In 1984, the Canada Health Act was passed, which prohibited extra billing by doctors on patients while at the same time billing the public insurance system. The system is for the most part publicly funded, yet most of the services are provided by private enterprises or private corporations, although most hospitals are public (Begin, 2010). Most doctors do not receive an annual salary, but receive a fee per visit or service. About 29% of Canadians health care is paid for by the private sector or individuals (Moore, Mcmullen, Woodford & Berger, 2010). This mostly goes towards services not covered or only partially covered by Medicare such as prescription drugs, dentistry and vision care. Many Canadians have private health insurance, often through their employers, that cover these expenses. The Canada Health Act of 1984 does not directly bar private delivery or private insurance for publicly insured services, but provides financial disincentives for doing so. Although, there are laws prohibiting or curtailing private health care in some provinces, they can be changed according to a report in the New England Journal Of Medicine (Begin, 2010).
For decades, economists and politicians have been deploring the condition of the United States health care system. Skyrocketing medical care costs, rampant waste, and the declining number of practicing physicians are touted as evidence of the seriousness of the situation. Entire books have been filled with accounts of individuals who have allegedly been denied medical care. Many feel that the relatively high percentage of uninsured Americans is yet another indication of the failings of our health care system. The United States spends more money on health care per capita than does any other industrialized nation, and yet our country is the least healthy (in terms of health outcomes) of the developed nations. These factors and diverse others have caused many to declare that the United States is in the midst of a health care crisis (Firth & Reay, 2008).
One proposed solution to these problems is known as universal health care. Universal health care is the catch phrase for a mandated, nationalized, government-funded, single-payer health care system. This would be a radical change from our current market-driven system. Universal health care has been debated for years, most notably during the Clinton administration, with First Lady Hillary Clinton's failed attempt to nationalize the health care system. Now, with the beginning of the Obama administration, it is likely that the health care debate will once again gain national attention (Ardito, 2010).
In 2007, Democratic Presidential candidate Barack Obama gave a speech at the Families USA Conference. He expressed dismay over the current state of the nation's health care system, and asserted that the only solution is the nationalization of health care. Furthermore, the emergence of new and bold plans from across the spectrum has effectively ended the debate over whether or not we should have universal health care in this country (Ardito, 2010). In reality, however the debate is far from over. Universal health care is still a controversial topic. In the political world, what is promised and what is delivered are often different things. In the case of universal health care, it is fitting that looking closely at what is proposed and compare with the results in countries that have implemented such systems. In comparing our health care system with Canada's will first refute several common myths regarding health result discrepancies between our nations. Then point out some of the major problems with the Canadian health care system (Rakich, 2010).
Out of the all the wealthy, democratic nations in the world, the United States is the only country without a nationalized health care system. Perhaps the main argument made by proponents of universal health care is that these other nations all have better health care access and results than we do. Canada's nationalized health care system is often considered a model that should be emulated by the United States. Canada has a successful health care system. Judging by health outcomes, it can be argued that Canada provides better care and live longer. Because they organize it right Canadians do not (Rakich, 2010).
But can the health disparity between Canadians and Americans be wholly attributed to the differences in our health care systems. Some think not and many factors affect the health of a nation. These factors include the environment, behaviors and practices, culture, economic statues, education levels and even race.
In 2005, Canada's infant mortality rate was 5.4 per 1000 births, while the infant mortality rate in the United States was 6.86 per 1000 births (Eggerston, 2010). Proponents of universal health care would have you to believe that Canada's lower figure is due to a health care system that provides more access to prenatal care. However, lack of prenatal care is not completely responsible for infant deaths. Babies born to teenage mothers are 50% more likely to be low birth weight, and therefore more likely to die in infancy, than those born to mothers of age twenty or twenty-one. Teen pregnancy rates are significantly higher in the United States than Canada (Eggerston, 2010). In 2002, the teenage pregnancy rate in the United States was 76.4 per 1000, and in Canada, the rate was 33.9 per 1000. The large number of teenage pregnancies in the United States helps to account for the higher infant mortality rate (Eggerston, 2010).
Race is also a big factor in infant mortality. The infant mortality rate among African Americans is more than double the rate for whites. According to the National Center for Health Statistics. In 2005 there was a more than threefold difference in infant mortality by race and ethnicity and many of the racial and ethnic differences in infant mortality remain unexplained. In fact, the infant mortality rate for whites in the United States is only slightly higher than Canada's total infant mortality rate (Eggerston, 2010). The United States has a much higher percentage of minority groups than Canada does. For example, the percentage of African Americans in the United States is 13.4%, while the percentage is only 2.5% in Canada. Thus, asserting that Canada's health care system can be credited for the country's lower infant mortality rate is a non sequitor (Eggerston, 2010).
Life expectancy is higher in Canada than the United States, but again, this cannot be attributed to Canada's health care system. Obesity is one of the factors that affects life expectancy, and it is much more prevalent in the United States than Canada. In 2004, 34% of adults in the United States were obese with a Body Mass Index of 30 and higher, while only 23.1% of Canadians were obese Eggerston, 2010). In fact the life expectancy at birth for an African American man is sixty-eight years, seven years less than for a white man in 1990. African Americans are more likely than any other racial or ethnic group to develop cancer, and thirty percent more likely to die from it. So although the United States has a lower life expectancy rate, and a higher infant mortality rate than Canada, they cannot blame the American healthcare system for these short fallings ( Eggerston, 2010).
Let's move onto another common argument in the health care debate. American-made pharmaceutical drugs are more expensive in the United States than they are in Canada. Some would declare that this is evidence of the superiority of the Canadian health care system. However, argues that pharmaceutical drugs are expensive in the United States because manufacturing companies must not only cover the cost of ingredients, but must also charge for the high cost of inventing the drugs Cohen, Stolk & Niezen, 2007). Brand name drugs are expensive because the manufacturing companies are trying to recover the money invested in the development process. However, after the patent expires, other drug companies use that formula and market it as a generic drug. These generic drugs are less costly because their manufacturing companies do not have to charge for the cost of invention. Canada's health care system can then make a very low offer covering only manufacturing costs to the American drug company, which then has the choice of selling the drugs cheaply, or losing a large amount of business. Usually it takes the former option. This is the reason for the lower drug prices in Canada.
Although some would say that this method of forcing down prices is beneficial, which would contend that it is demonstrably counter-productive. Forcing pharmaceutical companies to accept less money than covers production costs causes both quality and the rate of invention to decline. Currently, the United States is a world leader in drug innovations. This is a direct result of our market-based health care system. But if we instated a government-run health care system that dictated prices to the pharmaceutical companies, our leading position in drug discoveries would be compromised (Cohen, Stolk & Niezen, 2007). Reducing the brand-name producers abilities to recoup their costs means reducing the incentives for continuing the development of new drugs to deal with other diseases and conditions. This is just one example of the potential negative effects that would be realized if we implemented a national health care system and the price controls that go with it. Drug costs are the primary source of cost increases in workers' benefit plans. Employers are demanding savings, and locals are fighting back at the bargaining table to protect workers benefits. In the meantime, at the national level, is promoting, along with the Canadian Health Coalition (Cohen, Stolk & Niezen, 2007). A National Pharmacare program that will improve access, cost savings, improve drug safety and promote economic productivity for all Canadians. While the Canada Health Act guarantees access to doctors and hospitals, Canadians do not have equal access to drug medications. Work based plans, usually negotiated by unions, cover 58 percent of workers and their families. Almost one million Canadians three percent are uninsured and have to pay sometimes more than 4.5 percent of their gross family income for drugs (Cohen, Stolk & Niezen, 2007).
Another inherent problem with nationalized health care is lack of funding. Dr. William E. Goodman attested to this in a speech he gave at a meeting of the Association of American Physicians and Surgeons in 1989 (Goodman, 2010). Dr. Goodman is an otorhinolaryngologist who practiced medicine in Toronto for many years both before and after the advent of nationalized health care. The basic and unalterable flaw in any system like the Canadian model is that, in economic terms, it is an open-ended scheme with closed-end funding. In other words, the potential demands are completely unrestricted, but the money to pay for them is not. Goodman maintains that lack of funding is a huge problem in Canada, and the country continually raises taxes and goes deeper into debt to pay for health care (Goodman, 2010).
Americans already suffer from a high tax burden. With a nationalized health care system, would undoubtedly begin paying even more. An American works full time for one year. The total burden of taxes is so heavy that it consumes his entire income. A Canadian has to work over six months solely to satisfy government's constantly increasing demand for taxes. And yet, even after imposing this high tax burden, the Canadian health care system lacks the funding it needs (Goodman, 2010).
One result of this lack of funding is that some Canadian physicians' salaries are capped by the government, meaning that they can only make up to a certain amount of money per year. Once a physician has met this amount, he has absolutely no incentive to continue working, because he would not be compensated. The patients that need his services suffer the most from this arrangement, as they may need to wait many months for an appointment.
Universal access is not a reality and Price controls and capped salaries have caused shortages, declining quality, and less access to medical care. Often, patients cannot get the medical care they need because the system does not have the finances. Yet the government has made it illegal for the patients to pay for their needs themselves. In this case, the only way to get proper treatment is to go out of country and many do. The Canadians often travel to the United States to get the medical care they need is more proof that the Canadian system is not adequately providing for its constituents (Goodman, 2010).
Besides lack of funding, many other flaws trouble the Canadian health care system. Loss of doctors is a major problem. Canadian physicians and other health care workers, realizing that they are not being adequately compensated for their work, either retire early or immigrate to a country where they can get proper pay. If the United States implements universal health care, then limited number of health care workers will likely dwindle as well (Goodman, 2010).
In conclusion these are only some of the many problems with the Canadian health care system and believe elieve that by studying Canada's failures and the devastating effect of nationalized health care in that country, Americans will come to realize that universal health care is not the answer for our country. Though our system is not ideal, nationalization would only make matters worse. Americans are convinced they can work together to find a solution that will not compromise our current standing in the world. Canada is proof that universal health care does not live up to its name, nor fulfills the promises we've heard from American politicians. By increasing awareness of the Canadian failure can prevent repeating that disaster in this nation.
