As far as the federal sales tax and lower incomes go, if you’re under a certain income level (for a single adult, I believe it’s in the mid 30s), you get a partial rebate of a few hundred dollars back.
High rates of sales taxes are also common in Europe. And indeed, IMO, it’s a bad thing, because, as you mentionned, they hurt mostly the lower income brackets. However, this isn’t going to change, because, the sale tax is somehow “invisible”. You don’t notice you’re paying close to 20% of your income in taxes when you’re buying stuff. On the other hand, when you’re writing a check to the equivalent of the IRS, you notice immediatly how much you pay. So, no sane government is going to lower the sale tax and raise the income tax. They are willing to do the contrary, though (at least, they did over here…and the general population didn’t raise an eyebrow, generally speaking).
By the way, I also dislike the sales tax due to its “inisibility”. I think that in a democracy, each citizen should be able to easily figure out how much exactly he contributes to the public expenses. And the better way to do so is to use mainly direct taxes (income tax, in particular) instead of 50 different kind of taxes as “invisible” as possible that, grouped, represent way more than the income tax which is the only one people pay a serious attention to.
I just checked, and my GST credit is $110 quarterly (single, low 20s income), or the GST on the first $6k I spend. Sheesh. I don’t think I spend $6k annually on items that are GST-able. Forget everything I ever said about getting rid of that tax!!
Also, adding to what clairobscur mentions, in a number of jurisdictions that use the VAT or GST system, it is customary to have advertised prices be quoted to consumers already including all or part of the tax, furthering the invisibility thereof. As in: “This product is on sale for €200 including VAT”, but it’s up to you to remember that this means that 20 of those 200 are for the tax, and that the local GST will hit ya for another 15.
It’s not that way here. I wish it were. I’d rather look at an item on the shelf priced at 9.99 and know I can actually take it to the checkout, hand over a $10 bill and get back a penny.
To go back to the OP, I’ve got experience with health care in Quebec, British Columbia, and New York. They’re all different.
In Quebec, like most provinces, most health care costs are invisible and taken out of general tax rolls (dental’s not included, neither is eyecare for those between 18 and 65, and you can pay to jump to the front of the line for an MRI).
In BC, you pay a monthly fee (about $1/day, IIRC) for basic health care that matches what’s covered by taxes in Quebec. (I believe only British Columbia, Alberta, and Ontario have monthly health fees.)
In New York, you pay thousands of dollars annually for health care coverage, AND you fork over $10 to $30 almost every time you see a doctor (“Wellness” visits are usually exempt). This can add up damn fast if you need multiple visits for something… Your insurance company will also mail you the ‘not-really-a-bill’ bill, so you can see that Doctor X is charging you $400 for a ten-minute exam.
Health care coverage across Canada most resembles being part of a very good HMO in the States. For every problem, you’ve got to see your GP first (emergencies excluded, of course), then you see a specialist. The notion of going to a cardiologist without a referral is laughable.
It can take a long time to see your GP, especially if you’re one of the one-in-three Canucks without a GP, so you have to visit a clinic. But once you get that referral to a specialist, you can probably get in very quickly unless you’ve got a common problem (like a hip replacement).
In New York, I can usually see my GP quickly (and I didn’t have problems finding one), but I’ve had a longer wait to see an opthamologist. In Canada, since eyecare isn’t part of the health care system, I can walk into an opthamologist’s office directly.
Both countries have problems, but I think the problems are much worse in the U.S. I’ve read that upwards of 45 million Americans have no health care whatsoever-- so any time they see a doctor, they get stuck with the whole bill (that $400 figure I mentioned). You can probably guess why medical bills are one of the top reasons Americans declare bankruptcy.
Canada could be more efficient, but it already does a lot more with less money. The U.S. wastes a lot ( a 30-year-old with no family history of heart disease does NOT need an EKG during a routine physical…)
In my opinion, the best way to improve Canada’s system would be to make it more desirable for doctors to become GPs. Step two would be to add some needed technology to speed up MRIs and the like, and free up operating rooms to improve quality of life issues.
In the U.S., they need to bring prices way, way down. (My last dentist visit was $175 for a cleaning, and $200 more for x-rays of my never-had-a-cavity teeth…)
Yeah, my biggest gripe with Ontario’s health-care system is the difficulty of finding a “family doctor” (GP).
On the other hand, I’m very glad to know that I won’t be bankrupted by medical bills.
As a resident, I have to be one of the least in-demand physicians in my city, and I don’t think I have a single available appointment in the two months I have left in the program. When I was working with the local GI group last May, they were scheduling non-emergent new patient visits for September. Non-emergent MRIs are 3-4 weeks out lately. New patients at our GYN clinic, which sees mostly indigent patients, have a two-month wait if they aren’t emergent.
Orthopedics, the specialty most often used to illustrate the waiting list phenomenon in Canada, is actually one specialty that you can get into pretty quickly around here. There is a high demand for their services, and their reimbursement (gov’t sources or otherwise) is excellent, so we have a good supply.
Consider also that I have about a half-dozen patients in my clinic who have debilitating back pain that could probably benefit from surgery, or at least an evaluation from a neurosurgeon, but they have absolutely no way to pay for it and no prospects to be able to anytime soon. In Canada they might have to wait a while to get in, but they’d eventually get in.
Canadian waiting lists are almost certainly longer than ours, for the most part, but it’s important to remember when comparing the two that the phenomenon is not unknown to us.
As you’ll probably know if you’ve ever watched E.R., in the U.S., uninsured poor people often take non-emergency complaints to a local hospital’s emergency room because that’s where they won’t be turned away for lack of funds or insurance. (The hospital can always send them a bill afterwards, but chances of collection are slim.) I take it this never happens in Canada?
What never happens? I’m sure people take non-emergency complaints to ERs all the time, just because they don’t know any better. It’s discouraged, though, and you won’t be seen till after anyone with an emergency complaint. Could be several hours, because you just won’t be a priority. On the other hand, you could go to a walk-in clinic and probably see a doctor for a non-emergency complaint within an hour. At least, that’s been my experience.
On the issue of relative levels of taxation:
Canada
GDP(2004) - Cdn$1.29 trillion (Statscan)
Total govt revenues, all levels(2004) - Cdn$459 billion (Statscan
Total tax - 35.6% of GDP
Total govt revenues for the US are hard to find. The most recent data I can find is for '95.
US
GDP(1995) - US$7.08 trillion (defenselink.mil) bit of a weird cite, but the first place I found a reference for 95 GDP
Total govt revenues, all levels(1995) - US$2.76 trillion (US Census Bureau)
Total tax - 39.0% of GDP
Now of course, these figures are 9 years apart, and taxes have come down in both countries over that period. If we look at the earliest data from the Statscan pages, we see that in 2000 the Canadian rate was 38.5% and in 2001 it was 40.3% More recent data for the US would take into account the Bush tax cuts, etc. Still and all, it seems like it’s not a foregone conclusion that Canadians are, overall, taxed at a higher rate than Americans are.
I’m happy to accept any corrections on my data. More recent figures for the US would be good, too.
I’m reasonably content. It’s my opinion that any shortcomings in the Alberta healthcare system are not inherent in the single-payer system, but are due to inadequate funding. Any system will suffer if it is not properly funded.
The following is anecdotal evidence, of course:
I scratch my cornea. I call my doctor, I can see him immediately or in three hours. Immediately is out of the question, so I wait three hours. He has a peek, takes a swab just in case it’s pinkeye, decides that 'tis but a scratch, patches my eye and tells me to come back the next day. The next day I’m told it’s not pinkeye, and the patch is removed. My eye is fine. That’s that.
I have allergy troubles, suspecting my new cat. I’m asked to go to the closest hospital for a Pulmonary Function Test one week later and am given a prescription for Fluticosone. The Fluticosone works wonders, so it doesn’t bother me that I’m to wait some months for an allergy assessment. Total cost of this assessment will be $25. I don’t mind the wait.
I burst my spleen in a bicycle accident at noon on a Wednesday about three years ago. I’m taken not to the closest Edmonton hospital, nor the second closest, but the third closest. There’s no room at the first two emergency rooms on the list. On a Wednesday. At noon. What the hell? The surgery was top drawer, and the drugs were free, but there are no electric beds in the recovery ward. When you’ve had your abdominal muscles cut clean through and have tubes coming out of every arm and orifice, an electric bed that lets you sit up to eat is not a luxury. Trust me. And if you listen carefully in the dead of night, you may still hear the faint echoes of me screaming "Whaddya mean you don’t have any wheelchairs? This is a hospital fer Chrissake!" The painkillers (Darvon N) I was prescribed afterward cost me a grand total of $12 for a bottle of 30 pills.
Sorry for the war stories, but that’s the only way I can think of to describe the pros and cons of Alberta’s health care system. It works well, but it used to work better.
Every time I saw Klein holding up a sign saying “Paid in Full” and being praised for paying off the debt I found myself wondering if he’d get a wheelchair if he found himself staying in the hospital for a week. I’m of the opinion Alberta’s budget surpluses could’ve been more wisely spent, but on the whole I’m reasonably satisfied with our health care system.
No, I would not prefer to live under the American system. The idea of being told I can’t see a certain doctor or receive a particular treatment because it’s not on my plan seems foreign to me. And the costs! Hundreds of dollars every month! Amazing. Every time I’m in the states I get asked questions about the health care system here, and every time I say my premiums are $44/month I end up tripping over my host’s jaw. I also feel it’s as wrong to deny adequate health care as it would be to deny fire or police services.
I can’t imagine why a single-payer system wouldn’t work in the States. The infrastructure, the hospitals and so on, are already there, and you have ten times the tax base to pay for the system. But I’m no expert in the matter.
You might find this CDC/Statistics Canada survey interesting as well.
http://www.cdc.gov/nchs/pressroom/04news/firstjointsurvey.htm
I’ve got a private insurance in one of the worst markets in the US, and I can still get mine wholly on my own for less than 100$. Who the heck is paying several hundred?
In any case, what I dislike msot about proponents of the single payer plan is that they sem to believe in magic. There will be costs. There will be huge costs one way or the other. To believe otherwise is to put faith in magic. And I cannot stand people who cannot admit there will be costs. No proponent of those systems here in the US seems to be able to sit down and rationally explain what the costs will be, and until they do I won’t time them the time of day.
According to this, lots of people.
The average cost of single coverage is $281.92, and if you and everyone else with your coverage is paying far less, someone else must be paying more.
That’s fine, I have no use for people who set up straw men then tell me I believe in magic. And I own a watch. The fact remains, administrative costs in Canadian health care are one third those in the United States. You’re the one saying there will be costs and they will be huge, why don’t you tell these rubes who believe in magic what these costs will be?
I spent a couple of years in France a long time ago. There were no fat high schoolers, unlike my high school in the US. My wife and I were there a little over 10 years ago and one of the things she remarked on was that she didn’t say the hugely obese people you see everywhere in the USA. Yes, they have high calorie and/or fat foods, but they eat reasonable portions with lots of fresh vegetables and fruit. Americans eat very badly, on the whole, and don’t exercise. It’s that simple.
But do Canadians eat any better, or exercise any more?
Sorry, my comment was ambiguous.
Your claim was that Canadian pay HIGHER TAXES in support of the health care system than Americans do. That is simply not true, Sam. Americans pay just as much in tax towards Medicare and Medicaid as we do towards our system; one could argue they will end up paying more, since the U.S. government is in fact spending far more than it’s taking in taxes, and sooner or later will have to pay all that back with interest.
And, incidentally, those two programs in the U.S. do far less than ours, despite costing just as much.
Well, I think that Canadians WORK less then Americans do. I think this extra free time translates into more home cooked food, more activity, and less fast food grabbed between meetings.
I would say that Canada is between Europe and the US in terms of activity and work load, although moving more towards the US model.
However, it will be pretty hard to convince people such as myself, that I should give up the 6 weeks of vacation I have a year, and the 35 hour work week, to convert to a more US type of system.
/hijack
As to health care - recently, I’ve had a whole boat load of things go wrong with my health. At no point did I ever wonder “How am I going to pay for this?” or “Is my insurance going to cover all these costs?” or “How much is my co-pay?”
I just went and got every assessment and treatment that I needed, in a reasonable amount of time, with no expense to myself.
Works for me. 