As an American who lives a couple months a year in Ontario, I tend to get four sides of the story; the plusses and minuses from the US and the plusses and minuses from Canadians.
I was one of the people massively helped by the ACA. During my very horrific divorce and subsequent hospitalizations, I was unable to work, had been previously self-employed, and had $28,000 in medical bills. This was all pre-ACA. I applied for Medicaid three times, which was a grueling process of paperwork, phone calls, scrutiny, documentation on bills, expenses, assets, and humiliation. All during a time when I was in and out of the psych ward because I was having trouble coping with things like stress. Three times denied. Three times appealed. Three times denied again. The process used to go like this in PA. You apply. The assistance office has 30 days to respond. On the 29th day, you get a terse phone call that says they need 20-30 additional proofs of something that is impossible to provide in that last 24 hours; vehicle appraisal, copy of a birth certificate, independent appraisal of your home, its equity, and your debt. Things like that.
I struggled for over a year, living with my parents, chasing paperwork, in and out of the hospital and getting counseling so that I didn't down a bottle of Ambien or put a 9mm to my chin. Ya know... important reasons. All while increasing my debt.
Sidenote: in my case, I applied for medical assistance with the hospital and one of the hospital's benefactors covered most of my bills. Otherwise I would still be forced to work while I was not even close to capable of working just so my elderly parents didn't go bankrupt. Happy ending for me. The other happy ending is that I'm a well-adjusted and working member of society again.
The first year of the ACA I went to the marketplace website, entered all my normal information. At the end, it said (paraphrasing) "you qualify for medicaid. Your county assistance office has been notified and you are covered as of today." Two days later I got an insurance card in the mail. No papers, no appraisals, no appeals. Just DONE. Now, there are multiple times I have to re-enter my information and update any money I make, but the approval process was simple. When I got a job, I called and updated my income and requested to be terminated from medicaid. It was easier than turning off a faucet. They verified my identity and said OK, done. No questions about income, work, anything.
The following year, I had a part time job that didn't offer insurance. So off to the marketplace I went. I found a fantastic self-pay plan for $181 a month. Deductibles were high, but I viewed it as a major medical plan. When I get a cold, I sleep for a day and take cough syrup. This past year, my plan did go up in price significantly.
One of the things I DON'T want to do (no offense, Canadians) is to adopt Canada's structure. The wait times for healthcare up north are not something Americans will really want to tolerate. I needed an MRI on my back and it took 3 days to schedule it. My neighbor in Ontario needed one for his knee and it took 9 months. Your system works well for providing healthcare for everyone, but (in my opinion) doesn't go far enough toward combating healthcare costs and the result appears to be that its spread too thin.
We're also partly to blame down south for that in an indirect way. With our healthcare costs being 10 times greater, the opportunity for profit is massive. With your education costs being so low and subsidized along with the high quality of it, many doctors are being educated up here, then migrating south for the profits.
Two sides of the coin. I'm all for making money and profiting, but the way our democracy is set up, it does nothing to keep some things in check. You Canadians are seeing that dynamic playing out right now with Sears where the Execs get something like $9M bonuses while they lay off thousands of store associates because they're cutting corners. So make money, make profit. But when that profit begins to tank the national economy on the backs of the poor, I take exception. Then when they say "just get a job," I want to throw punches. How could I get a job when I'm in a hospital and not allowed to have shoelaces or magazines with staples in them?
So the two sides of the coin: Do we go back to the old system where tens of thousands of people die every year because they're lazy, jobless trash in the eyes of the unaware? Or do we go further and do what the ACA missed the first time and risk the temporary (but massive) growing pains?
