When you hear people talk
about health care in America there is one country
that seems to get a good amount of attention. It’s a single payer
health care system. Kind of like the “Medicare
for All” plans that some well-known Democrats
have been promoting. In fact, the system’s
unofficial name is also Medicare. It has
universal coverage. It has relatively cheaper
drug prices than the United States and it also
has reports of long waiting times and endless
reams of red tape. You’ve probably guessed
which country we’re talking about: Canada. Canada’s health care system
is playing a larger role in America’s political
discourse, as the 2020 presidential elections
heat up. Progressives on the left
love pointing to Canada as an equitable and
efficient health care system. Conservatives, on the other
hand, use Canada as an example when warning
about the dangers of socialized medicine and
unchecked bureaucracy. So how different, really,
is Canada’s health care system from what’s going on
in the United States. In 2017, it’s estimated
that Canada spent around 10.4 percent of its
GDP on health care. By comparison the United
States is estimated to have spent about 17.2 percent of its
GDP that year. The OECD estimates that
Canada spent around 4,500 USD per person in 2017. In the United States,
though, the figure is expected to be at least
double that at ten thousand dollars
per person. Out-of-pocket spending is also
lower in Canada. On average Canadians spent
around 650 USD per person in 2016. The average for
Americans was around eleven hundred dollars
that year. Canada still spends more than
the average of all 36 OECD countries, which
comes in around 3,800 dollars per person
and 8.8 percent of GDP. Despite spending less than
the United States, Canada’s medicare system
ensures citizens have universal coverage for medical
needs that are deemed essential something
the U.S. hasn’t accomplished. Canada also has comparable
or better health outcomes than the U.S. even though it
spends less money. But, compared to other
countries, Canada’s health care system has
room for improvement. Researchers looked at the
rate of deaths that could have been prevented
with proper access to care across 11 countries. Canada ranked seventh on
the list while America was last. We can see the same
trends in infant mortality rates. Canada outperforms
the U.S. but other countries like
Sweden and Australia have much lower infant
mortality rates than Canada. Canadians also live
longer than Americans. Canada’s average life expectancy
is among the highest of all the countries
and is nearly four years higher than
the U.S.. Additionally, Canada’s maternal
mortality rate is almost four times lower than
that of the United States and more Americans
die of heart disease and stroke
than Canadians. So how does Canada manage
to spend less money than the United States
while having a more effective health
care system? Canadian medicare is a
publicly funded model with private delivery. The system was established
in order to ensure equity among citizens
regardless of people’s ability to pay. It was also created
in order to keep administrative costs low. “There’s no private plan
can take cognizance of the family’s ability
to pay. Only a government can levy
taxes on that basis.” All Canadians receive
their coverage through Medicare which is run at
the local level by each of the 12 provinces
under federal supervision. “So basically the health
ministry in the capital in Ottawa determines what
procedures are going to be covered. What we’re going to
pay for it. What pills we’re going to
cover on our list. These are decisions that
are made separately by insurance companies, basically,
in the United States.” That’s T.R. Reid author of the book
“The Healing of America.” He traveled the world
exploring different health care systems and how well
they work in Canada. “Everybody has the
same treatment. They would drive them nuts
if George got better health care than Sam did. That’s that’s not
acceptable in Canada.” There’s some variation on what
is covered based on province but most medically
necessary care is covered with no
out-of-pocket costs. There are some
universal exceptions. Prescription drugs are
not considered essential under medicare. Dental, mental health, and
optometry are also not covered unless they
are considered medically necessary. Because Medicare does
not cover everything. Most Canadians also buy
private health insurance through their employers to
supplement out of pocket expenses. They cannot however use
that private insurance to purchase care that is
covered under the government plan. “If there’s any treatment
or procedure or surgery that the system covers under
its rules, then you can’t buy it privately. This is because – you know
how in America we hate this notion of socialized
medicine, whatever it seems that’s
really bad… in Canada the bad thing
is what they call two tier medicine. That is, they don’t
want rich people getting better care for all that
would be terrible that would violate their basic
gallantry and values. In America we kind of take
it for granted that a rich kid is going to
get better treatment than a poor kid, that’s kind
of standard. In Canada, that would
be taboo. That’s a sin.” In 2015, private funding
such as household out-of-pocket costs and
private insurance spending accounted for about
30 percent of health care spending in Canada. Despite the majority of
health care being publicly funded, most
hospitals and doctor’s offices are privately
owned and operated. Doctors who own their
own private practices are considered contractors who
bill the government insurance fund for
their services. The government is
not their boss. “The doctors are not
allowed to practice outside of the system. They can either practice
completely in the government medicare system or
completely out of it. And there are very
few places Canada where a doctor can make a
living without taking the Medicare patients, and therefore
for most people that’s the only choice.” Despite having universal coverage
the system still has some problems. Wait times are longer in
Canada than the United States. In a 2016 survey
53 percent of Canadians said they were not able
to get an appointment on the same or next day
when they were sick or needed attention. The United States performed
slightly better at 42 percent. Out of all of
the 11 countries surveyed, Canada performed the worst
in that category. Thirty percent of Canadians
said they waited two months or longer to see
a specialist compared to 6 percent in
the United States. Nearly one in five Canadians
waited four months or more for elective surgery while
only 4 percent of American respondents said
the same. About 60 percent of
Canadians find it difficult to access medical care
in the evenings, on weekends or during holidays
without going to a hospital. These long wait times
can lead to the overuse of the emergency
room, where half of Canadians said they’ve waited
two hours or more to be seen. “It’s a good system but
it doesn’t work that well in Canada, interestingly. In its own home country,
there are long waiting lines. You know, there
are constant stories about care being denied or people
just had to wait months just to
see the doctor. And I believe that’s because
the Canadians are too cheap about it. They just don’t spend enough
on health care to have a lively system. Some provinces like
Saskatchewan where this started, have shorter waiting
times for both acute and elective treatment
than most of the United States. So there are parts of
Canada where it works.” Not all medical care is
covered in Canada which leads people to
have significant out-of-pocket costs. Medicare does not classify
prescription drugs as essential which means they
are not covered for many patients. There are some social
programs to help Canadians pay for drugs, but the
benefits vary by province. For example, Ontario
provides prescription drug coverage for anyone under 24
years old who does not have
private insurance. The province also has a
drug program for people 65 and older. Canadian pharmaceutical costs are
also not as controlled as
other countries. Canada spends approximately the
same amount as the UK on pharmaceuticals
despite having only half the population. There are also no
out-of-pocket caps on spending. In 2015, Canadians spent
around $670 U.S. dollars per capita on
retail prescription drugs compared to the United States
per capita costs of roughly 1000 dollars
in 2016. One in 10 Canadians did
not fill a prescription or chose to skip a
dose due to cost. This is still significantly
better than the United States where nearly
one in five people chose not to buy
medication because of cost. Despite the problems Canadians
are proud of their health care system but they
do recognize it needs reform. 94 percent of Canadians surveyed
said it was an important source of both
personal and collective pride. But nearly one
in four Canadians were concerned about whether they would
be able to pay for all of the care they
might need if they ever became seriously ill. Despite that concern 45
percent of Canadians rated the overall quality
of medical care in Canada as excellent or very
good and nearly three quarters said the same of
their personal care in the past year. “The citizens are
crazy about It. It’s egalitarian and treats
everybody the same. That’s the most important
societal value in Canada is treating
everybody equally. The other thing they like
about it is they know it’s better than the U.S. system. They have better
outcomes, they have better recovery rates from
disease, they have longer life expectancy and they
pay less and man they love being better
than the U.S.. That matters
to Canadians.”