Well, when you say “insuring” that has quite a different meaning in our system than in the States. Canadians don’t pay premiums or co-pays, and don’t deal with private insurance companies. The provincial governments pay for each resident’s health care. I just show up at the doctor’s office, show my provincial health card, and Bob’s my uncle. I see a doctor and get treated.
The legislation setting up the systems does use the term “insurance” but I’ve always thought it was misleading. It’s a government service, just like roads, education, police and firefighting.
Just adding that there is no restriction to which doctor you see, either. I have “my” doctor, but if it’s urgent but not ER-level and he’s not available, I can see any other doctor in his practice if they have a free slot, or go to one of the many walk-in clinics.
The whole “in-network” business is just head-scratching to non-Americans.
Or the hospital being in network, but that one doctor who comes by, asks how you’re doing and squiggles something on your chart - out-of-network. Full freight, you pay. Just bizarre.
And, also, the vast majority of private healthcare is used as a top up to the NHS - gaining access to private rooms and faster care. As such, the fees are much lower than in the US. Vanishingly few people use only private healthcare.
If private health was prohibitively expensive, people just wouldn’t buy it, as it’s already seen as a luxury not a necessity. So market forces keep the costs down.
The amount/level of competition between the private sector and the NHS is, I suspect, not that great. The NHS owns the great teaching and research hospitals, and does the “heavy lifting”. The private sector is mostly for things like optional cosmetic surgery, or for the people who wouldn’t be seen dead among the plebs, or for people who can get elective treatment quicker - relatively straightforward stuff, which can keep costs down because the NHS is there to pick up the pieces if something goes badly wrong or it gets complicated.
Just curious, what happens when a resident of one province needs medical attention in another province? For example, if they are on vacation, have a second home, are on a business trip, etc?
Believe me, the in-network business is not something I am a fan of. I have to pay nearly twice as much for insurance to have any even minimal coverage outside my home state.
They get it in the other province, just by showing their home province’s health care card.
One of the provisions of the Canada Health Act is reciprocity between provinces, allowing Canadians and permanent residents to travel anywhere in Canada, and receive care outside their home province should they need it. For example, a physician or hospital in Ontario will honour my Alberta Health card, if I need care while visiting that province.
This is one of the things about the US health care debate that I don’t get. I’ve seen people say “We’re 350 million - we just can’t provide a national health care system. It’s too complicated.”
That argument seems to ignore one of the strengths of the United States’s political system: you’re a federation. The whole point of a federation is that there are some things that are best dealt with at the national level, and some things that are best dealt with at the state level (and going one step lower, some things at the municipal level).
So take the principle of UHC and adapt it to your federal system, the way Canada has. The Canadian federal government doesn’t run hospitals and pay doctors. It provides the broad-brush basic administrative requirements for UHC, things like universal coverage, no user fees, and portability between provinces. And then it backs that up with money: “You want money for health care, provinces? Follow these rules and you get federal cost-sharing, but it’s up to you to run the system.” And the provinces and territories have all said, “We’ll take the money and do it.”
The regulation and administration of the health care system is governed by the provinces, with further sub-delegation to the municipalities or local governments. Each province determines for itself how best to meet the needs of its residents, and ties it to local service delivery at the municipal level. That’s why we say we don’t have a national system; we have 13 provincial/territorial systems.
That model relies on the strengths of a federal/provincial/municipal allocation of resources and powers. I don’t see any reason why that couldn’t be considered as an approach in the US. Don’t focus on NHS in Britain as meaning UHC needs a national health care delivery system, or that UHC has to be a federal program like VA. Start with the question: “How best to deliver a UHC system, taking into account the strengths of our federal system?”
I would like to think that would work here but I have lost all faith in any kind of honest billing and diagnostic system. The MRi machines are viewed as ATM machines by the medical profession, same way with the urgent care and emergency room visits.
Sort of analagous situation within the EU: all member states allow residents of other member states to access their medical services on the same terms as their own citizens/residents. Granted, though, health care and medical services aren’t an area within EU competence, so there is no standard-setting (other than on safety of medicines) or finance on an EU-wide level; some people are always a bit confused that they have to pay in the other country for something that’s free at home, or vice versa.
As for the difficulty of controlling costs in the US, is it really beyond the wit of man to create some sort of agency, whether governmental or through some established research organisation, to monitor and analyse prices and at least advise on value-for-money/cost-effectiveness?
To get to the OP’s question - Canada has set up their health system to deliberately forestall any chance of a parallel private system like Britain with NHS and private care. Doctors are either all in or all out. If they are in, they cannot also provide (covered) health services for a fee outside the system. If they are outside the system, the patients cannot get reimbursement from the government system. So the doctor either charges the fee schedule or gets all their business from people who can pay out of pocket. Employers don’t provide “Health Insurance” for primary care, because there’s a system that works, so it’s a waste of money. (But yes, supplementary insurance for prescriptions, dental, medical devices like orthotics, massage therapy etc. - is a typical employer benefit).
So if the USA adopted the same system, it would be as if everyone got Medicare, and doctors were not allowed to charge above the Medicare fee schedule. If this is free, why would anyone want anything else for thousands of dollars a year in premiums? The existing system would simply vanish, and millions of dollars of excess profits would vanish.
A good analogy is public vs. private school systems. The vast majority send their kids to public schools - unless the public system seems somehow unusable and the parents can afford private school tuition.
As the discussion about medical tourism shows, Canadian politics is an ebb-and-flow battle between cutting back because the system is too expensive, then realizing that the voters are discontent and spending more money to fix the system. And you think things are messed up now - the typical scenario for cutting costs is to reduce (or not raise) the fee schedule for doctors. Under the US system, doctors can charge a high fee because the insurance companies pay it, an then charge the employer or insured. If they don’t agree, the doctor is not in their network. With a universal plan, all the doctors only have one network to join… Imagine all those doctors in the USA suddenly discovering they are paid half as much as with private care.
The independence of doctors was a major sticking point when the NHS was created, although this was somewhat countered by doctors returning from WW2 with no jobs to go to and no money to set up a practice. There had been a health service although the only people entitled to free treatment were those with jobs; but the war and the under-investment of the pre-war years had reduced the system to a state in which medical staff were being asked to work almost for nothing.
Initially, all prescriptions were free, but charges were introduced in 1952 using legislation introduced by a Labour Government. In July 2017 the Prescription Charges Coalition said that a third of patients of working age have not collected a prescription because of cost, currently, £8.60 per item unless you are one of a long list of exemptions.
I suspect that to introduce UHC into the US it would take a great deal of gold.
Follow-up question on CHA. What is the percentage of income tax taken to fund it? Always hear about Norway paying (relatively) a lot, but never heard a number for Canada.
That’s a difficult question to answer, because there is no separate tax to cover it. The Medicare system is funded out of general tax revenues, both federal and provincial. In that respect, it’s just like police, and fire protection, roads and other public services. If you earn more, you pay more income tax, but it’s not linked to health care.
However, one measure that seems generally accepted is that Canadian governments collectively pay less for our universal health care, as a % of GDP, than American governments collectively pay for your non-universal system, as a percentage of GDP. When the amounts that US individuals pay for health care is added to what the US governments pay, it’s a considerably larger % of US GDP.
That brings up another question about the taxes though. I know the in the US Social Security is something like 7.5% paid by the worker, matched the same by the employer for 15% of gross wages up to whatever the cap is on the limit this year. As an aside that’s fully paid by the employee since the worker should get the money from the employer instead of Washington, but I digress, not getting Pitty. (I remember when my dad was alive he’d hit the limit around September then didn’t have any SS money withheld) Medicaid/Medicare I think is around 3.5% of gross. I think that’s close and not sure of employer match for that so be gentle on me.
Either way, someone in the land to the gentler north must know the percentage of taxes withheld that go toward health care.
And to be totally honest, Land That Gave My Penguins Sidney Crosby, I don’t even know if you have a tax withholding system like the US. So let’s fight ignorance and take it easy on me. K?
It’s not like Social Security withholdings. Health care costs are not allocated as a percentage of your witholdings.
We have witholdings for Canada Pension Plan, Employment Insurance and Income Tax. CPP and EI witholdings go to the funds for those plans, and income tax goes to the federal and provincial General Revenue Funds, but not allocated specifically to health care.
Now, you can find out how much the Feds and the provinces spend each year on healthcare, but it’s not directly broken down per person the way CPP and EI are.
Suppose you have a single person earning $100,000, and a married person with two kids earning $100,000, with the spouse at home.
The single person will pay more taxes out of their $100,000, because the single person doesn’t get deductions for spouse or dependents. Assuming the single person and the adult couple all use health care at the same rate. In any given year the family of four will be getting more health care for less taxes than the single person.
But what if the family of four is reasonably healthy, but the single person has heart disease and lung cancer from a lifetime of smoking, and requires heart surgery and chemo? The single person will likely use much more on health care.
Asking how much any particular taxpayer in Canada pays for health care is the same as asking how much any American taxpayer pays for police services. Healthcare in Canada is a public service paid for out of general tax revenues, just like police in the States.
I’m sure someone does know, but it’s not an easy calculation. I can give you some numbers from Saskatchewan’s budget. Health expenditures make up 38% of the provincial government’s spending. But some of that spending is funded by transfer payments from the federal government - 17% of total revenues, in Saskatchewan’s case. I’m going cross-eyed trying to figure out what percentage of the fed’s spending is transfers to provinces. It looks like 23%, but I might not be reading the charts right. Then if we make some assumptions which are definitely false, such as that federal money makes up an equal portion of revenue for all provinces, we can work out that roughly 25% of all federal and provincial tax money is spent on health care.
That is not correct. It overlooks differences between provinces. It neglects non-taxation sources of government revenue. Probably some other stuff I’m overlooking. But it should be in the ballpark.
