Winnipeg Free Press - PRINT EDITION

Health care blind spots on both sides

  • Print

One thing Americans and Canadians can agree on is we don't want each other's health care systems. In truth, most Americans don't know how Canada's system works and Canadians don't know much about the U.S. system.

What Americans know has come mainly from the negative talking points of politicians and others who have argued for years against national health insurance. Two decades ago, the New York Times reported Canadian women had to wait for Pap smears, a point vigorously refuted by the Canadian ambassador who shot back in a letter to the Times editor: "You, and Americans generally, are free to decide whatever health care system to choose, avoid or adapt, but the choice is not assisted by opinions unrelated to fact."

Yes, there are waiting lists for some services -- but, no, Canadians are not coming across the border in droves to get American care.

There's misinformation among Canadians, too. Wherever I went, Canadians told me they thought, mostly based on what they said they heard on CNN and Fox, that Obamacare meant America was getting universal health coverage like their country has.

When I explained the law was just another patch on a patchwork quilt of coverage, and the Congressional Budget Office estimated last year there would still be some 30 million people without insurance, the reaction was "the news media didn't tell us that."

Separating fact from opinion was something I tried to do as I travelled across Canada while visiting recently. In some ways, the Canadian system is very different from U.S. health care. In other ways, it's very much the same and faces similar challenges.

Although the Affordable Care Act in the U.S. calls for more people to have health insurance by offering subsidies and mandating all Americans have it or face penalties, the concept of universality is still a far distant goal. The Canada Health Act, on the other hand, calls for universality -- all residents must be covered by the public insurance plan run by their province on uniform terms and conditions. They have coverage wherever they are treated in their home province, and there's none of this stuff about limiting the doctors and hospitals patients can use as a condition of getting full benefits. In Canada, there are no financial barriers to care at the point of service as there are in the U.S.

Canadians don't pay co-insurance of 30 per cent or 50 per cent if they have an outpatient procedure or go to an urgent care clinic, charges that are increasingly common in the U.S. They don't worry about paying a gigantic bill if they happen to use an out-of-network doctor or hospital. Their publicly funded system bases patients' access to medical services on need, not on ability to pay. To use the word "ration," Canadians ration by need; Americans ration by price and will continue to do so as the ACA is implemented.

Because it's publicly funded, Canadian health care is more equitable. There's no such thing as buying a platinum plan and getting first-rate coverage or a cheapo bronze policy and paying 60 per cent of the bill yourself. The tiered policies available in the state exchanges further bake inequality into the U.S. system. People have wildly varying benefits depending on where they live, how old they are, where they work and how much they can afford to spend on health insurance.

That's not the case in Canada, except for prescription drug coverage. Drug benefits are quite unequal in Canada, and the lack of them is a pretty big hole for about 10 per cent of the population. There is no universal drug benefit, although two provinces have mandatory drug insurance -- you can get it from an employer or buy it from a public plan. About 40 per cent of the population gets coverage from their employers. If you can't afford the premium, there are subsidies. In that sense, Canadian drug coverage in those provinces resembles Obamacare. Still, having drug benefits does not necessarily mean adequate coverage, says Globe and Mail health columnist, André Picard: "The big difference from the rest of Canada's system is there is very little first-dollar coverage of prescription drugs."

On this trip, I heard much more about the social determinants of health than I hear in the U.S. Almost everyone I interviewed mentioned the dismal health status of aboriginal people and the need to improve access and quality of care. I tried to remember the last time I heard anyone discuss the medical problems of Native Americans or quality of care provided by the Indian Health Service.

I asked Michael Decter, a health policy expert and a former deputy health minister in Ontario, what was his wish list for Canadian health care. Topping his list was not more money for the health system; it was more for education aimed at improving the lives of aboriginal peoples. Better education correlates with better health. The second was drug coverage. Canada's infamous waiting times were not high on his list of priorities. In fact, he didn't even mention them as a problem.

 

Trudy Lieberman, a former president of AHCJ, is a contributing editor to the Columbia Journalism Review. She is a fellow at the Center for Advancing Health and blogs about paying for health care. Published with permission of the Association of Health Care Journalists.

Republished from the Winnipeg Free Press print edition January 24, 2014 A13

Fact Check

Fact Check

Have you found an error, or know of something we’ve missed in one of our stories?
Please use the form below and let us know.

* Required
  • Please post the headline of the story or the title of the video with the error.

  • Please post exactly what was wrong with the story.

  • Please indicate your source for the correct information.

  • Yes

    No

  • This will only be used to contact you if we have a question about your submission, it will not be used to identify you or be published.

  • Cancel

Having problems with the form?

Contact Us Directly
  • Print

You can comment on most stories on winnipegfreepress.com. You can also agree or disagree with other comments. All you need to do is be a Winnipeg Free Press print or e-edition subscriber to join the conversation and give your feedback.

You can comment on most stories on winnipegfreepress.com. You can also agree or disagree with other comments. All you need to do is be a Winnipeg Free Press print or e-edition subscriber to join the conversation and give your feedback.

Have Your Say

New to commenting? Check out our Frequently Asked Questions.

Have Your Say

Comments are open to Winnipeg Free Press print or e-edition subscribers only. why?

Have Your Say

Comments are open to Winnipeg Free Press Subscribers only. why?

The Winnipeg Free Press does not necessarily endorse any of the views posted. By submitting your comment, you agree to our Terms and Conditions. These terms were revised effective April 16, 2010.

letters

Make text: Larger | Smaller

LATEST VIDEO

Glenn January won't blame offensive line for first loss

View more like this

Photo Store Gallery

  • Goslings with some size head for cover Wednesday afternoon on Commerce Drive in Tuxedo Business Park - See Bryksa 30 Goose Challenge- Day 12- May 16, 2012   (JOE BRYKSA / WINNIPEG FREE PRESS)
  • MIKE APORIUS/WINNIPEG FREE PRESS BUSINESS - cow on farm owned by cattle farmer Lloyd Buchanan near Argyle Wednesday afternoon -see Larry Kusch's story  January 04/2006

View More Gallery Photos

Poll

Should Manitoba support the transport of nuclear waste through the province?

View Results

Ads by Google