Term Paper on "Medicare in Canada Advantages and Disadvantages"

Term Paper 17 pages (5697 words) Sources: 1+

[EXCERPT] . . . .

Crisis in Canada:

Are the Universal Health Care Policies in Canada failing?

According to American reporters, and some conservative sources inside Canada itself, the Canadian Medicare system is showing signs of extreme stress and is in danger of being bankrupted entirely. The public perception in America, and increasingly in Canada as well, is that universal care has resulted in tightly rationed care, government interference in the ability of individuals to receive adequate and timely treatment, and significant budget deficits. The perception presented in media releases, such as Peter Jenning's report (Feb 3rd, 2004) on ABC, is that Canada is "struggling with universal healthcare," and that "many Canadians believe it is the healthcare system itself that is truly sick." (in: Marmor and Sullivan) Recently many politicians in Canada, such as Premier Ralph Klein in Alberta, are pressing for increasing privatization in the system, claiming that "tough" reforms will improve the situation in his province. (CUPE)

However, despite these media-reported failings and political maneuvers, polls in Canada have consistently shown that the universal care system is integral to the nation's conception of itself, and a point of great pride. In the most recent Gallup poll to ask Canadians whether they preferred their own system to the privatized system in America, 96% responded positively, and only 2% dissented. (Fairness and Accuracy...) Additionally, Canada continues to have a higher life expectancy at every life-stage than does America, consistently report equal or superior satisfaction with their health-care experiences compared to people in America, and nationally spend considerably less money per capita compared to the American public.

Three basic questions need to be answered:

Is there a crisis? If there is a crisis, what are the causes? Once the causes are known, the question must be as to what sort of policies will correct this problem - is privatization really a good idea, or are there other options? In all this it is important to know the history of the systems involved, the supposed facts of the crisis, and what sorts of solutions are being proposed. It is also important to analyze any proposed solutions not only on how effective they might be for the health and budget of the nation, but also what their possible interactions would be with other national laws (for example, considering the idea of further price-setting might be blocked by trade agreements), and finally what their impact would be on both public opinion and on the powerful factions who pleasure or displeasure can change the fortune of any policy-setter (e.g. corporations and the more educated or wealthy segments of the population).

In all this debate, it is also vital to keep in mind that this is not only an issue of social justice and life-or-death decisions, and that the wrong policy will quite literally be lethal to many people, but also that this issue may play a significant role in the way the nation defines itself. All economic, political, and even health issues aside, the way in which universal health care is handled in Canada may be vital to the way in which Canadians perceive themselves, and this itself is a sort of political currency which should not be ignored. Almost every Canadian source to which one turns in investigating this issue mentions, at least in passing, the way in which its health care system is a point of national pride and international definition. As Roy Romanoz, author of one of the most influential government reports on the subject, is quoted as saying "The principles of the Canada Health Act began as simple conditions attached to federal funding for Medicare. Over time, they became much more than that. Today, they represent both the values underlying the health care system and the conditions that governments attach to funding a national system of public health care. The principles have stood the test of time and continue to reflect the values of Canadians." (in: Health Canada, 2) Any policy recommendations must absolutely take into consideration the deep emotional and social attachments which Canadians have to their system of universal care, and the instinctive gut-reaction which the majority will have to a system which proposes to return to a less-equitable or more capital-driven mode of health-care delivery.

Case History: What policy decisions have led to the current situation?

Canada has had a national Medicare program since the mid-1960s, and individual provinces were providing health care plans of various sorts for almost twenty years before that. The national system itself has evolved significantly since the 1960s. Up until the early 1990s, most of these shifts in policy were directed at creating more standardized and equitable care across-the-board, though in the last decade most moves have shifted in the opposite direction. Through-out Medicare's history, it has been strongly opposed by varying groups of economically interested groups, including some doctors, many big businesses (especially those with interest in pharmaceutical, medical, or insurance corporations), and of course most insurance companies. It has been most supported by grassroots and social justice forces. (Health Coalition)

The history of Medicare in Canada begins with the province of Saskatchewan, where universal hospital insurance was officially established in 1947. Though by that point all ten of the provinces had some form of public, comprehensive insurance for in-hospital care, in 1962 Saskatchewan found that its doctors were still not particularly found of price-setting and universal, government supported care. When the insurance provisions there were extended to include more routine health care, doctors unsuccessfully went on strike for three weeks. Nonetheless, the province's program was apparently sufficiently successful that the Royal Commission recommended national universal insurance. (Health Coalition; Health Canada)

Around 1966, a nationalized Medicare was created which assured universal and comprehensive medical coverage. This program balanced national and provincial financial responsibility, in which Ottawa was responsible for paying a full 50% of provincial health costs. This system lasted for approximately ten years, during which Canadian health care was ranked as one of the best in the world. (Health Coalition)

In 1977, however, Trudeau Liberals decided to rework the financial support of the system, and replaced 50:50 funding between Ottawa and the provinces with a form of block funding in which more of the money for each provinces needs became the individual responsibility of that province. As will be discussed in more detail in the following sections, it was in this decision that the seeds of the current financial crisis (to whatever degree it is a crisis) were planted. (Health Coalition)

Within a year, social observers noted that doctors and hospitals were "extra-billing" and/or charging extra user fees to patients in order to increase their revenue. Extra-billing, then as now, was the practice of charging prices above those subsidized by the state or recommending and charging for services not covered by the state. Such arrangements could be used to allow more wealthy patrons exclusive or preferential access to more talented or qualified doctors, or even to allow queue-jumping for services which might have waiting lists. This practice was brought to the attention of the public, and created a degree of outrage as it was made clear that such practices created a "two-tiered system" in which the poor who could not afford extra bills or user fees did not have access to the same quality of care that the rich could expect. Parliament addressed these concerns in the 1984 Canada Health Act, which was unanimously passed. Extra-billing and user fees were in this act entirely rejected by the parliament (at least to the best of their ability within the confines of a somewhat decentralized federal structure) - provinces which allowed extra-billing or user fees for federally covered services suffered automatic dollar-for-dollar reductions in their federal funding. This was one of the last reforms instituted in the name of reducing the privatization of health care. (Health Coalition; Health Canada)

Almost ten years later, the pendulum of political sentiment began to swing away from a commitment to universal, free (to the user) health care, though there were still mixed responses. In 1993, partly in response to international pressure regarding trade standardization and the lobbying of pharmaceutical companies, the Molroney administration extended the patent protection given to name brand pharmaceuticals, which had the effect of increases medication costs. Two years later, the Canada Health and Social Transfer legislation led to significant cuts in funding for health and social programs; on the other hand, in 1997 the National Forum on Health strongly recommended that Medicare begin to include homecare, more alternative/preventative treatments, and drugs - they also suggested reducing profit orientation in medicine by turning away from fee-for-service payment to doctors. (This would have encouraged only necessary tests and procedures to be done, rather than encouraging the maximum number of procedures possible per patient)

The pendulum only picked up steam in 1998 when the Chretin administration agreed to the demands of the Premiers that provinces be allowed to interpret the Canada Health Act themselves. (Health Coalition) re-evaluation of the health system appears to have been quietly underway from 1998 to the… READ MORE

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