Canadian Health Care

How it works

Canada’s health care system is based on a National Health Insurance model that is publicly financed but delivered by private doctors and hospitals.

The Canadian system is called "Medicare" and mirrors the US Medicare social insurance health care system for senior citizens.

Every citizen is covered by Medicare as coverage is not dropped due to unemployment and there are no lifetime limits or bans because of pre-existing conditions. Citizens also have their choice of any doctor and general practitioners can recommend to specialists. Nobody in Canada goes financially bankrupt from medical bills and the system operates at about 1 percent overhead.

Canadian Medicare is often identified as a single-payer system, although this is inaccurate as each of the 13 provinces and territories has its own Medicare plan that covers all citizens and differs from province to province. For example, some provinces will pay all of a patient’s doctor bill while others require a small copay before Medicare pays the rest.

Despite 13 different plans, they work together like a single-payer system as the government provides much of the funding and sets rules for negotiating prices for prescription drugs and services that help control costs.

In some provinces, Canadians can purchase private supplemental insurance through their employer such as plans that allow them to have a private room if they are hospitalized or pay for drugs that Medicare doesn’t cover.

Concerns

As is often reported about Canada’s health care system, it is plagued by long waiting lines for non-emergency, elective care to control costs.

Former Washington Post correspondent and author of "The Healing of America: A Global Quest for Better, Cheaper, and Fairer Health Care" T.R. Reid noted that general practitioners can recommend to specialists, but wait times for elective surgery such as a shoulder replacement can take up to 10 or 12 months for a consultation and another 6 to 8 months for surgery.

One caveat however is that if someone has an acute problem or emergency in Canada, they’ll be treated right away and for free, Reid notes.

Canada is known for being particularly stingy when it comes to funding Medicare as its level of spending — about 11 percent of GDP — cannot compensate for the rising costs of medicine. Reid notes that Medicare is "underdoctored" because of inadequate funding and because medicine is seen as a less desirable career — fewer college students are willing to become nurses or physicians.

Denver Post writer and Canadian native Rhonda Hackett notes that, "From a purely statistical standpoint, there are enough physicians in Canada to meet the health care needs of its people. But most doctors practice in large urban areas, leaving rural areas with bona fide shortages. This situation is no different than that being experienced in the U.S."

Medical Tourism

Detractors of the Canadian model exclaim that Canadians come by the thousands to the U.S. for medical care because of long wait times. Although this is true to an extent, the anecdotal reports of Canadians crossing the border are not supported by any statistical research and is rather tiny, Reid notes.

As reported in the Denver Post, Canadians that do go to the US for medical care are fully paid by their provincial government as long as services are deemed medically necessary, are not experimental, and are not available at home for whatever reason such as a shortage of doctors or medical equipment, notes Hackett.

Patients that come to the US and pay out of pocket for medical care are those who perceive their care to be more urgent than it likely is.

Conversely, Americans are traveling north to fill their prescription drugs as Canadians pay one-quarter to one-half the price for the same pills, due to the strong negotiating clout the government has with drug manufacturers and providers.

The Orlando Sentinel reports that an estimated one million Americans purchase Canadian drugs online annually.

History

Canada’s history of universal health care is tied to the Baptist minister and former premier of Saskatchewan Tommy Douglas. At seven years old, Douglas was chosen at random to have a demonstrative surgical procedure to fix a broken leg he suffered a year earlier.

Although Douglas’ leg healed, he knew that his family would have never been able to pay for the treatment had he not been chosen at random. This inspired Douglas to pursue universal health care and years later would say, "I felt that no boy should have to depend either for his leg or his life upon the ability of his parents to raise enough money to bring a first-class surgeon to his bedside."

In 1944 Douglas was elected premier (governor) of Saskatchewan and created a single-payer insurer for all 1 million residents of the province. The program was publicly financed but delivered by private providers and won over the province’s residents.

By 1961, Douglas won his fifth term as premier and the success of Saskatchewan’s health care system created a demonstration effect that had the other provinces demanding the same health care spread to their provinces. In 1964 after a federal commission studied Medicare and deemed it effective at controlling costs and keeping the population healthy, a bill that established Medicare for each province on a national level passed unanimously through Parliament.

The Canada Health Act of 1984 places rules for all provinces and territories in order to receive federal financial aid such as keeping basic care not-for-profit, covering medically necessary services, providing equal treatment to all, covering everyone in every province, and treating everyone for the same fee.

What the US can learn

Aside from the fact that Canada’s and Taiwan’s health care systems mirror US Medicare, Reid parallels the Canadian example that if a US state could find a Medicare-for-all system and it worked, then other states might demand the same type of plan and eventually the US would have a national system.

Canada’s Medicare system mirrors the country’s egalitarian approach to health care where many Canadians, rich or poor, don’t mind waiting for elective surgery as long as all Canadians wait.

Before the US can find a solution to its health care problems, it must address the basic moral question of whether health care is a right or a privilege.