The hospital thing is standard practice in the US. The Canadian hospitals likely have to lie to get reasonable payouts from US insurance companies.

For instance, I once needed $600 of tests at the ER. The hospital billed $80K. The insurance company paid $7K. I paid $100.

Sure, the $600 does not include the ER overhead, but the $7K was still insanely inflated. The important thing is that the money ultimately came from insurance premiums, so every middleman was able to reliably extort all patients.

> For instance, I once needed $600 of tests at the ER. The hospital billed $80K. The insurance company paid $7K. I paid $100.

The other bit of the story was "we realised you might not be American from your face when we showed you the price list". (They told me Americans would have seen the same list and thought the prices were reasonable). I'm guessing you are American?

You need to understand how utterly insane this sounds if you are used to European systems.

And don't get me started on the fact Canadian healthcare doesn't actually transfer between provinces.

What? You can use your provincial health care card in any other province. My mom made an urgent care visit while in BC, showed her Alberta health care card, and got the usual service with no extra paperwork or costs. (Behind the scenes, BC would have billed Alberta for this visit)