MarylandNed

Of course if you compare countries at that site, you get a very different answer:

http://www.numbeo.com/cost-of-living...=United+States

scrubbedexpat091

It all comes down to expectations, in the US those well off get healthcare the rest get none or very poor access to healthcare, you can't have a US style system when single payer, but no way I'd give up what we have in Canada for anything like the US, and I was born and spent 25 years there, so I have experience with both systems as well.

I personally don't like the no referral needed for a specialist, I as a patient like most don't have the medical knowledge to know if one is needed or not, and thus we should be seeing our GP first, why waste a specialists time if one is not needed?

I've never experienced anything bad in BC in regards to healthcare, waits have always been minimal, and in a true urgent situation there has never been a wait yet for me or my partner.

Longest wait has been 7 months for a heart echo I had, but considering I've had the murmur since I was an infant, I wasn't concerned, I mean I have only had it for 35 years, and multiple US doctors were never concerned about it, so the fact my GP decided to at-least check it out, scores more points then any of the US doctors who ignored it for 30 years...

MarylandNed

Like mine, your experience may not be typical. Wait times are an issue in Canada. Just because your heart issue didn't cause you concern, it doesn't mean that there aren't people whose health is placed in jeopardy because of long waits. I waited just 1 week for an echocardiogram here in the US earlier this year.

As for referrals, let me turn it around and ask you why waste a GP's time if you know a specialist is needed? If my wife knows she has a gynecological issue, why not go straight to the gynecologist instead of wasting the GP's time? If she has an issue she's not sure about, she'll go to the GP first. I prefer to have this type of choice.

This makes for interesting reading:

http://www.huffingtonpost.ca/nadeem-...b_3639186.html

Don't get me wrong, I hate the US health insurance system overall. It's bloated, expensive, inefficient and unfair. The healthcare itself is fantastic (if you can access it).

Steve_

I've lived various places in the US and Canada and it varies regionally. And it varies over time too, when I moved to Calgary the healthcare system was in total crisis, now it's far, far better.

It's hard to generalize because it depends on what healthcare problem you have.

For example the emergency care I got in California and Atlanta was top notch, in Florida it was pretty awful. But then again certain parts of California seem to me to basically have no doctors, it's absurd.

I think the key advantage in Canada is that it is just simpler to understand, no effing about with insurance companies. Even with dental care which isn't covered it's pretty simple compared to the US.

I'm sure there are longer wait times for certain things in Canada, but that's not to say there aren't access problems in the US either. This is the criticism that is levelled at Canada, ooh, but you have wait times - yeah but at least I can get to see a GP and get on a wait list to begin with! And I don't have to argue with an insurance company about it either.

It does depend on the procedure.

I've never had an ER in Canada attempt to defraud me either as happened to me in Florida. But on the other hand I shouldn't have had to go to an ER in Canada because the local clinic was constantly full with an enormous wait.

It's all hit and miss, depends on where you are at any given time.

Like I said at the start of the thread, the one immutable fact is this - payroll taxes are lower in Canada, there is no Medicare tax either. Payment for healthcare comes largely out of your income taxes, not your after tax income.

So even if it is total crap in both places - at least you're better off in Canada. Or Alberta at any rate.

That comparison website doesn't factor in healthcare costs or taxes.

Rickyk

I have experienced both US, Canadian, and UK (and others) healthcare and they are both good in general, the issue I have with Canada is the lack of choice.

At least in the UK if you want to opt out of the state run healthcare you can, there are plenty of private health care options. In Canada it is the Provincial health care or nothing for any serious procedure. I had a number of cases where my schedule did not allow me to make appointments I had waited for weeks to get.

Overall I am happier with the US system. I buy my own insurance and I get to choose what level of service I have. Sure I have to pay for it directly but someone has to pay for it and I guess that should be me.

scrubbedexpat091

And I would have never been able to access an echo in the US most likely since I could not afford insurance, and when I did have it via work, the out of pocket costs were too much to ever see a doctor.

I prefer my GP being in the loop and knowing what is going on with my health, and (in BC anyhow) if you need a specialist the referral is good for 6 months so you can self book as long as the referral is standing, and generally the specialist will renew it if you need to continue seeing them.

I don't have to for example get a referral each time I see my psychiatrist, my GP sent 1 referral and that was that, the specialist renews it every 6 months, and I just book directly with the psychiatrist.

You only need to see the GP for the first one, and then you generally don't.

Its not perfect but certainly getting better in many area's.

MarylandNed

I agree with this. I would say that dealing with health insurance issues has been the single biggest PITA issue during my time in the US. In addition, my plan changes every year to some degree - sometimes even changing health insurance company completely.


I'm pretty sure at least some provinces use sales tax to fund healthcare.

Whether or not you are better off in Canada or the US depends on your individual circumstances and there are many factors apart from just payroll taxes (e.g. salary, location, lifestyle, sales taxes, etc). The cost of goods is higher in Canada in general and that's before you add on the higher federal and provincial sales taxes. Some US states don't even have a sales tax or a state income tax. The mortgage interest tax deduction is of huge benefit to many Americans. It has resulted in me obtaining $1000's every year in tax refunds.

This article is 3 years old but probably still valid:

http://www.investopedia.com/financia...americans.aspx

Steve_

This used to annoy me when I first moved here but since AHS was formed and they've got their act together the service has improved substantially so it doesn't bother me anymore.

One advantage of living in a petrochemical dependent state is that if the state has the money and the state is responsible for healthcare, you can get some pretty swanky hospitals built.

If I was in, say, Texas, I'd have to pay for it.

Steve_

The difference in payroll taxes though isn't some minor difference, it's huge as I pointed out in post #8, as soon as you get over around USD $46,000 in earned income the savings go from a fair bit to a lot and if you're self-employed you can double that.

Try banging your salary into an Alberta tax calculator and see what you come up with.

If it wasn't for the payroll tax difference and the healthcare, I'd be living in the US. Also short-term capital gains taxes are less here which makes investing simpler.

I figure CPP, OAS and whatever I get out of the DWP when I hit retirement age make up for not bothering with Social Security.

MarylandNed

The mortgage interest tax deduction isn't a minor benefit either.

The other point I've been making is that I wouldn't be getting anywhere near my US salary in Canada and certainly not in Alberta. I also doubt that I'd be getting anywhere near my current US vacation allowance either.

Lifestyle is another factor I mentioned. I could live in Canada again quite happily but my wife just isn't going to put up with at least 5 months of winter every year. She wants to move further south - not north.

gad33

Our payroll deductions here in California are less than they were in Alberta even including medical insurance. Sales tax is higher but most goods are cheaper.

Utilities here are way cheaper and that's comparing summer months but out property taxes are high.

I can see that the cost of health care is a concern but I do not agree that payroll taxes are lower in Alberta.

scrubbedexpat091

All depends on personal situations, for example for me I'd pay 0 in Alberta in taxes on my income last year, 65 in BC but I got a 75 credit in BC, so it wiped out any taxes owed in BC, and 0 in federal.

According to the FTB website for California, I would have owed 132 dollars in taxes there, so more then double what BC was before the tax credit.

And this is before any medical costs are accounted for.

Steve_

Assuming you have a mortgage - but most people have a job so the payroll tax is a bigger factor, imo.

I'd be surprised if you didn't get the same vacation allowance, median salary is $89,000 iirc in Calgary: http://www.statcan.gc.ca/tables-tabl...il107a-eng.htm. So higher than DC apparently: http://www.city-data.com/income/inco...-Columbia.html

I've got a friend who lives in Adelphi, MD and one thing I am certain of over the last few years the weather in the DC area has been far worse during the winter, first she is up to her eyeballs in snow, then a hurricane, then polar vortex etc.

Okay yes it's cold here but at least it was predictable!

Did you try the tax calculator? http://www.finance.alberta.ca/calc-script/tax_calc.html

Steve_

It's not a theory, it's a fact - as I explained in post #8. Payroll taxes in Canada (not just Alberta) are 6.83% and FICA in the US is 7.65%. This assumes you earn $46,000 US or less - because that's around the cap for CPP and EI in Canada. But above that in the US you're still paying 7.65%, up to the social security limit of $117,000 and above that you're still paying Medicare tax of 1.45% and above $200,000 you get to pay an additional Medicare tax of 0.9%

And of course if you're self-employed, you double that.

And... not only that, but California has a variety of its own payroll taxes: http://edd.ca.gov/Payroll_Taxes/What...roll_Taxes.htm

So basically, WAY more payroll tax.

Note that I'm talking about payroll taxes here, not the entire tax deduction on your pay stub, which would include income taxes. The income tax comparison is a bit more tricky as it depends on what your income is and what deductions you can claim.

MarylandNed

I don't live in DC. I live in Montgomery County, Maryland which is probably one of the most affluent counties in the US. I'm sure the median income in DC is quite a bit lower than here. Many people who work in DC commute from very affluent suburban counties in Maryland and Virginia.

This past winter was one of the worst I can remember. It was much longer than usual and probably quite a bit colder than normal.