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How do they DO that?! Canada's Medicare explained by an expert

Martha Livingston, one of the editors of 10 Excellent Reasons for National Health Care, supplements the wonk, describing how Canadian Medicare came about and how it works today.




Just a few points I found interesting [and there's lots more in the videos; you should watch them]...

  • In 1962, when Saskatchewan went to single payer, doctors went on strike. How did everyone cope? Doctors from Britain came over and filled in until their Canadian counterparts came to their senses.
  • 1983 gets mentioned here too. The Canada Health Act, enacted to deal with financing Medicare, is 13 pages long, and that includes the wide margins and the English and French translations. Remember that the next time you're tempted to scoff at the lack of dead-tree-ness in HR 676 [PDF].
  • Paperwork to bill [Canadian] Medicare for one week's worth of healthcare delivered by a doctor takes... 45 minutes. I defy you to find a doc here in the US who can say that about their practice.





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Andre's picture
Submitted by Andre on

I've followed the system (actually 13 systems, one for each province, under a Federal mandate) for several years now. Ontario is probably the best situation on which to model our plan. A starting point would be to unequivocally state that Canada does better (has less deaths) than US on every area of 'death by'. They do better than us on death by coronary heart disease, death by colon cancer, etc.....

Here's a place to start:

http://secure.cihi.ca/cihiweb/splash.html

Submitted by hipparchia on

thanks for the links. i look forward to playing around with the data.

is there anything in particular that makes ontario the best model?

Andre's picture
Submitted by Andre on

most like the US, they're also the most populous province, and the symbiotic relationship between the University of Toronto and Ontario health care is very interesting, with the province paying for a lot of the research UoT does, and UoT running several hospitals. Their two largest areas of concern are quality and cost containment. The Onatrio health care apparatus is remarkable to me.
Quebec is kind of interesting too. Quebec (and Manitoba and I assume other provinces) sell auto insurance (the provincial government sells it), which I assume (I've never checked it out) is to help control medical costs, vehicle accidents being quite expensive. And there is no such thing as workmen's compensation in Canada. No need for it.

Submitted by hipparchia on

the auto insurance sounds like it could turn into one of those camel-nose-in-the-tent things. like maybe if the auto accident insurance works out, workers comp could be the next thing split off from the system. i'd hate to see that happen in canada, because i've used there'd be no more workers comp insurance to buy as a selling point when i try to talk small business owners into being for single payer.

thanks for all the links and information and stories too. so far, i've spent some time looking around the university of toronto site [especially the hospital system] and playing with the cihi database stuff.

Submitted by hipparchia on

i've been looking for a nice capsule explanation like that for two years now. i was thrilled to find it, and like some of my other finds, this one too was completely serendipitous.

Submitted by lambert on

That's the bottom line here. That's why the health care material on the new White House site is not merely disgusting from a rhetorical standpoint, but morally wrong. More today on this I hope. Yes, the new administration is not insane, and they've brought in some good people. That's setting the bar awfully low, I think.

First they ignore you, then they ridicule you, then they fight you, then you win. -- Mahatma Gandhi

Aeryl's picture
Submitted by Aeryl on

Would be better on a Tshirt. IMO.

Shorter and to the point, moreso than the one that's up right now.

He who will not reason is a bigot; he who cannot is a fool; and he who dares not is a slave.
- Sir William Drummond

Submitted by hipparchia on

although 'business model' isn't in everybody's lexicon, so maybe people are dying to support the health insurance companies. accompanying graphic could be a bunch of dead sick figures lying around [i envision something this guy would draw, or maybe this one].

connecticut man1's picture
Submitted by connecticut man1 on

health care... Just not for Americans. I would be very interested in seeing how much easier the billing is in a direct comparison of their two billing methods (the private American billing VS the single payer Canadian billing).

Submitted by hipparchia on

for health care, and not really about who delivers it. the canadian govt is an insurer just like our insurance companies are, so no reason for the hospitals to not contract with any of them if they want to.

i agree, it would be interesting to hear from the horse's mouth so to speak, what u.s. hospitals have to say about their experiences with billing our insurance companies vs their experiences with billing the canadian govt.

connecticut man1's picture
Submitted by connecticut man1 on

hospitals like the one in Detroit that have an agreement with the Ontario government for delivering care to the locals in Windsor.

When I traveled to the US as a youngster we had to pay cash to the US hospitals and would get reimbursed by Quebec. Inevitably, the cost at the US hospital would be more than Quebec would pay, part of the reason why the US hospitals and Doctors would ask for cash up front. Back then the difference was not a huge amount of money. Now? You have to buy something like Blue Cross to cover the gap if you are a Canadian traveling in the US. Otherwise, you might die from a lack of treatment if you don't have a HUGE bank account.

Submitted by hipparchia on

because most of our hospitals would cost you a fortune otherwise.

but from the videos, it sounds like some u.s. hospitals that are very near the border have specifically contracted with canada, just like they could with any other insurer. but yeah, i'd like to know the details too.

Andre's picture
Submitted by Andre on

two or three years ago about a guy from Boston who was visiting Toronto, and had need for medical attention. He went to the hospital in Toronto and was taken care of, and then sent up to the billing office at this Toronto hospital. He said there was one person working there, where his hospital in Boston (the 'belly of the beast') with which he was familiar had eleven hundred people working in billing. To the Canadian health care system, billing is a near unnecessary appendage to the whole process, and it is in fact one of the major things that makes the system so efficient. Billing is near non-existent. I used to handle health care for a US government entity and it's just difficult to get your head around the idea that premiums, copays, coinsurance, etc. etc. are not part of the Canadian system, and are a major reason why our system is so expensive.

I also have a good story about my ear wax problem and a friend in Mississauga ON who has the same problem and how both systems handled the problem, a story for another time!

Submitted by hipparchia on

you should tell us that story some time.

thanks for the billing comparison. it's difficult sometimes to get people to imagine that things could be so different from we have, and at the same time better than what we have.

Submitted by lambert on

I'd love to write the headline...

First they ignore you, then they ridicule you, then they fight you, then you win. -- Mahatma Gandhi