~ Public administration
~ Comprehensiveness
~ Universality
~ Portability
~ Accessibility
Public Administration avoids the profiteering and the costs associated with for-profit companies. Comprehensiveness means that all necessary services are covered by the system. Universality means that everyone is covered. Portability means that you keep your health coverage no matter what you do: you can change jobs, or move to another state and still keep the same coverage. Even when traveling abroad, Canadian residents are covered. Accessibility means that nothing should prevent someone from getting the care needed. (Armstrong p.XV)
Accessibility means that �necessary services must be provided in a way that �does not impede or preclude, either directly or indirectly� access to care�. (Armstrong p.34) It also means that there cannot be one service for the poor and one for rich, or one for those who can pay and one for those that can�t pay. Hospitals and doctors receive a �reasonable compensation for all insured services rendered�, which they negotiate with the government. On the other hand, they cannot charge patients any extra fees for any of the insured services. Fee-less health services are a very important part of the Canadian health system. It prevents the poor from being discouraged to get needed care and the rich from buying �quicker access, preferred status, or better facilities�(Armstrong p.3). It is also forbidden to get private insurance for services covered by the public plan. The reason for that is that if everyone uses the same system, they have the same interest in making sure the system is good. (Armstrong p.54)
What we are often told in the US about Canada�s healthcare system is that there are long waiting lists for care. However according to Pat Armstrong who is the Director of the School of Canadian Studies of Carleton University in Ottawa, Canadians do not wait for care that is required immediately. Patients who require urgent care are admitted in emergency rooms without regard to ability to pay. Also, �surgery that is deemed medically necessary on an urgent basis is also done quickly�. (Armstrong, p.56) The waiting times are longer than in the US for only a few special types of surgery. When asked about waiting times for surgery, �84% of Canadian respondents and just over 85% of American ones were �very or somewhat satisfied with their waiting times��. (Armstrong p.57)
We are also told in the US that Canada lacks new technology in healthcare. While Canada does have high technology equipment, there are not as many there as there are in the United States. Access to high technology equipment such as MRI�s is more limited. The reason is that the government tries to control rising costs by �allocating the use of technology among hospitals in any given region� (Bernard, p.158). The director of the Trade Union Program at Harvard University, Elaine Bernard, explains that it is much different in the US. Hospitals themselves decide what to buy to stay competitive in the market place. This leads to �a proliferation of high-cost technology which is, arguably, unnecessary�. (Bernard, p.158) In Universal Healthcare, Pat and Hugh Armstrong give an example that clearly illustrates this point. They explain that in 1990 �there were 10,000 mammography machines in the United States. It would have taken only 2000 machines to meet the needs of the women who were obtaining mammograms regularly. If all women got all of the recommended screening exams, only 5132 machines would be needed. Because there are too many machines, each exam costs more.� (Armstrong p. XIII)
Despite the high quality of care and the amount of services the Canadian system offers to all its residents, it costs less than the American system. The reason is that it is a publicly administered single-payer system, which greatly reduces the administrative costs and other types of costs that the private multi-payer system of the US creates. (Armstrong p.99) The structure of the multi-payer system in the US comprises 1500 different insurance companies, Medicare, Medicaid, and employer-provided plans. For instance hospitals in the US have to send bills to the state and federal government, insurance companies (which use different forms and have different rules depending on the company) and the patients. They also bill patients for the smallest things such as aspirin tablets and Band-Aid. In Canada however, hospitals receive a lump sum from the government, thus simplifying the whole process. According to Armstrong, a quarter of US healthcare workers do mostly just paper work. (Armstrong p.114)
(Table: Armstrong, p. 104)
As the table above shows, Canada spent $2,049 per capita in 1995, while the US was spending $3,701. Canadians were spending only 55% of what Americans were spending per person. When looking at public spending on health, we can see that Canada and the US spend almost the same amount. However in Canada, the public money spent on health is used to cover all Canadians for a variety of health services. In the US, public money spent on health benefits only 30 percent of Americans: those getting Medicare, Medicaid, and military care plans. (Armstrong, p.105)
Since taxes are financing the entire health care system, one might wonder if taxes in Canada aren�t really high. Well they�re not. Individual income taxes in 1996 ranged from 25.2% to 54.2% in Canada, and from 15% to 51.6% in the US. Corporate taxes were almost the same, while payroll taxes and employee benefits were quite higher in the US. �The level of taxes in Canada is about average in comparison with the levels in other industrialized countries.� (Armstrong p.125)