Does Canada have universal health care?
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Medicare () is an unofficial designation used to refer to the publicly funded, single-payer health care system of Canada. Canada does not have a unified national health care system; instead, the system consists of 13 provincial and territorial health insurance plans that provides universal health care coverage to Canadian citizens, permanent residents, and certain temporary residents. These systems are individually administered on a provincial or territorial basis, within guidelines set by the federal government. The formal terminology for the insurance system is provided by the "Canada Health Act" and the health insurance legislation of the individual provinces and territories.
Medicare (Canada)
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Canada (with the exception of the province of Quebec) is one of the few countries with a universal healthcare system that does not include coverage of prescription medication (other such countries are Russia and some of the former USSR republics even though Russia is considering a switch to full coverage of many prescription medications in the near future). Residents of Quebec who are covered by the province's public prescription drug plan pay an annual premium of $0 to $660 when they file their Quebec income tax return. Pharmaceutical medications are covered by public funds in some provinces for the elderly or indigent, or through employment-based private insurance or paid for out-of-pocket. Most drug prices are negotiated with suppliers by each provincial government to control costs but more recently, the Council of the Federation announced an initiative for select provinces to work together to create a larger buying block for more leverage to control costs of pharmaceutical drugs. More than 60 percent of prescription medications are paid for privately in Canada. Family physicians (often known as general practitioners or GPs in Canada) are chosen by individuals. If a patient wishes to see a specialist or is counselled to see a specialist by their GP, a referral is made by a GP in the local community. Preventive care and early detection are considered critical and yearly checkups are recommended for everyone.
Healthcare in Canada
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The Canada Health Act of 1984 "does not directly bar private delivery or private insurance for publicly insured services," but provides financial disincentives for doing so. "Although there are laws prohibiting or curtailing private health care in some provinces, they can be changed," according to a report in the New England Journal of Medicine. The legality of the ban was considered in a decision of the Supreme Court of Canada, which ruled in "Chaoulli v. Quebec" that "the prohibition on obtaining private health insurance, while it might be constitutional in circumstances where health care services are reasonable as to both quality and timeliness, is not constitutional where the public system fails to deliver reasonable services." The appellant contended that waiting times in Quebec violated a right to life and security in the Quebec Charter of Human Rights and Freedoms. The Court agreed, but acknowledged the importance and validity of the Canada Health Act, and at least four of the seven judges explicitly recognized the right of governments to enact laws and policies that favour the public over the private system and preserve the integrity of the public system.
List of countries with universal health care
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In 1999, during his abortive 2000 Reform Party presidential campaign, Trump told TV interviewer Larry King, "I believe in universal health care." In his 2000 book, "The America We Deserve", Trump reiterated his call for universal health care and focused on a Canadian-style single-payer health care system as a means to achieve it. Though he characterized the Canadian health-care system as "catastrophic in certain ways" in October 2016 during the second presidential debate, the Trump campaign website wrote in June 2015 about his support for "a system that would mirror Canada's government-run healthcare service" under the title "What does Donald Trump believe? Where the candidate stands on 10 issues". In 2015, Trump also expressed admiration for the Scottish health-care system, which is single payer.
Political positions of Donald Trump
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The government ensures the quality of care through federal standards. The government does not participate in day-to-day care or collect any information about an individual's health, which remains confidential between a person and their physician. Canada's provincially based Medicare systems are cost-effective because of their administrative simplicity. In each province, each doctor handles the insurance claim against the provincial insurer. There is no need for the person who accesses healthcare to be involved in billing and reclaim at all. Private health expenditure accounts for 30% of health care financing. The Canada Health Act does not cover prescription drugs, home care or long-term care or dental care, which means most Canadians rely on private insurance from their employers or the government to pay for those costs. Provinces provide partial coverage for children, those living in poverty and seniors.
Healthcare in Canada
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The Canada Health Act, which sets the conditions with which provincial/territorial health insurance plans must comply if they wish to receive their full transfer payments from the federal government, does not allow charges to insured persons for insured services (defined as medically necessary care provided in hospitals or by physicians). Most provinces have responded through various prohibitions on such payments. This does not constitute a ban on privately funded care; indeed, about 30% of Canadian health expenditures come from private sources, both insurance and out-of-pocket payments. The Canada Health Act does not address delivery. Private clinics are therefore permitted, albeit subject to provincial/territorial regulations, but they cannot charge above the agreed-upon fee schedule unless they are treating non-insured persons (which may include those eligible under automobile insurance or worker's compensation, in addition to those who are not Canadian residents), or providing non-insured services. This provision has been controversial among those seeking a greater role for private funding.
Healthcare in Canada
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According to Canada's constitution, the provinces have responsibility for health care, education and welfare. However, the federal Canada Health Act sets standards for all the provinces. The Canada Health Act requires coverage for all medically necessary care provided in hospitals or by physicians; this explicitly includes diagnostic, treatment and preventive services. Coverage is universal for qualifying Canadian residents, regardless of income level.
Medicare (Canada)
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In defending the changes, the government explained its rationale as being to ensure equality between the health care received by refugees and that afforded to Canadians such that refugees would not receive superior benefits. Former Citizenship and Immigration Minister Jason Kenney emphasized the generosity of Canadians and Canada's immigration system, stating that the government did “not want to ask Canadians to pay for benefits for protected persons and refugee claimants that are more generous than what they are entitled to themselves.” In a related case, Nell Toussaint v. Attorney General of Canada, the Supreme Court cautioned that by extending universal health care regardless of immigration status, Canada “could become a health-care safe haven”.
Refugee health care in Canada
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Because medical marijuana is legal in Canada but illegal in most of the US, many US citizens with cancer, AIDS, multiple sclerosis, and glaucoma have traveled to Canada for medical treatment. One of those is Steve Kubby, the Libertarian Party's 1998 candidate for governor of California, who has adrenal cancer. Recent legal changes such as Proposition 215 may decrease this type of medical tourism from California only.The Canada Health Act covers the services of psychiatrists, medical doctors with additional training in psychiatry. In Canada, psychiatrists tend to focus on the treatment of mental illness with medication. However, the Canada Health Act excludes care provided in a "hospital or institution primarily for the mentally disordered." Some institutional care is provided by provinces. The Canada Health Act does not cover treatment by a psychologist or psychotherapist unless the practitioner is also a medical doctor. Goods and Services Tax or Harmonized Sales Tax (depending on the province) applies to the services of psychotherapists. Some coverage for mental health care and substance abuse treatment may be available under other government programs. For example, in Alberta, the province provides funding for mental health care through Alberta Health Services. Most or all provinces and territories offer government-funded drug and alcohol addiction rehabilitation, although waiting lists may exist. The cost of treatment by a psychologist or psychotherapist in Canada has been cited as a contributing factor in the high suicide rate among first responders such as police officers, EMTs and paramedics. According to a CBC report, some police forces "offer benefits plans that cover only a handful of sessions with community psychologists, forcing those seeking help to join lengthy waiting lists to seek free psychiatric assistance."
Healthcare in Canada
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As per the Constitution of Canada, health care is mainly a provincial government responsibility in Canada (the main exceptions being federal government responsibility for services provided to aboriginal peoples covered by treaties, the Royal Canadian Mounted Police, the armed forces, and Members of Parliament). Consequently, each province administers its own health insurance program. The federal government influences health insurance by virtue of its fiscal powers – it transfers cash and tax points to the provinces to help cover the costs of the universal health insurance programs. Under the Canada Health Act, the federal government mandates and enforces the requirement that all people have free access to what are termed "medically necessary services," defined primarily as care delivered by physicians or in hospitals, and the nursing component of long-term residential care. If provinces allow doctors or institutions to charge patients for medically necessary services, the federal government reduces its payments to the provinces by the amount of the prohibited charges. Collectively, the public provincial health insurance systems in Canada are frequently referred to as Medicare. This public insurance is tax-funded out of general government revenues, although British Columbia and Ontario levy a mandatory premium with flat rates for individuals and families to generate additional revenues - in essence, a surtax. Private health insurance is allowed, but in six provincial governments only for services that the public health plans do not cover (for example, semi-private or private rooms in hospitals and prescription drug plans). Four provinces allow insurance for services also mandated by the Canada Health Act, but in practice there is no market for it. All Canadians are free to use private insurance for elective medical services such as laser vision correction surgery, cosmetic surgery, and other non-basic medical procedures. Some 65% of Canadians have some form of supplementary private health insurance; many of them receive it through their employers. Private-sector services not paid for by the government account for nearly 30 percent of total health care spending.
Health insurance
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There is evidence of inequality in health care for refugees that seek asylum in Canada. The health care needs of refugees is unique in that these people often require additional care than normal immigrants due to conditions in their home country. Despite the uniqueness of this situation, there appears to be a lack of information on whether refugees experience barriers in receiving health care. Additionally, there is a lack of public perception about the health care needs of refugees in Canada which causes public policies to sometimes overlook the wants of this societal group. Furthermore, the passing of the Protecting Canada's Immigration System Act in 2012 created inequalities in health care for refugees. The act formed a two-tiered system that separated care based on certain characteristics of the refugees under it. Differing levels of care are seen to be provided to refugees based off how the refugee came to Canada, the refugee's home country, and many other factors. Another impacts on refugees that the Protecting Canada's Immigration System Act had was on the levels of health care coverage for refugees provided by the Interim Federal Health Program (IFHP). The reforms of 2012 saw cuts to coverage for refugees by the IFHP which represents another unequal divide in health care between the general populace and refugees. Some of the results of the changes in the health care programs for refugees is that there appears to be a rise in emergency room visits due to lack of provisions of health care to refugees. This effect worries many people in Canada as they believe that the cost of health care will rise due to an increase in ER visits from refugees that have health concerns not cared for under IFHP. A study by Evans, Caudarella, Ratnapalan, and Chan on the consequences of cuts to IFHP for refugees suggests that another problem created by these changes is that there is great uncertainty over funding for programs that help pay for ER costs that recipients of care cannot afford. These problems spawned from the 2012 reforms and suggest that refugees receive a much lower level of care than the general populace in Canada.
Healthcare in Canada