How does Canada’s Medicare health care system work?

At this year’s Single Payer Strategy conference held last weekend in Portland, I had the pleasure of interviewing Monika Dutt about Canada’s Medicare health care system. Dutt is a family physician, public health specialist, and a long-time health care advocate with Canadian Doctors for Medicare and Healthcare Providers Against Poverty. Here’s what we learned about the Canadian Medicare program.

Canada’s Medicare is a universal health care system with national standards. It is administered by Canada’s provinces and portable from one province to another. It covers the full cost of medically necessary physician and hospital services. No matter who you are, you pay nothing for your care.

How is health insurance paid for in Canada? All medically necessary physician and hospital services are funded through Canada’s tax base. That said, Canadians pay for about 30 percent of total health care spending, through a combination of private supplemental insurance, which covers services that Canada’s Medicare does not cover, and out-of-pocket costs. About 15 percent of costs go to supplemental insurance, which pays for home care, institutional care, prescription drugs, dental physiotherapy and routine vision. Sometimes for some populations, at a province’s discretion, a province will pay for some of these services.

Often, employers contribute to the cost of private supplemental insurance in Canada. About two thirds of Canadians get supplemental insurance through their jobs. Another 11 percent or so get it through the Canadian government.

Canadians have free choice of doctors and hospitals anywhere in the country. Medicare in Canada works a lot like Medicare here, except, like Medicare for All, it covers everyone and has no out-of-pocket costs. Most doctors are paid on a fee-for-service basis.

People never have to worry about getting care in Canada. And they do not have to wait when they have an emergency or an acute health care need. There are no waits for emergency or urgent care services. No one whose health is endangered waits for care.

The biggest shortcoming of the Canadian system is that there are waits for people whose needs are less urgent. Those waits are often fairly similar to waits here in the US. In Canada, you cannot pay more and wait less. Everyone is treated the same.

Conservative policymakers are trying to turn Canada’s system into a two-tiered system. It would allow private pay for the wealthy to get to the front of the line and doctors could charge their private pay patients whatever they wanted. A court case in Canada is currently challenging the right of patients to pay privately for care. The problem with such a system, says Monka Dutt, is that it is more expensive, less efficient, and it creates inequalities, as can be seen in Australia, which has such a system.

Dutt sees the possibility of Medicare for All in the US, notwithstanding the challenges of enacting it. She explains that it took several decades for Canada to get its universal health care system. As in the US, it began with a lot of opposition. Today, not many doctors will speak against it.

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