Academic journal article Health and Social Work

Canadian and American Health Care: Myths and Realities

Academic journal article Health and Social Work

Canadian and American Health Care: Myths and Realities

Article excerpt

This column will appear soon after the inauguration of President Bill Clinton. Thousands of social workers across the country applauded his victory because his philosophy and proposed social agenda are closer than those of the other candidates to the values and goals that social workers espouse. However, his approach to health care reform does not envision a single-payer system as does the national health care plan developed by the National Association of Social Workers (Mizrahi, 1992).As the debate heats up on which of the many proposals will get serious attention by the new president and the new Congress, a propaganda campaign will likely intensify by conservative interests opposing a single-payer, universal-access, comprehensive national health plan. These forces will attack the Canadian health system as a model that should not be considered in the United States. Therefore, we need to understand the Canadian system better to be able to counter the arguments being made against it. Although no system is perfect, the Canadian model is certainly the one that comes closest to a plan that would be feasible and acceptable to the vast majority of Americans.Myths and exaggerations abound about health care in the United States and Canada. In this column, we will briefly examine assertions and facts about financing, waiting, rationing, government intrusiveness, physicians and consumer satisfaction, technology, choice, and quality as they relate to both systems.SUMMARY OF CANADIAN HEALTH SYSTEMFully enacted in 1971, Canada's publicly funded health system consists of 10 provincial plans that share common features. Founded on the assumption that health care is a right of residency, it is based on the following principles:* universality: Everyone is covered and has the same benefits.* portability: Benefits are not linked to employment or province of residence.* comprehensiveness: Benefits include full coverage of medical and hospital care, long-term care (covered separately and differently, depending on the province), mental health services, and prescription drugs for people over 65 and for people with catastrophic illnesses, and other services.* public, nonprofit administration: The system is publicly run and publicly accountable, with provincial governments as the single payers of physicians and hospitals.* freedom of choice of provider.Myth 1: We cannot promise full coverage to everyone because we can't afford to spend more on care. Can we afford a Canadian-style system? The U.S. health care system is gripped by a wild inflationary spiral. As of 1990, Americans spent more than 11 percent of the gross national product on health care, and that percentage has been steadily rising. It is expected to reach 16.4 percent of the GNP by the year 2000. In contrast, Canada spends 8.5 percent of its GNP on health care, and the cost of the Canadian system is stable and rising at a much slower rate. Canada spends roughly one-fourth less per capita on health care than does the United States (General Accounting Office |GAO~, 1991).What accounts for this difference? The U.S. system wastes resources on a bloated bureaucracy, including administrative costs, insurance overhead, hospital and nursing administration, and physicians' overhead and billing expenses. The United States spends about $106 per person per year on administrative overhead; Canada spends about $17 per person per year. Twenty-four percent of all health care spending in the United States goes for administration, compared to 11 percent in Canada. Canadian physicians spend 9 percent of their gross income on billing; U.S. physicians spend 20 percent of their gross income on billing. The General Accounting Office estimated that $67 billion of the U.S. health care expenditure in 1991 went to inefficient administration (GAO, 1991).In an attempt to control inflationary pressure, the United States imposes burdensome cost-containment measures. Providers and consumers alike feel they are drowning in red tape. …

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