One thing Americans and Canadians can agree on is that we don’t want each other’s health-care systems. In truth, most Americans don’t know how Canada’s system works, and Canadians don’t know much about the U.S. system.
What Americans know has come mainly from the negative talking points of politicians and others who have argued for years against national health insurance.
There’s misinformation among Canadians, too. Wherever I went, Canadians told me they thought, mostly based on what they said they heard on CNN and Fox, that Obamacare meant America was getting universal health coverage like their country has.
When I explained the law was simply another patch on a patchwork quilt of coverage, and the Congressional Budget Office had estimated last year there would still be about 30 million people without insurance, the reaction was “the news media didn’t tell us that.”
Separating fact from opinion was something I tried to do as I made my way across Canada while visiting recently. In some ways, the Canadian system is very different from U.S. health care. In other ways, it’s very much the same and faces similar challenges in the years ahead.
Although the Affordable Care Act in the U.S. calls for more people to have health insurance by offering subsidies and mandating all Americans have it or face penalties, the concept of universality is still a distant goal. The Canada Health Act, on the other hand, calls for universality — all residents must be covered by the public insurance plan run by their province on uniform terms and conditions.
They have coverage wherever they are treated in their home province, and there’s none of this stuff about limiting the doctors and hospitals that patients can use as a condition of getting full benefits. In Canada, there are no financial barriers to care at the point of service as there are and will continue to be in the U.S.
Canadians don’t pay coinsurance of 30 per cent or 50 per cent if they have an outpatient procedure or go to an urgent-care clinic, charges that are becoming increasingly common in the U.S. They don’t worry about paying a gigantic bill if they happen to use an out-of-network doctor or hospital.
The publicly funded system in Canada bases patients’ access to medical services on need, not on the ability to pay. To use the word “ration,” Canadians ration by need; Americans ration by price and will continue to do so as the ACA is implemented.
Because it’s publicly funded, Canadian health care is more equitable. There’s no such thing as buying a platinum plan and getting first-rate coverage or a cheapo bronze policy and paying 60 per cent of the bill yourself.
The tiered policies available in the state exchanges further bake inequality into the U.S. system. People have wildly varying benefits depending on where they live, how old they are, where they work and how much they can afford to spend on health insurance.
That’s not the case in Canada, except when it comes to prescription drug coverage. Drug benefits are quite unequal in Canada, and the lack of them is a big hole for about 10 per cent of the population. About 40 per cent of the population gets coverage from their employers.
On this trip, I heard much more about the social determinants of health than I hear in the U.S. Almost everyone I interviewed mentioned the dismal health stats for aboriginal populations and the need to improve access and quality of care. I tried to remember the last time I heard anyone discuss the medical problems of Native Americans or quality of care provided by the Indian Health Service.
I asked Michael Decter, a health policy expert and a former deputy health minister in Ontario, what was his wish list for Canadian health care.
Topping his list was not more money for the health system; it was more for education aimed at improving the lives of aboriginal peoples.
Better education correlates with better health. The second was drug coverage. Canada’s infamous waiting times were not high on his list of priorities. In fact, he didn’t even mention them as a problem.
Trudy Lieberman, a former president of the Association of Health Care Journalists, is a contributing editor to the Columbia Journalism Review. She is a fellow at the Center for Advancing Health, where she blogs about paying for health care.
