Posted by: Bob Fisher | November 7, 2013

Transborder Sensibilities: Health Care Heal Thyself

Universal Health Care

Ask any Canadian why she or he is quite happy – thank you very much – not to be American, and at the top of the list will be “health care.” However, giving an overview of their system versus ours is like presenting a synopsis of justice or beauty.

But here goes.

As citizens of a nation born out of revolution, Americans are not partial to intervention in their private lives, especially when it comes to taxes. Remember that dust-up called the Boston Tea Party?

Canadians however are loyalists and have always had a greater penchant for not going it alone completely. Perhaps our frontier spirit is a bit more cautious. And our collective value system doesn’t require that the individual be solely responsible for providing the ways and means to wellness.

Americans seem to have developed a sauve qui peut approach to keeping well. And I dare say that in Canada health care is less of a business opportunity.

In terms of health care – how you get it, the real costs, who pays for it – Canadians and Americans face a number of similar issues. Canada’s system provides universal health care but is not a nationalized system as it is, for example, in the UK. It is often called “socialized health care” but the term only applies because it is publicly funded; the majority of health care providers in Canada are not state employees.

As a matter of fact, Canadian doctors have been referred to as “small hardware stores,” “entrepreneurs” and participants in a system of “passive privatization.” Most of our services are provided by the private sector not the public; in short, the patient pays the doctor for services rendered.

However, most hospitals in Canada are not private institutions and under the Canada Health Act the private hospitals and clinics that do exist cannot receive public funding. So this is not “state medicine”; fear of which can cause serious palpitations among doctors.

In the U.S. health care is provided by an enormous array of individuals and legal entities, for-profit and not-for-profit, but primarily the former.

A little over 80 per cent of Americans buy private health care insurance which pays for their medical needs, both routine “maintenance” as well as most hospital costs. They pay for this insurance out of their pockets either through a plan set up by their employer, individually, through a government program; or if they can’t pay, they may – if they qualify – be insured through government programs for the poor, the elderly, and the disabled.

However approximately 16 per cent of the population (46,000, 000 Americans) have no health insurance and frequently just do without (as enfant terrible and documentary film-maker Michael Moore points out in Sicko, his latest film and broadside against the American Dream).

But the United States spends more of its gross domestic product on health care than any other developed nation. The majority of American hospitals are not-for-profit but their in-hospital patients are what they are all about.

If you go to an emergency room because you are not insured and can’t pay, you cannot by law be turned away, but the only care you will get is emergency care.

Forget the annual check up.

Whether it’s Canada or the United States, the fundamental issue debated on both sides of the border is “single payer universal health care.” I advise you to parse that sentence carefully and consider the implications and ramifications of each word. Canada’s national health care program ensures that every resident of the country gets medical care and hospital treatment regardless of their ability to pay, because the costs come out of the collective purse, i.e. taxes.

Remember what I said about Americans and taxes? And to a great extent we owe this enviable state of affairs to a prairie preacher called Tommy Douglas whose “socialist” provincial government got the whole ball rolling in Canada following the Great Depression.

According to a recent blistering editorial in The New Yorker magazine by Atul Gawande, assistant professor of surgery at the Harvard Medical School, the American “health-care morass is like the problems of global warming and national debt – the kind of vast policy failure that is far easier to get into than to get out of.”

Gawande also points out that Americans “balk” at specific solutions to the morass when they realize that “any plausible approach will shift substantial costs from the private sector to taxpayers” – one more major social issue that divides our American friends.

Lest you think we Canadians are Miss Goody Two Shoes, please be aware that we constantly struggle to figure out how we got it right back in Tommy Douglas’s time, how we can hang on to it, how we can continue to pay for it, and how we can stave off creeping privatization.

In another recent issue of the New Yorker, there is a cartoon titled “Jimmy and Jane Play Doctor” in which Jimmy says, “What sort of insurance do you have?” Jane replies, “Actually, I don’t have any.”

Dr. Jimmy responds, “Goodbye then.”

For more information on where the Canadian health care system came from, read Saskatchewan: Learning From the Landscape.


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