Bryant decided it was time to pay out of pocket to see a better doctor—and since she lives in the U.S., she could. So she found a blog on which New York women leave comments about their experiences with different OB-GYNs, and then made an appointment with Dr. Janice Marks for the very next day. Dr. Marks’ practice is completely private; the reason she doesn’t take insurance, according to Bryant, is that she doesn’t have to. Marks initially spent an hour and a half talking to Bryant about the plan for her care, asking her preferences, and reassuring her. During the following months, which included a scare involving early contractions around 22 weeks, Bryant was always able to reach Marks personally within minutes through her answering service. Marks even called her unprompted during a vacation in Colorado just to check up on her. The total cost out-of-pocket to Marks for all of Bryant’s visits? $12,500.
“You get what you pay for,” says Bryant. “There’s this shame we’re supposed to feel for being … rich, but that’s not fair, is it? I wasn’t born rich. I worked really hard. You should be able to buy what you want with your money.”
To her, the American attitude toward medical care comes as a dose of welcome reality. “The message in the Canadian system is that we’re all alike, and there’s something nice about that when you’re not sick,” she says, “but if you actually have medical problems, and you’re in a system that’s designed to treat the most people and save money, and not to do absolutely everything that’s possible, then that’s when it becomes an issue. If I were dying of cancer, I’d rather live here.”
When she went into labor in September 2012, Marks was waiting and ready at Lenox Hill Hospital. From 10 a.m. until the birth of Bryant’s daughter at 4 p.m., Marks was there virtually the entire time. She performed a successful C-section when it became clear that Bryant’s pelvis was too narrow to let the baby’s head pass.
Back in Newfoundland, when Davis went into labor with her daughter, she went straight to the case room of the local hospital and waited to be seen by whoever was on call. She didn’t have control over who her doctor would be. “I wish I could have had a doctor who was following my pregnancy and knew me,” she says, “but it ended up fine.”
After she delivered a healthy girl, she shelled out $300 for a private room, rather than share a ward with three other women. The money was the only amount she spent in medical costs during her whole pregnancy and labor, unless you include the annual 45 percent of her income she pays in taxes partly to help cover the cost of MCP, the health care plan for her province.*
Davis says she would have paid for more attentive care if she could have, “just for the reassurance alone. It would have been nice how [Bryant] could call up her private doctor with any concerns, and I didn’t have that. If I had questions, I had to wait, or take a trip to the emergency room. It was a little inconvenient.” If she were in the States, she says she wouldn’t have hesitated to pay the $12,500.
So under which system does each prefer her daughter to grow up? Bryant’s response is unequivocal—she wants medical care that can be bought—but Davis hedges. “It’s tricky,” she admits. “Within Canada, she’ll have access to care, but if there was anything complicated or specialized, I wouldn’t hesitate to go to the States.” And if, after many years of health care reform, the U.S. becomes even more like the province of Newfoundland, abandoning private care altogether, then where would the women go?
Bryant pauses. “I don’t know,” she finally says. “Where else is there to go?”
*Names have been changed to protect the women’s privacy.
Correction, July 3, 2013: This article originally misidentified the MCP as the Canadian national health care plan. It is the provincial health care plan for the province of Newfoundland. (Return to the corrected sentence.)