Canada’s universal healthcare system contrasts with the U.S. model, where healthcare often operates as a commercial enterprise
Prof Satya Narayan Misra
The next Canadian PM, Mark Carney, responding to Trump’s egregious threat of annexation and the looming trade war, observed: “In America healthcare is big business. In Canada, it is a right. America is a melting pot. Canada is a mosaic.” Carney has impeccable credentials as a banker as he navigated the subprime crisis of 2008 very effectively when he was head of the Bank of Canada and earned encomiums as the first non citizen to run the Bank of England.
However, Trump’s present challenge is a different kettle of fish. In his first stint as President, Trump had declared his intent to repeal the Affordable Health Care Act 2010 of Obama, through which 14 million Americans receive premium subsidies and access to Medic aid to 21 million low-income adults. But it was not successful. He so far has not revived his dubious plan. It would be, therefore, useful to understand the healthcare system in the two countries, its impact, and the politics that overarches the debate between health care as a right or commercial enterprise.
A Comparative Picture
The two countries had similar healthcare systems in the 60s and 70s before Canada changed its system through the Canadian Health Act of 1984. It provided all Canadians with a publicly funded healthcare system, called ‘single player’ because all funds and payments come from a single source, the Canadian federal government.
Insured health services include both inpatient and outpatient medical care. It is often considered a well-funded example of universal healthcare. It was a bill passed universally and it aimed to ‘promote, protect and restore the physical and mental well-being of residents of Canada and to reasonable access to health services without fine or other barriers.’
In contrast, the USA has a hybrid system of public and private, for-profit and nonprofit insurance and health care providers. It was Johnson through the Great Society movement started the medical aid health insurance for adults and children with limited income and resources in 1965 and Obama’s ACA Act of 2010 extended the scope to people with income of 138% of the Federal Poverty line.
By 2022 nearly 85 million low-income and disabled people have been covered by these two programs. While Canada’s universal single-payer healthcare system covers about 70% of expenditure and all insured persons are fully insured without co-payment and about 91% of hospital expenditure is financed by the public sector, in the USA nearly 16% are uninsured at any point of time. Besides around 44% of those with marketplace coverage are underinsured in terms of coverage.
Impact
As per a Commonwealth study, Canadian Medicare, based on the criteria of affordability, equity, administrative efficacy, and outcomes ranked 10th, one step ahead of the USA but below Norway, Netherlands & Australia ranked 1, 2 & 3.The USA spends much more money
on healthcare, on both per capita basis and as % of GDP. The per capita spending was $3678 in Canada in 2022 was around $6833 as compared to $12474 in the USA. In terms of % GDP spent; it’s around 16.6% in the USA in 2022 while Canada spent 12.2%. A comparative picture of Infant Mortality Rate (IMR) per 1000 reveals that it is 5 as against 6.3 in the USA.
In Maternal Mortality Rate (MMR) per lakh also, as against 11 in Canada, it stands at 33 in the USA. The Life Expectancy is 82.6 in Canada as against 76.3. The overall health service performance by the WHO, a comparative measure of achievement in the level of health, distribution of health, level of responsiveness, and fairness of financial contribution, Canada ranked 30th, and USA 37th amongst 191 countries.
Cata Institute has expressed concern that the US government has restricted the freedom of patients under Medi aid to spend their own money on healthcare and has contrasted these developments with the situation in Canada, where the SC of Canada in 2005 ruled that it cannot prohibit its citizens from purchasing covered services through private health insurance.
Gordon Guyatt conducted a meta-analysis of all studies that compared health outcomes for similar conditions in Canada & USA and concluded that ‘health care outcomes may be superior in patients cared for in Canada Vs USA’. A peer review study in 2006 showed that US residents are 33% less likely to have a regular doctor, and 25% more likely to have unmet healthcare needs. The access problems were particularly dire for those uninsured in the USA.
Ideology & Politics of Health
Canadians strongly feel very strongly that health care is a public good and a right of citizenship, not a commodity or business venture. When the conservative party of Canada considered increasing the role of the private sector, public backlash caused these plans to be abandoned and the governments that followed reaffirmed its commitment to universal
public medicare. In the USA these rights of citizenship are labeled as entitlements and often discussed in a negative context. Americans have a national ethic of individualism.
Redistributing the cost of health care so that everyone pays roughly the same is viewed as unfair. President Bill Clinton tried to significantly restructure healthcare architecture but the effort collapsed under political pressure against it, despite tremendous public support.
The US approach loses sight of the fact that insurance is a social institution, invented to pool and spread risk. Canada has been more successful at primary health care to a large proportion of its population at far less cost than the USA. Approximately 50% of respondents in Canada believe that the healthcare system needs minor change.
In contrast, people are least satisfied with the health care system. The poor and less educated are more likely to utilize health care as a right in Compared to the USA, with its infallible belief in the free market system. As Kailash Satyarthi, the Nobel laureate believes compassionate health care ‘must encompass equitable, accessible, and quality health care for all, irrespective of their socio economic stature, gender, or caste. It is time to globalize compassionate healthcare for all.’
Healthcare as a right ‘Trumps’ a culture based on business or individualism. An inclusive society with universal healthcare scores over a hybrid insurance model of the USA. Carney must be complimented for bringing universal health care as a public right-based good to the center stage.
(The writer is a Professor Emeritus, KiiT University, Bhubaneswar. Views expressed are personal.)
