Hybrid system may be best solution

As the discussion about health care reform intensifies across America, myths and misconceptions abound, and the truth is often the first casualty of the debate.

“People are not dying in the street in Canada because they have to wait for care, just like people are not dying in the street in the U.S. because they don’t have health insurance,” said Tom Noseworthy, director of the Centre for Health and Policy Studies at the University of Calgary in Alberta, Canada.

Nor is Canada’s universal health care system the Utopia it is often rumored to be.

The reality of Canada’s universal health care system is that overall, citizens are happy with the quality of care, but they are troubled by long waiting periods for procedures; conflicted about the idea of some privatization; and concerned about accessibility in rural areas.

The reality of the U.S. health care system is that 46.6 million Americans did not have health insurance in 2005, according to the U.S. Census Bureau. Meanwhile, health care costs continue to skyrocket past the rate of inflation at an unsustainable pace.

“One problem I think in the U.S. is in a lot of cases, people, particularly with no insurance coverage, don’t go to a doctor until often conditions are quite serious and they end up in emergency treatment in the hospital, which is probably the most expensive way of covering illnesses,” said Peter Scherer, counselor to the director of the employment, labor and social affairs directorate at the Organization for Economic Co-operation and Development (OECD), based in Paris, France.

“Having good prevention coverage through easily accessible primary care can often reduce the total cost (of health care) and avoid expenditure,” Scherer said.

In 2004, per-capita spending for health care in the United States was $6,096, more than double that of Canada’s $3,038, and yet Canada has a longer life expectancy and a lower infant mortality rate.

Both countries are looking for solutions to the complex issues of health care coverage while trying to preserve the aspects of the systems that they believe are successful. Canada is looking for future funding options and sustainability, but is hesitant to move to a two-tiered system for fear of losing accessibility and affordability.

The United States is looking to offer health care to more citizens and curb the ever-increasing costs of the system without compromising innovation and profitability.

In Wisconsin alone, the proposed Healthy Wisconsin initiative would create a universal state health care plan that would be funded by a $15.2 billion annual new tax, which would make Wisconsin the highest-taxed state in the nation, according to the Tax Foundation, based in Washington, D.C.

“I don’t see the U.S. adopting a universal system, but I could see some hybrid combination of public and private,” Noseworthy said. “We might meet in the middle.”

The Canadian federal government spends $19 billion per year to fund health care at the provincial level, according to Finance Canada. Each province has its own budget. Ontario spends $8.5 million of its budget on health care, which is about 46 percent of the spending on all of Ontario’s government programs, according to the Ontario Ministry of Finance.

“One thing that complicates the Canadian system is it is run by the provinces, but the basic framework everyone has to follow is under federal legislation,” Scherer said.

Canada’s public health insurance system is called Medicare, and it is structured as a single-payer system. The federal and provincial governments fund Medicare based on allocations from individual and corporate income taxes, but additional expenditures are allocated from out-of-pocket payments from citizens and private insurance.

The single-payer system provides social fairness by equally offering medical care to every citizen and cost effectiveness by simplifying and reducing administrative costs, said Paul Duchesne, media relations officer for Health Canada.

About 8.5 percent of a Canadian citizen’s federal income taxes are collected to fund health care.

Ontario offers a health premium program for individual income tax and a tax rate for corporate income tax to fund its health system. Corporations pay between 0.98 percent for corporate incomes under $200,000 up to 1.95 percent for corporate incomes of more than $400,000, according to the Ontario Ministry of Finance and Ministry of Revenue.

Individuals pay premium amounts depending on their incomes. Those with incomes of less than $20,000 per year are exempt, and those with incomes of more than $200,000 per year pay no more than $900 per year.

Canadian Medicare is regulated by the Canada Health Act, which was passed in 1984. The act institutionalized the founding principles of universal health care with provisions aimed to both eliminate and prevent future direct charges to patients, aside from insured health care services.

The criteria for any current or future Canadian health care system, according to the Canada Health Act, includes the requirement of public administration, comprehensiveness, universality, portability between provinces and accessibility.

However, waiting times can be more than a year for some procedures, such as hip replacement surgery. So, Canada’s wealthier citizens often turn to private clinics, paying doctors on the side or traveling to the United States to be treated in a shorter period of time.

Provinces such as Ontario have seen more private clinics open to accommodate this surge in recent years, a trend that is in conflict with the principles of the Canada Health Act.

“A two-tiered system might take some of the pressure off of the public system, which is precisely where I think we should be going,” said Fred Gilbert, president and vice chancellor of Lakehead University in Thunder Bay, Ontario. “The level of care that is ultimately provided in the country is very good. It is just the time involved to get there.”

A private sector of doctors would take pressure off the system in terms of the number of patients, but then the number of providers would drop, Gilbert said.

Health Canada plans to meet with provinces and territories to ensure that the universal care system does not present a barrier to innovation, Duchesne said.

“Health care is one of this government’s top priorities,” Duchesne said. “Ensuring the system is timely and sustainable means implementing reforms that ensure that Canadians receive the services they need when they need them, and that they are delivered in an efficient manner; it requires innovation in the way we do things, and we are working with provinces and territories to make this happen.”

The first step in this process was to address the wait times. Every province and territory in Canada offers Patient Wait Times Guarantees, Duchesne said.

Residents of Ontario can visit the Web site, www.OntarioWaitTimes.com, to view patient wait times for elective surgeries per region. If a resident wants to know which hospital has the shortest wait time, the data can be re-sorted to show wait times in chronological order.

Since launching the wait times strategy three years ago, Ontario has invested $611 million for additional procedures leading to a 19.6 percent reduction in wait times for cataract surgery; 17.9 percent reduction in wait times for hip replacement surgery; 23.3 percent reduction in wait times for MRI exams; 25 percent reduction in wait times for angioplasty; and a 50 percent reduction in wait times for angiography procedures.

Ontario has increased investments in home care by $340 million since 2003, created 150 new Family Health Teams of doctors, nurses and health care professionals and adopted proactive preventative and wellness initiatives to help the population of Ontario understand its health risks.

The future of the Canadian system is uncertain, and citizens may argue about the impacts of privatization and big business, but they seem to almost universally embrace the concept that everyone should have access to medical care.

“Many European countries with universal health care have made modifications to their systems because they would have bankrupted their countries,” Gilbert said. “At some point, we have to recognize that philosophy is a wonderful idea, but there is that critical juncture where we have to have some element of the private sector to ensure ultimately we can afford to provide services to those who most desperately need it.”

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