# Why moderate income people would retire in Canada



## osc

By moderate income retiree I mean anyone making at least 100k/year. 
I can come with a lot of reasons why not retire in Canada:
- high taxes and the money partially go to finance the retirement of people who did not save during their lifetime. In contrast, one could retire in a Caribbean country and pay no taxes.
- terrible health-care. It's true that the direct cost is very low, but the service is awful.
- bad weather year round except a couple of months on the west coast.
I'm interested in the reasons why current retirees chose Canada and why future moderate income retirees would retire in Canada.


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## clovis8

osc said:


> - terrible health-care. It's true that the direct cost is very low, but the service is awful.



This is the biggest fallacy on earth. Do you know a single person that had to wait for anything non-elective ever? I doubt it.


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## steve41

Look, if were retired with $1M in my savings nest egg, I will be forced to endure an income tax rate fluctuating somewhere between 12 and 20% (fed&prov), and I would enjoy an aftertax lifestyle of $58k annually.

This buys me pretty good health care, a country which is politically and economically stable and secure. Plus I have access to good infrastructure and consumer goods, with the added bonus of being close to my kids and grandkids. I choose Canada for those reasons. If you want to live in Haiti behind a concrete wall with razor wire.... go for it.


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## kcowan

Also you can pay taxes in Canada and avoid the worst weather by becoming a snowbird. Enjoy some to the world's best weather in the middle of the year. And if you make a lot less than $100k, collect OAS too.


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## osc

clovis8 said:


> This is the biggest fallacy on earth. Do you know a single person that had to wait for anything non-elective ever? I doubt it.


Are you serious? Anyone I know (including me) has to wait 5-6 months to see a specialist for any problem. ER waiting times are outrageous. The number of doctors is the lowest in any developed country and they have a monopoly to prevent foreign trained doctors to practice.
Also, proper health-care is denied by law in Canada, as I cannot purchase private health insurance or at least pay to see a specialist in Canada in a timely manner.


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## Addy

osc said:


> Are you serious? Anyone I know (including me) has to wait 5-6 months to see a specialist for any problem. ER waiting times are outrageous. The number of doctors is the lowest in any developed country and they have a monopoly to prevent foreign trained doctors to practice.
> Also, proper health-care is denied by law in Canada, as I cannot purchase private health insurance or at least pay to see a specialist in Canada in a timely manner.


Where do you live? I was able to see a specialist in less than a week.... my appt is this Thursday. ER wait times are long for people who show up at ER without any emergency. They should wait.


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## steve41

The only time-related stat that is meaningful to health care is life expectancy. Canada is number 10 out of 190. The US is buried down in the mid-30s. (although I am certain you would be able to get an appt with that plastic surgeon immediately in the US)


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## brad

Moving to another country is a big deal, and the older you are, the harder it can be to adjust. Inertia and proximity to family are probably the leading reasons why many Canadians choose to stay in Canada during retirement, but it's also entirely possible that many of them love living here and wouldn't consider moving. I'm a dual US/Canadian citizen and I live here by choice; I don't know if I'd ever move back to the States. I like winter; if anything I'd retire to a location farther north than where I live now.


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## loggedout

osc said:


> By moderate income retiree I mean anyone making at least 100k/year.
> I can come with a lot of reasons why not retire in Canada:
> - high taxes and the money partially go to finance the retirement of people who did not save during their lifetime. In contrast, one could retire in a Caribbean country and pay no taxes.
> - terrible health-care. It's true that the direct cost is very low, but the service is awful.
> - bad weather year round except a couple of months on the west coast.
> I'm interested in the reasons why current retirees chose Canada and why future moderate income retirees would retire in Canada.


There's lots of non-financial reasons:

Friends and family are here. Are familiar with the culture and like living where they are.


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## GeniusBoy27

I'm going to go defend Canadian health care. Having worked both in the United States and Canada, I chose to return home to Canada for a multitude of reasons.

The pros of the American health care system. If you're in the 80% who has health care, in general, it's better with regards to the speed of getting things done. Wait times at private hospitals are indeed lower.

However, the Canadian medical training is among the most rigorous in the world. That's why there is restrictive policies of not letting every foreign doctor in. It's to preserve quality of care.

The question that should be asked is does the delay in health care lead to worse outcomes? Yes, there are exceptions to the rule, but in general, it doesn't really lead to significant increases in morbidity or mortality.

Outrageous wait times in the ER? Perhaps in other ERs, but the numbers aren't any different than they were in the US for the same volume hospitals. In the US, however, there are many more hospitals geared toward attracting business, so that an individual volume is much less, and the key is that nursing ratios are quite different (and that's your limiting factor in your ER -- the nursing ratios both on the ER, and what they can take on the wards).

Compare our hospitals to US public hospitals, and we're way better. Go to Cook County in Chicago, or any of the Baltimore public hospitals, and I've seen developing country hospitals that are way better.

So, if you're going to a location with better health care, and you're going to transport yourself, how much more insurance will you need to pay? What are the additional costs, if you're not supported by a company? If you're in 65+ year-range, the premiums are going to be extremely high, and if you're not insured well enough or run your limits (and 75% of your lifetime health care costs come in your last year of life), you can easily go bankrupt. 

(As an aside, I had a close friend and his wife in the US, both of who were doctors (and high paying doctors) and had the insurance from the hospital, go bankrupt when their son had cancer. If it wasn't for the generosity of friends, they would have lost everything. Is this a society I want to live in? Nope.)

The US is in big trouble presently with their health care system. It's 16% of GDP and growing (in comparison, it's 10% of GDP in Canada). So either they cut back on what government spends on health care, or it's going to further bankrupt the system as the boomers hit retirement. Our system will sustain much more stress. I also think there's a great fallacy is that health care is hospital care. Our system needs to build up longer-term facilities and more primary care. The speed of seeing a specialist isn't how we should measure the success of our health care system.

Why do I stay in Canada when I came make 2 or 3 times as much in other places in the world? Family is a big reason. I also like the fact that I can go outside and not run the risk of getting shot or mugged. And I like our tolerant multi-cultural society. 

BTW, someone making 100K/year as a retiree is NOT a moderate income retiree. That's a high income retiree. Everyone worries about the high taxes we pay. Trust me, of all people who know about that, the majority of my taxes are at a 46% marginal tax bracket. But in the grand scheme of things, for the tolerant, safe society that we live in, Canada's a damn good place to be. Amd when you're really, really sick, Canada treats its ill, pretty well.


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## OhGreatGuru

osc said:


> ...
> I'm interested in the reasons why current retirees chose Canada and why future moderate income retirees would retire in Canada.


If you have to ask, discussion would be pointless. By all means go, and good riddance.


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## steve41

and don't forget, that guy in the 47% marginal tax bracket is probably only paying 25% as an effective tax rate. People who throw around that marginal tax rate statistic, inferring they only get to keep half their income after tax are, in most cases, guilty of gross exaggeration.


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## Eclectic12

brad said:


> Moving to another country is a big deal, and the older you are, the harder it can be to adjust. Inertia and proximity to family are probably the leading reasons why many Canadians choose to stay in Canada during retirement, but it's also entirely possible that many of them love living here and wouldn't consider moving. I'm a dual US/Canadian citizen and I live here by choice; I don't know if I'd ever move back to the States. I like winter; if anything I'd retire to a location farther north than where I live now.


Yup ... I can see inertia and proximity to family. It's probably the same reason why Canadian hockey players stay in the US the where they played. Or similarly, why some US football players stay in Canada after their career in the CFL is over.


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## kcowan

The joke amoung expat retirees here in Mexico is that all the Americans are depending on medicare. And once they are 65, it is a good deal. Yet those on medicare have the worst of the private system.

I have had the misfortune to have several family and friends rely on Canadian health care during the last 2 years. They all received excellent care with no serious wait times. Only one person waited an extra 4 months for their dual hip replacement.


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## Square Root

Steve for high earners the marginal rates get pretty close to the average rates. In Alberta the benefit of all the lower rates is only around $18k I think. As far as health care is concerned it isn't perfect. Health care is rationed by the system. We usually get our time sensitive service at the Cleveland Clinic. You would be amazed at how good it can be if you can afford to pay. I agree this doesn't work for everyone(obviously) but we do indeed have two tier health care in Canada. Second tier is US. Best of both worlds for us. Really hard to understand why Canada can't produce or attract more doctors?


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## steve41

OK.... with $5M split evenly between rrsp and taxable, your effective tax rate fluctuates between 17% and 35%

This delivers you a $200k ATI.

At $200k, what on earth are you doing hanging around on this forum.... why don't you get your manservant or butler to do your communicating?


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## atrp2biz

Square Root said:


> Really hard to understand why Canada can't produce or attract more doctors?


Actually, Canada has no problem attracting doctors. My wife is a physician and all the good jobs are in Canada. Ontario has lifted the cap on earnings (which never made sense to begin with) and physicians don't have to worry about the credit-worthiness of their patients. She's completing her fellowship this year and we are looking at a plethora of opportunities--however, I think we have our hearts set on Calgary. Calgary works for me as well since I'm in the energy industry.

I think one of the problems with Canada's health care system is the ER. I would think only a small fraction of the patients in the ER are actually there for an emergency. I'm all for user fees (even $5-$10 per visit)--I think this would significantly improve the efficiency of ER operations.


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## MoneyGal

There *are* user fees, to some degree, in the Canadian health care system for unwarranted ER use: capitation payments to doctors. 

I am on the board of directors for a community health care centre - we provide primary (not urgent) care for a client base of people who experience barriers to receiving health care (our focus is on elderly clients with multiple, complex, chronic disease - and a special focus on diabetes). Keeping these clients OUT of the ER and IN their homes or other appropriate care settings is really the entire focus of our centre.


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## andrewf

The issue in Canada isn't an inability to attract doctors, but a disastrous supply-management strategy 20 years ago. Governments thought a good way to manage health care costs would be to reduce the number of new doctors entering the system. Who knew that would have unintended consequences?


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## andrewf

MoneyGal said:


> There *are* user fees, to some degree, in the Canadian health care system for unwarranted ER use: capitation payments to doctors.
> 
> I am on the board of directors for a community health care centre - we provide primary (not urgent) care for a client base of people who experience barriers to receiving health care (our focus is on elderly clients with multiple, complex, chronic disease - and a special focus on diabetes). Keeping these clients OUT of the ER and IN their homes or other appropriate care settings is really the entire focus of our centre.


This is the key. People who show up in the ER with non-critical health problems aren't going to be dissuaded by a $10 fee. The waits are already ridiculous. We need a solid primary care system that is readily accessible to these people, when they need it. I think most people who show up at the ER with frivolous problems would much rather go to a primary care centre, were one available.

We should also have a 811 service for non-emergency calls (such as reporting gas leaks, reporting minor crime/disturbances, etc.).


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## atrp2biz

Also, internationally-trained doctors are at a severe disadvantage compared to their domestically-trained counterparts. Board exams are tailored to cases that have only been seen by Canadian residents.

It costs well into the seven figures to train ONE doctor--Canada should be welcoming foreign doctors with open arms since our taxes weren't used to train them.


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## GeniusBoy27

steve41 said:


> and don't forget, that guy in the 47% marginal tax bracket is probably only paying 25% as an effective tax rate. People who throw around that marginal tax rate statistic, inferring they only get to keep half their income after tax are, in most cases, guilty of gross exaggeration.


Hmmm, since I have my pay stub in front of me, my effective tax rate is 40%. As you make more, you average tax rate does approximate your marginal tax rate.

We could argue about unfairly brain draining other countries. The trade off in training, though occurs during residency and fellowship. You're highly underpaid for the service that's provided. So to say that it costs $1-1.5 million to train a doc is correct, but then again, you pay some of this back during residency and fellowship training.

I actually would argue that the board exam differentiation usually isn't in the written part of the exam, which is mostly knowledge-based. This is mostly factual knowledge. Where most foreigners fail is actually in the oral component of the examination, where examiners ask questions, and you have to explain your thought process. Since this tests the all-important communication component, it's actually important no matter where you're from that you're able to communicate to your patients/colleagues well.


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## steve41

Well, if your taxable income (salary) was 300K, your effective tax rate would be 38%, so..... congratulations are definitely in order. You are earning well over 300K. A true 'genius boy' at age 27!

I am going smack my 2 boys around next time I see them.


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## atrp2biz

GeniusBoy27 said:


> I actually would argue that the board exam differentiation usually isn't in the written part of the exam, which is mostly knowledge-based. This is mostly factual knowledge. Where most foreigners fail is actually in the oral component of the examination, where examiners ask questions, and you have to explain your thought process. Since this tests the all-important communication component, it's actually important no matter where you're from that you're able to communicate to your patients/colleagues well.


Hmmm...I would argue that it would be differences in access to OSCEs.


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## Square Root

steve41 said:


> OK.... with $5M split evenly between rrsp and taxable, your effective tax rate fluctuates between 17% and 35%
> 
> This delivers you a $200k ATI.
> 
> At $200k, what on earth are you doing hanging around on this forum.... why don't you get your manservant or butler to do your communicating?


I'm wondering too.


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## Eclectic12

atrp2biz said:


> Also, internationally-trained doctors are at a severe disadvantage compared to their domestically-trained counterparts. Board exams are tailored to cases that have only been seen by Canadian residents.
> 
> It costs well into the seven figures to train ONE doctor--Canada should be welcoming foreign doctors with open arms since our taxes weren't used to train them.


Depends ... the one I had in high school I could barely understand and didn't like his preference to medicate the symptoms.


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## GeniusBoy27

steve41 said:


> Well, if your taxable income (salary) was 300K, your effective tax rate would be 38%, so..... congratulations are definitely in order. You are earning well over 300K. A true 'genius boy' at age 27!
> 
> I am going smack my 2 boys around next time I see them.


Well, I'm not 27, I'm 38. But yes, I do earn above the 300K mark. But I do also have 17 years of post-secondary school university training.


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## atrp2biz

GeniusBoy27 said:


> Well, I'm not 27, I'm 38. But yes, I do earn above the 300K mark. But I do also have 17 years of post-secondary school university training.


What's your specialty?


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## the-royal-mail

Wile E Coyote....a GENIUS!


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## loggedout

On the general topic of health care, I think our health would be better served if we invested on the "front-end" by giving people the best chance of staying healthy by investing in gyms, recreational centers, physical fitness trainers, physiotherapists, nutritionists, etc.

Also, we'd be better off if we just let really old and chronically ill people in miserable states just die, instead of keeping them hanging on with the use of machines.

Good for doctors for making so much, but I think it's absurd and not a good investment in lieu of alternatives. I do my best to maintain my physical fitness and never see a doctor. I do not trust them at all.


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## steve41

> staying healthy by investing in gyms, recreational centers, physical fitness trainers, physiotherapists, nutritionists, etc.


 You forget Orthopedic Surgeons. If it weren't for the wacky, over-the-top, fitness, running, exercise, propaganda we have been indoctrinated with, the need for major joint replacement surgery would drop to near zero.


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## brad

steve41 said:


> If it weren't for the wacky, over-the-top, fitness, running, exercise, propaganda we have been indoctrinated with


I suppose the 26 studies (which are merely the tip of the iceberg) cited here do not provide enough evidence for the benefits of exercise?

http://www.hsph.harvard.edu/nutritionsource/staying-active/staying-active-full-story/index.html


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## loggedout

steve41 said:


> You forget Orthopedic Surgeons. If it weren't for the wacky, over-the-top, fitness, running, exercise, propaganda we have been indoctrinated with, the need for major joint replacement surgery would drop to near zero.


People are designed to live active lifestyles. That doesn't mean running 20 miles a day, which I think is stupid, but weight training and high intensity cardio (sprinting) coupled with low impact low intensity cardio like walking or swimming are good for your overall health. 

And I'm willing to bet that most joint replacement surgeries have to do with ppl being overweight than due to over-exercise. A physiotherapist could probably help active people from problems with joints by teaching them the proper running technique.


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## brad

I think it's important to separate the idea of "exercise as a weight loss strategy," which is questionable, from the idea of "exercise as an overall health strategy" which is much harder to assail and which has a lot more evidence to back it up. I know Gary Taubes has written about the ineffectiveness of exercise as a way to lose weight, and while I think there are many reasons to question Taubes's conclusions on diet I think he is correct on this front and there are many experts who would back him up. His conclusions are not news.

But the overall health benefits of exercise are well documented.


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## steve41

Gary Taubes new book is coming out this month. Watch for it. I have a lot of time for GT.... I read GCBC twice. Every medical professional/nutritionist should read it.


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## brad

steve41 said:


> Gary Taubes new book is coming out this month. Watch for it. I have a lot of time for GT.... I read GCBC twice. Every medical professional/nutritionist should read it.


Yes, but I think his argument is that increasing exercise is not an effective weight loss strategy, which I don't think any researcher would argue with. I feel like he's set up a bit of a straw man for that one, because pretty much everyone knows that weight loss is achieved by burning more calories than you consume. If you exercise more, you will most likely eat more unless you also put yourself on a calorie-restricted diet. And people who are disciplined about exercising generally eat fewer calories because they are health-conscious, so their results are misleading. All of this is common knowledge.

The thing about Gary Taubes is that his arguments make intuitive sense, but you have to keep in mind that 1) he's a journalist, and 2) he's a gadfly. He writes about controversies; I've been familiar with him and his work for 15 years through my membership in the National Association of Science Writers, and he thrives on controversy. Intuitive arguments are powerful, and he has a background in science so he knows how to back up his conclusions. And science isn't done by vote: one person who's right is worth 10,000 who are wrong. He could be the guy who's right.

But just because his arguments make sense doesn't make them correct. Part of my job involves responding to questions from people who make very intuitive and common-sense arguments against the claim that humans are changing the climate. These arguments make perfect sense (CO2 increases during past interglacials lagged behind temperature increases instead of leading them, Mars is warming but has no carbon dioxide, water vapour is the most powerful and prevalent greenhouse gas but is largely uninfluenced by human activity, etc.), and yet there are easy, basic Climate 101 answers to refute most of these arguments. None of these intuitive arguments have swayed the established conclusions about climate change, and it's not because there's some conspiracy or vested interest in keeping the climate scare alive. I know quite a few climate scientists, and most of them would love to be able to prove that climate change is not a problem.

Similarly, Taubes raises a lot of interesting and compelling questions, and the health/nutrition establishment needed someone like him to rock the boat. But it's going to take time and research to determine whether his arguments actually hold water. That's why the establishment hasn't changed its recommendations yet. It's easy to conclude that the establishment has a vested interest in sticking to its views, and that's probably true for commercial nutritionists, dieticians, etc. who sell their services and products based on current conventional thinking. But scientists are interested in learning the truth, no matter how inconvenient it may be, and I can guarantee that there are people out there now working on definitive, tightly controlled experiments that will show whether Taubes is barking up the right or wrong tree. We just have to wait a decade or two to know. 

In the meantime, I see no reason to believe him over anyone else just because he advocates a diet or lifestyle that seems more convenient to me.


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## Four Pillars

brad said:


> I think it's important to separate the idea of "exercise as a weight loss strategy," which is questionable, from the idea of "exercise as an overall health strategy" which is much harder to assail and which has a lot more evidence to back it up. I know Gary Taubes has written about the ineffectiveness of exercise as a way to lose weight, and while I think there are many reasons to question Taubes's conclusions on diet I think he is correct on this front and there are many experts who would back him up. His conclusions are not news.
> 
> But the overall health benefits of exercise are well documented.


I think that diet is generally a more efficient way to lose weight. However, it might depend on the starting point - someone who is very sedentary might benefit a lot from doing even a moderate amount of exercise, whereas someone who is already fairly active will find that increasing their exercise provides diminishing returns in terms of weight loss.

I guess the same logic could apply to diet.

You guys might find this article interesting:

http://www.cnn.com/2010/HEALTH/11/08/twinkie.diet.professor/index.html


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## steve41

Taubes isn't a medical researcher, he has a science/physics background, however his contribution to the diet argument is to detail all the past and recent diet science and present the effect of carbohydrate on human nutrition/health as a hypothesis. (OK, OK, for 'detail' read 'cherry-pick', but the reason it resonated with me is I had a 65 pound Atkins experience about 10 years ago.)

The carbohydrate hypothesis seems more reasonable (to me anyway) than the simplistic calories in = calories out hypothesis.


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## GeniusBoy27

atrp2biz said:


> What's your specialty?


I'm in emergency medicine.


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## GeniusBoy27

loggedout said:


> On the general topic of health care, I think our health would be better served if we invested on the "front-end" by giving people the best chance of staying healthy by investing in gyms, recreational centers, physical fitness trainers, physiotherapists, nutritionists, etc.
> 
> Also, we'd be better off if we just let really old and chronically ill people in miserable states just die, instead of keeping them hanging on with the use of machines.
> 
> Good for doctors for making so much, but I think it's absurd and not a good investment in lieu of alternatives. I do my best to maintain my physical fitness and never see a doctor. I do not trust them at all.


What I'd love to see is an increase in the tax credit for recreational activities from children to include adults, and to raise the limit from $500 to $1000. I mean, if you want to improve the health of the country, I'd be the first to say stop spending it on health care, and spend it on preventing health issues in the first place.

I'll say this. The Canadian physician salary increase in the past decade has been astronomical, to try and retain supply (i.e. physicians working, especially those hitting retirement ages). The salary push varies, but it's been far above inflation, especially if you factor retention bonuses paid to get people to go to under-served areas and on-call stipends. On the balance of this, somehow, the nurses haven't gotten that same percentage raise. Has it led to significantly improved health outcomes? Not really, except on our "target measures", but the overall system hasn't improved.

However, in general, there's still a large demand for physicians, and with close to 10-15% of the population without primary care services, that demand will continue to grow, until supply starts coming in.


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## Berubeland

Only nincompoops who watch too much US propaganda think our health care is worse than theirs, unless of course you're going to be a senator or very rich. 

The #1 leading cause of bankruptcy in the United States is health care related. (maybe now it's the foreclosure problem) 

My husband is from the USA so I feel quite well informed on this subject. 

He used to work for a big credit union and so had what most people would call excellent health care and of course he had other employers as well and so a variety of experiences with different providers. 

First of all the most significant difference between the two countries is attitude, here health care is a human right rather than a being a status symbol. 

Any comparison in tax rates between the two countries must also compare the difference between our health care which is included and unlimited in every single way and the cost of buying such a policy in the USA (If it were available). We've done these calculations and Canada is the cheaper place to live. 

Let me draw a little picture for you... my husbands father is in his 70's and has Parkinsons disease. He got a job at Home Depot and must still even though he is sick, go to work every single day or lose his medical coverage, yes he has medicare because of his age but his medicines and health care are not of course fully covered so he needs the additional health coverage by his employer. Otherwise it would bankrupt him. This is the only reason he works there. 

Average people in the States are terrified of any change to their health care, even on Medicare my Mother in law must pay for supplemental insurance. considering her pension is about $800 and she pays an additional $127 for "top up insurance" it must be important. 

Compare this to the most excellent care I received when I was pregnant and ill, my husband watched in amazement as I got 11 ultrasounds to monitor the growth of the baby, I went once a week to the OB, I had a special diabetes clinic I went to, I had a specialist in gestational diabetes to go to once per week, plus my family Doctor. Then I narrowly escaped having a C section. All at no expense to myself. Even the diabetes medicine was most free. I tried to get health insurance to go to the USA for a visit but there was none to be had, god forbid something should have happened if I went, Instead I just didn't go. 

Health care is a primary reason we stay here and will continue to stay here. Maybe this is just a raging liberal talking here, but I'm not sure I want to live in a country where it's acceptable for the indigent to die because they are too poor to afford health care. 

Oh and in case your confused about this maybe you should look up what's happening in Arizona where they're denying people transplants because it's too expensive and the people with end stage liver disease can't work and have health care, or look into the many many fundraising activities to help with the cost of cancer treatment for children. Personally I can't imagine anything worse than have a seriously ill child that you can't afford to get treatment for. 

So go ahead, go wherever you like, just don't get sick. A heart attack will cost you an additional 100K above your insurance. I'm not sure as Canadians we can imagine the horror of being seriously ill and being denied coverage because of something hidden on page 67 of your insurance policy. There was also a big scandal a while back about insurers retroactively canceling policies because women with breast cancer had "lied" or "omitted" stuff on their initial applications. One of them I remember had forgotten to mention that she had been treated for a yeast infection. So even thought she had reliably paid her premiums for years when she needed the coverage it was denied. 

Last time I went to the ER it was indeed packed full of people with minor conditions who waited a long time while people with heart attacks and serious injuries went first. When I went there with my son, who had eaten a bunch of Nicorette gum (poison) I did not wait. I'm not sure what's wrong with that. 

If you don't want to wait every single one of those people who are not receiving as fast as they want health care here have the option of going to get health care in the USA. They can go ahead any time and pay a couple hundred thousand to get a brand new hip joint replacement instead of waiting a year. Funny I don't hear about too many people doing that nor do I hear about clinics in the USA in border cities being inundated with Canadians who want to pay cash for service instead of waiting. I have heard about Americans who come over to Canada and buy our heath care service because it's much cheaper to pay cash for health care here.


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## brad

Berubeland said:


> So go ahead, go wherever you like, just don't get sick. A heart attack will cost you an additional 100K above your insurance.


I think the picture is a little more complicated and depends strongly on your health plan, where you live, etc.

When I lived in the Boston area, most of us were enrolled in HMOs (health maintenance organizations); the experience was very similar to that here in Canada except you paid a dollar per visit. Friends of mine who got pregnant paid a dollar to go to the hospital and have their baby delivered, for example. Employers picked up a large share of the insurance premium, and employees paid a small portion (about $30 or $60/month) out of their paycheques in addition to the dollar per visit to the doctor or hospital.

Having lived most of my life in the US (until I was 42) and then moving here 8 years ago, I don't see many differences overall in quality of life or level of taxation. I'm in Canada's highest marginal tax bracket, but my overall tax burden is pretty similar to what I had in the US when you consider federal, state, and local taxes, sales taxes, and health insurance premiums. 

For me, the provincial health plans are an invaluable safety net. I am much less worried about what would happen if I lost my job, because I know I won't have to pay for health insurance. That's the main reason why I doubt I'll ever move back to the States. My brother had no health insurance for most of his life, finally got insurance, but then got laid off and now has to pay $900/month in insurance premiums; he's used up most of his retirement savings paying for rent and health insurance.


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## osc

I don't see why everyone here compares our health care to that of US. I think both have problems. Our health care is good for the poor, which otherwise wouldn't afford health care, but is basically a Communist plan, with all forced into it. For me, it's totally inadequate. I would prefer a multi-tiered plan with different premiums and a basic taxpayer funded plan for the poor. I would also prefer to be able to choose from multiple plans, some private. Monopolies are never good for the customer.
The US health care is good for the middle class and for the rich. It is not good for the poor or for the under-insured. I think US would need a public plan to provide an alternative to the big insurance corporations and to provide health care to the poor.
If I were to choose, I would definitely choose the US system and I'd buy the most comprehensive insurance available.


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## Berubeland

Well OSC I have very good news for you, you may whenever you like go to the US, purchase insurance and get health care there. I'm not sure why you're not already if our health care is so bad. 

You also have the option to pay cash whenever the wait is too long. No one is stopping you. You do have the choice. 

Government run health care is not a monopoly. We all pay to take care of each other. The last thing I want when I'm sick is someone trying to figure out how they are going to get money out of me instead of figuring out how to get me well. 

Certain things are much better administered by government than for profit companies. Car Insurance and health care are much cheaper when operated by the government. I blissfully remember the days of paying for car insurance in Quebec.


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## osc

Berubeland said:


> Well OSC I have very good news for you, you may whenever you like go to the US, purchase insurance and get health care there. I'm not sure why you're not already if our health care is so bad.


Really, I can purchase insurance in US (and I mean insurance, not medical services)? Are you sure? Could someone else confirm this?


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## dogcom

I have to agree with berubeland on this one. I believe the US system is a nightmare except if you have the money of course, it seems that so many countries in the world are getting a lot cheaper system then the US and everyone is covered.

I often wonder why the people in the US want to save money all their working lives only to give it all to the doctors some day. I believe like berubeland that certain things are better administered by the government than for profit companies. The people in the US are always worried about their freedom and are probably less free today then they have ever been with the police state they are trying to form after 9/11.


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## marina628

loggedout said:


> On the general topic of health care, I think our health would be better served if we invested on the "front-end" by giving people the best chance of staying healthy by investing in gyms, recreational centers, physical fitness trainers, physiotherapists, nutritionists, etc.
> 
> Also, we'd be better off if we just let really old and chronically ill people in miserable states just die, instead of keeping them hanging on with the use of machines.
> 
> Good for doctors for making so much, but I think it's absurd and not a good investment in lieu of alternatives. I do my best to maintain my physical fitness and never see a doctor. I do not trust them at all.


Sometimes you have no control on you physical health ...


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## marina628

I was in a serious Car accident which left me permanently disabled .I do not speak about my situation often but until you go though a life threatening situation you do not appreciate the health care system we have.

I have no memory of the accident itself except hearing the tools the firemen used to cut me out .Even to this day certain sounds cause me to have a reaction . I had a broken back , pelvis ,legs and my right arm was nearly severed.

I am sure I felt pain but the things I hold to in my memory to this day are voices of the people who cared for me ,the EMS team,the nurses and Doctors who cared for me the six weeks I was in the hospital.I had eighteen surgeries before I could go home and many more since then and it has never cost me a dime.My husband and mother were told i had oxygen levels in the 30s and it did not look good but I survived.

I love to travel and would go and spend a couple months down south but I would never leave Canada because of the health care I DO continue to receive.I lost almost 1/2 inch of bone in my right hip/leg as my right side was nearly crushed so I do use a wheelchair 90% of the time .But I continue to get more function back every time i have surgical tweaks.

I have also received many Plastic Surgeries that Ohip paid for over the years.I can't even guess what the bill would cost for all the things I have had done.

ER waiting rooms may have long lines but it is there when you REALLY need it .I am sure I was a big mess for them to face the night I was brought in and probably people in the waiting room thought they were doing a bad job but they saved my life and my arm.

Marina


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## loggedout

marina628 said:


> Sometimes you have no control on you physical health ...


That's understood and your situation is unfortunate.

However if we could cut down on preventable illnesses and problems due to unhealthy living and our sedentary lifestyles, more resources could be allocated to the other illnesses and emergency situations like yours.

Another point, IMO, unless you need surgery for something you really don't need to see a doctor. Other, cheaper medical professionals can substitute sufficiently for everyday medical needs.


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## GeniusBoy27

osc said:


> I don't see why everyone here compares our health care to that of US. I think both have problems. Our health care is good for the poor, which otherwise wouldn't afford health care, but is basically a Communist plan, with all forced into it. For me, it's totally inadequate. I would prefer a multi-tiered plan with different premiums and a basic taxpayer funded plan for the poor. I would also prefer to be able to choose from multiple plans, some private. Monopolies are never good for the customer.
> The US health care is good for the middle class and for the rich. It is not good for the poor or for the under-insured. I think US would need a public plan to provide an alternative to the big insurance corporations and to provide health care to the poor.
> If I were to choose, I would definitely choose the US system and I'd buy the most comprehensive insurance available.


The average cost of health insurance in the US without a deductible is $13000. If you allow a $10000 deductible (i.e. you pay for everything up to $10K), then it's $5700 (give or take a few dollars). This type of medical plan would be equivalent to what you would get here in Canada, with the exception that you probably have better access to your primary care physician. It does not mean you get to see your specialist tomorrow if you want, because the majority of health care in the US is via Health Maintenance Organizations (HMOs), which still uses your primary care doc as a gatekeeper.

If you're truly looking for a comprehensive insurance plan without deductibles in the US, you're talking in the $25-30K/year (and even more) for health care insurance. If you're rich, no problem. (And to be honest, health care is one of the great enticements for employment.)

I just finished publishing a cost study between US and Canada for one of the drugs we commonly use in the ED. The hospitalization costs in the US is about $7700 per day (in 2008), compared to Canada, which is about $1400 per day (not including physician costs or any procedures).

How much does it cost for an ER visit? In the US, it's about $1000 for Medicaid (never mind what it is for private insurance) (that doesn't include the physician cost, the cost of any procedures, etc.); in comparison, it's about $150 in Canada.

As I said above, I've seen extremely wealthy individuals go bankrupt quickly because a child or family member got sick. I've had a classmate, who moved to the US, worked for Google, was a prof in New York, and came from a wealthy family (i.e. he was not poor to start off with) commit suicide because he had disabled twins, and his health insurance ran out and he was bleeding dry from paying all the bills.

The risk pooling effect of Canada's health care system (i.e. a generalized taxation system) is still the most efficient overall health care system. To be honest, it's already a two-tiered system (with prescriptions, parahealth, dental, and some non-essential medical care being funded via insurance or out-of-pocket), but that risk pooling lowers costs. Without the government as a large buyer, costs would skyrocket. Who's paying for it in the US? You are (either out of pocket, or through really high premiums for the service that you would want.)

The only way the US is getting this done right now, is via insurance through employers, and we saw it's wonderful impact on the automobile industry in the US. Health insurance is a major liability to US business today.

BTW -- you could probably get your private insurance and health care health in Canada in various places like Calgary, Vancouver, Edmonton and Toronto, (for at least primary care, radiological services, and some surgical areas (don't get me started on my opinion on that)).

Also, if you want the best bang for the buck in health care (country-wise), most people would argue for Cuba, a communist country, where there's a doctor for every 100 families. The model is to prevent ill health by having access to a physician that doesn't just treat disease, but also prevents illness by teaching about nutrition, health, and takes the care out of the hospital. Better life expectancy than the US; <1 % of their cost.


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## I'm Howard

Cool today, but should be mid to high 70's by Friday.

No HST, $ at par, $25 for 18 holes of golf, and no shovelling.

Bad News, only three months left.


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## Jungle

steve41 said:


> and don't forget, that guy in the 47% marginal tax bracket is probably only paying 25% as an effective tax rate. People who throw around that marginal tax rate statistic, inferring they only get to keep half their income after tax are, in most cases, guilty of gross exaggeration.


A lot of people are guilty of this, including me. When we are mad at all the deductions off our pay cheques, it's the first thing that comes out. 

People also see everything coming off, like CPP and just assume the whole thing is a tax.


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## Square Root

OK Let's agree that neither system (US or Canada) is perfect and could be improved? Wait times are too long in Canada and tbe poor are underserved in the US. Couldn't we come up with a hybrid system that works better than either? What would it look like? Maybe a base level of service paid by the state with higher levels paid by the individual? If so how would you keep he good doctors in the lower tier? Would you need to? I can afford more expensive care and I would rather get it in Canada. Why not? If I want a more expensive house or car nobody says it isn't fair if I do so?


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## OhGreatGuru

osc said:


> ...
> 
> I'm interested in the reasons why current retirees chose Canada and why future moderate income retirees would retire in Canada.


- Medicare;
- Subsidized Long Term Care;
- First World Standard of Living;
- First World Standards of Public Health
- Public Safety
- Low crime rates compared to many of the alternatives
- Freedom of Speech, Assembly, Religion, & Press;
- Stable (more or less) Democratic Government
- Simple gratitude to the country that made it possible for you to earn a "moderate" retirement income of $100K.
- No malaria, no Tsetse flies, very few poisonous snakes, no obscure tropical diseases, no 'gators, 'crocs or sharks
- infrequent tornadoes compared to US
- very rare hurricanes compared to US & Caribbean
- no volcanoes

Need I go on?


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## OhGreatGuru

osc said:


> ... I mean anyone making at least 100k/year.
> ... In contrast, one could retire in a Caribbean country *and pay no taxes*.
> ...


By the way, if your 100K/year income includes any of the following, you are still going to pay 25% withholding tax to CRA:

_The most common types of Canadian income subject to Part XIII tax are:

* dividends;
* rental and royalty payments;
* pension payments;
* Old Age Security pension;
* Canada Pension Plan and Quebec Pension Plan benefits;
* retiring allowances;
* registered retirement savings plan payments;
* registered retirement income fund payments;
* annuity payments;
* management fees.
_
So if you live in Aruba on these incomes you will be paying Canadian taxes and getting no services for it. And before you get incensed about it, most of these are either from tax-deferred accounts (pensions, RRSPs, & the like) or from business operations in Canada (rents & royalties)

The average tax rate in Ontario on $100K is 27.4%, counting no tax credits other then basic deduction. Less after you count other credits such as pension & age amounts, medical expenses, charitable donations, etc. So unless your income is from portable wealth that you can take out of the country with you, your CDN income tax bill may be about the same whether you stay or leave.


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## osc

I partially take back my first statement about high taxes. The taxes are high only before 65. After 65, the pension income could be split, the $100k split income qualifies for full OAS and according to taxtips.ca the income tax would be $18k. Since $12k is OAS, the retirees are left with $94k after taxes.
I've also seen some other good arguments. Maybe a snowbird lifestyle makes more sense after all.


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## Spidey

osc said:


> By moderate income retiree I mean anyone making at least 100k/year.
> I can come with a lot of reasons why not retire in Canada:
> - high taxes and the money partially go to finance the retirement of people who did not save during their lifetime. In contrast, one could retire in a Caribbean country and pay no taxes.
> - terrible health-care. It's true that the direct cost is very low, but the service is awful.
> - bad weather year round except a couple of months on the west coast.
> I'm interested in the reasons why current retirees chose Canada and why future moderate income retirees would retire in Canada.


Boy your definition of "moderate" income for a retiree is much different than mine and also much different than the statistics for average Canadian retirees would indicate.

I don't know how these would apply to other jurisdictions but the reasons I would stay over going to the US:

medicare - There are often loopholes in the American insurance plans. Someone told me of their friend, who thought he had good insurance, having to sell his house due to complications from having Alzheimer's disease.

family and friends

Complications and red tape with US estate taxes. 

Crime rates and litigious judicial system

A sense of patriotism

All that being said, I could easily see spending a couple of winter months in a warmer climate.


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## DavidJD

EVERYONE who can hobble back to Canada for health services does. One illness away from bankruptcy is a strong motivator. Enjoy retirement abroad but tell the ambulance to drop you off at the airport and have your travel agent's number on speed dial.

Physical recovery is much quicker than financial recovery.


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## kcowan

DavidJD said:


> EVERYONE who can hobble back to Canada for health services does. One illness away from bankruptcy is a strong motivator. Enjoy retirement abroad but tell the ambulance to drop you off at the airport and have your travel agent's number on speed dial.
> 
> Physical recovery is much quicker than financial recovery.


Everyone I know has insurance coverage of some type to handle emergency situations.


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## OhGreatGuru

kcowan said:


> Everyone I know has insurance coverage of some type to handle emergency situations.


Yes, they do. But;
- a) it gets more expensive with age;
- b) if you are fit to be transported, the insurance company will often gladly pay for an air ambulance back to Canada rather than pay your US hospital bills. 

When a friend of my parents was diagnosed with a serious liver ailment in Florida, his doctor's advice was to take an immediate plane back to Canada.


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## kcowan

OhGreatGuru said:


> Yes, they do. But;
> - a) it gets more expensive with age;
> - b) if you are fit to be transported, the insurance company will often gladly pay for an air ambulance back to Canada rather than pay your US hospital bills.


Plus if you don't have a permanent policy, pre-existing conditions can remove you from eligibility. There is specific medivac insurance that is cheaper than others. It relies on you having coverage up north. But some of them charge more for Canada because they have to stay with you until you get admited. And this can take a few days if your life is no longer in danger (almost always because medivac staff make that call).


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## uptoolate

A good read. Seems we are pretty happy with the quality of our healthcare system. Thanks to all the contributors.


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## OhGreatGuru

See this CNN article: *Medical bills prompt more than 60 percent of U.S. bankruptcies*

http://articles.cnn.com/2009-06-05/...ls-bankruptcies-health-insurance?_s=PM:HEALTH

_Quote:
This year, an estimated 1.5 million Americans will declare bankruptcy. Many people may chalk up that misfortune to overspending or a lavish lifestyle, but a new study suggests that more than 60 percent of people who go bankrupt are actually capsized by medical bills.

Bankruptcies due to medical bills increased by nearly 50 percent in a six-year period, from 46 percent in 2001 to 62 percent in 2007, and most of those who filed for bankruptcy were middle-class, well-educated homeowners, according to a report that will be published in the August issue of The American Journal of Medicine.

"Unless you're a Warren Buffett or Bill Gates, you're one illness away from financial ruin in this country," says lead author Steffie Woolhandler, M.D., of the Harvard Medical School, in Cambridge, Mass. "If an illness is long enough and expensive enough, private insurance offers very little protection against medical bankruptcy, and that's the major finding in our study."_

Save this for the next time you hear someone questioning the value of Medicare. Yes, we have service delivery problems in Canada, but at least we have a public health care sytem.


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## uptoolate

The stat doesn't surprise me Guru. When we talk finances with friends in the States, health insurance is always front and centre.


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## luisa

atrp2biz said:


> I think one of the problems with Canada's health care system is the ER. I would think only a small fraction of the patients in the ER are actually there for an emergency. I'm all for user fees (even $5-$10 per visit)--I think this would significantly improve the efficiency of ER operations.


I live in a smaller city and have 2 young children. A walk-in clinic with good operating hours to cover off the times when my doctor is not open and my children have an affliction that is not an emergency, but that needs to be addressed/diagnosed before they can return to school or daycare, would keep us out of the ER entirely. That is a big, gaping hole in our local healthcare system.


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## cato

osc said:


> I can come with a lot of reasons why not retire in Canada:
> - high taxes and the money partially go to finance the retirement of people who did not save during their lifetime. In contrast, one could retire in a Caribbean country and pay no taxes.
> - terrible health-care. It's true that the direct cost is very low, but the service is awful.
> - bad weather year round except a couple of months on the west coast.
> I'm interested in the reasons why current retirees chose Canada and why future moderate income retirees would retire in Canada.


Two things stand out as really important for me personally:
i) Security of Person
ii) Access to affordable healthcare
There are other things but these two rank at the top of my list.

Healthcare - physicians are paid extremely well in Canada, the only country that pays more is the USA, and this may be due to the fact that training as a MD is mostly similar and the border does not present a problem for a Canadian physician who wishes to practice in the USA. 

I do not have a particular issue with access, my experience is that access to care for emergency stuff is excellent, and the elective stuff, well that is the price you pay for a healthcare system that covers everybody. 

I do, however, have an issue with the fact that some physicians and nurses treat their patients as paupers and not deserving of respect, and sadly this seems to become worse as they grow older and have no one to advocate for them.


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## Islenska

My wife had to go in for day surgery at a nearby town in Manitoba so we didn't know anyone at the hospital. I was so moved by the compassionate care she received that I wrote a note to admin and promptly got a courteous reply. Thankfully we are not big health care users but if this was an indication of our healthcare system we are a very fortunate society. Of course you will run into glitches but overall remember---it could be worse. Now only if we can return the Stanley Cup to Winnipeg!


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## Brenner

I rarely use medical services anymore, but when I do and don't have to whip out the credit card I am very thankful to be in this country.


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## DanFo

a friend of mine went to hospitol in the states for one night.......$29 000..... thank godfor out of country med insurance!!!


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