As is appropriate on Canada Day, Wonkblog’s indispensable Sarah Kliff provides a careful comparison of the much-praised, much-malinged health care system to our north with the system the Affordable Care Act is designed to create once it has been fully implemented.
While Kliff’s headline (“How aboot that Obamacare! Why health reform won’t turn us into Canada”) suggests she’s rebutting conservative complaints that Obamacare will Canadize American health care, what struck me most were the similarities once you discard casual stereotypes of both systems. Though Canada’s system of guaranteed health insurance is indeed “single payer,” private supplemental insurance is available and used pretty heavily. And to the extent that Medicaid is expanded, Obamacare relies more on publicly provided insurance than a lot of its progressive critics usually acknowledge. In Canada the provinces play a central administrative role in health care, as will the states continue to do in the U.S.
But one big difference that Kliff highlights goes to the question of “rationing,” fears of which have played a big role in the semi-successful demonization of Obamacare among U.S. seniors. To the extent there is rationing in Canada, it is driven by a global health care budget with caps on total spending. While the U.S. has defined budgeting for the various programs and expenditures involved in Obamacare, there are no caps. That is a rather large difference with even larger implications.
You should also check out Kliff’s post to see a close-up photo of that fine artery-clogging Canadian delicacy poutine. The bowl she displays has a little less gravy than I tend to prefer, but it gives you a good idea if you’ve never eaten the stuff.