If health care is free in Canada, why can't this woman afford surgery?

Alheli Picazo is a writer and former elite gymnast based in Calgary, Alberta, who has struggled with a serious disease called ulcerative colitis. Though she was able to get the condition under control by having her large intestine removed, she's still suffering from one major aftereffect: the bones in her mouth have eroded painfully.

Because she lives in Canada, you might think her medical treatment would be paid for by the state's generous health-care plan.

But there's one glaring gap in Canadian medical coverage: government-subsidized dental care.

Picazo's gastrointestinal condition — which went undiagnosed and untreated for years — left her emaciated, malnourished, and suffering from severe acid reflux. This wore down the enamel of her teeth and caused the equivalent of osteoporosis in her oral cavity. The 30-year-old needs urgent oral surgeries, including bone and tissue grafts, to remove and replace what she described painfully as "the increasingly diseased bone."

The surgeries would reverse much of the damage in her mouth and should have happened months ago. But Picazo has to wait until she can amass the $100,000 needed to pay for the procedures.

For now, Picazo finds herself in a position that has become familiar to many Americans: crowdfunding her medical bills. As of this writing (March 16) she has raised just over $40,000 through Project Smile, which brings her less than halfway to her goal.

Why is this Canadian crowdfunding her health care?

Picazo in 2012. (Via Tmi.apicazo.com)

Canadian health care is extremely generous, except when it comes to dentistry. (Canada is also the only country with universal health care but no pharmacare to cover the cost of drugs.) Dental care north of the border is almost exclusively paid for by private insurance companies.

Aboriginal Canadians have access to government-funded dental insurance, some provinces have government plans available for preteens, and charities do a patchwork job of filling in some of the gaps. But most Canadians rely on private insurance through their work to pay for their oral health needs, and sometimes those plans don't go far enough. All told, the government only covers 6 percent of total dental spending — one of the lowest rates in the world.

This is similar to a gap in Obamacare: health plans on the exchange aren't required to offer dental coverage. But as health policy reporter Andre Picard recently pointed out, even the US does slightly better than Canada on this matter. "Even the US has a higher public share, 7.9 per cent," he wrote. "Many European countries include dental care in their universal health programs. In Finland, for example, 79 per cent of dental care is publicly funded."

Project Smile will hopefully cover Picazo's dental bills

Picazo's crowdfunding campaign, Project Smile, came about when she found out her insurance provider would only cover a fraction of the cost of the dental care. Even though her gastrointestinal — and subsequent endocrine — disorders led to her dental problems, they're still considered oral health issues and therefore don't fall under the medicare umbrella.

Picazo in May 2014 after three intestinal surgeries. She weighed 85 pounds. (Via Tmi.apicazo.com)

This revelation arrived after her family refinanced their home because they couldn't afford her $800-a-month medication tab.

Then things got even worse.

"When the costs of simply maintaining — trying to prevent further breakdown — of the dental structure and preserve underlying bone mass (as my intestines were non-functional and the body was starving to death), we remortgaged," Picazo wrote on her blog. Her family then had to take out a medical loan — but Picazo's insurance coverage maxed out, and the bills kept piling up.

After some initial dental care failed to address the systemic decay in her mouth, she found out she needed more care. Then she also had to go into the hospital for extra surgeries on her bowels: part of her healthy small intestine twisted off and died. "Because the bowel was dead, it perforated, and my organ shut down, so I went into an emergency second surgery and was on watch for a number of weeks," she told Vox. "Doctors weren't sure I was going to pull through."

"I can't imagine having to fight costs with basic health care like that"

When Picazo arrived at the hospital, she weighed 130 pounds. She left the hospital weighing only 90 pounds. "I'm now missing so much of the small healthy gut that I have short gut syndrome," she said. "I'm constantly fighting to avoid malnutrition, and regaining the weight is tough because I've got so much less absorption area."

She's also in constant pain, but because of her gut issues she can't take anything more than Tylenol. "It feels like when you have a toothache, but the pain is all over and it never abates," she said. "At night, it gets worse. When you lie down, it turns into a pounding headache."

In recent weeks, Picazo has been feeling weaker. She dealt with a bout of sepsis and pneumonia — but in these health woes, she saw a silver lining. "It reminded me of how good our health-care system is. I didn't think twice about going to the hospital, back and forth, to get fluids. I can't imagine having to fight costs with basic health care like that."

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