As a transplant from Canada, I’ve been meaning to write about healthcare in the U.S. for the last two-and-a-half years I’ve lived in San Francisco. Now that I’m pregnant, I have further inclination. I still laud and respect Canada’s system and, as I learn more, often wonder: why am I having a baby in the U.S.? I remind myself that it’s because of timing. Good ole life circumstances. They are going to cost me.
The main differences I see—in very simple terms—between American and Canadian healthcare are paying and waiting. Even if you have insurance coverage, you pay in the U.S. However, you barely wait for an appointment or test. If I’ve wanted to see a specialist in SF, I’ve waited tops, a week and a half. I’m sure it helps I’m in an urban centre, but, still, pretty impressive. Of course, I’m aware I’m probably not waiting also because people without coverage avoid the healthcare system. The wait in Canada can be tedious. On the other hand, there, you don’t pay.
Let me give you some examples of how you pay in the U.S., even with coverage. Before my pregnant days, I had a co-pay of $20 for each time I went to see a doctor. Guaranteed. (I’d also like to call out that I was paying into my insurance coverage through deductions on my pay cheque too.) Depending on the tests I’d get, I’d have to pay a certain amount called co-insurance, which was 20% for the plan my company had me on. That certain amount is often a surprise. It arrives in the mail via a summary claim from your insurance company. Sometimes the bill from the provider beats the claim. Yes, that’s two different paper trails for EACH appointment/test. Imagine how much that costs the system (Stew on that Republicans.)! Oh yes, and if your provider isn’t in-network, your insurance covers less for an appointment/test. Here’s a concrete example. I recently had a routine, second-trimester ultrasound. I received the bill before the claim. I owed $200-and-something dollars, whereas the overall cost had been $900-and-something. Fascinating. And thankfully—because Paul and I can afford it—do-able. Also, the ultrasound had been in-network. We are keeping a running grand total of these costs out of grim curiosity.
A while ago, I started to slightly panic on how much it may cost us for the baby’s delivery. I’d been told by reliable sources of people who were billed $20-(freaking)-thousand dollars! Granted, that was without any coverage. Others had said it can be as high as $10K with coverage. According to everything I’ve found via my insurance provider’s cryptic website, my Google skills, my HR department, and my honed telephone patience: we will pay $2500 at the most. That’s the yearly amount of co-insurance I have to pay for an in-network provider. (Note, the ultrasound cost is rolled into that.) If the hospital of our choice wasn’t in-network, we’d pay as much as $3500.
Then there’s the cost of my salary, or lack-there-of. In Canada, you get back a chunk of what you’ve paid into Employment Insurance. That chunk is up to $43,200 for an entire YEAR of maternity leave. Maternity leave? Ahem. That’s a relatively new concept in the U.S.
The amount of time you get off for maternity leave in the U.S. depends on which state you reside in. Lucky for me, I live in progressive California. That means with all programs combined, I’ll get four-and-a-half months off with my little one. I hope the Canadians and Europeans reading this have gaping mouths. Mine fell open when I figured out just how bad it was in the U.S. Paul and I even considered moving back to Canada, without him having a job and with me needing a transfer. We stopped ourselves because we figured it was worth it to stay and be less stressed out. We figured it was better to be more financially put out.
I can take state DISABILITY leave (California State Disability Insurance (CA-SDI)) for four weeks before birth and six weeks after birth. If I have to have a c-section, I’ll get eight weeks instead. For the time off, I’ll get 55% of my salary. I will need a note from my doctor to say I’m disabled. That’s right, say it with me: DISABLED. Rather archaic, don’t you think?
I’ll get another six weeks thanks to Paid Family Leave (PML). I tag it on after my “disability” leave. Again, I’ll get 55% of my salary.
That makes a grand total of 12 weeks which are paid, or 14 weeks for c-sections. During those times, my job will be protected under the Family and Medical Leave Act (FMLA) if there are 50 people in my workplace within a 75-mile radius. There aren’t. Thankfully, my work has assured me that they’ll protect my job.
I can extend my time off unpaid. The California Family Rights Act (CFRA) will give me another six weeks with job protection and benefits.
Let’s get back to the four-and-a-half months I’m allotted. I’d like to breastfeed. The ideal amount of time to breastfeed, according to the World Health Organization, is six months. My hope, right now, is to do it for the first year. Canadian mat leave works perfectly for that line of thinking. Well, in the U.S., women need to pump at work. In fact, some workplaces allocate a meeting room as a pumping room. Sure, that’s much better than using the restroom etc., but I can’t shake the cattle reference.
Don’t get me going on how the U.S. has the second worst newborn death rate in developed nations, or how healthcare and maternity leave in Europe make even Canada look stingy.
At least our baby will have the option of three citizenships: American, British, and Canadian. He or she will pretty much be able to work anywhere in the world. However, I’m going to have something to say about my grandchildren being born in the U.S. Here’s hoping more progressive changes in healthcare and mat leave happen long before then.
(Chart via Aran Johnson)