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Health Care In Canada Vs. The US: A Tale Of Two Countries

Meredith Miller | Published: February 22, 2018

US Canada flags

Health care is an essential aspect of quality living. People who can afford quality health care live longer, fuller, more productive lives because they aren't sidelined by a sudden illness or medical condition.

Nearly half the world's population lacks full coverage or accessibility to essential health care. Furthermore, 100 million people around the world are facing poverty due to increasing medical debts. Medical costs are so enormous that over 12% of the world's population spend at least 10% of household income on health care expenses.

You may have heard terms such as "single-payer" and "universal health care," which have gained traction and popularity throughout most of the world. More and more countries are making a concerted effort to provide quality health care access to everyone. India is just the latest example and wants to give 500 million people free health care.

To further understand the need for a functional health care system in the United States, that is universal or single-payer structured, look no further than our neighbors in the north, Canada. The two countries couldn't more different in terms of health care, let's take a look at how and why.

Single Payer Health Care

Single payer health care is a health care system that is financed through a public tax. It operates as a public service offered to citizens and legal residents regardless of age, socioeconomic background, or preexisting conditions, with few exceptions. Single payer health care can be managed by the government or operate as a publicly owned and regulated agency that is an extension of the government.

In single-payer systems, one set of rules is established for a variety of items including, services offered, drug prices, reimbursement rates, and minimum standards for basic care. By using these regulations, governments ensure that a quality medical standard of care is provided to all citizens on an equal basis.

Multi-payer healthcare systems, conversely, use both public and private resources such as qualified individuals and employers and thus can introduce limitations and restrictions on health care based on any number of reasons. Restrictions to health care under these systems can be due to age, pre-existing conditions, financial means, etc. Establishing single-payer health care is a strategy used by governments to achieve a number goals including:

  • Improved health of the population
  • Reduction of medical debt and economic burdens
  • Pathway to obtaining universal health care

Considering that "universal health care worldwide" is a stated goal of the World Health Organization since 2010, the push for single-payer health care systems as a global standard is becoming more and more popular.

Universal Health Care

Universal health care also referred to as, universal health coverage, and universal care, provides both health care and financial protection from medical debt, to all of the citizens and legal residents of a country. The system is organized to provide a specific package of benefits to all members of society, without exceptions. This effectively provides improved health care, easier access to quality health care and protection from financial debt due to medical complications. Health care that is universal unifies services while simultaneously delivering them in a comprehensive and integrated way. The bottom line in determining universal coverage are these three factors:

  • Who is covered?
  • What services are covered?
  • How much of the cost is covered?

The World Health Organization considers universal health coverage, a situation where citizens can access essential basic health services without incurring financial hardship, the "single most powerful concept that public health has to offer."

A mixed model of funding has helped universal coverage gain in popularity throughout the world. In many countries, the primary source of funding universal health coverage is through tax revenue. However, some countries have supplemented health care by specific levies charged to individuals or employers.

Private Health Insurance

Private health insurance is offered through employers or other organizations. Some employers offer only one type of health insurance plan, while others may allow you to choose from more than one plan

Some insurance plans work with specific health care providers and facilities, what is known as part of the plan's "network." This sometimes helps lower the costs of medical care, particularly if the network is large enough. Insurance plans and their networks often offer a variety of "managed care," programs that outline which care services are offered and which services health insurance doesn’t cover. Two different types of managed care programs include:

Health maintenance organizations (HMOs) – covers medical care within the network of providers. HMO's are generally cheaper than plans that offer a greater choice of providers.

Preferred provider organizations (PPOs) – if care is obtained from the network of care providers, PPO's your medical costs are more fully covered. In some cases, PPO's might still pay for care outside the network. Usually, private health insurance out-of-pocket expenses are costlier than public options in general. It's important to discuss options with a health insurance agent to be sure you find the best healthcare service available for your needs.

Health Care In Canada

Canada is an example of a single-payer health care system it is delivered through 13 provincial and territorial systems of publicly funded health care also known as Medicare. Guided by the provisions set forth in the Canada Health Act of 1984, federal standards dictate the quality of health care in Canada. Though the government does not get involved with day-to-day operations nor collect private information about an individual's health, they do determine the qualifications for essential health benefits.

Currently, the Canada Health Act does not cover prescription drugs, home or long-term care, prescriptions glasses, or dental services. Limited coverage for these services are provided for vulnerable populations such as children, but Canadians usually pay out-of-pocket for these services.

The simplistic quality of Canada's Medicare system in which doctors and physicians handle insurance claims against provincial insurers directly without involving the person(s) accessing health care makes the system more cost-efficient and effective.

Health Care In The United States

The United States has a mixture of single-payer system and private health coverage. Medical expenses not covered by the public option or Medicare can be supplemented by using private coverage and/or out-of-pocket expenses. For Medicare coverage in the United States the following qualifications apply:

  • People over the age of 65 are qualified to receive Medicare or Medicaid
  • People under 65 and suffer specific disabilities are also eligible
  • Low-income people can qualify for Medicare coverage

The rising costs of medical expenses combined with the limited coverage of Medicare in the United States have led to a decrease in coverage for the population. As evidenced by a 2003 Gallup poll which found that only 25% of Americans were satisfied with the availability and quality of healthcare in the United States. Implementation of the Affordable Care Act has sought to change this problem, by providing patients with financial protections and basic quality health care for as many citizens as possible.

Health Care In Canada Vs. The US: Which Is Better?

In a poll conducted by Harris-Decima in 2009, 82% of respondents favored Canadian health care over the United States. Another poll conducted by Nanos Research in that same year found that 86.2% of Canadians supported public health care.

Advocates for "Canadian-style" health care, argue that universal single-payer health care can and does save hundreds of billions of dollars per year. Not only would universal and/or single-payer health care systems save money, these structures would further benefit economies both locally and nationally.

Health coverage provided through single-payer and universal coverage is not affected by loss or change of jobs and cannot be denied due to unpaid premiums. Lifetime limits and/or exclusions for pre-existing conditions are also prohibited. In these systems, all essential basic care is covered, including maternity, unlike the United States, where maternity care is usually offered through private health insurance.

While detractors have argued such as the Congressional Budget Office and the New England Journal claim that single-payer and universal health coverage systems are more expensive because people use preventative care more, studies have shown that preventative care is more cost-effective through the long-term. This is one of the most striking differences between health care in Canada vs. the US. Canada understands that preventative care improves the economy not detract from it.