Janna Stam is a Toronto-based freelance writer and
communications professional in Canada. She has written for diverse audiences,
including healthcare IT users, non-profit organizations, and political
campaigns. She holds a Master of Arts in English Literature from Queen's
University. For more information, visit jstam.ca
It’s among the many questions posed to
Trudy Lieberman, past president of the Association of Health Care Journalists and
press critic for the Columbia Journalism Review. Lieberman is
visiting four cities across Canada as a Fulbright Scholar and guest
of the Evidence Network of Canadian Health Policy, commonly known as EvidenceNetwork.ca.
Lieberman’s timely visit comes just two
weeks after the official U.S. government implementation of the Patient
Protection and Affordable Care Act (PPACA), also called the Affordable Care Act
(ACA) or "Obamacare." Signed into law by President Barack Obama in
2010, PPACA legislation initially inspired some to hope for a more
“Canadianized,” equitable version of American healthcare.
But closer analysis reveals this is far
from the case. McGill University Associate Professor of Political Science
Antonia Maioni aptly illustrates this in a recent Globe and Mail article
informed by Lieberman’s observations, Obamacare vs. Canada: Five key differences.
Lieberman is quick to point out that
Obamacare builds inequality into the system rather than legislating fundamental
reform. Lieberman cites two major differences between attitudes toward health care
in Canada and the United States:
1. Equity. Canadian healthcare ideology dramatically differs from how Americans
view healthcare. Lieberman admits that a market-driven economy and powerful
politics from stakeholders, particularly health care providers and insurance companies,
are major obstacles to changing cultural attitudes toward equitable health care
coverage. “If we (Americans) ever adopt
a different system, the impetus would have to come from the business community.
It won’t come from advocates or academics, or the media,” says Lieberman. “We have a largely employee-based system with
160 million people covered by their employers. The spark for wholesale reform
of the system will have to come from employers.
2. Focus on Aboriginal health
care. “I don’t recall ever writing about the Indian
Health Service,” Lieberman muses. “In Canada, I’ve heard more discussion of
aboriginal health than wait times.
Lieberman points out that the results of Obamacare
legislation may take years to determine. In the meantime, there are ways our
two systems have similarities.
1.
Health care costs increasingly shifted to individuals. “We can see a shift in both countries toward making the patient pay
for more,” Lieberman notes. “Americans are paying more out of pocket for health
care. In Canada, many services are not covered, and depending on the outcome of
a court case in British Columbia, Canadians may pay more out of pocket, too.”
2.
Quality concerns. “Both countries have
various problems with aspects of medical quality and both have to work on
improving care, especially long-term care for the elderly,” Lieberman points
out.
3.
Increasing Demand and Cost for Technology. “We still haven’t figured out a way to reign in the cost of
technology. Patients want the latest and greatest but the U.S. doesn’t have
anything like the United Kingdom’s NationalInstitute for Health and Care Excellence (NICE), which looks at the
cost and efficacy of new treatments before recommending these to NHS doctors.”
What
do you think: will Obamacare give Canadians a new perspective on health care
policy?
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