Lessons of Canada's Medicare

...In 2006, an examination of 12 specialties showed that the median waiting time from referral by a general practitioner to treatment by a specialist was about 18 weeks...

...He further points out that Japan, with a rapidly aging population, has excellent care and no waiting lists at a lower cost than Canada...

...Comparing the medical coverage of industrialized countries suggests questions American politicians and policymakers should ponder: How can average health standards for a population be raised without impinging on those who are able and willing to pay for above average treatment...

...about insurance companies...

...Canada’s Medicare is certainly a big stride forward, despite the dissatisfaction with aspects of it...

...And some 47 million people have no medical insurance at all...

...Consequently, even though health care is “free,” it is often a scarce resource necessitating judgments about allocation...

...Most strikingly, every legal resident of Canada is totally covered by Medicare for physician fees and hospitalization, whereas in the U.S...

...At the same time, there are complications...

...There have even been reports of patients traveling as far away as India for expensive operations that cost much less than in the U.S...

...Nor is there a charge for visits to an emergency room or outpatient clinic...

...That is a key question...

...The problem for the doctors is that even as a group they have little leverage in negotiating with provincial governments...

...He did add, however, that the existing system could benefit from “exposure to some of the principles that operate in the marketplace...

...Perhaps because it is so close to the United States (not only geographically), and, more important, because it has a single-payer health system (also called Medicare), those embroiled in the medical coverage debate across the border often point to Canada—approvingly and otherwise, depending on their ideological sympathies...

...More recently, an Alberta woman about to give birth to quadruplets was sent to Montana at government expense because there were not enough neonatal beds available...

...In Canada bureaucrats make general policies that impact the quality and timeliness of everyone’s care...

...The basic elements of Canadian Medicare—public administration, comprehensiveness, universality, portability, and accessibility—were prescribed in the Canada Health Act, unanimously passed by both houses of Parliament on April 1, 1984...

...In Quebec, where I live, everyone receives a Medicare card at birth, or at immigration, and uses it to establish entitlement to hospitals and physicians...

...are 74.2 and 79.9...

...ON BALANCE, what are the advantages and disadvantages of Canada’s Medicare system...

...Since private insurance for this track is not permitted, patients of such doctors literally have to pay the bill out of their own pockets...

...In many ways it works very well...

...Most coverage is provided to varying degrees by employers through private insurance companies, whose premiums have been escalating...

...What is the reality...

...In effect, the waiting lists constitute the present allocation method...

...Small wonder...

...And how can this be achieved at a more reasonable cost than present outlays...

...Arguably they are forced to function in a somewhat coercive atmosphere...

...In any event, impatient Canadians whom the government will not pay to send elsewhere have two choices: They can seek private care locally, assuming it is available, or go abroad...

...The opposing view that has prevailed until now, defending the egalitarian notion that access should be the same for everyone, regardless of socioeconomic status, is no longerlooked upon as a settled principle...

...Thus the Act lays out the broad criteria for Medicare, and requires an annual report to Parliament demonstrating compliance, but the idea of a federally run system is anathema in Canada...

...Even Medicare, the government’s program for seniors, is steadily being privatized...

...At both the provincial and federal levels attempts are now being made to at least loosen this knot by specifying clinically acceptable waiting periods and finding the funds to achieve them...

...Many have in fact done so and affected the ability of Canadian Medicare to meet the demands on it...

...Everybody is covered, and when immediate treatment is needed for a serious problem, you usually get it—with no out-of-pocket fee...

...The finding highlighted Canada’s resistance to having a private insurance system operating parallel to the public system, as is common in Europe...

...The worst of them is the existence of waiting lists due to funding that cannot keep up with demand, insufficient numbers of physicians and other medical personnel, plain inefficiencies, and, some critics contend, outmoded guiding principles that inhibit necessary reforms...

...Payments are made according to a negotiated fee schedule, with a set fee for every specific service, treatment or procedure...

...In addition, there is a dwindling supply of family doctors...

...Then he or she can charge whatever the market will bear and collect the payments directly...

...Harold M. Waller, who writes for the NL on Canadian affairs, is a professor of political science at McGill University...

...The last item can be covered by supplementary insurance, and many people carry it...

...Presidential campaign ever moves forward, one of its recurrent subjects is health care...

...Nadeem Esmail, who directs health policy studies at Fraser, argues that this “policy mix is common to all of the top-ranked health care programs in the developed world...

...There is no charge for a room that accommodates four or more patients...

...They can strike, but a government can always pass a law ordering them back to work, as happened in Quebec in 1970 when Medicare was in its infancy...

...Infant mortality per 1,000 live births is 5.3 per cent here and 6.9 in the U.S...

...Richard S. Katz, a political scientist at Johns Hopkins University, has compiled some relevant statistics based on data from 2000 and 2006...

...Instead, each of the 10 provinces and three territories has devised its own Medicare program within the national guidelines, manages it under its own laws, and receives annual cash transfers from the Federal government to fund a substantial portion of the cost...

...it has been a Democratic staple for decades...

...only 24.7 per cent of the population is fully covered...

...rarely do they consider individual cases...

...Ye t most Canadians would agree that their system, described by some as a “powerful symbol of the national identity,” needs considerable improvement...

...Of course, physicians also have the option of moving to another country, like the United States...

...If there are too few doctors practicing, governments will not be able to provide acceptable levels of service...

...Still, Medicare remains popular despite grumbling about a few of its details...

...They show that Canada generally outperforms the United States...

...The shortcomings are more complex, but they can be boiled down to scarcities resulting from an inability of governments to afford the levels of care citizens expect...

...HOWWELLdoes the Canadian system work from the perspective of the patients...

...In other words, there is reasonable care for all in most situations...

...Sometimes there is a waiting list for urgently needed care...

...Participating doctors are responsible for all the usual costs of running an off ice...

...Brian Day, who practiced outside Medicare, has disavowed any intention of promoting privatization...

...Given the regulation of fees, Canadian doctors’ incomes tend to be substantially below those of their counterparts in the U.S., though they remain the highest paid occupational group in the country...

...Excluding Ontario, there is an alternative: A doctor can opt out of Medicare...

...Nevertheless, in some cities there are clinics oriented toward executives and their families that operate outside Medicare...

...Germany spends more, but has avoided waiting lists...

...This country’s federal system, though similar in some respects to that of the U.S., allows the provinces to be much bigger players than the American states...

...When you go to a doctor’s off ice or a hospital, you present your card and the bill is sent to the provincial government, which pays it...

...This may seem merely an echo of complaints in the U.S...

...Its roots are a 2005 Supreme Court ruling that very long delays in providing treatment (like waiting over a year for a hip replacement) deprive a patient of his rights, and that in such circumstances there should be an insurable private care option...

...A few years ago, when Quebec and Ontario were unable to keep up with the need for cancer radiation treatment, they had to send patients to the U.S...

...Vancouver’s conservative Fraser Institute advocates introducing a combination of copayments, private competition among hospitals, and private insurance for the private sector of doctors...

...Consequently, no one is bankrupted by medical expenses, no matter how catastrophic the condition...

...The new president of the Canadian Medical Association, Dr...

...He argued that “to privatize the Medicare system in Canada would be an impossible task, even if you wanted to...

...In the U.S., by contrast, insurance companies tend to address specific complaints, creating a sense of more personal concern...

...Which brings us to a related grievance: that government employees and their political masters make the health care decisions, not a doctor and his patient...

...But there is no reason to...

...the doctors are not government employees and the hospitals are not necessarily government-owned...

...They are compensated on a fee-for-service basis, but there is only one payer, the government, so there are no bad debts to collect...

...The advantages are clear: Everyone is covered, patients can go to any doctor in the system who has an appointment available, and the fear of running up huge bills is essentially nonexistent...

...But there is a crucial difference...

...Progress, unfortunately, has been slow...

...The issue is hardly new...

...In 2005, when the condition of an Ontario woman who was going blind from a brain tumor was misdiagnosed and she could not get timely attention, in desperation she finally went on her own to the Mayo Clinic, where she was correctly diagnosed and an operation saved her sight...

...Exactly what should be allowed beyond Medicare or uninsurable private care is the heart of Canada’s cur rent health debate...

...Indeed, after a stay in a hospital for surgery or any other treatment, the only charges to a patient are likely to be for a desired telephone or television, or the differential for a requested semiprivate or private room...

...The patient incurs no outof-pocket expense...

...Technically, this is not socialized medicine...

...But it has taken on a certain immediacy...

...Ye t Canada spends about 30 per cent less of its gross domestic product on health care than the United States—thanks largely to lower administrative costs because there is no private insurance company involvement...

...Detrimental as well are the disincentives prompting doctors to leave the system...

...Today, proposing a health care plan appears to be a requirement for any serious candidate...

...The Act marked the culmination of a process begun in the province of Saskatchewan in 1947...

...For example, life expectancy here is 76 years for males and 83 years for females, while the corresponding f igures in the U.S...

...First, though, American leaders have to open their minds...

...The United States is at present the only industrialized country lacking a universal medical program...

...Numerous nonemergency procedures—such as cataract operations and joint replacements—entail delays of months or occasionally more than a year...

...Canadians pay for their health care benefits through taxes that are much higher than those levied on Americans...

...at government expense...

...If the United States does seek to introduce universal care, there is much that could be learned from its northern neighbor and other countries that have had such systems for decades...

...Their inclination to reject other nations’ medical coverage experiences is a shortsighted way to make policy...