What can Canadians learn from Obamacare?
The title of a recent report that ranks the performance of health-care systems in wealthy nations is telling: Mirror, Mirror 2017, published by the Commonwealth Fund, reveals its ambitions for reflection by trying to determine which country is the “fairest of them all.”
Such an exercise, of course, is a dismal science. Part of this is because no matter how valiant the effort, the way certain dimensions, such as wait times and patience experiences, are weighted will dictate the rankings. People have different values and this is also true for societies in which health systems operate.
And even if we could distil the unique features from this lineup, it is not clear that transplanting ideas or certain elements without their accompanying cultural or political context would prove successful.
So, what are we to make of the results? In the overall health-care system performance rankings, Canada placed ninth out of 11 nations, just two spots ahead of the last-place Americans. And what are we to draw from Obamacare’s dubious fate?
Our poor ranking should probably not be met with full-blown denial or repentance. The notion that every Canadian has access to health care has long been a favourable and defining feature for us with Americans. But if we push past the slogans and superficial, the Commonwealth Fund’s ranking might force us to question what we actually have access to.
Hospital care, sure. Pressed visits with a primary care provider or specialist? Of course, although it can largely depend on where you live. Once outside the walls of a hospital or clinic, our health-care system is fraught with even greater inequities.
Take for instance the issue of drug coverage. We may not like to acknowledge it very much, but when it comes to essential medicines, Canada looks a whole lot like the United States did on health insurance before the introduction of the Affordable Care Act (ACA, or “Obamacare”).
We have a myriad of public and private drug plans whereby such fractured purchasing power results in higher drug prices and regrettable coverage. On the issue of access to mental-health services, it is also our poorer and more vulnerable patients whom are priced out of help.
What is currently happening in the U.S. is nothing but tragic. The ACA lives for now, but the health insurance of millions of Americans, notably children, continues to be at stake.
For many others, the Trump administration’s decision “to let Obamacare implode” means that the protection they were counting on won’t be available when needed. And so, any symptoms of rising premiums or copays will not be remedied.
In other areas of policy, from climate change to LGBTQ rights, Canada opted to act decisively and move in the opposite direction. We must now possess the same conviction about health care.
After stacks of reports and commissions, mental health remains public policy’s no-brainer. There is wide consensus in Canada about the need to support a wider range of mental-health services be- yond hospitals and physicians. As the evidence mounts in its favour, it is well past time to publicly fund treatments such as psychotherapy to mend the gap.
Pharmacare is an issue where we have already seen some action, but not nearly enough. There is no valid reason why the political commitments of the early 2000s, notably to determine a national formulary of essential medicines and to ensure every Canadian will be able to access these drugs if needed, remains out of reach.
It is also time that we start looking more seriously at the limitations inherent to the private insurance market for pharmaceuticals from costs to gaps in coverage. And we can learn from the experience of our neighbours, wherein leaving market forces to themselves with no guidance on values and fairness, or having patients put more “skin in the game,” has only brought most Americans more hard choices and heartache. We must be reminded of this every time there is a clarion call for more copays or user fees.
It can be easy to get down on health reform as real change is often hard and slow. But the ACA and recent repeal drama shows that any progress will require partnerships on many different levels and outright political courage.
This is where U.S. President Donald Trump may have offered a most honest policy lesson: “health care reform is unbelievably complex.”