[nozzlegear]

> But in the US, when I step outside the walled gardens of my community, I notice the brittleness underneath the shining streets, the way the wealth is not load-bearing. I notice the medical self-serve kiosks in grocery stores, the necessities behind locked shelves at CVS. Parents there are not given five hundred dollars a month to buy infant formula for their babies, even with a GDP per capita twice ours. To the extent that feeding our infants preclude Canada from investing more in The Next Big Technology, the regret I can muster up about it is half-hearted at best.

> When I think about the counterfactual me that grew up in a large American city, New York or L.A. instead of Toronto, I see someone who's more stunted than me, in important ways. No skating classes, libraries too far to walk to on a regular basis and more poorly stocked. Student debt. Without generous public incentives, that version of me would only have the life that her own parents can afford to provide for her.

I wonder if the author would have a better outlook on their counterfactual American self if that person had grown up in a smaller town like myself. I can walk to the library, grocery store, school, park and coffee shop; nothing is locked behind shelves in our pharmacies or stores; my nephews are in skating classes and play in a little league Hockey team, in rural Iowa of all places.

Yes, infant formula, and yes, student debt. Canada has the US beat for sure in social safety nets.

As a tangent: I wonder how writing a piece on appreciating my own upbringing in rural America might be received.

[raydev]

Have you had any stays in a hospital yet? Children?

I ask because a lot of Canadians can't fathom having to worry about those sorts of bills, given that many employers don't offer great insurance, and especially if you happen to be between employers. Like how do you handle a sudden $20k bill that insurance won't cover?

[nozzlegear]

Yes to the hospital and no to children. My insurance covered the hospital without any issues, just a small copay and $300-ish bill that I paid over several months. I wouldn't say I have great insurance. It's some run of the mill bullshit conglomerate that covers most people in my area.

> especially if you happen to be between employers. Like how do you handle a sudden $20k bill that insurance won't cover?

My wife is, for all intents and purposes, unemployed (she's a photographer starting her own business). When she left her job at the end of 2023, she was able to get on state-sponsored insurance pretty quickly and easily without any hassle. It's better insurance than I have, they've covered every appointment, walk-in and emergency she's had without any charge to her. And this is in a deep red republican state that isn't known for supporting public health insurance.

As for how I would handle that bill? I'd first try to use the patient advocates at the hospital or my insurance company (that sounds scripted but I've used them before) to reverse the decision. At the same time I'd work with the hospital to set up a debt repayment/forgiveness plan. Tax-exempt hospitals in the US (which is almost all of them I think) are required to have financial assistance policies to maintain their tax-exempt status. If I'm broke and out of a job/insurance, I should be able to make it manageable or put it on forbearance until I'm able to pay it or get it forgiven.

Note: none of this is to say that I like the insurance situation here. I would prefer a public option.

[greenavocado]

You prefer a public option because you have never been to a Western country with public healthcare and tried to obtain emergency medical care. I have. I was in an overcrowded waiting room for 12 hours and watched one person die as they rushed him past me and around the corner. The whole character set and scene was extremely grim. There was ONE ER doctor on duty at night. Contrast that to the US where I received prompt emergency care and was only charged a couple hundred dollars which were eventually dropped because I qualified for their compassionate care write off since I make under a certain amount. Childcare hospital facility expenses (~$3000) were also written off each delivery because of the income qualification (400% of poverty line + household size factor in). The office of the doctor they contracted for the delivery stiffed me hard in my wife's third birth, but I am on a $100 a month payment plan for 12 months to pay it off. Considering the far better state of healthcare in the US than the extremely grim hospital scene I took part in the capital city of a Western European country, compounded with the discussions I had with the various characters I meet in the ER treatment waiting area, I can fully appreciate the disastrous effects public healthcare has. I'd rather fight a $50,000 bill than to go through the wringer again aka the public hospital. Coincidentally my grandmother died shortly after she there a few years after my incident. She slipped and fell on the front steps; they sent her home after a 5 minute cursory evaluation and she ended up dying from awful complications a few tens of hours later. Not to mention you have to actually pull strings with bribes to be seen sooner than 6+ months out for basic diagnostics or procedures. Each evaluation and treatment step is a wait of 6+ months.

[nozzlegear]

To be clear, a public option means a government-backed health insurance plan that competes with private insurance plans to keep prices down. It doesn't mean abolishing private insurance and replacing it with public or universal healthcare. I don't personally believe European or Canadian-style healthcare systems would work in the US at this point and I don't want to try them here either.

[greenavocado]

They will find a way to make it cost more and introduce more shortages

[fragmede]

In the US, you start a GoFundMe and beg everyone you know to help you pay your bills, and then work out a payment plan with the hospital, to be paid every paycheck for the next 3-20 years. What part of that seems unreasonable to you?