Global Health

The Price We Pay for Health: US and Canada

Key Economic Concepts:

Overview:

We will review the health systems of United States and Canada. You will identify the positive aspects of each system. You will look at the trade-offs associated with those positive aspects. In Canada, everyone has health care, but certain specialized medical services are not always available. In the United States, many people are not insured, yet for many people the access to technology and specialization is phenomenal. Which is the better choice? You will also recognize that choosing between these two systems requires a trade-off between the economic goals of economic freedom and economic security.

Lesson Objectives:

Introduction:

Look at the attached handout as an overhead to aid in introducing the lesson.

Is America's health-care system better than Canada's? With over 40 million people without health care in the United States and many others dissatisfied with health-care service, many believe we need to have a system more like the one in Canada. Canada has a single-payer health-care system. In Canada, people do not pay insurance premiums to different insurance companies; the Canadian government is the only insurer. Canadian citizens pay taxes to the government, and the government, in turn, provides health-care coverage for everyone. In fact, it is against the law in some areas to pay out of pocket to receive better medical service than the service the government provides; the government is thus able to ensure that wealthy people don't get better care than others.

What would be the trade-offs in costs and benefits be if we switched to the Canadian system? Many argue that if our health-care system were like Canada's, the quality of our health-care services would go down. They fear that if doctors are told what to charge, then doctors will no longer compete for customers and have no incentive to try to give the best care possible in order to make the most money. Furthermore, if the government pays for health care, then the health-care system will be competing with other government-run programs. Health-care services may have to be rationed to keep costs within the budget.

Canada's government rations its health services by not providing for certain uses of advanced technology and experimental procedures in medical care. Canadian citizens may have to wait longer than most Americans would for hip-replacements or to get MRI's, for example. Canadians have chosen to put their funding into the basic health care of all citizens. The trade-off includes less provision for treatments using advanced technology that some people need when faced with serious health conditions or rare diseases.

Americans do not face the problem of rationing in the same sense. But some Americans are rationed out of the system by not being able to pay for it. With the current health-care system in the United States, most people are insured by their employer. Researchers point out, however, that this system of insuring people may keep the very people who need insurance from getting it. For example, if you lose your job or become too sick to work, you lose your (employer-provided) health-care insurance. If you do not have a job that offers health insurance or if you work only 35 hours a week, you are not eligible for health insurance. Many people say that the government already provides for people who cannot pay for their own health care (through a program called Medicaid). The problem is that many people fall between the two categories: they don't have a job that provides affordable health care, yet they are not poor enough to receive Medicaid.

What is America's responsibility to these people? Are all Americans responsible for caring for the uninsured? Our economy is a modified free enterprise economy in which the government does intervene and provide certain services such as Social Security, Medicare, and Medicaid. The government issues safety regulations for products we buy and it makes efforts to keep competition alive in our economy. Should it be more? Where should we draw the line with government intervention? If we allow the federal government to become the insurer of all Americans, do we risk losing the quality of health care that we now have? What is more important: making sure all Americans get basic care, or ensuring that when one receives health-care services, he/she gets the best care possible. These are some of the issues we will be discussing. As you look at the facts regarding the different health-care systems, ask yourself what system you think is better, the American system or the Canadian system? What economic goal do you think is most important--economic freedom (e.g. doctors setting their own fees and competing to give the best possible coverage) or economic security (e.g. making sure everyone has basic health-care coverage)?

Assignment:

Answer the following questions. After writing your answers, be prepared to share answers with the class

Answer the following questions about your thoughts on health care and print your responses:

    1.  Do you believe health care is a right that all Americans should have?

     2.  What is your current opinion (drawing from your own experiences) on the health-care system in the United States?

Website 1
 visit the following websites and answer the questions.

Go to www.pbs.org/healthcarecrisis/uninsured.html to answer the following questions (print responses when finished):

1. What is the number of insured people in the United States?
2. Why do many uninsured end up in hospitals to treat a condition that could have been avoided?
3. How does delaying health care lead to higher costs for all of us?

Website 2
Go to www.pnrec.org/2001papers/DaigneaultLajoie.pdf
Using the graphs from "Health Care Systems: An International Comparison" The page numbers are listed. Print responses when you are finished.

1. What percentage of Canadians have public health-care insurance? Americans?
2. What percentage of the GDP does Canada spend on health care? America?
3. Why does the U.S. spend more of its GDP on health care?
4. What is the income of physicians in the U.S.? In Canada?
5. What is the average life expectancy in Canada? In the U.S.?
6. What is the infant mortality rate of people in Canada? In the U.S.?
7. How many magnetic resonance imaging machines (MRI's) does Canada have per one million persons?
8. How many MRI's does the U.S. have per one million persons?
9. After comparing your answers for numbers 9 and 10, explain what you think these statistics reveal about Canada's technology.

Website 3
The Uninsured
'Speak Up, America! Health Care Is Our Right!'
www.amsa.org/uhc/theories.cfm
Use the above website for questions 2-4. Print your responses when finished.

1. When you think of uninsured people, who comes to mind? [Answers will vary.]
2. How many children are uninsured in the United States?
3. According to the article, how are they characterized?
4. Approximately what percentage of uninsured live in homes where at least one person works full time?

Website 4
Go to www.balancedpolitics.org/universal_health_care.htm
After reading this article, answer the following questions and print your responses when finished:

1. In a single-payer system like Canada's, how do patients drive the cost of health care up?
2. What have Canadians had to do to deal with the "budgetary squeeze" in terms of health care?
3. According to the chart on "average wait times," what is the average wait time in Canada for heart by-pass surgery?

Conclusion:

Conclude the lesson by discussing the following questions:

Now that you have examined aspects of both health-care systems, which system do you think is better? Why do you think so? Is this opinion different from what you said when you started this lesson? Why or why not?

  Remind students of the following important points: All Canadians have health-care coverage. Over 40 million Americans are uninsured. In both health-care systems there are trade-offs. If we moved to a universal health-care system (single-payer system), we may have to give up some of our high tech medical care and experimental procedures. Choosing one system over the other means trading off between the goals of economic freedom and economic security.