Both OHIP (in Ontario) and RAMQ (in Quebec) won't pay for some treatments. Examples of this can be found here and here. And down here in the southern U.S., my wife and I had to fight for coverage as well. Our private medical insurance flat-out refused to pay for a genetic test to make sure my wife wasn't a carrier for a rare but serious disorder which I happen to have. The thing is, the test is expensive ($650) and there is only one lab in the entire United States equipped to do it. This lab, of course, was 'out of network', and our insurance company therefore decided they weren't going to help us.
Leaving aside that the fact that there was only one lab in the entire U.S. that would even do the test, which should have automatically put it 'in network', in my opinion, if we hadn't had the test done, and our then sproglet-in-planning ended up being inflicted with the disorder, the costs for specific medical care for the child would have not only been far, far more expensive than the $600+ our insurance company was unwilling to pay, but would have lasted for the duration for child's life. Hundreds of dollars wise, thousands of dollars foolish. I actually wrote an entire post about this frustrating experience.
When our insurance company realized that were serious enough about this to fight them over it, they suddenly changed their mind and paid for the test.
In my opinion, whether it is a privatized or public health care system, you are bound to find services that will not be covered or may not be to your standards. This is usually for extreme cases, but may be more common that we believe.
Where Do We Go From Here?
As you know, health coverage in the U.S. is most often bought via your employment and your employer pays half the monthly cost. When someone loses their job, they are limited to two choices: They can go under the COBRA system, which allows the individual to continue using the same insurance company, but requires them to pay not only what they were previously paying out of their salary, but also what their employer had been paying on their behalf, effectively doubling the cost. This means that the person has to pay for his or her initial portion of the monthly payments as well as the portion the former employer was paying. Or they can lose their health coverage entirely. I've heard from a lot of people about the injustices of this system, especially if they're low-income or independent/contractual workers. It's not uncommon to see people here with medical conditions that they never get treated because they can't afford it. Which of course can lead to even more serious health problems and perhaps premature death. I can assure you that one would never see this in Canada.
Ultimately, I think the biggest differences in the systems of the two countries can be summed up like this: In America, the health care is great as long as you can afford it. In Canada, the health care is great as long as you can wait for it. Personally, I'd prefer to have to wait a few weeks or months than not be able to see a doctor at all.
Given my experiences with both systems, I strongly believe that everyone should be covered by some type of health insurance that's not tied to employment. In addition to making the overall work force in the U.S. more competitive (as I heard on the Today Show recently and corroborated here), no one would not have to worry about getting badly hurt or very sick. Living with uncertainty is stressful and can cause health problems. And health insurance is supposed to cover for catastrophic events (see Cindy Ross' blog post). Under the current U.S. system, it does not.
Now, is a Universal health care system the answer? The answer is yes (to some degree), especially compared to the current system. As described above, universal health care is however expensive enough to chew up almost half of the entire operational budget of a province (or state) (let's leave the government take over crap aside). Similar to what's happening in America (and probably elsewhere in the world), health care costs keep increasing and provincial governments in Canada keep trying to reduce costs by cutting down on services.
I believe a health care system that allows both private and public options would be the best solution. They do that in France, and according to every French person I know it's considered to be the best health care system in the world. In France, everyone is covered under the public system (though not for 100% of the costs except in the case of a long-term illness or very costly procedure - this is when the full public system kicks in). But if someone wants more personalized service and is willing to pay for it, they still have the option of using a private medical facility, which is often located in a private hospital.
A colleague of mine recently told me that the philosophy of the French Government is this: by providing good health care to all its citizens, people will become more productive members of the society, which in the end will benefit everyone. Interestingly, France has just been listed as the best place to live in the world. This ranking is primarily attributed to its health care system. I just wish Americans would think this way.
Creating a 'two-tiered' system such as this has been suggested a few times in Canada, but was rejected vehemently for being elitist. In other words, being able to pay to jump the queue went against the values associated--rightly or wrongly--with the Socialist Democracy Canada still likes to think it is. Note that the Supreme Court of Canada recently struck down the private medical ban in the province of Quebec, as it went against the Quebec's Charter of Human Rights and Freedom. This decision, which only applies to Quebec, made a lot of folks unhappy.
In 2006, the Quebec Government introduced Bill 33 that allows private clinics and private health insurance in order to comply with the Supreme Court ruling for a limited number of medical procedures. More than two years after the introduction of this Bill, the private medical insurance companies have yet to sell a single policy (note: who would pay for private medical insurance when they already pay via taxes for the same procedures?). In the words of the current health minister: "We have such a good access to the surgeries in Quebec that the industry knows they won't be able to sell any insurance to anybody." I think the minister is overenthusiastic about the efficiency of the system in Quebec in my humble opinion.
Amusingly, the idea of having a 'socialist' Universal health care system freaks a lot of Americans the heck out. It's like the grass is always browner on the other side of the fence.
For those interested (here is my academic side coming out!), I found this publication, in which the author noted that after the Universal health care was introduced in Canada, the number of medical visits per person (usually to treat the same illness) increased significantly, which actually adds to the cost of health care. More details can be found here: Danzon P.M., 1992. Hidden overhead costs: is Canada's system really less expensive? Health Affairs. Vol. 11, No. 1, pp. 2143.
It should be pointed out that this study has been criticized by others (e.g., Aaron, H.J., 2003. The Costs of Health Care Administration in the United States and Canada - Questionable Answers to a Questionable Question. New England Journal of Medicine, Vol. 349, No. 8, pp. 801-803) in terms of cost estimates and for the methodology used by the researcher. The point I wanted to make in the paragraph above is that the introduction of a Universal health care system would obviously increase usage by people who are covered with a private insurance and those who aren't (these folks still use the system a lot, but often wait until it becomes almost catastrophic and end up at hospital emergency ward; hence increasing the total health care costs). (see also McDonald, A. D., J. C. McDonald, et al., 1974. Effects of Quebec Medicare on Physician Consultation for Selected Symptoms. New England Journal of Medicine, Vol. 291, No. 13, pp. 649-652)
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