Public infrastructures tend to match the characteristics of the citizens. The Canadian health care system evolved from a medical plan that was introduced by the Sasktchewan government in 1962. The federal government provided sufficient funding in 1966 that the other provinces adopted similar plans. The Canadian system is actually a mix of public and private funding (private insurance or out of pocket). Private funding covers those services not covered under government plans (about 30% of services). The delivery is through a mix of private and public facilities. Doctors do not work for the government and in most cases are renumerated on a fee for service basis. The cost of publicly funded services are controlled for the most part by rationing services. Canadians on the other hand accept the fact that you might have to wait for non-urgent care in exchange for free access to unlimited hospital and medical services. And there are no death panels in Canada.
America is more of a laissez-faire, capitalist marketplace that would never accept rationing services. In addition, there is a large, sophisticated insurance sector in the U.S. which did not exist in Canada back in the 1960s. A much different model is needed.
As I see it, there are several problems that exist beyond the fact that 47 million Americans are uninsured. There is no portability so Americans are stuck in jobs because of concerns over health care coverage. This creates a drag on the economy. Consumers are concerned about arbitrarily losing insurance coverage. Also, health care in the U.S. is too expensive because of the added cost of medical malpractice. Practicing defensive medicine is very expensive.
Here are my proposed fixes:
- Drive down the cost of health care by introducing malpractice reforms.
- There should be a minimum level of coverage that all health insurers must provide.
- There should be a "take all comers" rule that would require that every insurer must provide anyone requesting a quote with a rate and must provide every applicant with a policy.
- Workers should be able to continue purchasing coverage from an insurer after leaving a workplace.
- Employers who provide health insurance as a benefit should be required to give their employees the option of joining their plan or funding to purchase insurance from another insurer.
- The government could provide grants to the unemployed and workers without health care coverage which would allow them to purchase coverage on their own.
- The government could compete with the private health insurance companies.