On Minnesota-Canada border, ‘either you die or you pay’

For people who live on the Canada side of the U.S. border, emergency health care can be a horror show.

In Sprague, Manitoba, not far from Warroad, Minn., residents have been left with huge bills to pay for treatment in the U.S., thanks to their falling through the cracks of the difference between the U.S. and Canada health care systems.

They don’t have a lot of choice when it comes to emergency care, the Winnipeg Free Press says, reporting on three cases in the town as an example.

Andrew Thiessen was diagnosed with kidney failure at a Roseau clinic, and was taken to Grand Forks by ambulance for emergency treatment. His bill: $28,939.46. The province, under Canada’s health care system, paid about $2,000. Thiessen had to sell family-owned land to pay the rest.

Verna Kittleson’s heart condition landed her in the hospital in December 2015. $69,000. She and her husband are borrowing against their home to pay.

And Jon Rozsa was rushed to the Roseau clinic with symptoms of a heart attack and then transferred to Grand Forks for angioplasty after a hospital in Manitoba didn’t immediately respond to questions about whether it could take his case. Doctors said there wasn’t time to wait. It cost about $80,000 in U.S. dollars.

Manitoba Health wouldn’t cover the expense, saying it wasn’t an emergency.

Rozsa says he can’t pay.

“I’m renting a room from my mother,” he tells the paper. “What can I do?”

“This isn’t doing any good for my heart, worrying about a US$80,000 debt,” he said. “Every morning I wake up worrying about it. I told one of my doctors (in Roseau) that I wished I would have died.”

Under a cross-border agreement, Canada’s public health plan will reimburse at Manitoba health care rates, unless the service being provided on the Minnesota/North Dakota side of the border isn’t available in Canada. And those Manitoba rates seem pretty low, judging by the piddling reimbursements.

In southeastern Manitoba, however, the province has made arrangements to pay in full for emergency services and primary care at two clinics in Roseau, Minn. and Warroad, Minn., the provincial spokeswoman said. The agreement with Altru Health System facilities in Roseau and Warroad does not address costs associated with transportation.

“Although there is a provision in the agreement that requires the American physicians to repatriate patients to a Canadian facility for specialist care, Altru physicians may choose to transfer patients onto another US facility rather than to repatriate the patient to a Canadian facility,” a statement from the province said. “As charges for medical services outside of Canada are frequently significantly higher than rates in Manitoba, all Manitobans are strongly encouraged to obtain sufficient private insurance to cover any health care needs that may arise when they are outside the country.”

“The only time we would send someone to Grand Forks is if we cannot find a physician to accept the patient (in Winnipeg) or if there’s going to be a real lengthy delay in transportation, whether it’s a ground or air ambulance,” Keith Okeson, CEO of LifeCare Medical Centre in Roseau, said.

The situation seems to be a collision of two systems that don’t work — the high cost of health care on the U.S. side vs. the unwillingness to pay for it on the Canada side with people needing emergency care stuck in the middle.

“Either you die or you pay,” Verna Kittleson said. “Something should be done for our emergency care. It’s not right.”