How Canada's Universal Health-Care System Works

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."