PHYSICIANS FOR A NATIONAL HEALTH PROGRAM 29 EAST MADISON SUITE 602 CHICAGO, IL TEL: (312)

Lessons From the North; the Canadian Experience

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

1. Universal coverage 2. Reasonable accessibility to services 3. Portability of benefits from province to province 4. Coverage for all medically necessary services 5. Publicly administered, non-profit program Minimum Standards For Canada's Provincial Programs

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 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 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 The insured went to the hospital more often, but the uninsured stayed much longer and thus cost more

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 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 Despite better health, higher income groups received more care

Saskatchewan again led the way In 1961 Tommy Douglas succeeded in pushing through a compulsory public universal insurance plan 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 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 They won concessions that included the ability to have fee-for-service payment By 1963 their income had increased by 35% By 1963 their income had increased by 35%

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

The Canada Health Act-1983 Rising costs and Monique Be’gin brought things to a head Rising costs and Monique Be’gin brought things to a head 13 pages long it passed unanimously 13 pages long it passed unanimously 5 basic principles: 5 basic principles: 1.Public Administration 2.Comprehensive3.Universal4.Portability5.Accessibility

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

Health care system Funding Delivery PrivatePublicPrivatePublic For-profitNot-for-profitFor-profitNot-for-profit Isn’t that socialized medicine?

Health Care Financing Today No health policy guaranteeing coverage except to those qualifying for Medicare and Medicaid No health policy guaranteeing coverage except to those qualifying for Medicare and Medicaid Does not guarantee adequate financing of our health care services 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 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. When the fixed costs of the infrastructure aren’t paid, a deficit results.

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

Overall Administrative Costs NEJM 2003; 349: 769

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

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

Myth: Canadians come here for care Over 80% of US ambulatory border facilities treated <1 Canadian per month Over 80% of US ambulatory border facilities treated <1 Canadian per month Hospitals in MI, NY, & WA saw 909 Canadians 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 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 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

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

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.

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

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

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

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

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”

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 ---Tommy Douglas