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."