Lessons From the Canadian Experience: Achieving Universal Coverage

1. PHYSICIANS FOR A NATIONAL HEALTH PROGRAM 29 EAST MADISONSUITE 602CHICAGO, IL 60602TEL: (312) 782-6006WWW.PNHP.ORG

2. Lessons From the North; the Canadian Experience

3. How the Canadians got Universal Coverage • It began with Tommy Douglas • Universal Hospital Insurance began January 1, 1947 with a $5 premium • No one was turned away and everyone stayed as long as they needed care • Saskatchewan became a role model

4. Minimum Standards For Canada's Provincial Programs • Universal coverage • Reasonable accessibility to services • Portability of benefits from province to province • Coverage for all medically necessary services • Publicly administered, non-profit program

5. Canadians learned what the US still has not learned • Ontario research showed there were significant limits to people who could be covered by voluntary employee plans • Taylor Report found voluntary insurance plans were part of the problem • The insured went to the hospital more often, but the uninsured stayed much longer and thus cost more

6. Research Pointed the Way • Federal research on illness clearly established the link between low income and poor health, as well as a disproportionate financial burden on those in ill health • Despite better health, higher income groups received more care

7. Saskatchewan again led the way • In 1961 Tommy Douglas succeeded in pushing through a compulsory public universal insurance plan • Doctors went on strike and threatened to leave the province, the strike lasted 8 months • They won concessions that included the ability to have fee-for-service payment • By 1963 their income had increased by 35%

8. Universal Medical Care • The Medical Care Act of 1966 was only 8 pages long • Spending money to collect premiums seemed silly, Ontario moved away from it • Fees were negotiated by medical societies

9. The Canada Health Act-1983 • Rising costs and Monique Be’gin brought things to a head • 13 pages long it passed unanimously • 5 basic principles: 1.Public Administration 2.Comprehensive 3.Universal 4.Portability 5.Accessibility

10. Government Roles in Medicare Federal Government transfers funds to provinces and territories, and control the implementation of the principles of Medicare Provinces and territories plan, finance and evaluate the provision of Medicare in their jurisdiction

11. Isn’t that socialized medicine? Health care system Delivery Funding Private Public Public Private For-profit Not-for-profit For-profit Not-for-profit

12. Health Care Financing Today • No health policy guaranteeing coverage except to those qualifying for Medicare and Medicaid • Does not guarantee adequate financing of our health care services • Is complicated and creates a massive bureaucracy that consumes 31% of the health care dollar • When the fixed costs of the infrastructure aren’t paid, a deficit results.

14. The Healthcare Americans Get • 1/3 are uninsured or underinsured • HMOs deny care to millions more with expensive illnesses • Death rates higher than other wealthy nations’ • Costs double Canada's, Germany's, or Sweden's - and rising faster • Executives and investors making billions • Destruction of the doctor/patient relationship

16. Overall Administrative Costs NEJM 2003; 349: 769

17. Myth: Canadians ration dialysis American Journal of Kidney Diseases 2001; 38(1): 36-41

18. Myth: Canadians don’t get mental health services Health Affairs 2003; 22(3): 128

19. Myth: Canadians come here for care • Over 80% of US ambulatory border facilities treated <1 Canadian per month • Hospitals in MI, NY, & WA saw 909 Canadians • 83% of them were non-elective • Only one of “America’s Best Hospitals” treated more than 60 Canadians/yr • In a survey of 18,000 Canadians, only 90 had received care in the US that year • Only 20 went there electively Health Affairs 2002; 21(3): 19

20. What's OK in Canada? Compared to the U.S…. • Life expectancy 2 years longer • Infant deaths 25% lower • Universal comprehensive coverage • More MD visits, hospital care; less bureaucracy • Quality of care equivalent to insured Americans’ • Free choice of doctor/hospital • Health spending half U.S. level

21. This study examined in detail the costs of aortic aneurysm repair in two hospitals - one in the U.S. and one in Canada. While the clinical costs were quite similar, bureaucratic costs were far higher in the U.S.. This case study data confirms the broader statistical data showing potentially huge administrative savings that could be realized through the adoption of a single payer system.

27. Here's how the British hold back the waters from flooding London:

28. And the Dutch solution to protecting an entire nation that mostly rests below sea level:

29. The Italians are defending their city on the sea, Venice:

30. And... Here's how the richest, most powerful and technologically advancednation on earth protected against the long-forecasted flooding of New Orleans:

32. A shift from curative procedures to preventive strategies “The primary objective of Canadian health care policy is to protect, promote and restore the physical and mental well-being of residents of Canada and to facilitate reasonable access to health services without financial or other barriers”

33. The Challenge for the Future “Removing the financial barriers between the provider of health care and the recipient is a minor matter…a matter of law, a matter of taxation. The real problem is how do we reorganize the health delivery system. We have a health delivery system that is lamentably out of date.” ---Tommy Douglas