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Excellent public healthcare in the USA? Surprise!

Oakville Hospital Foundation
Oakville Hospital Foundation

My wife Patti is a Canadian citizen and has lived here since 1987. But she was born in Seattle, holds American citizenship, and files U.S. taxes every year.

She has also worked in health care all her life, and has a PhD in nursing from the University of Toronto. Before coming to Canada, she experienced the challenges faced by uninsured patients working in the American system and is a strong advocate of Canada’s single payer universal health care model.

So when her left hip began to hurt so badly that even injections couldn’t relieve the pain and let her live her active life, we went the normal route, with a diagnosis that a total hip replacement was necessary.

That was in May 2023. The first available orthopedic surgeon appointment was offered for March 2024.

After some receptionist persuasion to move that appointment earlier, she was seen last November by the Oakville surgeon who gave her a surgical date of June 2025. Asked if there was any way to have it sooner, the response was "I’m not the scheduler", with no alternatives offered.

This doesn’t jive with what you will find in a google search, which turns up Ontario government wait time websites, but it is what happened to us. Judging by our friends and acquaintances, we are not alone.

There are two things Patti really cares about: her volunteer work in rural Kenya to run free mobile health clinics there, which takes place each spring (and now also fall); and horseback riding. The timing of the projected surgery would mean she would miss leading the Kenya expeditions two years in a row, and be off her horse for almost two years.

In her role as President of Canadian Nurses for Africa, which is actively expanding nursing outreach into Kenya, with a recent push to include more maternal-child care (infant and maternal mortality is quite high there), to say she was shocked by the surgical wait time would be an understatement. Everyone is replaceable, but she is currently the driving force behind the expansion initiatives.

On top of that, at her age (not to be divulged, but she is officially retired), that long a period of inactivity would be unhealthy, and it is hard to imagine how she could get back to her previous levels of activity after such a long stretch of enforced sedentary existence.

No, this was not a life-threatening condition, but it certainly threatened her quality of life, and impacted her participation in family activites, and meant she would be much less of a contributor to society than if she could get the surgery in a more timely way.

And none of that takes into account the pain she was experiencing. In spite of medication, all with its side effects, she already hadn’t had a good night’s sleep in more than a year. Another nearly two years was tough to contemplate.

A plea to the surgeon for special consideration given the upcoming Kenya expedition fell on deaf ears. (We aren’t naming anyone…the problem is more systemic than personal as far as we can tell.)

That’s when Patti decided to see what her options were in the American system. Americans over 65 qualify for Medicare, which is a public health care insurance plan.

Democratic Presidential candidate Bernie Sanders has been advocating for "Medicare for all" for decades now, but health insurer lobbies and American individualism, among other factors, have stopped it being implemented. But if you are retired, your healthcare is free or at least very low cost.

Could Patti use her American citizenship and get her U.S. Medicare to pay for a hip replacement surgery in Buffalo? And if so, how soon?

Well, the answer was yes. It wouldn’t be free; free Medicare covers in-patient procedures, and a hip replacement is outpatient, but she could upgrade the free plan to cover this and any other outpatient requirements for less than $200 Canadian per month.

A hip replacement paid for privately in Buffalo runs about $40,000 Canadian. She would get this free.

So how soon could she get it? A meeting was arranged with the surgeon for January. After confirming the need for the new hip, he asked, so when is your Kenya trip? Once he had the date he worked back from there to ensure she would be well enough recovered to participate and set the date for last week: February 22nd. Quite a contrast with our Oakville experience.

Kenmore Mercy | Chris Stoate
Kenmore Mercy | Chris Stoate

We drove to Buffalo the morning of the surgery, less than 90 minutes away - including the border crossing. Because of the distance home they kept her overnight (most people would have gone home that day.) All in all, a great experience, with friendly and helpful doctors and nurses every step of the way. 

There were no charges at the hospital, Kenmore Mercy, outside of the Tim Horton’s in the lobby of course. The hospital is one of the top places in the U.S. for hip and knee surgery.

They sent her home with pain medications (about $65 Canadian in co-pay), an electric ice pack machine, leg compressors to combat blood clots, and a trigger-controlled claw gadget so she can reach things from her bed. All at no charge.

If she lived in the U.S., she would also have received free in-home physiotherapy visits until she recovered.

When we hear about the challenges of wait times in Ontario, quite often people bring up ideas about incorporating private options, so people can pay to jump the queue. Sometimes, it is suggested this would take the pressure off the public system.

Yet what happened to us in Buffalo was in a purely publicly funded single payer (the U.S. government) health care system. And it is a system whose clients are all over 65, the period of life when health care needs become the most frequent and the most expensive.

U.S. private insurers may not want to lose the health care business they have for people under 65, but one imagines they are quite happy to have the high-cost part of people’s lives covered by the government!

Meanwhile, operating rooms Ontario public hospitals are unused owing to lack of funding, and new money is flowing to private for-profit health care options.

So, let’s stop talking about undermining our public health care system, once the envy of the world, and fix it. If Americans can do this for the most cost-intensive age group—so can we.

Come on Ontario. We can do better.