CCommunity Health CommonsRegina, Saskatchewan

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Coverage is not access

Position paper Sources checked 2026-08-04

An insurance card can coexist with an unaffordable deductible, a restricted network, a demand for prior authorization, a denial, and an appeal the patient must know how to pursue. When protection depends on clearing every one of those gates, being covered on paper is not the same as being able to obtain care without financial harm.

Why a Regina project is looking south

Canada is not the United States, but a public entitlement can become hollow when the care behind it is unavailable. Statistics Canada reported that the share of adults with a regular health-care provider fell from 85.8% in 2022 to 82.8% in 2023. Nearly three million people aged 15 and older reported an unmet health-care need in 2022. In 2024, among Canadians aged 45 and older, 27.8% reported difficulty accessing specialist care and 18% reported an unmet need. Long waits, unavailable services, and cost were among the reasons.

That is the danger point. When the public lane cannot deliver, a private-pay lane can be sold as relief. Saskatchewan already permits private MRI and CT facilities to charge patients directly for medically necessary scans under its Patient Choice Medical Imaging Act. Health Canada's 2024–2025 Canada Health Act report identifies those charges explicitly. The same federal report says patient charges create barriers to care and records transfer deductions for extra-billing and user charges.

The Canadian warning is therefore not that both countries already have the same system. They do not. It is that capacity failure can prepare the political ground for access based on ability to pay. Importing U.S.-style financing mechanisms would not fill an empty public lane; it would add deductibles, billing disputes, networks, authorization rules, and debt to the existing wait.

Canada's legal spine still matters. The Canada Health Act requires reasonable access to insured hospital and physician services on uniform terms and prohibits extra-billing and user charges. A federal services policy effective April 1, 2026 also treats charges for medically necessary physician-equivalent services—such as covered care delivered by nurse practitioners—as prohibited patient charges. The practical test is whether governments enforce that principle while rebuilding capacity, or let private payment become the route around scarcity.

The claim we can support

The evidence does not support saying that every insured American will be ruined, that $7,500 is a standard deductible, or that every other wealthy country has solved every access problem. It supports a narrower and still damning conclusion: the United States leaves a measurable share of insured people exposed to health-care debt, and its fragmented financing system imposes cost and administrative barriers that peer systems reduce more effectively.

The U.S. Census Bureau found that 16.2% of households whose members were insured for the full year still held medical debt. KFF's broader 2022 survey found that 61% of insured adults under 65 had experienced owing money because of medical or dental bills during the previous five years. Those measures are different and should not be collapsed into one number. Together, they establish the point that insurance does not reliably end financial exposure.

The obstacle course is real

Deductible. KFF's 2025 employer survey found that 88% of workers with single coverage had a general annual deductible. Among workers whose plans had one, the average was $1,886; 34% were in plans with a deductible of at least $2,000. A claim about one person's $7,500 deductible may describe that person, but it is not a responsible national statistic. The structural point does not need the exaggeration: insured workers routinely have to spend substantial money before their plan pays for most services.

Network. Coverage is attached to a plan's contracted providers, not simply to whatever care a patient can reach. Federal surprise-billing protections close some of the worst gaps, especially for emergency care, but they do not turn every clinician or facility into an in-network option.

Prior authorization and denial. A plan can require approval before care and can deny payment before or after a service. In a 2022 audit, the U.S. Department of Health and Human Services inspector general found that some Medicare Advantage prior-authorization and payment denials met Medicare coverage or billing rules. This does not describe every insurer or denial. It does demonstrate that an initial “no” is not always evidence that the care was ineligible.

Appeal. U.S. law gives many consumers internal and external appeal rights. That is a real protection, but it is also another process the patient or provider must initiate. CMS guidance says a person in a job-based plan may have to appeal to the plan again before seeking external review. A remedy that exists only after notices, deadlines, documents, and repeated requests is not equivalent to automatic coverage.

The named exit has to open

A denial letter that explains an appeal is better than a denial with no recourse. It does not follow that every person can use that recourse. Time, language, health, internet access, records, confidence, and the ability to keep pursuing a decision all affect whether a formal right becomes an actual remedy. The correct measure is not whether an appeal process exists. It is whether people can complete it in time and obtain the care or payment to which they are entitled.

This is where navigation helps—and where its limits matter. A navigator can explain a letter, identify the next step, help assemble questions, and follow up. A navigator cannot erase a deductible, create an in-network specialist, make unaffordable care affordable, or guarantee that an appeal succeeds. Recording a referral or explanation as “resolved” would hide the barrier rather than remove it.

GoFundMe is relief, not a health-financing system

Medical crowdfunding can keep a particular person housed, fed, travelling to treatment, or paying a bill. That makes it valuable relief. It does not make it dependable coverage. A peer-reviewed study of U.S. medical GoFundMe campaigns from 2016 through 2020 found that campaign outcomes followed existing social and economic disparities. Success depends in part on a compelling public story, a network able to give, and the ability to circulate the request. Need alone does not allocate the money.

The same distinction applies to charity care, a successful appeal, or a generous fundraiser: humane exceptions can save people without changing the default that exposed them. A financing system distributes protection by rule. Crowdfunding distributes attention and voluntary generosity case by case.

The international comparison, without the slogan

The strongest available comparison is not “America is the only developed country with problems.” Canada, the United Kingdom, Australia, and other wealthy countries still have wait, coverage, geographic, dental, drug, and out-of-pocket gaps. Medical crowdfunding occurs outside the United States too.

What the 2024 Commonwealth Fund comparison does show is that the United States was the clear overall outlier among ten high-income countries. It ranked last overall and last on access to care; the report tied the difference to universal coverage and lower cost barriers in the other nine systems. That is a defined comparison across defined measures—not a verdict about every wealthy country or every patient's experience.

What the Commons takes from this

The Commons is a Regina project, not a U.S. insurance-help service, and this page is analysis rather than individual billing advice. The U.S. case sharpens an operating rule that applies here: never confuse the existence of a pathway with access to its destination.

Sources