Tag: Canada

Can we fix our broken health care system without reining in costs?
Aaron Carroll writes for the New York Times about how to fix our broken health care system.

Notwithstanding all the ways the Covid-19 pandemic exposed fissures in our health care system, bringing with it more than one million deaths, Congress is doing precious little to address uninsurance and underinsurance and their consequences for our health and well-being. Carroll studied health systems in five other wealthy countries to appreciate differences between them and the US. Carroll suggests that universal health care is the solution to our broken system, whatever it looks like; he doesn’t see health care costs in the US as a stumbling block.

We spend more per person on health care than any other country, and health outcomes are generally significantly worse than in every other wealthy country, including life expectancy. So, what does the United Kingdom, France, Australia and New Zealand do differently? They all guarantee health care coverage to their citizens.

Carroll posits that in every other significant way these other wealthy countries are different from one another. But, these countries not only share guaranteed universal coverage. They all have a sets price for most health care goods and services. It’s that combination, along with significant restrictions on insurance company profits, that make health care affordable for their citizens.

Australia, New Zealand and Canada all offer government-provided coverage, sometimes called single-payer. Australia and New Zealand’s single-payer systems allow people to buy private insurance to improve their access to care. Canada does not allow that. Australia’s system requires people to contribute significantly to the cost of their care.

Carroll says France’s system is not quite single-payer because people get their coverage through different systems. But, it is primarily with government funding, either through their jobs or some other means, and with significant government rules and regulations. France requires people to pay upfront for their outpatient care and then reimburses them for the cost.

Britain likely offers the most robust coverage of all these countries. Most services come with no out-of-pocket costs. Britain’s system is different from single payer because it is not insurance-based. Rather, the government employs physicians and owns hospitals and covers people’s care directly. The British system is socialized medicine. While people can have private insurance for enhanced benefits, almost no one does.

Singapore offers everyone only catastrophic coverage for high-cost services. People can buy private insurance to supplement the public coverage, but few do.

Carroll acknowledges that public hospital systems in all these countries make a huge difference in improving access to care, eliminating competition for profits. It seems hard to imagine how the US moves to that system to reduce costs and improve access, given the very limited number of public hospitals here. Is there any way to open up the Veterans Administration hospitals to all Americans? And, even if there were, would that give people living in remote areas adequate access to care?

Carroll points up that housing, food and education also contribute significantly to better health. Other countries invest in these “social determinants of health.” The US does not, but we could.

Carroll suggests that if we allocated some of our health care budget to the social determinants of health, we would likely see far better health outcomes. But, we are currently on the reverse trajectory, cutting this discretionary spending, such as food stamps. With all the money we invest in health care, Carroll has hope of realigning these investments. He thinks it’s simply a matter of political will.

Here’s more from Just Care:
June 14, 2023
Health insurers spread lies to promote shareholder value
In a Washington Post op-ed, Wendell Potter, president of the Center for Health and Democracy and a former Cigna executive, explains that his job at Cigna was to spread lies to Americans about health care in order to promote value for Cigna’s shareholders. As a result, millions of Americans are uninsured or underinsured today. And, thousands of Americans have died preventable deaths from lack of care during this pandemic.

In response to Michael Moore’s film, Sicko, in 2007, Potter worked in collaboration with executives at other health insurers to keep Americans from advocating against our for-profit health care system. Sicko claimed that the US corporate health care system was a failure, and Canada’s public health care system worked quite well. They hired a PR firm to develop talking points about the problems with Canada’s health care system. They pulled quotes from unreliable sources and spread falsehoods, misleading Americans to believe that the US health care system was best in class and other public health car systems were seriously flawed.

As Potter explains, the US’ inability to contain the novel coronavirus and Canada’s relative success demonstrates the superiority of Canada’s system. The US is seeing three times more coronavirus infections per capita and has twice the mortality rate of Canada. The health insurers’ trade association, AHIP, continues to spread nonsense about wait times to get care in Canada when Canadians have far more doctors and better access to medical care than Americans.

People in Canada have access to COVID-19 testing and treatment without having to worry about the cost. They have no out-of-pocket cost–no deductibles, no coinsurance, no copays. And, when they lose their jobs, they still have health insurance. This helps explain why so many fewer Canadians are dying than Americans.

If you look at a variety of metrics, people get better health care in Canada. People in Canada are hospitalized less frequently as a result of a chronic condition. They have longer life expectancies, 82 v. 78.6. And, they spend half the amount we do per person on health care. Moreover, their hospitals rely on a global budget and are protected financially when fewer people seek treatment.

We need a public health insurance system in the US if we care about ensuring Americans receive the care they need. Our private health insurance system is designed not to pay for care, to profit from imposing financial and administrative barriers to care.

Here’s more from Just Care:
August 12, 2020
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.

Here’s more from Just Care:
October 21, 2019