Sunday, January 27, 2008

Canadian Health Care: A(n Abridged) Primer by Neasa Coll

I'm excited to introduce you to the first guest post (hopefully the first of many!) by Neasa Coll. Neasa and I went to UWC together in Wales, and were also together in Boston our undergrad years-- she in Harvard and I in Wellesley. I fondly remember our breakfasts together in the Dining Hall at AC! Since then, she has returned to Calgary and we have found ourselves thinking of similar things. I am really grateful for her willingness to contribute to this small blog, and am really looking forward to the last two posts in this series. Thank you so much!


In November 2004, Canada’s national broadcaster, the CBC, encouraged audiences to nominate the country’s “Greatest Canadian.” The top ten nominees included a number of internationally recognizable names: Wayne Gretzky, David Suzuki, Alexander Graham Bell, Frederick Banting.

So who won?

Tommy Douglas – not a hockey player at all, but a prairie politician, and the father of Canada’s public health care system. Douglas holds an important place in Canada’s national imagination (most of us either don’t know about, or turn a blind eye to his early scholarly work on eugenics, which he thankfully abandoned following experiences in Chicago and Germany).

Douglas’ win was no small testament to the value placed on public health care in Canada, and its significance in terms of our national identity. Public portrayals of Canada’s health care system, such as that in Michael Moore’s “Sicko,” only serve to perpetuate the misunderstanding that health care inequities don’t exist in this country. They do – but they don’t have to.

The causes of health care inequities (and subsequent solutions) are multiple and complex, and are best understood within the framework of Canada’s health care system. I’m certainly not an expert, but what follows is a brief (amateur) explanation of health care in Canada:

The Canada Health Act, passed in 1984, ensures “that all residents of Canada have reasonable access to medically necessary hospital and physician services on a prepaid basis, and on uniform terms and conditions.” We don’t have, however, a national health plan. Instead, the 13 provincial and territorial governments provide health insurance plans that must adhere to the requirements of the Canada Health Act. What this means is that health coverage varies from province to province and territory to territory.

For instance, physiotherapy is fully covered by Saskatchewan’s health plan, but is not covered at all by Alberta Health & Wellness (although it was, at one point in the recent past). Another example is eye exams and optometrist services, which are usually fully covered for those under the age of 18 and over the age of 65, but not for anyone between those ages. The extent of provincial/territorial coverage (or partial coverage, for some services) depends entirely upon where you live as a Canadian resident.

(The health care equation becomes more complicated when I explain that health care systems are funded via a combination of federal transfer payments and provincial/territorial taxes or premiums, depending upon where you live. Also, the federal government (not provincial or territorial governments) is responsible for providing health care to veterans, federal inmates, members of the Royal Canadian Mounted Police, and Aboriginal peoples living on reserves. I maintain that health coverage in Canada is impressive and generally worry-free – but gaps do exist.

So what fills in the health care gaps? Private insurance. Employers and schools in Canada provide benefit packages that make up about 30% of health care expenditures in Canada. This includes coverage for prescription drugs, complementary health services, dental care, and “wellness” expenses such as gym memberships or exercise equipment. Anyone self-employed, not a student, or otherwise not receiving benefits has to purchase private health insurance or risk the potential costs of independently paying for medications, rehabilitation therapies, or any other services that happen to fall outside of their provincial/territorial plan. (What exactly falls outside these plans depends upon the nature of the health concern.) Given the extent of coverage under our public health care plans, however, the cost to employers (and even individuals) of supplementary coverage is minimal compared to that in a country such as the United States, and the coverage itself tends to be far superior in terms of scope.

For a country that publicly prides itself on providing health care for all, there is a surprising amount of political talk about privatization or the creation of a two-tiered health system. In 2002, however, a report was made by the Commission on the Future of Health Care in Canada, a government-created initiative to review the state of Canada’s health system. That report proposed sweeping changes to Canada’s health care program, but only to make it more comprehensive, more public, and ultimately to strengthen and ensure the longevity of universal health care. In reviewing health systems around the globe, the report ultimately concluded the public health plans are cost-effective, efficient, and sustainable – more so than any sort of private health system. (For those interested, the full report and supporting documents can be found here)

Although reports show time and time again that health care as a commodity is, quite simply, a market failure, the debates continue. Those debates often focus on cost, cost-effectiveness, and the economics of public vs. private health care.

But let’s step away from the dollar quotient. Isn’t health care inextricably linked to social justice? Shouldn’t the conversations be about health care as a right, as opposed to a privilege?


More to come…

Check back soon for two future posts by Neasa.

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