Healthcare - Go Bankrupt, Or Wait And Risk Your Health - October 24, 2025

Medicine In Canada vs. The United States

I recently heard a story from a friend who is Canadian, but spends most of his time in Florida.  He was in Ottawa in November 2024, when he suffered a heart attack while driving his vehicle.  His wife was in the passenger seat, accompanying him on that drive.   While driving, he started feeling pain in his chest. Despite the discomfort, he tried to manage his way through the pain and briefly continued to drive the car.  When the pain became unbearable, he told his wife that he was having chest pains and he shouldn’t drive.  Despite the precarious position he was in, he safely brought the vehicle to the side of the road, switched places with his wife and she drove them to the Heart Institute emergency room.  Fortunately, he arrived there before too much damage was done. He was admitted and then taken to an operating room, where an angiogram was performed on him. An angiogram is a procedure that inserts a microscopic camera into your arteries and lets the doctors see what is occurring in those arteries.  The angiogram revealed that he had major blockage in one of his arteries, and that was disrupting the blood flow to the heart from that artery.   When a patient has an angiogram and the doctors find blockage, they perform another procedure, known as an angioplasty, right away. The angioplasty inserts a tiny balloon in your arteries and that balloon pushes away the plaque buildup in the artery, clearing away the blockage.  My friend had all of this done, and that took him out of immediate danger.  

After the procedure, the doctors told him he was ok for the time being, but that the angiogram revealed considerable blockage in another of his arteries.  He was told there was no immediate danger and they could schedule him for another angioplasty in a few months.  My friend was not happy with that solution, as he was naturally worried about the remaining blockage and it causing another heart attack.  He was told that because he was not in immediate danger, they could not schedule the follow-up procedure for some time.  There was a backlog of patients in the Ottawa area waiting for this medical service. So while all of this medical service was covered by the free Ontario provincial medical system, he would have to wait for the follow up procedure and put his health at risk, despite what the doctors were telling him.  Not being satisfied with the situation, he returned to his Florida home and consulted with doctors there.  I’m glad he chose to pursue alternate avenues for medical treatment, as many people who have the resources to do so would not wait for the Ontario medical system in dealing with a heart issue.  

In Florida, the doctors/hospital he consulted with said they could perform the angioplasty on his blocked artery right away, but they asked if he had insurance.  He replied that he was not planning to go through insurance, and that he would pay for the procedure himself.  The hospital administrator told him that most patients that get this procedure go through their health insurance plan, and that the hospital normally bills the insurance company $450,000 for this procedure. Once the shock wore off, my friend asked the question, “what will the cost of the procedure be if I pay in advance with my credit card?”.  After some back n’ forth, the hospital administrator told my friend they could do the procedure for $19,000. While $19,000 is considerably less than $450,000, it was still a shock. As Canadians and as Ontario residents, we’re used to only paying for parking, not several thousand dollars, let alone several hundred thousand dollars, for medical care.  My friend paid the $19,000 and had the procedure done shortly thereafter.  This Fall I saw him back in Ottawa and he looked no worse for wear, and was in good spirits.  My friend is fortunate to be able to manage a sudden $19,000 payment, but this story educated us all on the differences between Canadian health care and US health care. 

In obtaining his permission to share his story in this article, he commented that acute care in Canada is very good, but follow-up care is not great.  I’ve had the same experience and heard similar sentiments from others going through the Canadian medical system.  

Apparently it’s common practice in the United States for hospitals and doctors to issue enormous bills to health insurance companies and then negotiate a settlement for some lesser amount.  This is a standard practice, and all part of the “medical business” in the United States.  This practice or business side of medicine is foreign to Canadians, as we are used to “free” health care.  Free in the sense that obtaining medical treatment won’t send you into bankruptcy in Canada, but we’ve all experienced painful wait times in the emergency room, for minor ailments.  Or the wait time my friend was going to experience for “non-urgent” care, or the wait or availability for an MRI in Canada.  So while our health coverage is free, we do pay a price under the Canadian system.  

Is waiting or a delay in getting treatment worth the savings?  

In the United States, a healthy 35-year-old will pay about $500 a month, or $6,000 per year,  for basic health insurance, or their employer will pay 80-90% of that amount if they offer such benefits to their employees.  And, for family coverage (two adults, two children) you’re looking at $1,200 per month or $14,400 per year. This is the cost of buying health insurance through the public marketplace and under programs such as The Affordable Care Act (or “Obamacare”).  Either way, that is a lot of money that someone has to pay for basic health care, which covers doctor visits, hospitalization, and prescription drugs.  

On the other hand, Canadians don’t pay directly for most essential medical care (doctor visits, hospital stays, emergency care), but they do pay indirectly through taxes and some out-of-pocket costs for things not covered by provincial plans. Now Canadians do pay for prescriptions outside a hospital, if it's not covered by their employer’s health benefits plan.  But most employers offer some supplemental health insurance, because Canada’s public health system already covers hospitals and physician care, so private plans only top up the system — they don’t need to insure against catastrophic medical costs.  That’s why a Canadian employer’s cost per worker for health insurance coverage is often one-quarter or less of a U.S. employer’s cost.  

A common argument in favour of the American system is that while Canadians have “free” health care, they are actually paying for it in higher taxes.  Canadians do fund universal health care through their taxes, especially income taxes, but also sales taxes, payroll taxes, and corporate taxes.There’s no separate health insurance premium for basic coverage (as there is in the U.S.). Instead, the system is paid for collectively out of general government revenue.  The Fraser Institute’s 2024 estimate says the average Canadian family of four pays about CA$17,000 per year in taxes that go toward health care.  A single adult might contribute roughly CA$$6,000 per year through their share of income and consumption taxes.  Leaving the currency exchange rate out of the discussion, when you compare the amount noted above that Americans pay for their health care, with the portion of their taxes that Canadians pay towards health care service, Canadians are actually paying slightly more for health care services than Americans.  

BUT…

A 2019 study published in the American Journal of Public Health estimated that around 530,000 Americans file for bankruptcy each year because of medical bills or illness-related work loss.  The same study found that about 66 % of personal bankruptcy filings were associated with medical issues (illness, injury, medical bills) in the U.S.  The comparable data for Canadian medical expense-related bankruptcies was not readily available.  However, a study of Canadian bankruptcy filers found that 60% reported having a medical bill in the two years before filing, but only 7% reported a medical bill over CA $5,000. This suggests that unpaid medical expenses were not a contributing factor to Canadian bankruptcies.  

So, what does all this tell us?  

Canadians may have to wait longer for medical treatment in Canada, and those that have the means to do so, are seeking and paying for premium health care service outside the publicly funded system - either within Canada, in the United States, or in Europe.  Canadians may complain about wait times, but they are accustomed to paying more in taxes, to know that this health care is available to them, and they feel good knowing that they and their fellow Canadians are not going bankrupt because of unpaid medical bills. 

On the other hand, Americans may pay less in taxes and have near-zero wait times, but over a half-a-million Americans are going bankrupt because of their unpaid medical bills. They’re not keeping those tax savings aside to pay for medical expenses…more money in your pocket simply seems to mean more spending, to those south of the border.  

And, finally, Obamacare or not…

There is currently a shutdown of the United States government, with many federal employees either working without a regular pay cheque, or they are at risk of losing their jobs entirely.  This stalemate between the Democrats and Republicans seems to come down to Obamacare, or  the Affordable Care Act (“ACA”). Many Republicans believe the ACA gives the US federal government too much control over health care — a sector they think should be driven by private markets and individual choice. The ACA originally required everyone to buy health insurance or pay a penalty. Conservatives saw this as government overreach — forcing citizens to buy a product.  But when it comes to health insurance, judging by the number of medical expense-related bankruptcies, Americans seem to need a helping hand from their government.  The original intent of the ACA was to make health care in the United States. more accessible, affordable, and fair, without completely replacing the private insurance system. Before the ACA, about 48 million Americans (roughly 1 in 6 adults) were uninsured. Given how high that number is, I’m surprised the number of people filing for bankruptcy is only half-a-million people.  

I’m happy with the system we have in Canada. It’s not perfect, but I know I can get treatment, and that I can pay a premium to expedite the process.  I take comfort in knowing that all Canadians can get treatment too, and don’t have to lose their home in the process.