Last week, the Supreme Court of the United States heard oral arguments for King v. Burwell, the second major legal challenge in four years to the Patient Protection and Affordable Care Act, better known as Obamacare.
Regardless of what the justices decide on the case, the Supreme Court’s re-examination of President Obama’s signature legislative achievement has put the issue of health care reform front and center in the political arena yet again.
As a Canadian, following the debate on health care reform that President Obama began in 2009, which has subsequently continued as Obamacare’s provisions gradually came into effect, has given me fascinating insights into the political system and political culture of your country.
During this debate, politicians and pundits, both for and against Obamacare, have often used the Canadian health care system as an example to advance their argument. However, many of their examples of how well or how badly our health-care system works are misconceptions or exaggerations at best and simply downright false at worst. I’d like to clarify and explain exactly how our health-care system functions.
For starters, the Canadian health care system is a universal single-payer system in which the government pays for basic medically necessary services for all citizens and permanent residents. However, it is not quite the kind of “socialized medicine” as many Americans believe it to be.
Although its framework was initially designed by the federal government, Canadian Medicare is administered and partly funded through taxation by each separate province, our equivalence of your states. These provincial programs must meet a set of federal standards mandated by the Canada Health Act of 1984; namely, that the programs be publically administered, universal, comprehensive and portable within the country, along with a few other very broad guidelines. Provincial programs that do not meet these standards will not receive federal funding, called the Canada Health Transfer.
Within the provinces, the respective Ministries of Health act as the insurance agency in administering care. This means that most doctors are not public employees, (unless they are working in public hospitals,) but rather, private practitioners who bill the government for services they provide to patients, at rates that are negotiated between medical associations and the government.
All you have to do as a patient at a doctor’s office is give them your government-issued health insurance card, no co-pay needed. The fact that all financial settlement is streamlined between the government and the doctor leads to significantly lower administrative costs than those in the United States.
Unlike many other advanced economies with universal health care, however, most provincial programs in Canada do not have universal pharmacare or services beyond the medically necessary services provided by a doctor. This means that most Canadians have to pay out-of-pocket or with private insurance, usually provided through their employer like it is here in the United States, for services such as prescription medicine, eyeglasses, eye exams, dental cleanings, and braces. In fact, almost 30% of all health-care costs in Canada are paid for by private sources.
For example, when my mother got surgery a year and a half ago, her government insurance covered all of the costs associated with her surgery and subsequent stay in a quad room, from the drugs to the meals. The private insurance she had under my dad’s employer plan upgraded her to a semi-private one. Ultimately, my dad decided to pay an extra $50 per day out of his pocket so she could stay in a private room.
Had my family relied solely on the government’s “socialized medicine”, my mom would have been fine and we wouldn’t have had to pay a penny for her surgery. But we still had the choice to purchase the extra, better care for my mom’s stay in the hospital. To me, this is the perfect compromise to ensure a basic social safety net for all our citizens while maintaining some freedom of choice over the quality of care.
Finally, the most often heard criticism against the Canadian health-care system is how long we have to wait to see the doctor, a specialist or for a medically necessary procedure. Many Canadians also recognize this as one of the main flaws of our system. However, American critics vastly exaggerate the extent of the problem.
Although waits for some procedures are indeed long in some areas of the country, wait times have been improving over the last decade, at least where I live in Ontario, thanks to legislation in 2005 setting benchmarks for different procedures.
Right now, the estimated average wait time to see a specialist in Canada is just over four weeks. Wait times for surgeries vary, but my mom only had to wait a mere three weeks for hers. As for primary physician care, when I was home in February and needed a sinus infection checked out on a Saturday afternoon, I drove 5 minutes to the nearest walk-in clinic and waited 20 minutes before I went into the doctor’s office.
In sum, we have a system that, in general, works for most Canadians. No Canadian dies or has to declare bankruptcy because they can’t afford health care. No Canadian feels so tied down to their job because they would lose all health care coverage if they moved. Growing up in Canada, I never worried about getting sick or anyone in my family getting sick.
But I will be the first to admit that Canada is not the perfect health-care utopia that many American liberals would like to claim it to be. At the same time, it is not the crude and inefficient bureaucratic nightmare that American conservatives think it is either.
For us, living in a country often so culturally, politically and economically overshadowed by our good neighbours to the south, universal health care (not quite socialized medicine!) has become a marker of our national identity, of that which makes us different from you Americans.
And just as having a strong safety net for health care has now been ingrained in our political and national culture (our governing Conservative Party is committed to maintaining the current universal system), your country’s culture of individual responsibility, particularly for one’s own well-being, may just explain why our kind of universal system will always remain a pipe dream in the United States.
