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The Guardian

America, Want Freedom of Choice? Try Public Healthcare Like Canada

Our system ensures the right to care without considering ability to pay or profit margins. No one gets betweens us and our doctors

Canadians are following the implementation of the Affordable Care Act with the hope that it will lead to better healthcare for all Americans. But that hope is tempered by feelings of disappointment and confusion that America still has not progressed to a single-payer universal healthcare system.

For Canadians, the value of public healthcare is self-evident.

We spend roughly 60% of what the United States does on healthcare (pdf), and manage to cover everyone (10.6% of GDP in Canada vs. 17% in the US). In a public system, spending less does not mean worse healthcare outcomes. Measured by life expectancy, infant mortality, cancer survival rates and many other measures, Canadians enjoy the same or better levels of care than Americans. Public healthcare costs less, delivers more and is there for everyone, regardless of their ability to pay.

How is it possible for a public healthcare system to deliver more and better care at a lower cost? The secret is in the two major differences between the Canadian and American health care systems. First, in Canada, core hospital services can only be non-profit. Eliminating the need to funnel profits to shareholders represents a 10-15% savings right off the bat.

Second, the Canadian single-payer system – when expanded across the entire country – is simply the most efficient way to run a healthcare system. Risk is pooled across the largest possible population. And a large, single system means that the share of health spending that goes towards administrative costs is 16.7% in Canada, compared to a whopping 31% in the US. In a public system the emphasis is no longer on itemizing, invoicing and collecting payment from individuals, and resources can be shifted to where they are needed: patient care.

While for-profit health corporations and big pharmaceutical companies are fighting to privatize more of Canada's health care, polls consistently show that Canadians strongly oppose this. A survey in December 2011, found that 94% of Canadians are in favour of public over for-profit healthcare (pdf).

Public healthcare is funded out of general taxation, so Canadians never get a medical bill in the mail. The only plastic card we need to take to the hospital is our government issued health card. From there, the bill is settled between the hospital and the provincial government.


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Freedom from medical bills leaves Canadians with many more care options. Depending on the size of the city we live in (bigger cities have more options), we choose the doctors we want, the type of practice we're comfortable with (single-doctor, team based, community), or how we want to birth our children (with a midwife, a doctor, at home, in a birthing centre, or at a hospital).

If it is decided between a patient and their health professional that a procedure is medically necessary, we are referred for the service. There is no insurance provider coming between a patient and their doctor, deciding what services we can and cannot have done. As long as the procedure is not purely cosmetic, it is covered by public medical insurance.

We do not have to pass a medical exam to be covered by public insurance. Pre-existing conditions require future monitoring and additional care or services; they are never something that disqualifies us from coverage.

In a single-payer system you also are not locked in to your current job to keep health coverage. Public health insurance allows Canadians more freedom to change jobs and careers knowing that their healthcare coverage will follow them.

It is true that we do sometimes have to wait for care in Canada. How much time varies by procedure and province. The system is guided by triage; if you have a medical reason to get the procedure done immediately, you get it right away. If your condition isn't as serious, you might have to wait. But just because someone is wealthy does not mean they can pay and bump you down the list. We determine care solely by need.

Canada's public healthcare system reflects our belief in the right of every person to access care when they need it, regardless of their ability to pay. We believe that people should have the freedom to make decisions on health matters with their doctors and not have their choice invalidated by a large corporation looking out for their bottom line.

Canadians believe in a public, single-tiered, healthcare system that puts people first. We also believe that if Americans knew what they were truly missing, they would demand nothing less than the same for themselves.

Adrienne Silnicki

Adrienne Silnicki is the Council of Canadians' Health Care Campaigner. She writes for and Canadian Perspectives. She lives in Halifax, Nova Scotia, Canada. Follow her on Twitter @Asilnicki

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