Word Count: 1693
INTRODUCTION
Compensating the affairs of economic efficiency with the demands of
sociopolitical rights is a constant source of tension in Canada and the United States alike.
In no other element is this tension more apparent than in the group of complex markets
we call the health care system.
Canadians have been fortunate enough to receive a universal health care system
for nearly forty years. This is a single-payer system funded by the governments, both
provincial and federal, but at what costs? Is health care not unlike any other commodity,
or is it the privilege of every citizen? Health care has elements of common economic
behavior, however, there are also certain social values associated with it. It is this
struggle of defining what health care is that causes such anxiety among economists. The
Canadian health care system is slowly crippling the economy, and reforms must be
devised to preserve the pride of Canada; our health care system itself.
The pluralistic health care scheme of the United States, as well, has serious
socioeconomic implications, and American policy makers are looking toward the model
of the Canadian system for answers. Both the United States and Canada must reform
health care policy, but to what extent? Obviously these questions cannot necessarily
yield clear, concise answers, however they will provide insight into analyzing the current
and proposed systems of health care.
Certainly if Canada is to maintain a high standard of care it must adopt an
economically efficient, revenue generating system. Moreover the United States must
adopt the single-payer system of Canada while still retaining a strong revenue base. This
paper will discuss the strengths and shortcomings of the Canadian health care system, and
how health care is a sociopolitical enigma. Furthermore, how the single-payer system is
the only realistic response to the growing inadequacies within the American
socioeconomic status.
CANADIAN HEALTH CARE STRUCTURE
Serving as a general background in its appraisal, it is necessary to outline the
history and the ambient factors of the Canada health care that is so sought after by the
United States. The Canadian health-insurance program, called Medicare, is administered
by provincial governments and regulated and partly financed by the national government.
Medicare pays basic medical and hospital bills for all Canadians, where the governments
determine the criterion of basic care, to insure and maintain a standard level of service.
As early as 1919, Canada’s Liberal party promised national health insurance, but the first
real step was taken in Saskatchewan, where in 1947 province wide hospital insurance was
introduced. A national hospital-insurance act followed in 1958, and by 1960, 99% of
Canadians were covered by government run hospital insurance. Saskatchewan was
again the first in 1961 to introduce medical-care insurance which covered doctors’
services as well. However, this was not an easy transformation. In 1962 when the
medical insurance act was implemented, the doctors of Saskatchewan went on strike. As
a part of the settlement the government agreed to a modified plan that addressed some of
the doctors’ grievances. Despite the opposition from provinces, doctors and insurance
companies, national Medicare legislation was in place by 1967, and today health care is a
constitutional right.
The arrangement reached by all provinces by 1972 was that the federal
government paid half the cost of the provincial plans, provided the plans met five
principles: accessibility, universality of coverage, portability from province to province,
comprehensiveness of service, and government administration. Under the system the
health care provider bills the provincial plan directly. The Canadian Health Act, effective
in 1984, clarified the national standards and may penalize provinces that allow doctors to
bill for more than the Medicare rate.
The Canadian provinces spend a third of their budgets on health and hospitals.
High-tech medicine and an aging population have caused Canada’s medical costs to rise
significantly over the past decade. Increasingly, governments attempt to control costs by
promoting personal fitness, cutting back the number of hospital beds and establishing
caps on doctors’ earnings. The costs have become so overwhelming some provinces
have considered revoking coverage of prescription drugs for seniors, optometry,
physiotherapy, and chiropractic treatments. There are no doubt different views regarding
spending for health care, however, few wish to revert to a free market system. In fact,
most Canadians consider the health care program the pride of Canada and that they have
an advantage over the United States system that costs Americans more. “Canada spends
$1000 less per capita on health care than the U.S., but delivers more care and greater
choice for patients.” The Canadian health care system has gone through extensive
transitions and is a part of an evolutionary process.
AMERICAN HEALTH CARE STRUCTURE
Over the past several years, the provision of medical services has increasingly
become the responsibility of the state in developed nations, except for in the United
States. “Unlike the rest of the world’s systems, the United States medical care system
remains largely private and entrepreneurial.” The popularity of free market health care
systems was fueled by its successes in technological and pharmaceutical inventions that
followed the wartime experiences. This reinforced the American public to resist
government interference in health matters. Nevertheless, public funds have been used,
and there has been a certain degree, public administration in the health system. “The
inability of millions of citizens to obtain or to pay for even minimal levels of care forced
the federal government to intervene.” It was not until the early 1960’s the United States
government passed the Medicare and Medicaid laws that established the federal
government as an integral part of the health system. The U.S. medical care system is
primarily based on the private practice of medicine and job related health insurance
programs. American health care is essentially entrepreneurial, with physicians earning
their income through a variety of reimbursement mechanisms other than salary, such as
the following: fee-for-service, capitation, and per-session. However, this structure is
changing as more and more doctors are employed by health maintenance organizations
(HMOs). These organizations offer comprehensive service and maintain a certain level of
control of spending by regulating doctors’ billing. Costs have risen enormously forcing
the government to raise more and more funds to accommodate the needs of the public.
The following pie graphs illustrate the economic scope of the American health care
system of 1990 and that of the dawn of the 21 century.
FIGURE 1.
FIGURE 2.
Laborious efforts have been made to contain and control costs, without limiting access
and the availability of service for the poor, aged, and debilitated. Consequently, the
mixture of private and public health care systems is characterized by maldistribution of
resources and serious inadequacies of access. The current health care system of the U.S.
is laden with deficiencies. To illustrate these shortcomings; 17% of the population, some
40 million people, are not covered at all, and another 40 million are only partially
covered. Some HMOs make it a condition of a physician’s salary that he or she not
overstep the boundaries of insurance costs. This raises questions of whether the doctor
may be tempted to limit needed services or fail to take adequate steps to establish a
diagnosis, and may discharge a patient prematurely.
In the early 1990’s the United States was in a state of uncertainty. Despite highly
trained staff and stock piles of high technology, the United States health care system was
a statistical failure. It ranked 16th in the world for infant mortality rates, and life
expectancies fell short of that of most industrialized countries. President Clinton has
made the most visible attempt to reform the health care program in the United States.
Both he and his spouse, Hillary Rodham Clinton, have developed a strategy to prepare
and propose a health reform program that the public would understand and accept, and
that would neutralize opposition from pharmaceutical manufacturers and the health
insurance industry. This illustrates the necessity not only for the evaluation, but the
development of alternatives to attain greater economical and social efficiency. The
current system is clearly inadequate, the problems are evident: a large percentage of the
population cannot access sufficient medical care, and is not covered or protected against
the climbing costs. A system whose costs are out of control, and a growing national
deficit that the health care system heavily contributes. Unmistakably, the United States
health care system is grossly incompetent in providing the public with a standard level of
care, and reforms must be taken to contain the swelling costs.
CONSTITUTIONAL RIGHT TO HEALTH CARE, FOR BETTER OR FOR WORSE?
Economic efficiency and sociopolitical rights consistently clash in a capitalist
democracy, and this tension is prevalent in the health care system. A basic economic
concern is whether health care is like any other commodity. The health care industry can
be analyzed with economic frames of reference: wealth, risk aversion, efficient transfers,
and utility. However, there are certain symbolic elements of health care that cannot be
easily measured. Cultures have fundamental beliefs that encompass the valuation of life
and health. Bearing this in mind, it would only seem realistic that there is some sort of
right to health care. Nowhere in the American Constitution is it stated that an
individual has the right to some basic set of health care services, however, there are
certain undefined responsibilities the government has. It can be argued that the
Declaration of Independence supports the right for each and every citizen to have the
basic care needed to sustain life so as to exercise one’s liberty and to allow the pursuit of
happiness. It has been argued that there is a common-law right to equal services, a right
of equal access to basic services: such as drinking water. Furthermore this right extends
to all citizens and is beyond the reac
Keywords:
word count introduction compensating affairs economic efficiency with demands
sociopolitical rights constant source tension canada united states alike other element this
tension more apparent than group complex markets call health care system canadians
have been fortunate enough receive universal health care system nearly forty years this
single payer system funded governments both provincial federal what costs health care
unlike other commodity privilege every citizen elements common economic behavior
however there also certain social values associated with this struggle defining what that
causes such anxiety among economists canadian slowly crippling economy reforms must
devised preserve pride canada itself pluralistic scheme united states well serious
socioeconomic implications american policy makers looking toward model canadian
answers both united states canada must reform policy what extent obviously these
questions cannot necessarily yield clear concise answers however they will provide
insight into analyzing current proposed systems certainly maintain high standard must
adopt economically efficient revenue generating moreover adopt single payer while still
retaining strong revenue base paper will discuss strengths shortcomings canadian
sociopolitical enigma furthermore single payer only realistic response growing
inadequacies within american socioeconomic status structure serving general background
appraisal necessary outline history ambient factors that sought after insurance program
called medicare administered provincial governments regulated partly financed national
government medicare pays basic medical hospital bills canadians where governments
determine criterion basic insure maintain standard level service early liberal party
promised national insurance first real step taken saskatchewan where province wide
hospital insurance introduced national hospital followed canadians were covered
government saskatchewan again first introduce medical which covered doctors services
well however easy transformation when medical implemented doctors saskatchewan
went strike part settlement government agreed modified plan that addressed some doctors
grievances despite opposition from provinces companies medicare legislation place today
constitutional right arrangement reached provinces federal paid half cost provincial plans
provided plans five principles accessibility universality coverage portability from
province province comprehensiveness service administration under provider bills plan
directly effective clarified standards penalize provinces allow bill more than rate spend
third their budgets hospitals high tech medicine aging population have caused costs rise
significantly over past decade increasingly attempt control costs promoting personal
fitness cutting back number beds establishing caps earnings have become overwhelming
some considered revoking coverage prescription drugs seniors optometry physiotherapy
chiropractic treatments there doubt different views regarding spending wish revert free
market fact most consider program pride they advantage over americans more spends less
capita than delivers greater choice patients gone through extensive transitions part
evolutionary process american structure over past several years provision services
increasingly become responsibility state developed nations except unlike rest world
systems remains largely private entrepreneurial popularity free market systems fueled
successes technological pharmaceutical inventions followed wartime experiences
reinforced public resist interference matters nevertheless public funds been used there
been certain degree public administration inability millions citizens obtain even minimal
levels forced federal intervene until early passed medicaid laws established integral part
primarily based private practice medicine related programs essentially entrepreneurial
with physicians earning their income through variety reimbursement mechanisms other
salary such following service capitation session structure changing employed
maintenance organizations hmos these organizations offer comprehensive maintain
certain level control spending regulating billing risen enormously forcing raise funds
accommodate needs following graphs illustrate economic scope dawn century figure
figure laborious efforts made contain control without limiting access availability poor
aged debilitated consequently mixture private characterized maldistribution resources
serious inadequacies access current laden deficiencies illustrate these shortcomings
population some million people covered another million only partially hmos make
condition physician salary overstep boundaries raises questions whether doctor tempted
limit needed services fail take adequate steps establish diagnosis discharge patient
prematurely early state uncertainty despite highly trained staff stock piles high
technology statistical failure ranked world infant mortality rates life expectancies fell
short most industrialized countries president clinton made most visible attempt reform
program both spouse hillary rodham clinton developed strategy prepare propose reform
would understand accept would neutralize opposition from pharmaceutical manufacturers
industry illustrates necessity only evaluation development alternatives attain greater
economical social efficiency current clearly inadequate problems evident large
percentage population cannot access sufficient protected against climbing whose growing
deficit heavily contributes unmistakably grossly incompetent providing standard level
reforms taken contain swelling constitutional right better worse efficiency sociopolitical
rights consistently clash capitalist democracy tension prevalent basic concern whether
like commodity industry analyzed frames reference wealth risk aversion efficient
transfers utility symbolic elements cannot easily measured cultures fundamental beliefs
encompass valuation life bearing mind would seem realistic sort right nowhere
constitution stated individual undefined responsibilities argued declaration independence
supports each every citizen needed sustain life exercise liberty allow pursuit happiness
argued common equal equal such drinking water furthermore extends citizens beyond
reac
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