The U.S. health-care system is getting to be just like the weather--everyone talks about it, but no one does anything about it. That's especially true in Washington, D.C., known for both its steamy summers and its all-season political hot air.
But some talkers there are forecasting that a cool, refreshing breeze from the north is the way to bank the raging fires of health-care spending growth, as well as blow away the problem of 37 million Americans without health insurance and another 30 million whose coverage is inadequate.
Some U.S. pharmacists may know that their friendly northern neighbors have universal health insurance that covers all residents for physician visits and hospitalization. But where do Canadian pharmacists fit into the health-care equation? How do they like their system? Are outpatient prescription drugs covered? How do Rx prices compare on both sides of the 3,987-mile (6,379.2-kilometer) border?
For U.S.? Should the United States embrace any or all of the insurance plan Canadians call Medicare? To find out, Drug Topics took a look at what national health insurance means in Canada and how American politicians, bureaucrats, and policymakers view it as the 1992 Presidential election season heats up.
"The Canadian public supports the Medicare system. The medical professionals support it, as do the provincial governments. The private sector is supportive. It is the one thing which even all of Canada's political parties concur." At least that's what D.H. Burney, the Canadian ambassador, told a U.S. audience this summer. One might expect a government official to vigorously extol a government program, but can anyone imagine a high-ranking U.S. official lavishing such praise on Medicaid with a straight face--even to foreigners?
But Burney wasn't finished. "Perhaps most important of all," he continued, "taxpayers overwhelmingly agree that this is one area where they get the most visible and acceptable bang for their tax dollars." Medicaid, anyone?
Some similarities: Actually, Medicaid does resemble the Canadian system in at least some aspects. Both are funded from a combination of federal and state (provincial) revenue. Both have certain national standards, but states and provinces have some latitude. And providers of services are reimbursed by their respective governments at government-set rates. But let's not go overboard with the comparisons.
Briefly, none of Canada's 26 million residents is uninsured. They don't pay doctor or hospital bills. There are no deductibles or copayments for those services. Outpatient drugs for the elderly, poor, and unemployed are covered. In three of the 10 provinces and the two territories that comprise the world's second largest nation, all residents, regardless of age or income, are covered under some government drug program. Those provinces have deductibles or copayments for drugs.
Residents not covered for Rxs can buy private insurance, often through their employer. About 15% of Canadians pay all Rx costs out of pocket, said Wayne Schnarr, research director of the Canadian Drug Manufacturers Association, the generic industry's trade group; 40% are covered by provincial government plans, and 45% by private insurance.
How long? U.S. and Canadian politicians began discussing national health insurance at about the same time. Teddy Roosevelt made it a campaign issue in his 1912 Bull Moose bid for the presidency. Similarly, it was debated in Canada's 1919 federal elections but with no result.
While Franklin D. Roosevelt considered national health insurance and Harry Truman proposed it, Canadian provinces started taking the first steps after World War II. By 1961, after countless federal-provincial meetings, all provinces had public insurance plans with comprehensive coverage for hospitalization. By 1972 that was extended to doctors' services.
The federal government pays about 40% of total health-care costs. …