Saturday 4 July 2009


There are a lot of people, on both sides of our common border, who think Americans and Canadians are pretty much the same. That is true, superficially. When given more consideration, the hypothesis begins to fall apart.

That doesn't mean that Canadians are good and Americans are bad. Or vice versa. It is just that we are different. We see things differently; we value things differently.

The starting place, I suppose, is our own respective institutions. Americans are in search of "life, liberty and the pursuit of happiness," according to the Declaration of Independence (traditionally thought to be signed on July 4, 1776). In the British North America Act (July 1, 1867), Canada's first constitution, a key phrase refers to "peace, order, and good government."
Those phrases represent two very different approaches to life. So one should hardly be surprising that our thinking is different.

Though I'm being a bit "broad brush" here, I think it is fair to say that Americans are more individual-oriented, while Canadians are more community-oriented (though much less now that in the past).

Nowhere is this more obvious that in our approaches to health care. Canada has, in effect, a single-payer system. Each province (state) has its own health care program, and pays for hospital and physician services in its province. (Constitutionally, health care is a provincial responsibility.) There is a federal act which co-ordinates inter-provincial collaboration, and provides federal money to the provinces, so similar services can be maintained nation-wide, regardless of the relative wealth of the various provinces.

This did not come quickly or easily. It evolved over a 20 year period, from the end of World War Two until the mid-1960s. Saskatchewan (where I now live) was the first province to take action. In 1946, the Saskatchewan Hospitalization Act was passed, giving free hospital care to virtually everyone in the province. The provincial government wanted to do more at that time, but didn't have the money. By 1957, the Federal government passed the Hospital Insurance and Diagnostic Services Act, which extended the Saskatchewan model to all provinces through permanent Federal-Provincial shared-cost funding. With the federal money in place for hospitals, Saskatchewan again took the lead in providing coverage for physicians services in 1962. By 1966, there was another Federal act, which provided shared-cost funding for physicians services. And while there has been some fine-tuning of the system over the subsequent years, the principles are still much the same.

I knew some of the pioneers of the Saskatchewan acts. The acts came about because of citizen pressure on government. There were lengthy public discussions -- in Church basements, Community Halls, and School classrooms. Rural people, particularly, saw neighbours loosing their farms -- both their homes and business -- in order to pay their hospital and doctor's bills. They agreed that sort of thing shouldn't be happening in a country like Canada. (That's not "peace, order and good government.") The leading party in Saskatchewan, the Co-operative Commonwealth Federation, was both instigator and responder to the citizens demands. And citizen demand is what ultimately led to the development of what is referred to as "medicare" in Canada.

So today, every person's hospital care, and doctor's care, is covered. A couple of provinces charge premiums for individuals or families, but these are relatively small, certainly not at the levels of US insurers. (To get Canadian-level care in the US, people would have to pay over $1,000 per month).

Ironically, the challenge which led to Canadian medicare is still a huge problem in the United States. Almost 50 million Americans (just under 20 per cent of the population) have no health care coverage, because they cannot afford it. Many more have inadequate coverage. Unpaid medical bills are the leading cause of bankruptcy in the US; of those who go bankrupt, 75% have some, but not enough, health insurance.

The proposed solution is a single payer. It's called HR676, and is slowly gaining support. A recent poll I saw indicated about 60 per cent of health care professionals, particularly doctors, support some form of this plan. This plan appears to go well beyond the bounds of Canadian legislation, in that it covers a lot more than Canadian medicare

What will happen next is not clear, for either country. Some Canadian physicians are pushing for a return to more private health care (meaning more money to doctors, at patients' expense). Some Americans are pushing for better care through better insurance, even if that is provided by government (with or without some premium paid by the insured).

Interesting times await.


  1. Rob-Bear, I think you have just touched on the tip of the iceberg here. Not so much in the comparison between Canadians and Americans but in the basic differences in the complete Health Care Systems of each nation. You could probably write a few novels the size of War and Peace to try and layout the percentages of every aspect of the Health Care Systems from the points of view of both patient and Doctor. From wait times in ER's to pieces of equipment such as MRI's and CT Scanners as well as other technology advancements. Not to mention wait times to see specialists, costs for medication and increased malpractice costs. The list is endless really. It would take a few pots of coffee to review all of the available data for this kind of a comparison.

    Thanks for the early morning eye-opener.

  2. What Canada needs to do is protect itself from people coming to the country in order to take advantage of its' free medical system and also other benefits, without putting anything back. Too much abuse weakens something that should be allowed to stay freely available - this is what is happening in the UK. I hope it doesn't happen to Candada.

  3. This is timely and thorough. Thank you for this analysis. We Americans tend to be way too individualistic and simplistic when it comes to govenment sponsored programs. But. we must put our heads together and work out a solution that is better than what we have now.

    Both my husband and I are over sixty-five and covered by Medicare, as long as we pay the premiums. Since Medicare only covers major hospitalization, we still need private gap insurance for everything else. For the two of us the monthly bill for medical is around $800 with co-payments and limits. What it means is that a catastrophic illness over our limits will send us into bankruptcy for sure.

    It's mad. It's unworkable for most people, and must be addressed during this administration.

  4. Really interesting and well-written. I love reading all perspectives of our healthcare system (even though all perspectives pretty much agree it sucks!).

  5. ® Right on, Bogey. All very complex. The big question, in the midst of the complexity is, "How do we care for people?"

    ® Joanne: Important point. Other side of that problem -- we have foreign-trained doctors driving taxi cabs because our medical establishment won't allow them to practice. This, at a time when we are short of doctors.

    ® Mrs4444: Not sure about your cryptic response, but thanks for reading.

    ® lakeviewer: Sadly, you're in exactly the predicament I was describing -- one catastrophic (or not even so catastrophic) illness away from losing everything your have. That's exactly the reason that Canadians demanded, and got, our Medicare. It's not perfect by any means, but it works pretty well.

    ® Momma: So much for "life, liberty, and the pursuit of happiness." I hope you can work it out.

  6. We should protect our health care system with all our might in spite of it's shortcomings, even at that it is 2way better than what is available elsewhere.
    And sincere thanks to Tommy Douglass who had the courage and foresight to start it all.

  7. ® Potsoc: Thanks for dropping by. Yes, we need to defend, indeed strengthen, medicare -- especially when others are perfectly prepared to undermine it.

  8. Check out the article on reforming American health care in The Economist 25/06/09.

    Another fast fact. Canada completed our transcontinental railway in 1885, 20 years after America. We had a population of 4 million people in 1885 compared to America's 40 million. We also had 1500 miles of Canadian Shield that the USA did not have to build through. Government played a major role in financing the railway and for similar reasons has played a major role in a great many things in Canadian life.

  9. Interesting analysis. As someone with quite a number of Canadian and American friends I like your broad brush distinction between individuality and community and it rings true to me!

  10. Hi Rob-bear! I stopped by 3 of your 4 blogs and found all to be interesting. Not surprising based on your intriguing and diverse profile. The Health Care issue is quite the topic of discussion since Obama's talk on national TV the other night. You make some interesting points.

  11. ® I'll check that at my first opportunity, Blog Fodder. Right now, I'm like the proverbial absent-minded butcher.

    ® Elizabethm: Thanks for stopping by, and for your supportive comments. The balance between individuality and community is sometimes hard to achieve.

    ® Beverlydru: I appreciate your checking out my three blogs. The Health Care Challenge in the United States is not going to be solved easily. My best wishes to all Americans who are working on this challenge.


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