Foreign Remedies: What the Experience of Other Nations Can Tell Us about Next Steps in Reforming U.S. Health Care by David A. Rochefort Kevin P Donnelly

Author:David A. Rochefort, Kevin P Donnelly [David A. Rochefort, Kevin P Donnelly]
Language: eng
Format: epub
Tags: Social Science, Sociology, General
ISBN: 9781136340185
Google: j9PFBQAAQBAJ
Publisher: Routledge
Published: 2012-04-23T04:41:28+00:00

Coverage in the Balance

Earlier it was noted that foreigners often mistake health care in the United States to be a strictly private system. Conversely, many Americans typecast the health systems of other countries, particularly European nations, as all big government programs. In fact, a surprising diversity surfaces when one looks at how health insurance coverage is provided abroad.

Two policy design options dominate the universal health plans of economically advanced nations (Carrin and James 2005). The first is financing through government taxation, including general income taxes on individuals and businesses, local government taxes, and taxes specially earmarked for health care. The second is financing through social insurance, in which payroll-based contributions are collected from employers, employees, or both, for a statutory fund while government makes payments on behalf of those without means.

The health system of Canada, more than any other single country, has been examined—one really needs to say “argued about”—as a potential model for the United States. Canada presents a straightforward example of universal insurance through public financing (Health Canada 2011). Through personal and corporate taxes, sales taxes, payroll levies, and other revenue sources, Canada’s federal, provincial, and territorial governments collect the funds. The 10 provinces play the lead role, while the federal government provides cash and tax transfers to lower levels of government consistent with guidelines from the Canada Health Act. In terms of the OECD’s latest classification scheme, Canada has a “public contract model” in which private providers deliver the majority of services (Deber 2009). Most hospitals are non-profit entities; most physicians are in independent private practice. Canadian health care certainly has its controversies—waiting lists, fiscal strain, tension between federal and provincial authorities, and the emerging use of private insurance to give quicker access to services also covered under government’s Medicare plan (Tuohy 2009). Still, population health indicators in Canada rank among the best in the world, and a solid base of popular support undergirds the universal public program (Soroka 2007).

This upside probably matters little for an American audience given how polarizing the Canadian single-payer system, and its identification with the specter of “socialized medicine,” has become. Canada has “socialized financing” of medicine, an important distinction to make vis à vis countries where there is outright public ownership of health facilities and providers work for the government. As to how the Canadian model would actually perform in a country like the United States, which spends 90 percent more per capita on health care than its northern neighbor, one can only wonder. American single-payer die-hards continue the fight where and how they can. “Medicare for All” proposals are regularly reintroduced in Congress. Vermont and California are now reviewing bills combining universal coverage and singlepayer principles with an eye toward qualifying for “state innovation” waivers under the Affordable Care Act’s Section 1332. So far, however, there is little to contradict the judgment of health insurance expert William Glaser (1993: 700) who stated nearly 20 years ago: “Whatever its merits, the Canadian health financing system will never be enacted in the United States.

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