Canada’s Medicare system provides lessons for U.S. health-care debate
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NEW YORK—In mid-September, Montana Democrat Max Baucus, leader of health-care “reform” efforts in the Senate, released his proposed bill, which was praised by the White House and will likely be the basic outline for the final law. It includes mandates forcing workers to buy health insurance from the private sector, and has no public option. Taxes on “premium” plans mean many workers will immediately pay more, as will even the average family in a few years as health-care cost inflation brings the typical plan above the limit allowed by Baucus.
Soon after, the AFL-CIO convention passed resolutions in favor both of a public option and single payer, a compromise representing a significant step forward for single payer advocates, but one unlikely to yield any action on that front from officials.
Meanwhile, the racist bipartisan consensus against providing care to undocumented workers and their families stands firm. After South Carolina Rep. Joe Wilson called President Obama a liar for failing to propose enforcement provisions against the undocumented, Democrats, with Obama’s approval, rushed to add such provisions to their bills to prevent “illegals” from buying insurance even without subsidies, and are putting new barriers in the way of coverage of even “legal” immigrants.
In the middle of these developments, on Sept. 11, Socialist Action sponsored a talk in New York City Weisleder, based on research by fellow SA-Canada member Dr. Robbie Mahood, on the lessons of Canada’s struggle for universal health-care coverage. We present a summary below, and the entire speech is at www.socialistaction.org/weisleder45.htm.] Canada’s health insurance program, called Medicare, provides hospital and physician insurance to all Socialist Action Socialist Action (Canada) Nat. Secretary Barry Weisleder speaks at N.Y. health-care forum.
residents without deductibles or co-payments. It does not provide care directly from public hospitals or physicians.
Canada pays for more hospital days and doctor visits per capita than the U.S., but spends about 40% less. Doctors and other medical personnel are paid less, and there are fewer very expensive equipment and services. Yet open heart surgery, for example, costs about 30% less in Toronto than in Chicago. Canadians wait somewhat longer for those services, but in recent years improved management has reduced waiting lists for them. Canada has more general practice doctors per capita than the U.S. does, so basic office visits are considerably less costly.
Financing is simple. Patients face no bills for acute services. Doctors are paid electronically each month at a set rate, and hospitals follow a set budget.
Of course, after 30 years of neo-liberalism the system is now a pretty leaky vessel, with the sharks circling. The weaknesses of the system include its being limited to insurance [rather than provision of care]; coverage was restricted and highly uneven regionally, limited reformist ambitions of Canadian social democracy.
The struggle to defend Canadian Medicare entered a new phase with the 2005 Supreme Court ruling upholding the right of a patient to pay his doctor privately for a hip replacement for which he lacked timely access through the public system. Subsequently, the Quebec Liberal government introduced legislation allowing patients to pay privately for three common surgical procedures, a small but significant step toward parallel for-profit care competing with an increasingly stretched public system reeling from 20 years of neo-liberal austerity.
Ottawa originally enticed the provinces to sign on to Medicare in 1968 by paying 50% of the costs. By 1998, the federal contribution had sunk to 10%. Medicare was somewhat shielded from provincial cuts to social services and education because of popular antipathy to attacks on health care and also because Canadian employers derived a significant competitive advantage from public health insurance.
Nevertheless, the system has been profoundly affected by the neo-liberal offensive. Hardest hit has been the hospital sector, with the elimination of scores of hospitals, bed closures, emergency room congestion, and increased wait times. The brunt of the cutbacks have been born by women, who provide most of the labor needed to keep hospitals running and who have taken on almost all of the informal unpaid or low-paid duties as care has been de-institutionalized and shifted onto individuals and families.
Service shortfalls in publicly funded hospital and primary care are undermining confidence in Medicare. Yet the majority of working people in Canada and Quebec are committed to a public system provided that reasonable quality of care can be maintained.
In the face of these attacks, Socialist Action (Canada) calls for a comprehensive program to restructure the health-care system, extend socialization, and open up the possibility for rational planning. The program includes:
1) Eliminate for-profit care; restore federal funding to previous levels (50%). (2) No contracting out of services to the for-profit sector. Fund public hospitals or clinics adequately to perform needed services. (3) Nullify private-public partnerships. (4) Expand Medicare to include comprehensive pharmacare, home care, and dental care. (5) Eliminate fee-for-