[grecy]

I don't suggest you model it after Canada's system. It's good, but it could be better.

I moved to Canada from Australia, so I'll compare the two systems for you.

Canada: "healthcare for all" provides basic coverage of everything you need. Works pretty well. Even homeless / out of work people are fully covered. Things like dental and chiropractor are not covered, so you pay for those. Employers give "health care" which really just means they will pay a percentage of your costs for things like dental, chiropractors, prescriptions, etc.

The problem here is that if you want "better than basic" healthcare, it's tied to your employer, which has all the negative impacts of the US system of being stuck to your job. This sucks.

Australia: Same as Canada in that basic coverage covers emergencies and what-not for everyone. Again dental, chiropractors are not covered. BUT if you want "better than basic" care, it's your choice if you want to go out (with your own cash) and buy "private health care" which again will pay a percentage of your out-of-pocket costs for those extras (dental, etc.).

The massive, massive, massive advantage here is that your health is in not directly linked to your job. Your employer has no say or impact on your choice of healthcare provider, or if you even want to buy that extra coverage. As a single, healthy 30 year old, I've never seen the need to pay the extra, but in Canada I'm forced to because my employer says so.

I've been in Canada 7 years, and I actually think I'll go back to Australia, primarily for exactly that reason.

EDIT: OK, sure. In Canada you can also choose to buy your own "extra" health care from your own money. What I think is bad is how employers do it for you, without you having much say in the matter. In this way, Canadians feel their health is connected to their employer (a great example is when you interview for a job in Canada, people ask "what are the benefits like"? - In Australia, that is not a question.)

[jgon]

While most employers do offer an "extra frills" health plan as part of employment, private insurance at fairly good rates is available to everyone. I could call up Blue Cross this afternoon and get a private health plan equivalent to my employer's if I chose to.

EDIT: I still really like the Australian system and wouldn't be upset if we started incorporating some of the ideas it contains. I just wanted to point out that for at least this one case the Canadian situation isn't quite as bad as it would appear.

[grecy]

Right, but your employer is still deducting that amount from your paycheck, so you are losing out.

(At the Canadian company I work for, they estimate the 'benefits' overhead is around 26% of my salary - Yes, that is extremely high, because I can't choose the plan or coverage, the company dictates it for me. Married people with 10 kids pay the same amount I do... so you can see I'm getting a shit deal and would much rather just have my own money to spend)

[run4yourlives]

That's a condition of your employment though. Nothing is forcing them to offer a health plan at all.

[grecy]

Nothing is forcing them to offer it, but I'm expressing my opinion and saying something should force them not to, because my employer should have nothing to do with my health

[astrodust]

Here in Canada, if you want "better than basic" health-care you can pay for it yourself. The net cost is under $1,000 a year for a typical individual who wants the deluxe treatment.

[prostoalex]

Net cost of what? Pregnancy with complications, chemotherapy, spinal surgery or teeth cleaning is all <$1,000 with deluxe package?

[run4yourlives]

Pregnancy - Covered by national plan, all in.

chemotherapy - Ditto

spinal surgery - Ditto

Your $1000 is getting you a nicer room, name brand meds, etc etc.

teeth cleaning - This would be offered under Dental Coverage, which is completely private in Canada.

[prostoalex]

This is indeed a pretty sweet deal. In the US anything outside of teeth cleaning might result in personal bankruptcy, depending on employment situation.

[run4yourlives]

Yup. In Canada, hard-core health care is quick, cheap and amazingly efficient. Any thing that can seriously screw with you is covered 100%. People with a cancer diagnosis get started on treatment within days. Pregnancies are smooth and straightforward, even more so if there are complications. Trauma is just the same as an American hospital.

The Canadian system slips a little when it comes to non life threatening issues that could be considered "quality of life" concerns. Knee and hip surgeries, elective procedures, chronic conditions, non serious specialist procedures (dependent on field)

There is a movement here to expand private health care into these areas. Personally, I support such a move but in Canada we have a group as pig headed about "no private health care" as you do about "no public health care" which makes things a little difficult.

[beagle3]

net of teeth cleaning, it is included in the $0 basic packages (paid by taxes, so of course you pay for it if you pay taxes. But you get it even if you never worked and are unemployed and never paid taxes. Also, the taxes are independent of any "pre-existing condition" or anything like that).

Dental is not included in the $0 package. A dental package likely includes cleaning, for less than $1000 a year, yes.

[astrodust]

Some provinces have emergency dental care for minors covered under their health plans, which is a nice thing, too. A root canal can be an expensive procedure.

[baddox]

Does anything legally tie your optional health insurance to your employment in Canada and legally prohibit Australian employers from providing private health insurance, or is that simply the way the two markets have developed?

[mhurron]

> Does anything legally tie your optional health insurance to your employment in Canada

No. Supplementary insurance can be a perk of employment just like actual health insurance can be a perk of employment in the US, but you can get supplementary without it.

[grecy]

I don't know about Canada, but I believe in Australia it's illegal for an employer to have anything to do with your health care.

[driverdan]

It's a good thing they don't pay for pseudoscientific quackery like chiropractors.

[run4yourlives]

chiropractors, message, acupuncture, etc are often covered under private health insurance.

[run4yourlives]

Disclaimer: In Employee Benefits in Canada.

Canada's private health care insurance is very broad, and while you aren't necessarily incorrect about anything you are only giving part of the picture.

The "Employer sponsored" extended health coverage you are referring to is Group Insurance. It is a form of insurance that can be offered to all people aligned to an entity (employer, trust, association, etc) that removes the requirement for personal health questionnaires and medical assessments. The coverage you are offered by your employer as "mandatory" is guaranteed to you so long as you remain connected to the entity in question. There is a huge advantage to this and this is the reason it has become the de-facto standard for private insurance in Canada.

Of course the trade off is that the entity qualifying as a "group" needs to have an overwhelming percentage (often 100% if it is small) participating in the plan to mitigate the risk. Insurance breaks down if the only people buying it are high users.

That said, Private Insurance (i.e. not Group) is most certainly available and affordable in Canada. With private insurance however your rate is going to be based on your own individual heath assessment and life situation. That means that while your Extended Health rates might be lower, as a single 30 year old male your Life Insurance rates will be higher than a Female's, for instance.

Overall, for a majority of people Group Insurance has the benefit of spreading the fluctuating lifetime rates out so that they are predictable and more equitable. You aren't going to be 30 forever, after all.

People can and do waive their employer sponsored insurance all the time (with the exception of participation minimums). In addition, employers have started to introduce "flexible" group insurance that allows limited plan choices, based on fixed credits.

Not much beyond that is fixed in these group plans, so the variance in plans, costs, and overall benefit to the employee from one employer to the next can be huge. It is an effective enticement to have a good benefit plan, hence the interview question. There is also nothing at all forcing an employer to offer any extended coverage.

Personally, I think Canada is right on the money with regards to how we handle private health care services and insurance. Keep in mind that self management also presents a fair amount of improperly covered people. People are simply too ignorant of the situation. At least under an employer sponsored plan a trained professional is designing a plan that meets as many of the needs of the employer's workplace as they feel is required.

[grecy]

Thanks for the detailed and thoughtful reply.

> It is an effective enticement to have a good benefit plan, hence the interview question.

A better enticement is to divorce health coverage and employment 100%. They should have absolutely nothing to do with each other.

Imagine if the employer in Canada dictated where I can live, or what goods I can buy... that's how it feels for me when the employer dictates(or in fact has anything what-so-ever to do with) my health care.

> Keep in mind that self management also presents a fair amount of improperly covered people.

Those people are covered by Canada's public health care, which is exactly what it is there for.

> At least under an employer sponsored plan a trained professional is designing a plan that meets as many of the needs of the employer's workplace as they feel is required.

You are still not even accepting the option of no extended plan at all.

The number of people in Australia that opt for extended private care is small, because the public option is sufficient.

[run4yourlives]

>They should have absolutely nothing to do with each other.

Says the healthy young guy. :-) Many people receive extended benefits at a significant cost advantage through group insurance.

Also most employers pay a significant portion (if not all) of the premium of these benefits! You and I may see a health questionnaire as a simple form where you answer "no" to everything and sign it, but many, many people not much older than you aren't able to do that.

>Imagine if the employer in Canada dictated where I can live, or what goods I can buy...

Um, your employer does dictate where you can live, since most roles expect you to come to a structure of the employer's choosing, and what you can buy through your paycheck. Regardless, there is no dictation here at all. You are being offered benefits, often paid at least in part by the employer as a condition of employment. It's like being offered a cell phone or a car allowance.

>You are still not even accepting the option of no extended plan at all.

As I already stated, this option does exist and IS USED. In almost any company of significant size (i.e. above 10 employees or so) you can refuse all coverage. All you have to do is do so with a written form. You can do so for Health and Dental in ALL cases if you are expected to pay the premium and have coverage elsewhere, inclusive of personal coverage.

Why in god's name you would turn down what in many cases is free money is beyond me, but that is your prerogative. To suggest you are unable to do so in Canada is incorrect.

[grecy]

> It's like being offered a cell phone or a car allowance.

Which reduces your overall salary - you might not be aware of it, and it might not be said in those terms, but it's absolutely true. All "side benefits" or "perks" of employment are just a way for the employer to give you something other than money. Too bad if the last thing you want is a cell phone.

> Why in god's name you would turn down what in many cases is free money is beyond me, but that is your prerogative.

Because it's not free money! My salary is being docked for that expense, as the "benefits overhead" (my company told me to my face it's about 26%). I'm perfectly happy with the public coverage, and want the rest of my salary in my hand, thank you.

[run4yourlives]

At this point though, you are evaluating employers, not health care systems.

It's pretty easy to find an employer in Canada that offers no benefit plan at all, just stay away from larger companies.

Most privately run businesses would be more than happy contracting you at a higher rate and not paying you any additional benefits, or their share of CPP or EI. They are a significant expense to the company. Go get yourself a GST number and have at 'er.

Seriously, if this is that much of an issue for you, you should talk to your boss. I can pretty much guarantee they'd be more than happy to work something out with you.

[grecy]

> you are evaluating employers, not health care systems.

No I'm not. One health care system outright makes that illegal, so it's the health care system defining this, not the employers.

On that note, have you ever lived&worked in a system other than Canada's?

I ask, because you think Canada is "right on the money" with their system... though it makes me think you've not seen how other systems do it.

Don't get me wrong, Canada's system is good, but if I were in a country about to radically overhaul health care, I would by no means adopt Canada's system as-is (or any other single country, for that matter)

> if this is that much of an issue for you

You miss the point here thinking this is about me... The overall effect on society is very interesting and speaks volumes about a given system. Without a doubt, because of this "group plan" idea, Canadians are tied much more strongly to their employer, and that results in employees being treated worse, and overall a "negative" impact on those around me.

I don't like that about Canada's way of doing it.