Canada
The Canadian
health care system was established in 1971 to universalize
coverage for all of its citizens. In
this system, hospitals are still
privately owned and physicians may be
self-employed (just like the United States.) The
main difference is that all of its citizens are
enrolled in a government operated
insurance plan, and most other types of
private medical insurance no longer exist. In
this system, a patient may see any doctor
he or she chooses, simply by showing
their identification card.
Each
province of Canada may adopt varying plans, but
they must all abide by the five main rules
established in the Canadian Health Act. These
include
(1) Universality
- all citizens are covered
(2) Portability - people can
take their insurance with them when they move or
change jobs
(3) Accessibility - everyone has
access to adequate care
(4) Comprehensiveness -
necessary treatments are covered; and
(5) Public Administration
- the insurance is publicly operated
Hawaii
Hawaii's
Prepaid Health Care Act was also passed in the
early seventies. This legislation requires
all employers to provide health coverage for
their workers. The reasoning behind this
law is that the costs for expensive medical
treatments will be kept low by spreading the
risks over a large group of people. As a result
of this act, 96% of all Hawaiians have adequate
health coverage. This employer-mandated insurance
plan is extremely successful in Hawaii.
Europe
Both Canada
and Hawaii's health care plans contrast to many
other European countries in one major
characteristic. Neither of these plans is a form
of "socialized medicine." Their governments
do not own the hospitals, nor are the physicians
government employees.
United States
What makes the
health plans in these areas so revolutionary? How
are they so different from the one the U.S. has
in place? Under the system now in place, most
businesses are utilizing managed-care under
health maintenance organizations (HMOs). Patients
must go to specific doctors and hospitals and are
penalized for choosing other options. Also, millions
of Americans are not covered at all.
This contrasts sharply to the
"universality" of the Canadian system.
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Strengths and Weaknesses
of Each System
The
principals of the Canadian Health Act are some of its
most important strengths. Every single citizen is
covered, and people can take their coverage with them as
they change jobs. Also, their care must be
comprehensive, providing for all medically
necessary treatments. This system is very
popular, and has produced several objective measures of
success including a lower infant mortality rate than the
U.S. and a longer life expectancy than the U.S. Canada
also ends up spending less money per capita on health
care than the United States does.
But this system also has its drawbacks. Medical
research is restricted to keep costs down. Also,
primary care is emphasized and the number of
medical specialists is drastically reduced.
Canadian citizens must also wait longer
than American patients for specialized care, equipment,
and procedures.
Strengths of the Hawaiian system include the fact that 96%
of all Hawaiians are covered by this system.
Also, Hawaiians are considered healthier
than people of any other state. Finally, insurance
premiums are 30% lower than comparable coverage on the
mainland.
With all these strengths of Hawaii's system, are there
any weaknesses? Yes, the main one being that this
insurance is employer-mandated. Many
businesses may not want to pay out-of-pocket for their
workers well-being.
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Will
These Plans Work Everywhere?
Many
economists question whether the Canadian system would
work in the United States for several reasons. Some doubt
if our civil services measure up to theirs. Others
question if our national character of
decentralization will be able to accept a form
of socialized medical insurance. Also, Americans seem
much more unwilling to pay higher taxes--
even if it means universal care for all citizens, rich
and poor.
But what about
the Hawaiian system? Would it work in other states on the
mainland? Some experts claim it would not because businesses
would be tempted to relocate to nearby states to avoid
the cost of the employer-mandated system. Also,
Hawaiians are blessed with a small population in a
relatively healthful climate that many states do not
have.
- Should the United States
adopt the Canadian or Hawaiian health plans?
- If so, which one would
be better? If not, why?
- Do Americans have a
"right" to universal coverage?
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