recommend you have all your teeth pulled and replaced with implants. I can cut you a deal for $16K US."

Dad decided against the implants.


Cheers


----------



## Longwinston

_i have never waited more than 2-3 months for non-urgent tests ... that is the price we pay for having a universal system and it is well worth it
the us system works extremely well for the healthy or wealthy but badly for everyone else ... _

I'm happy you have a good experience thus far. But understand that private delivery doesn't mean that we need to remove the universality.

There are a range of solutions we can pursue. The US is far from the only model that we can look too and it is a baffling to me that everyone talks about the US system only in regards to reforming our system.


----------



## Eclectic12

+1 that multiple forms of delivery doesn't have to mean removing universality. It just has to be setup properly.


I am surprised you don't understand why people are so focused on the US system. It is what they hear about the most, have to evaluate if they are considering an cross-border job and are the most familiar with. I can count on one hand the number of people at work with experience with a European, Asian or African medical care system. Even then it's experience from twenty plus years ago.



Cheers


----------



## andrewf

There's no reason that we have to have long wait times for tests or procedures. It is not an automatic consequence of public insurance. And private delivery can allow some efficiencies in delivering routine tests or procedures (such as knee surgeries). The only reason to allow any delay is to ensure higher utilization. It doesn't even really save money.

I think one of the problems Canada has right now is with the dentistry cartel. Dental services are needlessly expensive, and dentists are extremely well-compensated, due to the artificially restricted supply of dentists.


----------



## fatcat

andrewf said:


> There's no reason that we have to have long wait times for tests or procedures. It is not an automatic consequence of public insurance. And private delivery can allow some efficiencies in delivering routine tests or procedures (such as knee surgeries). The only reason to allow any delay is to ensure higher utilization. It doesn't even really save money.
> 
> I think one of the problems Canada has right now is with the dentistry cartel. Dental services are needlessly expensive, and dentists are extremely well-compensated, due to the artificially restricted supply of dentists.


+1 ... i lived in san diego for many years and people used to go down to tijuana and get excellent dental work for a fraction of the price ... if you need bridges and crowns, you can fly to costa rica and get a vacation along with your teeth for the cost of the work up here



> But understand that private delivery doesn't mean that we need to remove the universality.


right, of course you can .... many europeans countries do this ... you mandate a level of service that is subsidized by income so everyone has access and then you allow private companies to offer plans

this is somewhat like what obama is now doing except his plan isn't universal (because he had to negotiate with the health care mafia in order to implement it)


----------



## Pluto

Longwinston said:


> _i have never waited more than 2-3 months for non-urgent tests ... that is the price we pay for having a universal system and it is well worth it
> the us system works extremely well for the healthy or wealthy but badly for everyone else ... _
> 
> I'm happy you have a good experience thus far. But understand that private delivery doesn't mean that we need to remove the universality.
> 
> There are a range of solutions we can pursue. The US is far from the only model that we can look too and it is a baffling to me that everyone talks about the US system only in regards to reforming our system.


It baffles me too. Seems to be resistance to thinking outside the box. In principle I don't see why a parallel private system must lead to a loss of universality. 

Long wait times, leading to going to another country, and then not getting any compensation from our own system is not a consequence of public insurance; it seems to be a consequence of a monopoly that is not accountable to patients. It could be arrogance fueled by no fear of competition.


----------



## Longwinston

_right, of course you can .... many europeans countries do this ... you mandate a level of service that is subsidized by income so everyone has access and then you allow private companies to offer plans_

Even simpler, just have public delivery and private delivery be compensated by service provided from the government.
That switches the system around 100% from where you are viewed as a cost to where you are viewed as a source of revenue and they compete for your service. Right now we have a public system that is a monopoly that is not 'paid' for the services they actually provide but for what they think will be provided. 

It's a subtle distinction that makes a big difference. Right now, the budget is set and every patient is eating away at that budget.

We need to change this. The provinces can do this now, under the Canada health act, just need a courageous politician to champion it.


----------



## Pluto

Longwinston said:


> _right, of course you can .... many europeans countries do this ... you mandate a level of service that is subsidized by income so everyone has access and then you allow private companies to offer plans_
> 
> Even simpler, just have public delivery and private delivery be compensated by service provided from the government.
> That switches the system around 100% from where you are viewed as a cost to where you are viewed as a source of revenue and they compete for your service. Right now we have a public system that is a monopoly that is not 'paid' for the services they actually provide but for what they think will be provided.
> 
> It's a subtle distinction that makes a big difference. Right now, the budget is set and every patient is eating away at that budget.
> 
> We need to change this. The provinces can do this now, under the Canada health act, just need a courageous politician to champion it.


You are a clear thinker. 

With the current budget approach, if there is a year with too many patients, they think of ways to turn you away. With your approach, they have no reason to make one wait, and everyone who need it, gets help.


----------



## fatcat

Pluto said:


> It baffles me too.


that's because the stakes are high and you have a bifurcation between the "universalists" and the "free marketers" ... there is little trust on either side

we need someone to stake out a middle ground that is acceptable to both sides

of the two, i see single payer as the better option versus the american/free-market system which is a failure

but i would much prefer a universal coverage system that was delivered by private insurers

the provincial health authority and large insurance companies share the same characteristics of being large, distant bureaucracies that are tough to go up against


----------



## andrewf

I'm not sure how you can get around all the problems that exist with private insurance without regulating it to such an extent it might as well be government run.


----------



## Eclectic12

Pluto said:


> It baffles me too ... I don't see why a parallel private system must lead to a loss of universality.


It does not have to ... the problem is that the past history for Canada was that a completely private system did not have universality, where those in favour of the private system fought tooth & nail to avoid the change. Add in lots of private versus gov't debates being played out in the US plus risk adverse politicians so that changes become difficult.



Pluto said:


> It could be arrogance fueled by no fear of competition.


Or just plain bias ... when Mike Harris tried to cut costs by mandating hospital shutdowns, he delegated to the medical profession expecting decisions to be made with everyone's best interest at heart. In some places, instead new facilities were closed forcing the patients to be sent to old ones that were not setup for them. The only sense that the local paper could make of it was that the decision makers were trying to sabotage the mandate by sparking patient/general public outrage.


At the end of the day - a mixed model can be implemented and can work but with the forces at play that prefer one or the other, it will take work to make sure the setup works properly.


Cheers


----------



## Eclectic12

fatcat said:


> that's because the stakes are high and you have a bifurcation between the "universalists" and the "free marketers" ... there is little trust on either side
> 
> we need someone to stake out a middle ground that is acceptable to both sides


I suspect this is understating the number of players involved, never mind the big dollars to be made or lost with their agendas. The big drug companies hate how short Canada protects proprietary drugs as well as Canada's preference for using the cheaper generic versions. Several US states look at how early the generic version is available and wish the same option was available for them. 



fatcat said:


> ... of the two, i see single payer as the better option versus the american/free-market system which is a failure
> 
> but i would much prefer a universal coverage system that was delivered by private insurers
> 
> the provincial health authority and large insurance companies share the same characteristics of being large, distant bureaucracies that are tough to go up against


One concern is how long the private more responsive insurers would survive. There are many examples including Air Canada where predatory pricing and/or buying out the smaller competition quickly changed the pricing back to the status quo.


Cheers


----------



## fatcat

Eclectic12 said:


> I suspect this is understating the number of players involved, never mind the big dollars to be made or lost with their agendas. The big drug companies hate how short Canada protects proprietary drugs as well as Canada's preference for using the cheaper generic versions. Several US states look at how early the generic version is available and wish the same option was available for them.
> 
> 
> 
> One concern is how long the private more responsive insurers would survive. There are many examples including Air Canada where predatory pricing and/or buying out the smaller competition quickly changed the pricing back to the status quo.
> 
> 
> Cheers


on the generics, good point, it is an excellent example of why the universal system works ... canada has tremendous buying power and can stand up to the drug companies ... in the usa they have powerful lobbyists and it isn't so easy

on the private companies being bought out, i think this is preventable via legislation ... we don't want to allow behemoth insurers ... we want enough companies to serve the varied needs of different kinds of customers all based a minmum level of service available to all regardless of income .. i think obama's copper silver and gold plans are the basic idea .. the copper must deliver something like what we have now and the higher cost plans can add whatever frills they like (guaranteed private rooms, more choices etc)

don't forget, in holland and switzerland and places that have this system, the state oversees the delivery of services and can prevent predatory pricing


----------



## Eclectic12

fatcat said:


> on the generics, good point, it is an excellent example of why the universal system works ... canada has tremendous buying power and can stand up to the drug companies ... in the usa they have powerful lobbyists and it isn't so easy


It would appear that at least one drug company has given up on the lobbying route.
http://www.cbc.ca/news/business/eli...it-against-canada-over-drug-patents-1.1829854




fatcat said:


> on the private companies being bought out, i think this is preventable via legislation ...
> don't forget, in holland and switzerland and places that have this system, the state oversees the delivery of services and can prevent predatory pricing


That's where there needs to be time to make the shift properly, in a well thought out way. 


Cheers


----------



## bgc_fan

Thought these links might be of interest regarding US Health care costs. As with anything on the Internet, take with a grain of salt.

Examples of bills: http://nedhardy.com/2014/05/08/shouldnt-get-sick-america/

Reasons for the high cost: http://nedhardy.com/2011/05/06/why-is-healtcare-so-expensive-in-america/


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## Eclectic12

fatcat said:


> ... don't forget, in holland and switzerland and places that have this system, the state oversees the delivery of services and can prevent predatory pricing


I'm not forgetting .... I am looking at the recent past gov't actions (ex. the Feds failing to anticipate that those with money would see the 1% TFSA over-contribution as cheap to convert over $100K to be tax free, Ontario's spending $1 Billion for eHealth in 2009 with nothing to show for it) and am not sure the appropriate actions will be taken.


Cheers


----------



## fatcat

Eclectic12 said:


> I'm not forgetting .... I am looking at the recent past gov't actions (ex. the Feds failing to anticipate that those with money would see the 1% TFSA over-contribution as cheap to convert over $100K to be tax free, Ontario's spending $1 Billion for eHealth in 2009 with nothing to show for it) and am not sure the appropriate actions will be taken.
> 
> 
> Cheers


believe me i am no fan of government bureacracies, but as bgc_fan indicates above, the private system is worse and pretty reliably guaranteed to be as predatory as possible



> Thought these links might be of interest regarding US Health care costs. As with anything on the Internet, take with a grain of salt.
> 
> Examples of bills: http://nedhardy.com/2014/05/08/shoul...-sick-america/


 don't forget, these are retail prices and the insurance companies pay much less than the "sticker" price ... canadians that have found themselves stuck with huge bills like these from illness or accidents on trips have often been able to negotiate much lower prices

but yeah, they are ridiculous


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## Eclectic12

Hmm ... do you have an references for Canadians able to negotiate a lower fee?

I have not met anyone Canadians who have had the charges reduced ... but that might be more around the fact that Canadians aren't used to negotiating healthcare charges.

The American neighbour in Clearwater was bitter that the hospital charged something like $5K for the meals her unconscious husband on an IV drip supposedly ate. According to her, her lawyer couldn't believe that despite examples of over-charges or bogus charges, he was only able to negotiate a 7% reduction for the final bill.

So yes, an insurance company *could* pay less but at the same time, they are also subject to bogus charges. One of the front page articles in the Tampa paper was a doctor who quit and was requesting a state investigation as according to him, those with insurance were being kept for long periods after they were well and those whose insurance had run out were being told they were well to get them out the door despite being sick.


Cheers


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## fatcat

Eclectic12 said:


> Hmm ... do you have an references for Canadians able to negotiate a lower fee?


http://www.cbc.ca/news/canada/briti...-rejected-by-travel-insurance-firms-1.1407701

..........
If that fails, he said, *U.S. hospitals will almost always discount bills by at least 30 to 50 per cent.*

One case in point is Anna Friesen of Abbotsford, B.C., whose story was featured by Go Public a year ago. A mistake on an insurance form left her with a $53,000 bill for treatment at the El Centro Regional Medical Center in California. *She appealed to the hospital under its "financial assistance" program, and her entire bill was forgiven. *

"There is always wiggle room to negotiate," Cappon said, *"Even the insurance companies don't pay [hospitals]

the full ticket price."*

even the hospitals know they are overcharging and they'd rather get some money in hand versus fight for the full amount down the road ... the markup is huge and they know it


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## Electric

If you are a professional like an engineer, and have a job, you are much better off healthcare-wise in a major urban centre south of the border. My father in law died on a Canadian waiting list for a heart bypass; he would have been operated on within hours in the States. Also you earn more, and you keep more of what you earn.


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## smihaila

+1


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## james4beach

Electric said:


> If you are a professional like an engineer, and have a job, you are much better off healthcare-wise in a major urban centre south of the border.


I'm a professional, in fact an engineer, with a job. Yet my US company health plan has several big holes in it. If I had certain medical conditions I could be paying several thousand $ out of pocket each year... my own money... despite having a health plan. This is the ridiculous complexity of US healthcare: not all plans are created equally and nobody can figure out the caveats (they're designed to be very complex). There's a woman in my office who told me a story about how she experienced a relatively simple infection and complication and she paid close to $10,000 out of her own pocket, again I will emphasize, while covered by the company's health plan.

This happens because health plans have deductibles and co-pay arrangements which means the plans cover only a certain % and leave you paying the other %. Because US hospital bills are astronomical, even a small % you're responsible for can translate to a huge amount you owe. Furthermore, because of the ongoing US recession companies have been trimming back their health plans and replacing them with less generous ones (for example HSA schemes). It's not the same as what you heard about the great old USA 10 years ago.

Trust me... USA is seriously slipping. I don't even have a dental plan, by the way! And yes I work for a well established, major employer who generally treats us quite well.



> My father in law died on a Canadian waiting list for a heart bypass; he would have been operated on within hours in the States.


Sorry to hear about that and perhaps you're right. Perhaps he would have gotten faster treatment in the US.



> Also you earn more, and you keep more of what you earn.


This was the whole point of my original post. This is not true in my own experience. As an engineer coming from Ontario to a high-tax west coast US state, my gross income went up but my net income stayed the same.

I keep less of what I earn in the USA.

Let me emphasize that again. While my gross income _did_ increase, my net income remained the same. *I don't take home any more pay in the USA than I did in Canada.*

Since California is a place that attracts a lot of engineers, this is worth noting: taxes in California are very high. So is the cost of living. Calculate everything carefully before you assume you'll be taking home more income. Adjust for the health care complications and risk of major expenses (for instance you get laid off and then have health problems), and I bet you that you're better off in Canada, financially.

There are exceptions to all of this... if you move to a state with low taxes for instance. Or if you're a huge consumer of goods that normally get HST in Canada but move to a no salestax state, then you may enjoy benefits.


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## Eclectic12

+1 for the "calculate everything ... there are exceptions". 


The part about carefully calculating everything was what I tried to tell a relative before he moved to the US but he was convinced there no need as in him mind, it was clearly superior. In hind sight, the calculations might have been a better road as he moved his family back to Ontario in under two years.


I'm not sure what makes this a polarizing discussion where people want it one way or the other. 
There's lots of letters to the editor, posts and articles to clearly show that it is a complicated situation where one size does not fit all.


Cheers


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## HaroldCrump

James4B, is this your first year in the US?
Have you filed a US tax return yet?
You may find that you will get a rather nice tax refund.
Calculate your final numbers once you have filed at least one tax return in the US.

California is amongst the highest tax jurisdictions in the US, so it is not altogether surprising that you aren't seeing the big tax savings that people speak of when moving to the US.


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## Eclectic12

HaroldCrump said:


> James4B, is this your first year in the US?
> Have you filed a US tax return yet?
> You may find that you will get a rather nice tax refund.
> Calculate your final numbers once you have filed at least one tax return in the US.


 ... good point.




HaroldCrump said:


> ... California is amongst the highest tax jurisdictions in the US, so it is not altogether surprising that you aren't seeing the big tax savings that people speak of when moving to the US.


Hmmm ... I thought I saw in on of the threads that the state in question was not California (or maybe my memory is failing me :biggrin: ) ... the OP can confirm.


Cheers


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## james4beach

HaroldCrump said:


> James4B, is this your first year in the US?
> Have you filed a US tax return yet?
> You may find that you will get a rather nice tax refund.
> Calculate your final numbers once you have filed at least one tax return in the US.
> 
> California is amongst the highest tax jurisdictions in the US, so it is not altogether surprising that you aren't seeing the big tax savings that people speak of when moving to the US.


Hi Harold. Yes it's my first year so I won't be filing taxes until next year -- true that I have to see how the filing plays out. But I've also used online tax estimators and the results are quite similar to what I see on my paycheque. I had also seen an accountant before moving and showed my estimates, and she more or less agreed with my figures.

I don't live in CA but rather OR. Income taxes are very high in both states.


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## Eclectic12

^^^

I thought I remembered something other than CA but OR slipped my mind ... (a sign of aging perhaps? :biggrin: )

I wouldn't have expect OR to be high but having traveled to several states as well as chatted with people, the fact that there is a lot of variation is clear.


Cheers


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## gibor365

HaroldCrump said:


> James4B, is this your first year in the US?
> Have you filed a US tax return yet?
> You may find that you will get a rather nice tax refund.
> Calculate your final numbers once you have filed at least one tax return in the US.
> 
> California is amongst the highest tax jurisdictions in the US, so it is not altogether surprising that you aren't seeing the big tax savings that people speak of when moving to the US.


If James didn't move his "tax home" to US, he will need to file also Caanadian taxes.... and to move "tax home" to US is not so easy, you should convince CRA that you moved for good...
Low taxes in USA is just a myth  When my wife got rellocation offer to move to California, I did all calculations and figured that income tax in Cali (for about 150K salary) is practically same like in Ontario and much higher than in AB or BC... Add medical expenses (that even with good coverage in US , you very freq should pay out of pocket), more expensive high education... all those gated communities , much higher that in Canada crime rate and generally less friendly people than here.... at the end we decided that it doesn't make sense to move to US (even though we we promissed L1A/L2A visas and Green card withinn 5 years + huge rellocation benefits).
btw, I was very surprised that gas prices in Cali is very higher, close to what we pay here....some other things in Cali pissed us off... even though my wife company gave mortgage guarant in WFC, we couldn't take mortgage (and we asked just 10-15% of value of the home - 85-90% we wanted to pay in cash), clerk said that we need to live at least 2 years in cali to get it... they don't accept Canadian credit history , even though credit ratings done by the same companies, you cannot bring there new car with less than specified mileage ... you need to perform same special emission test accepted only in Cali, need to do your driving license from scratch and I think some insurance companies even don't except Canadian driving experience.... and so on...
I think it would be easier to move to some Europen country than to US


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## uptoolate

Electric said:


> If you are a professional like an engineer, and have a job, you are much better off healthcare-wise in a major urban centre south of the border. My father in law died on a Canadian waiting list for a heart bypass; he would have been operated on within hours in the States. Also you earn more, and you keep more of what you earn.


Not sure that the 'earn more, keep more' is true' anymore (actually pretty sure it is not). I think MD's likely earn about the same and wind up keeping more than their US counterparts. This has probably been true for about the last 10 years. Varies from province to province/state to state. 

I'm very sorry to hear about your father but I would much rather take my chances in an urban center in Canada than one in the United States with a major health issue even if I had gold-plated coverage. I know many of my colleagues feel this way as well. Also bear in mind that even if you do have great health care coverage, once one gets sick, the health insurance provider will go to great lengths to get you out of their plan.


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## uptoolate

gibor said:


> I think it would be easier to move to some European country than to US


+1 on this for me.


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## fatcat

Electric said:


> If you are a professional like an engineer, and have a job, you are much better off healthcare-wise in a major urban centre south of the border. My father in law died on a Canadian waiting list for a heart bypass; he would have been operated on within hours in the States. Also you earn more, and you keep more of what you earn.


sorry to hear this but it is not the usual experience where we we usually triage people pretty well ... i lived in the usa for many decades, do you really want me to start counting the number of people who died from heart problems because of lack of access to care or substandard care ? ... the list would make your father-in-laws (admittedly awful ... my dad died 24 hours after getting his new pacemaker) experience a minor blip

american health care is a nightmare for all but the healthy and wealthy and as james said, the opportunities to slip through the tracks and end up with a huge bill are many and varied

canadians who pine for a us style health care system just have no idea how bad the american system really is ... its a predatory system where one group thrives at the expense of another


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## gibor365

fatcat said:


> american health care is a nightmare for all but the healthy and wealthy and as james said, the opportunities to slip through the tracks and end up with a huge bill are many and varied
> 
> canadians who pine for a us style health care system just have no idea how bad the american system really is ... its a predatory system where one group thrives at the expense of another


Agreed! 
No wonder that WHO ranked US helth care at 37th place and
CIA even lower (behind Cuba)
http://www.orthocuban.com/2009/08/healthcare-and-the-cia-world-factbook/
Canada needs not US style, but France style healthcare !


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## fraser

I have never worked in the US however I did work closely with a number of colleagues in the US. I do not know what the impact of Obama care will be however just prior to it's introduction I remember of comments of two fellow regional directors in the US. Both were in their mid/late fifties.

One had just been advised that he was being downsized. His biggest concern was not finding another position-he was not without resources. His issue was healthcare. His wife had cancer. His heath insurance was about to go away and according to him the implications for his financial stability were poor at best-unless he secured another position. The second director planned to retire early however the cost of insurance for him and his spouse from ages 58 forward until medicare kicked in was prohibitive due to existing health issues. My impression is that the system is somewhat like those Allstate hands in the commercial. If those support hands vanish you quickly fall into an abyss.


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## fatcat

fraser said:


> I have never worked in the US however I did work closely with a number of colleagues in the US. I do not know what the impact of Obama care will be however just prior to it's introduction I remember of comments of two fellow regional directors in the US. Both were in their mid/late fifties.
> 
> One had just been advised that he was being downsized. His biggest concern was not finding another position-he was not without resources. His issue was healthcare. His wife had cancer. His heath insurance was about to go away and according to him the implications for his financial stability were poor at best-unless he secured another position. The second director planned to retire early however the cost of insurance for him and his spouse from ages 58 forward until medicare kicked in was prohibitive due to existing health issues. My impression is that the system is somewhat like those Allstate hands in the commercial. If those support hands vanish you quickly fall into an abyss.


there is a huge and perilous valley in american healthcare ... it begins at age 55 and ends at age 65

when you reach 65 you are eligible for medicare, before 65 you wander in the village of damned

by 55 most people have health issues, some have significant health issues, it can make you either uninsurable or only insurable at high cost, sometimes very high costs (think 18K a year for a single person for premiums in the high risk pools ... this doesn't even include co-pays and the rest ... a single person can go over 20K in a year)

there is a bridge from job to job called cobra coverage but on the whole, it can be a nightmare for people in that age group

this is where a huge percentage of the health care coverage problems occur


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## gibor365

This is probably whu so many Americans in their 40's and 50's want to retire in Mexico, Costa Rico, PAnama, Ecuador etc...


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## fraser

Last year, on a cruise, I met a retired VP-HR of a large firm. He had retired early and was doing some consulting work. 

He said that health care costs were spiralling in the US and that many large firms actually self insure. They pay the insurance companies to administer the plans on a cost plus basis.

One interesting thing he said was that many firms we doing various things to reduce their health care costs. The first was placing an employee lifetime limit on benefits. It think he said PepsiCo had done this (could be mistaken) and their number was $1M. Not a lot if a serious long term dependent health issue arises. Some firms were increasing the employee pay amounts AND increasing the annual deductible before the insurance kicks in-some at 5K, others as high as 10K.

He was not optimistic about the direction but was certain that employees in most of the firms he was working with were going to continue to see significant cuts in health insurance benefits, ie they would have less benefits and would be paying more out of their own pockets.


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## fatcat

fraser said:


> He was not optimistic about the direction but was certain that employees in most of the firms he was working with were going to continue to see significant cuts in health insurance benefits, ie they would have less benefits and would be paying more out of their own pockets.


of course, obamacare didn't come in in a vacuum ... the insurance companies see the handwriting on the wall, as do the large companies, costs are increasing out of control

canada spends 10% of its gdp on health care ... the usa spends 16% of its gdp

you can either put the 6% difference in the pockets of the insurers or reduce the costs of the consumers

effectively, in canada we are reducing the costs to the consumers 

the usa system is broken, crumbling and obamacare notwithstanding, will eventually fall ...

it MUST fail because according the laws of capitalism it is selling a product that its customers can no longer afford


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## Cal

On a related note, I heard this week that Canada is opening up some tax info to the US as of July 1st, so that the US can track previous citizens who have not been filing US taxes.


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## fatcat

Cal said:


> On a related note, I heard this week that Canada is opening up some tax info to the US as of July 1st, so that the US can track previous citizens who have not been filing US taxes.


it's called FATCA and has been in the works for many years ...


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## Eclectic12

^^^

The articles I've read says it's banking information as a starting point.

If a Canadian bank has information that identifies a customer having a connection to the US, then the bank forwards their files to the CRA who then turns them over to the IRS.

One of the questions is how the US will deal with run of the mill people who are identified as the US estimates there's one million US citizens in Canada whereas only about 300K identify themselves this way. It may be people are aware of being a US citizen but are thinking themselves as Canadian. Or it may be they don't know that being born in Canada to a parent with US citizenship can be enough to be a dual citizen.

http://globalnews.ca/news/1130967/canada-u-s-sign-controversial-fatca-tax-deal/
http://www.cbc.ca/news/politics/fatca-tax-deal-forces-canadian-banks-to-send-info-to-irs-1.2690039


Cheers


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## RCB

I'm one of those affected by this FATCA mess. There are going to be a whole group of Canadians suddenly stunned to find the IRS considers them tax cheats, sending letters demanding they file taxes and pay penalties for not previously filing.

Even those who may have thought they were no longer US citizens, or those previously denied US citizenship could be caught up in this. US tax and citizenship law has changed constantly, re-imposing citizenship (and taxation obligation) on unsuspecting non-Americans around the world.

In my case, I was born in the US to Canadian parents there temporarily. I was repatriated to Canada as an infant. I was told by the US government decades ago that I was not a citizen. Around 2010, I learned through media reports, and research that they did in fact consider me to be a citizen, and a tax cheat as well. This despite never having lived or worked there (beyond infancy), never applying for a US passport or SSN, etc.

It's a pretty ridiculous situation.


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## Eclectic12

^^^^

My co-worker was saying he & his American wife started the process to renounce her citizenship (and the kids born in the US) but found at the time it was complicated/expensive. He now regrets not finishing up as going through their US/Canada specialist, it's costing something north of $4K.

He also said that with the passport swipes - he figures he won't be able to go to the US until their tax returns/citizenship is cleared up ( ... not sure if this is him being cautious and/or a recommendation made to him).


Cheers


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## RCB

Yes, it can be very expensive. Renouncing the citizenship will cost $450 US to the Dept. of State, plus a trip to a US consulate. (If you can relinquish, it's free, but few born dual can relinquish by law.). It's their demands that you become current on tax filings, FBARS (reporting your bank and financial accounts because they are foreign to the US), non-filing penalties, and filing the exit tax form that can be very expensive. Add in the cost of tax professionals, and it can get crazy. Preparing US tax returns is insane compared to filing in Canada. God help you if you have Canadian mutual funds...the dreaded PFICs.

I had to renounce (something they told me I didn't have 25 years ago), filed an exit tax form, filed no taxes or FBARS. I am 100% tax compliant in my own country (Canada), and I feel no need to donate to the US. I am fully prepared to never enter the US again, despite the fact that I can pretty much see their country from my front door. I have no US assets they can confiscate.


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