I have a guest post running over on Raising My Boychick today! It’s part of the Womanist/Feminist Parenting Primer, conceived by the fabulous Arwyn. After you read my completely non-authoritative primer on Canadian health care, hop on over and read my post, called Talking to Strangers.
I’m not a doctor or a nurse or a phrenologist and I don’t even play one on TV. I’ve never worked in health care other than a brief stint as a candy striper in the early 90s. But I have lived in Canada my whole and entire life, and I drew my first breaths in a Canadian hospital. So I decided to share my own perspective on our health care system, which we call ‘Medicare’. I am at least as qualified as any other random Canadian, after all.
This is not comprehensive, because I am not well versed in the complicated and bureaucratic intricacies. I’m limiting my discussion to what I would call the majority of cases and my personal experience. If you have anything to add based on your own experience please do share it in the comments.
I was prompted to write about Canadian health care when I saw this ad on a website:
As a Canadian this ad sort of shocks me. You see, we speak about the evils of ‘American-style health care’ all the time. During election campaigns politicians accuse each other of wanting to introduce a two-tier medical system that will kill us all. It doesn’t surprise me that they found a Canadian who’s unhappy, we are a country of 30 million people after all. But I think that most of us find this ad surprising given our general assumption that Canadian health care is better than American health care in the vast majority of cases.
So how does Medicare work? The health care system is regulated by the Canada Health Act and administered through the federal and provincial governments. There are slight variations from province to province, but the system remains largely the same across the country because it is required to. Here are the key components:
1. It’s universal – Everyone is required to participate in, and be covered by, Medicare. There is no such thing as being denied coverage because you’re out of network or have a pre-existing condition. There are no private insurers. There is a 3 month waiting period before Medicare coverage starts when you move from province to province, but you’re covered by your previous province during that time. Being uninsured is not something we understand, and it’s not even possible for most Canadians.
2. Publicly administered – Medicare is administered by a public authority in each province and territory. The plans are operated on a not-for-profit basis and the health authorities are accountable to the government.
3. Covers all medically necessary services – In Canada it is illegal to bill directly for a ‘medically necessary’ procedure, anything deemed necessary must be covered under Medicare. Pretty much any services offered by a doctor or hospital are considered medically necessary, such as regular office visits, emergency services, surgery and diagnostic tests. There are no co-pays, user fees, or deductibles. When I visit the doctor or hospital I present my health card and they bill the plan directly, I am completely uninvolved in the process.
4. Low or no premiums – In some provinces individuals do not pay any premiums for health insurance. Here in BC we do pay set medical premiums. The rates are $54 / month for singles, $96 / month for couples and $108 / month for families of 3 or more. If your family income is low you are subsidized in whole or part. If you are employed, your employer generally pays half your premium, so my family of 4 currently pays $54 / month.
Some services are deemed ‘uninsured’ and aren’t covered by Medicare, such as dental care, optometry, prescription medications, cosmetic surgery and naturopathy. Most employers offer an extended health plan to their employees, which covers some portion of selected services. For example, I am reimbursed for a portion of my dental and prescription costs, and I am covered for emergency care if I travel outside of Canada. The premiums for these plans are very low, or may be completely covered by your employer.
Most Canadians are generally satisfied with our system. According to our government in 2005 85% of Canadians were satisfied with the health care they received. And we’re getting good value for our money. In 2005 per capita medical costs in Canada were $3003 USD compared to $5635 USD in the United States. The per capita costs in the US from public sources were $2570 USD, compared to $2108 USD in Canada. Americans are already spending more for public health care without universal coverage.
There are downsides to Medicare. Some patients are dissatisfied with the care they receive, although I would venture to guess that’s true in every other country in the world as well. No matter how you fund medical care there will be doctors who make mistakes or nurses who are having a bad day. Because there is no option to go outside the system it leaves people who want to pay a premium for ‘better service’ without recourse. And it doesn’t allow doctors to set their own rates, since their rates are set by the public health authority.
But the truth is that we are not dying in droves. Our life expectancy is higher and our infant mortality rates are lower than in the US. We generally trust the system to care for our urgent needs. And we are thankful to know that in any circumstances we can count on our health care needs being met. We won’t become uninsured if we lose our jobs. A serious illness or injury won’t bankrupt us. Any of us. I think that’s a good thing.