If I Had Been Born in America, I Might Not Be Alive

I have spent most of my adult life inside the healthcare system. For more than thirty-five years, I have lived with multiple autoimmune diseases, undergone joint replacement and fusion surgeries, and relied on medications that cost tens of thousands of dollars a year. I have had MRIs, CT scans, cortisone injections, and more specialist appointments than I can remember. Yet in all that time, there is one thing I have never had to worry about: whether I could afford to receive medical care.

I live in Canada.

But the longer I watch the healthcare debate unfold in the United States, the more one uncomfortable question keeps returning to me: what would have happened if I had been born south of the border instead?

The issue of healthcare costs in the United States is impossible to ignore. Americans constantly worry about the cost of insurance premiums, prescription drugs, and medical bills. One of the loudest voices in that debate has long been Bernie Sanders, who has spent decades arguing that the United States should adopt a universal healthcare system similar to those used in Canada and much of Europe. Sanders often reminds Americans that “healthcare must be a right of all people, not a privilege for those who can afford it,” and that “no one should go bankrupt because they get sick.”

As someone who has depended on a public healthcare system for most of my life, those statements resonate deeply with me.

My medical history reads like a catalogue of chronic illness. I live with psoriasis, psoriatic arthritis, ankylosing spondylitis, and Sjögren’s syndrome. Over the years, I have had joint replacement surgeries and joint fusion procedures, including work on my cervical spine and a joint in my foot. Along the way, I have also dealt with high blood pressure, chronic venous insufficiency, secondary adrenal insufficiency, high cholesterol, hypothyroidism, kidney stones, irritable bowel syndrome, and sleep apnea.

As a result, I have spent decades rotating through the medical system. I have seen more than fifty doctors and specialists. I have undergone countless tests and procedures. Like many people living with chronic disease, I have had no choice but to become an expert in navigating healthcare.

Through all of it, however, there has been one constant: I have never once received a bill for the medical care that keeps me alive.

A friend of mine who works in the pharmaceutical world recently shared a story that made the contrast between the two systems painfully clear. Her spouse was diagnosed with brain cancer last fall. Fortunately, because they have excellent insurance, he was able to see top specialists quickly and begin treatment without delay. On the surface, this sounds like the American healthcare system working as intended.

But the total cost of treatment has reached $2 million. Even with insurance, the family is still responsible for $35,000 out of pocket. Imagine confronting a life-threatening illness while also negotiating with insurance companies over which treatments will be covered. It is difficult to comprehend the emotional burden of fighting both a disease and a billing system at the same time.

And that story involves someone who actually has insurance.

The same friend recently showed me a photograph of a young woman’s skin. The image was shocking: large, inflamed patches covered her legs, back, and head, raw and scaling in a way that immediately told me what I was looking at.

The woman had not seen a doctor because she could not afford to. Instead, she was trying over-the-counter creams and guessing at what might be wrong.

I suspected immediately that she was suffering from psoriasis because I lived with the disease myself for nearly twenty years. Many people dismiss psoriasis as a cosmetic skin condition, but that couldn’t be further from the truth. It is a serious autoimmune disorder that can dominate a person’s life physically, socially, and psychologically. When my disease was at its worst, my scalp was covered in plaques, and my skin burned and itched. Swimming, wearing short sleeves, or Bermuda shorts made you self-conscious. The social stigma alone can be devastating.

Today, we are fortunate to have a class of medications known as biologics that can completely clear psoriasis while also treating the inflammatory arthritis that often accompanies it. These medications have been life-changing for millions of patients. I currently take Rinvoq, one of the newer treatments for autoimmune diseases.

But these drugs are extremely expensive. RINVOQ alone costs between $17,000 and $27,000 per year, depending on the dosage. In Canada, medications like this can receive special exemptions that allow them to be covered by public healthcare programs. I have been fortunate to have my biologic treatments covered since 2004.

If I had been required to pay for these medications myself, even at an average of $20,000 per year, the total cost over the past two decades would exceed $400,000. There is simply no way I could have afforded that.

At this point in the conversation, the debate about healthcare usually turns philosophical. Some people believe healthcare should operate like any other market, where individuals purchase the level of coverage they can afford. Others believe healthcare should be treated as a public good, much like fire protection or public education. For people who have rarely needed medical care, the difference between those philosophies may seem abstract. But for those of us who depend on the system simply to remain alive and functional, the difference is not theoretical — it is existential.

What makes the situation even more striking is that the United States already spends far more on healthcare than any other country. In fact, Americans spend roughly twice as much per person on healthcare as the average developed nation, yet millions of people still struggle to access basic care. The system is not just expensive — it is uniquely expensive while still leaving many citizens unprotected.

Canada’s healthcare system is far from perfect. We have wait times for certain procedures and specialists, and there are ongoing debates about how to improve the system. But one principle remains intact: when Canadians become ill, they do not have to wonder whether they can afford treatment.

That is the fundamental difference.

In Canada, we believe that healthcare should be universal. Everyone contributes to the system through taxes, and everyone receives care when they need it. It is a collective approach that many European countries also embrace. Nations such as Norway, Denmark, Sweden, Finland, Switzerland, and Canada consistently rank among the highest in quality of life, and all provide universal or near-universal healthcare coverage.

Having spent decades inside the Canadian healthcare system, I feel incredibly fortunate. When I compare my experience with the reality faced by many Americans struggling to afford medical care, the difference is staggering. I think about that young woman with untreated psoriasis and wonder how different her life might be if she lived here instead. Why is this life-changing medication out of reach for her, but not for me? It’s not right.

Then I ask myself a harder question: what would my life look like if I had grown up where she did?

When I add up the surgeries, medications, and procedures that have kept me alive over the years, the total easily reaches hundreds of thousands of dollars, and likely into the millions of dollars. I never could have afforded it.

Which means the question I asked at the beginning of this essay has a deeply uncomfortable answer.

If I had been born in the United States, there is a very real chance I wouldn’t be here today.

I leave you with a beautiful song inspired by a sick child, called “Miracle Drug” by U2.

Written by Patrick Franc - Your Friendly Neighbourhood Bionicman