When the United States Senate took a big step on Dec. 21, 2009, towards approving the biggest-ever reform of the American health-care system, it ensured that — for the most part — the way health care is delivered would not change very much.
What was approved by the Senate — and the House of Representatives before it — was not a march to Canadian-style "socialized medicine," but rules that would maintain the U.S. as the only industrialized nation in the world without universal health-care coverage.
The countries that make up the World Health Organization adopted a resolution in 2005 encouraging countries to develop health financing systems that would provide universal health care, which
it defined as "securing access for all to appropriate promotive, preventive, curative and rehabilitative services at an affordable cost."
What the United States and Canada have in common when it comes to health care is that it is administered by insurance companies. In Canada, those companies are public, funded by tax dollars and controlled by the provinces and territories.
In the U.S., those companies are — for the most part — private for-profit corporations that sell you or your employer coverage plans. For those who are unemployed, there's
Medicaid a government-run insurance program that provides basic benefits to the very poor — only if they meet certain eligibility requirements that vary from state to state. For those over the age of 65, there's
Medicare — another government-run program that provides universal health care for seniors, as long as they meet residency requirements and have paid into the program. It does not cover the cost of prescription drugs or vision and dental care. There are private options that offer that coverage.
In 2008, there were 43.6 million Americans under the age of 65 with no health insurance. For most of them, their main option for care is to go a hospital emergency department when they get sick. Under U.S. federal law, a hospital must treat a person who shows up in the emergency department, regardless of their ability to pay. The hospital can bill the patient and try to collect.
You have to qualify for health-care coverage in Canada as well. Normally you have to live in a province for three months to be eligible. You have to be a Canadian citizen or a landed immigrant. If you're out of work, you're still covered for whatever services your province insures.
Canada's 5 'pillars'
The Canada Health Act sets out the primary objective of health-care policy across the country. That objective is "to protect, promote and restore the physical and mental well-being of residents of Canada and to facilitate reasonable access to health services without financial or other barriers."
The federal government transfers money to each province or territory to cover part of their health-care budget, as long as they meet the following five criteria:
- Public administration: provincial and territorial health insurance plans must be administered and operated on a non-profit basis by a public authority whose books are publicly audited.
- Comprehensiveness: a health-care insurance plan of a province or territory must cover all insured health services provided by hospitals, physicians or dentists in a hospital setting. The services of other health-care practitioners may be covered.
- Universality: health insurance must be available to all who meet residence requirements on uniform terms and conditions.
- Portability: you're covered by your home province if you're in another part of the country on business or on vacation.
- Accessibility: you should have reasonable access to hospital, medical and surgical-dental services on uniform terms and conditions — and not be charged extra for insured services.
While it
may take longer to access some of those services depending on which part of the country you live in, you will eventually receive care.
Under the proposed changes in the United States, 30 million previously uninsured people will join the ranks of the covered. Health insurance would be mandatory — unless you had a religious objection. Anyone else who declined to buy insurance would pay a fine. Low- and moderate-income people would receive government subsidies to help pay their insurance premiums.
It's estimated that as many as 18 million would still be without health insurance. A third of them would be illegal immigrants.
Modified status quo?
Health insurance plans would still be administered by large corporations. The Senate bill does not include a provision for a government-run insurance company as an alternative to the private companies.
Employers and people without coverage at work could buy plans in a national exchange. But there would be some key changes: insurance companies won't be able to deny coverage to people with pre-existing conditions. Insurance companies would not be able to charge higher premiums based on medical conditions or gender — and they would not be able to set lifetime limits on health coverage.
Even with health-care reform in the United States, Americans will still be paying substantial out-of-pocket expenses. Depending on the details of the legislation that President Barack Obama signs, health insurance may cover anywhere from 60 to 90 per cent of a patient's expenses.
The
American Medical Association has come out in favour of both pieces of legislation, saying the changes will improve choice and access to affordable health insurance coverage and eliminate denials based on pre-existing conditions.
One of the key goals of reforming the American health-care system is to get costs under control. Health insurance premiums have been rising much faster than incomes have grown and — depending on which study you believe — administrative costs eat up anywhere from 12 to 31 per cent of all money spent on health care in the United States.
The U.S. spends more on health care ($7,439 per person in 2007) than any country on the planet — yet fails to deliver consistent care to about 15 per cent of the population.
A study published in the
New England Journal of Medicine in August 2003 found that the U.S. was spending a lot more than Canada on health-care administration — and that the gap grew from $307 per capita in 1999 to $759 per capita in 2003. The study concluded that the U.S. could save a lot of money by adopting a Canadian-style health-care system.
http://www.cbc.ca/health/story/2009/12/22/f-health-care-canada-us-reform-access.html