Single Payer Health Systems and the Affordable Care Act

by Margot Heffernan, MLS 

President Obama’s re-election means that The Affordable Care Act will come to fruition.  Many questions remain, however, about just how his signature health care legislation will take shape in the coming months and years. So far, twenty states have opted out of creating their own health care exchanges, leaving this onerous task to the federal government. Even though fissures in the system are already apparent, some believe that  “Obamacare”  will eventually lead to a single payer health system.

Although many have clamored for universal health care, few understand the long term consequences of single payer systems. Canada’s health care system offers a compelling example of a model that has devolved into an inefficient government run program. Its system is enshrined in The Canada Health Act, which was enacted into law on April 1, 1984. This Act expanded on two previous pieces of legislation-The Hospital Insurance and Diagnostic Services Act of 1957 and The Medical Care Act of 1966.

Under The Canada Health Act, “medically necessary” services are paid for by Medicare, the government insurance that covers all Canadians; use of private health insurance is prohibited for any service or treatment that is covered under the government plan.

The philosophy behind this and all universal models is that government-run health care is inherently egalitarian; private insurance and institutions are unfair because they are inaccessible to the poor and underprivileged. History reminds those who listen, however, that these models ultimately punish everyone by necessarily limiting services and decreasing quality care for all citizens.

In fact, overall satisfaction with Canadian health care has markedly decreased over the years. The reasons for this decline in satisfaction are simple: Government administered health care operates within the confines of a static fiscal model that cannot possibly match the dynamic and changing needs of a growing population. In 1961, when Canada’s population was 18.2 million, a universal system was a plausible solution to a small population’s health care needs. Costly and sophisticated high tech medical diagnostics and treatments were yet to be designed.  Medical care was a much simpler matter, dictated by the basic technologies and treatments that were available at the time. However, Canada’s population has almost doubled since 1961, while per capita health spending has increased more than fifty times. As the population ages, chronic health conditions have become a formidable challenge for the universal model to contend with. Cutting edge treatments for cancer, heart disease, and a myriad of chronic diseases demand quick and efficient application.

Inevitably, the need for urgent and medically necessary care out runs the fixed resources that any government can provide. Reports about extended waiting times for necessary  medical treatments in Canada are not simply anecdotal. They have been evidenced by unacceptable waiting periods for such standard, life saving treatments as radiation therapy. This problem was so severe in the 1990’s that Quebec paid hospitals  in New York  and Vermont to treat breast cancer patients. In 2009, 4000 breast cancer patients reached a $5.4 million agreement in a class action suit against a dozen Quebec hospitals because they could not deliver this therapy within an acceptable time frame.

The high profile case of George Zeliotis, an elderly Quebec man who waited one year for a hip replacement, offers another lesson for those who imagine universal healthcare as a catholicon for all that ails the U.S.system. Zeliotis and Dr. Jacques Chaoulli, who sought to provide the surgery privately, were the appellants in a case before the Supreme Court of Canada.  They argued that the Quebec prohibition of private insurance was an infringement of  both the Canadian Charter of Rights and Freedoms and the Quebec Charter of Rights. In 2005, the Court overturned the Quebec law that bans the purchase of private health insurance for services covered by Medicare.

As stark realities of modern medicine collide with an idealized vision of universal health care, necessary changes to Canada’s one payer system have taken place. Legal challenges to the Canadian system coupled with ongoing dissatisfaction with long waits for medically necessary care have eroded the once iconic status of Canadian health care. Private health care options are gradually becoming reality.

Many believe that the implementation of  The Affordable Care Act will eventually provide the gateway to a single payer system similar to the one that Canada is edging away from. This would be a calamity for the United States, which has a population ten times that of Canada. The single payer system, far from the progressive model envisaged by some, will lead us all back to the end of  long lines, where we will wait, like Goerge Zeloitis, for fair and equitable treatment.