Health Care and Aging Populations: Canada and the United States

Canadian Review of American Studies Volume 23, Number 3, Spring 1993, pp. 93-108 Health Care and Aging Populations: Canada and the United States AkeG.Blomqvist Health Care Policy in the United States: Lessons for Canada 93 At first blush, the suggestion that the American experience in health care policy may contain some helpful lessons for Canada may seem surprising. For one thing, there is a large body of opinion in the United States (and also in Canada) which holds that the adoption of a system closelymodelled on the Canadian one represents a promising type of reform for the United States, as that country tries to repair some of the worst deficiencies in its systemof health insurance and health servicesprovision. By the same token, most Canadians consider their health care system as vastly superior to the American one, and would argue that any change inspired by the American example is bound to be a change for the worse. On the whole, I personally agree with the premise of the latter view,and if the question that is being asked is whether Canada would be better off adopting the American model without any modifications, I certainly would answer in the negative. Since the American health care system has two fatal flaws (it leaves some fifteen percent of the population without guaranteed access to care, and it is substantially more expensive,on a per capita basis, than Canada's, or indeed, than any health care system in the world), it is hard to imagine anyone seriously advocating that Canada should copy it in its entirety. But this way of visualizingCanada's policy options is not particularly helpful . In reality, any reforms of the Canadian health care system would ob- 94 CanadianReviewofAmericanStudies viously have to be designed in such a way that the principle of universal access was left intact1, and should obviously not copy those aspects of the American system that raise costs without enhancing the quality of care. Conversely ,copying the Canadian method of controlling costs by means of centralized government control of all hospital spending, for example, may not be the best option for controlling health care costs in the United States. In my personal view,recent proposals for health care reform in countries like the United Kingdom, Holland, and Sweden, are based on much more promising approaches than most of those currently used in Canada, or that predominate in the United States. Paradoxically, however, the plans for reform in Europe have, to a considerable extent, been inspired by ideas developed and at least partially tested in the United States. 2 Although it appears highly inefficient on average, the American health care system is highly pluralistic, and certain parts of it seem to function quite well.While private insurance covers the majority of individuals, there are also large public plans (covering all individuals over age sixty-five,and those meeting certain low-income criteria); some of the incentive systems developed and used within the framework of these plans have influenced the European reform proposals, and may well be worth considering for use in Canada. And, even within the private sector, some kinds of institutional arrangements for the provision of health insurance and health seivices have clearly demonstrated their ability to deliver high-quality care at a cost much below the American average. Again, the possibility of adopting some of these arrangements for use within the Canadian system may well be worth considering. All of this is known to professional health care administrators in Canada, and experiments with management and incentive systems similar to some found in the United States are quietly being undertaken in certain Canadian provinces.However,in order for system-widereform to actually come about, it is not enough to convinceprofessional administrators that they are likely to work well. In a government-controlled system such as ours, they must also be understood and accepted by the general public and the politicians. It is for this reason I believe it important that the Canadian debate on health care policy become less dogmatic, and willing to consider not only the negative lessons, but also some of the more promising methods of re- AkeG. BlomqvistI 95 source management that are found...