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Obamacare vs. Canada: Five key differences
1 year ago

Obamacare vs. Canada: Five key differences
Special to The Globe and Mail
Published Wednesday, Oct. 02 2013, 12:17 PM EDT
Last updated Thursday, Oct. 03 2013, 6:52 AM EDT

Despite the partisan war in Washington that shut down the federal government this week, President Barack Obama has succeeded in implementing the first major health reform in the United States in nearly 50 years, as the Patient Protection and Affordable Care Act goes into effect. Even though its most virulent critics raise the spectre of “Canadian-style” health care, “Obamacare” does little to change the enduring differences between the two health care system. What, exactly, does “Obamacare” look like compared to Canada?

Not single-payer: Canadian critics tend to rail against “two-tiered” medicine, but in fact, the U.S. has a multi-tiered system. And despite the hype on both sides of the Congressional aisles, Obamacare keeps the same complex structure in place, while adding another layer through the introduction of health care “exchanges” for uninsured Americans. But the majority of Americans will continue to access care through a variety of health insurance plans made available or subsidized by their employer; nearly 50 million elderly and disabled through the federal Medicare program; another 60 million lowest-income through state-federal Medicaid arrangements.

Not universal coverage: Health care in Canada is based on a simple proposition: every legal resident is covered through a publicly-financed provincial or territorial plan. The individual mandate, derived from a Republican precedent in Massachusetts, stands in stark contrast to Canada’s universality principle. Even though Obamacare broadens coverage, the individual mandate relies on a fundamental insurance principle – care depends on type of coverage – and compels Americans to purchase insurance to access care. Americans now have more affordable insurance options and subsidies to cover their costs, and the lowest-income may be eligible for public coverage through the expansion of Medicaid. Still, despite the crush of online traffic as enrolment began Tuesday, only half of the estimated 40-plus million uninsured will be affected by Obamacare.

Not “national” health insurance: One of the hallmarks of health care in Canada is that, although each province and territory administers a health plan, everyone can expect to be covered for a comprehensive range of services, no matter where they live. And the federal government is expected to chip in to provincial coffers to make this happen. There’s plenty of intergovernmental friction as a result, but nothing like the fractured federalism of the United States. The implementation of Obamacare will further exacerbate regional and state differences, mainly as a result of the Supreme Court decision to curtail the federal government’s obligation for states to expand their Medicaid coverage. As a result, only about half of the states have chosen to sign on to the new Medicaid program.

Not equal access: There’s been some controversy in Canada lately over wait times and access to timely care, but this pales in comparison to the wide gulf that exists in access to care in the United States. Obamacare tries to address this in its provisions for insurance reform, such as lifting pre-existing conditions and limits on co-payment. But for all of the emphasis on affordable care, the new law reinforces the notion that access depends on how much you can afford, not how much you need. In the health insurance exchanges, the price of premiums will depend on your age, health, income, and on whether you opt for a bronze, silver, gold or platinum coverage. In Canada, access to necessary health care services is not a competitive sport.

Not cost containment: The sharpest critics of Obamacare argue it does little to address the fundamental challenge of cost control. The new law includes a review of Medicare reimbursement and the expansion of Accountable Care Organizations to reward cost-effective care. But it doesn’t grapple in a systematic fashion with the overall inefficiencies in health care delivery and financing, the administrative burden of multiple payers, providers and plans, and the cost pressures of defensive medicine. Governments in Canada know that health care is a searing financial responsibility, but they have at their disposal cost containment measures – monopoly fee negotiations with providers, global budgets for hospitals – that remain unfathomable in the American context.

Obamacare is a huge step in American health reform and, if it seen to improve the system, will represent a major victory for Democrats. Like other major reforms of the past, however, it will entrench the private nature of the system, and likely render national health insurance, or anything remotely like “Canadian-style” health care, impossible to attain.

1 year ago

There have been some significant improvements in health insurance under the ACA.  And they are significant enough to drive the GOP to shut down the government to prevent them from being enacted.  

1.  Insurance providers now have to prove that 85% of their money was spent on patient care instead of profit.

2.  No pre-existing conditions.You can't lose your insurance because you were sick when you got it.  Insurance companies can't refuse to take you as a client because you are ill.

3. Children can stay on their parents' insurance policies until they are 30 years old.

4. Health care for women will be more comprehensive in terms of services for women, which is a real step forward.

The ACA isn't perfect.  After all, there was republican input into it's creation.  But it is a really good start in the right direction.  And it has been 70 years that American presidents have tried to enact more equitable health care - not 50.  Obama did it in his first term in office.  Amazing.  

This post was modified from its original form on 03 Oct, 19:36
1 year ago

It's not a really good start, it's just a start. A really good start would have seen a public insurance plan, i.e. a massive expansion of Medicare, a system already in place.

I thought children could stay on their parents' plans until the age of 26, not 30.

1 year ago

While the fights over Obamacare are sure to go on for years, the health care law is one of the least understood social programs of our time. "Understanding Obamacare: POLITICO's Guide to the Affordable Care Act" is a plain-English explainer of how the law is supposed to work, and what's likely to happen when the coverage begins. Written by POLITICO Senior Policy Reporter and health care expert David Nather, the guide also includes a series of reality checks to help you sort out the truth behind the political arguments you're most likely to hear.

Whatever you think of Obamacare, this guide is intended to help you understand what's at stake for consumers, employers and physicians — and help you cut through the political rhetoric as the law's biggest test begins.

Download a PDF of the full guide

1 year ago

For us, it's a damned good start.  And 30 is the surprising age.  

The thing about the ACA is that it is already saving lives of chronically and critically ill people, who used to be known as "uninsurable."  This is a real achievement.  I mean, look how corrupt our political system is.  That this could be passed is amazing.

This post was modified from its original form on 04 Oct, 16:18
1 year ago

I keep hearing about that age 30 thing (i thought it was 26) and yet I was on my parents insurance till I was 25.  It has been like that for some policies for a long time.  I had to be a student and I was, but YES, I was covered. 

1 year ago

I will never take our health care system in Canada for granted, it is much appreciated.

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