If Canadians are looking to the US for the care they need, they’ll be disappointed because Americans, ironically, are increasingly looking north for a viable healthcare model. There’s no question that American healthcare, a mixture of private insurance and public programs, is a mess. Over the last 5 years, health insurance premiums have doubled (it happened during the GOP watch), leaving large corporations, like General Motors bankrupt, which are just starting to come back. Expensive American healthcare has sent many families to the poorhouse. It is not a model to emulated but avoided because it is a broken system.
The Canadian universal healthcare system (healthcare plan) was conceived during the hard years of the Great Depression and its aftermath. It was the brainchild of a Baptist minister, turned politician, T.C. (Tommy) Douglas. He and others founded a new party in Saskatchewan, which later became the new Democratic Party based on “humanity before private interests.” Universal healthcare was at the top of their agenda. By 1964, Saskatchewan had a healthcare plan that included everyone according to their needs regardless of their ability to pay. The consequent doctor strike to kill it failed. Many thought it was a Communist conspiracy, exacerbated by the Cuban missile crisis. Opponents of programs benefitting the common people have always attacked them as Communist or Socialist throughout human history.
By 2004, the Canadian Broadcasting Corp did a poll to identify the greatest Canadian of all times. It was none of the politicians like Pierre Trudeau or movie stars like Kiefer & Donald Sutherland. It was their grandpa, Tommy Douglas. Today, when asked what they are most proud of, besides global peacekeeping, the response is unanimous—it is their healthcare system. When you hear horror stories about rationing healthcare in Canada or long waiting lines, remember that they came from the large American pharmaceuticals or the insurance industry which are worried of the handwriting on the wall, ending the abuse and robbing of the American people.
The Canadian system is not new to the US. We have been doing it for a long time now through Medicare, Medicaid, SCHIP, VA and Tricare. What perplexes many Canadians is so many Americans already have it and don’t even know it. That ignorance has caused so many people unnecessary worries, sleepless nights, funding manipulation from the conservative right who know about the proposed reform in bits and pieces from question- able sources. “A little knowledge is a dangerous thing” applies here.
The US spends much more than Canada on healthcare, both on per capita basis (Canada – $3,628; US – $6,714) and as a percentage of its GDP (Canada – 10%; US – 15.3%). In 2006, 70% of healthcare spending in Canada was financed by the government vs. 46% in the US. Total government spending per capita in the US was 23% higher than the Canadian government’s. A 2007 review of all studies comparing health outcome in Canada and US in a Canadian peer-reviewed medical journal found “that health outcomes may be superior in patients cared for in Canada than in the US, but the differences are not evident.”
US GOVT spending covers less than half of the healthcare costs ($5,372). Private spending is also greater in US than in Canada where the average of $917 was spent annually by individuals or private insurance companies for healthcare, including dental, eye care and drugs. In 2006, healthcare cost was at 15.3% of US GDP vis-à-vis 10% of GDP in Canada. The difference is a big departure from 1971 when spending between the two countries (Canada-7.1%; US-7.6% of GDP) was much closer. The demographics between the two countries differ substantially which may contribute to differences in health outcomes. Though both countries have white majorities, the US has significantly a larger minority population. The relative size of different ethnic and racial groups varies widely in each country. Hispanics (15%) and blacks (13%) constitute more than ¼ of US population though Canada has a relatively larger Asian population.
Life expectancy is longer in Canada, and its infant mortality rate is lower than that in US, but there is debate about the underlying causes of these differences. Numerous studies have attempted to compare rates of cancer incidence and mortality in Canada and US with varying results. Doctors who study cancer epidemiology warn that diagnosis of cancer is subjective and reported incidence of cancer will rise, if screening is more aggressive even if the real cancer incidence is the same. Statistics from various sources may not be compatible if they were collected in different ways. The proper interpretation of cancer statistics has been an important issue for many years.
Canada’s single-payer healthcare system covers about 70% expenditures, and the Canada Health Act requires that all insured persons be fully covered, without co-payments or user fees, for all medically necessary hospital and physician care. It is like our Medicare system in the US but includes everybody. About 91% of hospital expenditures and 99% of total physician services are financed by the pubic sector. There are more uninsured here in the US than the total population of Canada. With the new health plan that is being sold, the so-called consumer-directed plan uses a high-deductible plan. When you add those people, there are more who are either uninsured or under-insured than the entire people of the UK. Healthcare reform is necessary. We can’t let another opportunity slip by.
There is no doubt that cost, especially medicine, is an important factor in the debate. The Canadians have tackled the bull by the horn by finding ways to meet the medical costs of its seniors by expanding the use of generic drugs and buying them in bulk to cut costs. There’s no reason it can’t be done here. There is no reason to worry that by bringing additional 40 million-plus uninsured into the Medicare program, it will compromise services to seniors already in the program but will improve negotiations for them by the increase in the number of the insured. Ophthalmology and dental services account for a lot of the private expenditures in Canada. In the US, with its mixed public-private system, 16% or 45 million Americans are uninsured.
Canada has 4 doctors per capita (2.2 doctors per 1,000 people) than the US (2.4 doctors per 1,000 people). One of the important differences is the higher cost of drugs. In US, $728 per capita is spent on drugs vs. $509 in Canada. Consumption is higher in Canada (12 prescriptions per person) vs. 10.6 in US. The price differential for brand-name drugs between the two countries is upward to $1 billion US purchase of drugs from Canadian pharmacies. Centralized buying by provincial governments and in bulk is lowering prices. US Congress has given in to pharmaceutical demands that Medicare and Medicaid cannot negotiate the price of drugs.
The US spends more on technology than Canada. In a 2004 study of MRI, it was found that Canada had 4.6 MRI scanners per 1 million people while US had 19.5 per million. Canada’s 10.3 CT scanners per million ranked behind US which has 29.5 per million. This disparity in availability of technology results in longer wait times. But according to official statistics in 2007, all emergency patients received MRI within 24 hours. Increasing demands for healthcare in Canada due to aging population must be met either by increasing taxes or reducing other government programs.
The Canadian system has been 69-75% publicly funded though most services are delivered by private providers, including physicians (although they may derive their revenue primarily from government billing). Although more doctors work on a purely fee-for-service basis (usually family physicians), some family physicians and most specialists are paid through a combination of fee-for-service and fixed contracts with hospitals or health service management organizations. But Canada’s multi-billion budget surpluses have allowed it to assume new funding for the healthcare system.
The extra cost of malpractice lawsuits are relatively insignificant proportions of health-spending in both the US (0.45%) and Canada (0.27%). In Canada, the total cost of settlements, legal fees and insurance cases amount to $4 per person each year, but in the US it is $16. The average payout to American plaintiff was $265,103, while payment to Canadian plaintiff is somewhat higher, averaging $309,417.
We must remember that Americans voted for BHO overwhelmingly for change. If he backs off from a fight with even members of his political party, it is an understatement to say that many of his supporters will be disappointed. We remember what he said clearly during the campaign: Americans are not unrealistic to expect this kind of health coverage, but they want something. And the legislation must include a strong public plan.
We have been misled by so much hubris and garbage from American propagandists that “Canadians can’t compete with Americans because we are brainwashed to believe that we are a “special people” even though we are shortchanged and pushed to poverty by an unfair and costly system dominated by selfish corporate interests. It’s a simple clean-cut system: a) single-payer (government handles the bills and does the job to the satisfaction of patients). B) Patients choose their doctors—no buts, ifs or howevers. It is sustainable and affordable for future generations.
What is happening in this debate provides food for thought that is open for serious consideration—the viability of a third political party, because it seems like the current two we currently have are involved in a revolving door of exchanging places every few years while the country is getting deeper in a quagmire. We need real leaders, statesmen, not career politicians whose primary focus is to cling to their seats regardless of the interest of the nation. It’s time to start sending them home, and replace them with real public servants, like a Sen. Ted Kennedy, committed to the public good.
The Canadians are fighting back corporate interests in the US and are circulating a petition to register their anger at and concern for the lies and attacks on their healthcare plan. Remember that your health isn’t everything, but everything is nothing without your health.