# Affordable Care Act compared to Canadian Health Care **URL:** \ **Category:** Factual Questions\ **Created:** [June 6, 2013, 9:32pm UTC](https://boards.straightdope.com/t/affordable-care-act-compared-to-canadian-health-care/660333 "2013-06-06T21:32:12Z")\ **Posts on this page:** 20\ **Page:** 3
**Author:** ![Northern\_Piper](https://sea3.discourse-cdn.com/straightdope/user_avatar/boards.straightdope.com/northern_piper/32/5304_2.png) [@Northern\_Piper](https://boards.straightdope.com/u/Northern_Piper)\ **Post date:** [June 8, 2013, 11:33pm UTC](https://boards.straightdope.com/t/affordable-care-act-compared-to-canadian-health-care/660333/41 "2013-06-08T23:33:57Z")
> [@Lord\_Feldon](#): > > Only around 20% of US hospitals are for profit. True, but that article in Time a few months ago about the retained earnings of non-profit hospitals was eye-opening. I think it’s behind a paywall now - I’ll poke around a bit to see if I can find it. ---
**Author:** ![Northern\_Piper](https://sea3.discourse-cdn.com/straightdope/user_avatar/boards.straightdope.com/northern_piper/32/5304_2.png) [@Northern\_Piper](https://boards.straightdope.com/u/Northern_Piper)\ **Post date:** [June 8, 2013, 11:44pm UTC](https://boards.straightdope.com/t/affordable-care-act-compared-to-canadian-health-care/660333/42 "2013-06-08T23:44:13Z")
> [@md2000](#): > > Additionally, since there are no medical bills for most incidents, there are a lot less lawsuits. This is an important point. It seems to me that one of the drivers for the US tort litigation system is that if you’re injured and have medical bills that aren’t covered by insurance, you have to try all means to get them paid - and litigation is an obvious way to try. In Canada, since you don’t have medical bills, that incentive just isn’t there. > [@](#): > > Real Canadian lawyers will weigh in here I hope, but the rules in Canada are loaded against pain and suffering awards, and tend toward loser pays legal fees - so a lot less incentive to try for those stupid “I scalded myself with your coffee so it’s your fault” lawsuits. I wouldn’t say they’re loaded against pain and suffering awards, but rather that there are caps on the two major types of non-pecuniary losses arising from an injury: loss of enjoyment of life, and pain and suffering. Since these are purely subjective in nature, our courts have created guidelines for the possible ranges. If a jury exceeds those ranges, the trial judge can reduce the award. That prevents “runaway juries.” ---
**Author:** ![Northern\_Piper](https://sea3.discourse-cdn.com/straightdope/user_avatar/boards.straightdope.com/northern_piper/32/5304_2.png) [@Northern\_Piper](https://boards.straightdope.com/u/Northern_Piper)\ **Post date:** [June 8, 2013, 11:48pm UTC](https://boards.straightdope.com/t/affordable-care-act-compared-to-canadian-health-care/660333/43 "2013-06-08T23:48:07Z")
> [@Darth\_Panda](#): > > Obviously, lots of questions about negligence, responsibility, etc., but I feel like the myth around this story it “ow, that’s hot give me a million dollars,” when the truth was “holy crap that burned the living hell out of me, please help cover the actual costs.” And not just 3rd degree burns, but third degree burns to her genital area! :eek: She’d put the cup between her legs to hold it, which is pretty common when you’re going through a drive-through. ---
**Author:** ![leahcim](https://avatars.discourse-cdn.com/v4/letter/l/b4bc9f/32.png) [@leahcim](https://boards.straightdope.com/u/leahcim)\ **Post date:** [June 9, 2013, 12:25am UTC](https://boards.straightdope.com/t/affordable-care-act-compared-to-canadian-health-care/660333/44 "2013-06-09T00:25:07Z")
> [@KarlGauss](#): > > Doctors in the US spend a huge amount of resources dealing with the various payers - there are scores and scores of them, each with different processes, different criteria for reimbursement, different degrees of required documentation, etc. As I understand it, American physicians almost always require staff (singular or plural) whose only job is to deal with the multitude of payers (all the various insurance companies, etc.). Bottom line is that it is expensive, frustrating, and time consuming. There is even a segment of the software industry dedicated to creating software for medical billing, and people who advertise themselves as “medical billing specialists”. Both are dedicated to knowing and working through the arcana involved in American medical billing to ensure the highest possible acceptance rate from the various insurance policies. This is pure excise. One group of people dedicated to making things complicated, and another group of people dedicated to cutting through the complexity. These people could be sent out to build pyramids in the desert and then take them down again with the same effect. ---
**Author:** ![Muffin](https://sea3.discourse-cdn.com/straightdope/user_avatar/boards.straightdope.com/muffin/32/4341_2.png) [@Muffin](https://boards.straightdope.com/u/Muffin)\ **Post date:** [June 9, 2013, 12:38am UTC](https://boards.straightdope.com/t/affordable-care-act-compared-to-canadian-health-care/660333/45 "2013-06-09T00:38:35Z")
While hospitals may or may not be for-profit or aggressive-retained-earnings, it remains that the health insurance industry is for-profit, whereas in Canada neither the hospitals nor the governments that are the insurers are for-profit or aggressive-retained-earnings. ---
**Author:** ![Fear\_Itself](https://sea3.discourse-cdn.com/straightdope/user_avatar/boards.straightdope.com/fear_itself/32/19637_2.png) [@Fear\_Itself](https://boards.straightdope.com/u/Fear_Itself)\ **Post date:** [June 9, 2013, 12:44am UTC](https://boards.straightdope.com/t/affordable-care-act-compared-to-canadian-health-care/660333/46 "2013-06-09T00:44:12Z")
> [@A\_nice\_guy\_with\_an\_opinion](#): > > Don’t make me pay for it. Why not? You benefit from a healthier economy when more people have insurance; higher productivity, broader tax base, fewer people defaulting on medical bills. You reap the benefits of universal coverage, you should bear some of the cost of a more stable productive economy. ---
**Author:** ![Mdcastle](https://avatars.discourse-cdn.com/v4/letter/m/958977/32.png) [@Mdcastle](https://boards.straightdope.com/u/Mdcastle)\ **Post date:** [June 9, 2013, 12:46am UTC](https://boards.straightdope.com/t/affordable-care-act-compared-to-canadian-health-care/660333/47 "2013-06-09T00:46:21Z")
That’s simply not true. A number of health insurers are either collectives or non-profits. ---
**Author:** ![njtt](https://avatars.discourse-cdn.com/v4/letter/n/ecd19e/32.png) [@njtt](https://boards.straightdope.com/u/njtt)\ **Post date:** [June 9, 2013, 12:56am UTC](https://boards.straightdope.com/t/affordable-care-act-compared-to-canadian-health-care/660333/48 "2013-06-09T00:56:56Z")
> [@Mdcastle](#): > > That’s simply not true. A number of health insurers are either collectives or non-profits. And others _are_ for profit. It is still a _for profit_ industry. What is more, even in those non-profit health insurers, I am pretty confident that the people at the top are still taking home a lot a lot of money. In America, “non-profit” does not necessarily mean no-one is getting rich off it. ---
**Author:** ![Muffin](https://sea3.discourse-cdn.com/straightdope/user_avatar/boards.straightdope.com/muffin/32/4341_2.png) [@Muffin](https://boards.straightdope.com/u/Muffin)\ **Post date:** [June 9, 2013, 2:50am UTC](https://boards.straightdope.com/t/affordable-care-act-compared-to-canadian-health-care/660333/49 "2013-06-09T02:50:09Z")
> [@Muffin](#): > > While hospitals may or may not be for-profit or aggressive-retained-earnings, it remains that the health insurance industry is for-profit, whereas in Canada neither the hospitals nor the governments that are the insurers are for-profit or aggressive-retained-earnings. > [@Mdcastle](#): > > That’s simply not true. A number of health insurers are either collectives or non-profits. And I suppose the financial services sector is not a for-profit industry because there are some co-ops and not-for-profits, and the retail sector is not a for-profit industry because there are some co-ops and not-for-profits. :dubious: Look, pretending that the health insurance industry in the USA is not a for-profit industry simply because there are some elements of it that are not for-profit is ignoring the obvious. Sound policy decisions come from sound analysis, and sound analysis rests on sound facts. Pretending that the health insurance industry in the USA is not a for-profit industry will not lead to sound policy decisions. ---
**Author:** ![Mdcastle](https://avatars.discourse-cdn.com/v4/letter/m/958977/32.png) [@Mdcastle](https://boards.straightdope.com/u/Mdcastle)\ **Post date:** [June 9, 2013, 3:43am UTC](https://boards.straightdope.com/t/affordable-care-act-compared-to-canadian-health-care/660333/50 "2013-06-09T03:43:54Z")
What industry is the goal not to make enough money to at least pay your employees and CEOs, in the latter case rather handsomely. Certainly not the hospital industry, which like the insurance industry has both for and nonprofits. ---
**Author:** ![SmartAlecCat](https://avatars.discourse-cdn.com/v4/letter/s/67e7ee/32.png) [@SmartAlecCat](https://boards.straightdope.com/u/SmartAlecCat)\ **Post date:** [June 9, 2013, 11:24am UTC](https://boards.straightdope.com/t/affordable-care-act-compared-to-canadian-health-care/660333/51 "2013-06-09T11:24:23Z")
> [@Northern\_Piper](#): > > Right - because here in Canada we have all those unhealthy fast food places: McDonald’s, DQ, A&W, Wendy’s, KFC, Taco Bell, plus calorie-laden chains like Red Lobster and Olive Garden. And we have all those high calorie soft drinks, like Coke and 7-Up. > > You guys down south don’t have anything like that in your diet. > > Oh, wait … > > Seriously, what cultural diversity are you talking about? And, since this is GQ rather than IMHO, cite, please? Cite for which claim? That we have different eating habits, different health, or that eating habits can affect health? Here’s something to look at: Comparative Consumer Profile Canada and the United States - July 2010 [http://www.ats-sea.agr.gc.ca/info/5645-eng.htm](http://www.ats-sea.agr.gc.ca/info/5645-eng.htm) % of Population Aged 15 and Up 1979 1989 1999 2009 2019 CANADA - Obese 5,2 10,3 13,7 21,8 26,5 CANADA - Overweight 25,7 32,1 33,2 32,3 34,8 UNITED STATES - Obese 15,6 22,0 29,8 38,7 44,9 UNITED STATES - Overweight 32,4 32,6 33,3 43,2 47,3 (2019 is projected) While we do indeed have some of the same establishments, but, as a whole we are consuming differently. Supported by things like this: “Vegetables: Both countries are experiencing steady increases in per capita vegetable consumption that are projected to continue, but Canadians consume significantly more than their American neighbours. In 2009, average per capita consumption of fresh vegetables was 113.4 kg in Canada versus 67.5 kg in the U.S., indicating that the average Canadian consumed 45.9 kg more vegetables annually than the average American. Canadian consumers increased their annual fresh vegetable consumption by 2.6 kg since 1999, and Americans by just over 2 kg.” and this: “Nevertheless, consumers are looking for more than the conventional take-home options of pizza, drive-through, or TV dinners, especially in Canada. Canadian consumers are increasingly conscious of the health risks associated with convenience-oriented products such as fast-food and highly-processed, pre-packaged meals. Instead, they are seeking better-for-you options that emphasize naturalness, freshness and fortified ingredients, driving demand for convenient products that are also nutritious. Although convenience is important to consumers in both countries when making food purchase decisions, Canadians are less likely than Americans to sacrifice nutrition for the sake of convenience. There is notable opportunity for food producers that can satisfy consumers’ needs for both (Euromonitor, 2009b; The NDP Group, 2008).” ---
**Author:** ![Muffin](https://sea3.discourse-cdn.com/straightdope/user_avatar/boards.straightdope.com/muffin/32/4341_2.png) [@Muffin](https://boards.straightdope.com/u/Muffin)\ **Post date:** [June 9, 2013, 2:59pm UTC](https://boards.straightdope.com/t/affordable-care-act-compared-to-canadian-health-care/660333/52 "2013-06-09T14:59:18Z")
Yes, Americans tend to eat more of the wrong stuff than Canadians, and I expect that this has led to relatively more negative health outcomes for Americans. Both countries have a long way to go in this aspect of public health. BTW, last month the Conservatives shot down Bill C-460 in second reading. That’s the one that would have limited sodium in prepared/processed foods. South of the border, the USDA has been pondering limiting sodium in prepared/processed foods, but has not done so as of yet. ---
**Author:** ![Novelty\_Bobble](https://avatars.discourse-cdn.com/v4/letter/n/a3d4f5/32.png) [@Novelty\_Bobble](https://boards.straightdope.com/u/Novelty_Bobble)\ **Post date:** [June 9, 2013, 4:05pm UTC](https://boards.straightdope.com/t/affordable-care-act-compared-to-canadian-health-care/660333/53 "2013-06-09T16:05:51Z")
> [@A\_nice\_guy\_with\_an\_opinion](#): > > A lot of the poor want big screen TV’s, rims, 4 wheelers, Air Jordans, tacticool guns, iphones, etc. > > They are willing to pay for those things instead of health care. > > I say let them choose. Don’t make me pay for it. You’ll never stop people making poor short term financial decisions. As it stands they choose not to buy healthcare and you\* still\* pay for it! They don’t pay, they get sick, you pay for their treatment. Remember, in the USA you already cough up more of your taxes to pay for the various public healthcare schemes then I do in the UK…and we cover everyone! ---
**Author:** ![md2000](https://avatars.discourse-cdn.com/v4/letter/m/73ab20/32.png) [@md2000](https://boards.straightdope.com/u/md2000)\ **Post date:** [June 10, 2013, 3:51am UTC](https://boards.straightdope.com/t/affordable-care-act-compared-to-canadian-health-care/660333/54 "2013-06-10T03:51:32Z")
> [@Darth\_Panda](#): > > Just becasue it’s so commonly referred to, I just wanted to mention that in that coffee case, the person was actually pretty seriously injured: > > [Liebeck v. McDonald's Restaurants - Wikipedia](http://en.wikipedia.org/wiki/Liebeck_v._McDonald's_Restaurants) > > The person tried to settle out of court for about $20,000 (her hospital cost were over $10,000 and she wasn’t done at that point) but McDonald’s only offered $800, and that’s when it went into the full blown case. > > Obviously, lots of questions about negligence, responsibility, etc., but I feel like the myth around this story it “ow, that’s hot give me a million dollars,” when the truth was “holy crap that burned the living hell out of me, please help cover the actual costs.” > [@Northern\_Piper](#): > > And not just 3rd degree burns, but third degree burns to her genital area! :eek: She’d put the cup between her legs to hold it, which is pretty common when you’re going through a drive-through. She put a soft foam/paper cup filled with scalding fluid, between her legs in a moving vehicle that was going over speed bumps. Supposed she tried to remove the lid to add sugar or something. Plus IIRC it was an 80-year-old lady, so her manually dexterity and speed of reaction may have been impaired. Maybe I’m harsh, but I suspect the attitude “McDonalds has a lot of money so make them pay anyway” was the biggest factor in this suit. > [@SmartAlecCat](#): > > Cite for which claim? That we have different eating habits, different health, or that eating habits can affect health? > > Here’s something to look at: > Comparative Consumer Profile Canada and the United States - July 2010 > [http://www.ats-sea.agr.gc.ca/info/5645-eng.htm](http://www.ats-sea.agr.gc.ca/info/5645-eng.htm) > > % of Population Aged 15 and Up 1979 1989 1999 2009 2019 > CANADA - Obese 5,2 10,3 13,7 21,8 26,5 > CANADA - Overweight 25,7 32,1 33,2 32,3 34,8 > UNITED STATES - Obese 15,6 22,0 29,8 38,7 44,9 > UNITED STATES - Overweight 32,4 32,6 33,3 43,2 47,3 > (2019 is projected) Huh? Canadian Overweight percent went down between 1999 and 2009? Not that I saw… ---
**Author:** ![Northern\_Piper](https://sea3.discourse-cdn.com/straightdope/user_avatar/boards.straightdope.com/northern_piper/32/5304_2.png) [@Northern\_Piper](https://boards.straightdope.com/u/Northern_Piper)\ **Post date:** [June 10, 2013, 4:01am UTC](https://boards.straightdope.com/t/affordable-care-act-compared-to-canadian-health-care/660333/55 "2013-06-10T04:01:45Z")
> [@md2000](#): > > She put a soft foam/paper cup filled with scalding fluid, between her legs in a moving vehicle that was going over speed bumps. Not so, as summarised in the wiki article: > [@](#): > > Liebeck was in the passenger’s seat of her grandson’s Ford Probe, and her grandson Chris parked the car so that Liebeck could add cream and sugar to her coffee. Liebeck placed the coffee cup between her knees and pulled the far side of the lid toward her to remove it. ---
**Author:** ![Muffin](https://sea3.discourse-cdn.com/straightdope/user_avatar/boards.straightdope.com/muffin/32/4341_2.png) [@Muffin](https://boards.straightdope.com/u/Muffin)\ **Post date:** [June 10, 2013, 4:43am UTC](https://boards.straightdope.com/t/affordable-care-act-compared-to-canadian-health-care/660333/56 "2013-06-10T04:43:55Z")
Note that most of the damages awarded by the jury in the McDonalds matter were punitive damages, and even then they were greatly reduced on appeal. Punitive damages can be used to discourage repeating the offensive behaviour. For example, if it a company makes more money in the long run by hurting a few patrons notwithstanding those injured successfully suing for compensatory damages, then the company will not change its evil ways. Punitive damages, if set high enough, may cause the company (and other companies that have similar practices) to change its ways by making the bad conduct too costly. The USA is very big on punitives, whereas Canada not so much. ---
**Author:** ![Muffin](https://sea3.discourse-cdn.com/straightdope/user_avatar/boards.straightdope.com/muffin/32/4341_2.png) [@Muffin](https://boards.straightdope.com/u/Muffin)\ **Post date:** [June 10, 2013, 4:54am UTC](https://boards.straightdope.com/t/affordable-care-act-compared-to-canadian-health-care/660333/57 "2013-06-10T04:54:25Z")
> [@Northern\_Piper](#): > > This is an important point. It seems to me that one of the drivers for the US tort litigation system is that if you’re injured and have medical bills that aren’t covered by insurance, you have to try all means to get them paid - and litigation is an obvious way to try. In Canada, since you don’t have medical bills, that incentive just isn’t there. But note that an injured party’s health care expenses covered by a province typically are subrogated claims that are considered in the injured party’s litigation. ---
**Author:** ![Muffin](https://sea3.discourse-cdn.com/straightdope/user_avatar/boards.straightdope.com/muffin/32/4341_2.png) [@Muffin](https://boards.straightdope.com/u/Muffin)\ **Post date:** [June 10, 2013, 5:10am UTC](https://boards.straightdope.com/t/affordable-care-act-compared-to-canadian-health-care/660333/58 "2013-06-10T05:10:11Z")
For folks wondering why I used the weasel word “typically,” it is because subrogation is not absolute. For example, in Ontario, OHIP (the government’s health care insurance) by statute is not subrogated if the personal injury was from a motor vehicle collision that was covered by motor vehicle insurance. Since MVA injuries are very common, Northern Piper’s point stands. ---
**Author:** ![Northern\_Piper](https://sea3.discourse-cdn.com/straightdope/user_avatar/boards.straightdope.com/northern_piper/32/5304_2.png) [@Northern\_Piper](https://boards.straightdope.com/u/Northern_Piper)\ **Post date:** [June 10, 2013, 11:49am UTC](https://boards.straightdope.com/t/affordable-care-act-compared-to-canadian-health-care/660333/59 "2013-06-10T11:49:26Z")
Sure, there’s a subrogated claim - but my point is that health care costs are not the primary reason an individual in Canada who’s been injured would consider suing. They sue to recover compensation for the bodily injury they’ve suffered, loss of income from being off work, loss of future earnings if they’ve been so badly injured they can’t work, and so on. They don’t say, “my God - that bastard who hurt me has caused the gov’t to pay out thousands for my health care - I’ve got to sue to recover it for the Gov’t!” ---
**Author:** ![lance\_strongarm](https://avatars.discourse-cdn.com/v4/letter/l/87869e/32.png) [@lance\_strongarm](https://boards.straightdope.com/u/lance_strongarm)\ **Post date:** [June 10, 2013, 1:01pm UTC](https://boards.straightdope.com/t/affordable-care-act-compared-to-canadian-health-care/660333/60 "2013-06-10T13:01:24Z")
> [@Northern\_Piper](#): > > Not so, as summarised in the wiki article: Then the issue was, what, a defective cup? You can expect to spill hot coffee on yourself sometimes. You can expect it to be hot. It’s nobody else’s fault. [Previous page](https://boards.straightdope.com/t/affordable-care-act-compared-to-canadian-health-care/660333.md?page=2) [Next page](https://boards.straightdope.com/t/affordable-care-act-compared-to-canadian-health-care/660333.md?page=4)