The Price We Pay for Health: US and Canada

Students will review the health systems of United States and Canada. They will identify the positive aspects of each system. They 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? Students will also recognize that choosing between these two systems requires a trade-off between the economic goals of economic freedom and economic security.

Introduce the lesson with some of the facts about the health-care systems of the United States and Canada. Use the attached handout as an overhead to aid in introducing the lesson, or give a copy of the handout to each student. The following interactive also has the same information.

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)?

• Contrast the American health-care system with Canada’s.
• Determine the trade-offs involved in choosing one health-care system over the other.
• Explain how choosing one of the two systems requires a choice between the economic goals of economic freedom and economic security.

• The Price We Play for Health:: Use this handout or interactive story to introduce this lesson and give students some background information about the health care system in the United States and in Canada.
  Handout
  Interactive Story
  
  

• Health Care Crisis: The Uninsured: This article discusses the increasing number of Americans that are being forced to live without being able to afford health insurance.
  www.pbs.org/healthcarecrisis/uninsured.html

• Health Care Systems: An International Comparison”: A printable international comparison of health care systems including charts and graphs. (18 pages)
  https://preview2.econedlink.org/wp-content/uploads/legacy/535_DaigneaultLajoie1.pdf

• Speak Up, America! Health Care Is Our Right!: An article provided by the American Medical Student Association discussing what a “Single Payer Health Care System” is.
  www.amsa.org/uhc/theories.cfm

• National Health Care: This site discusses the pros and cons of universal health care like that in Canada and if it is a good idea in the United States.
  https://www.balancedpolitics.org/universal_health_care.htm

• Cover the Uninsured Week: Read testimonies of experiences of the uninsured in this weekly online magazine.
  covertheuninsured.org/stories/

• The Failings of Canadian Health Care Hit Close to Home: An article by Jack Koenig discussing the downfalls of the Canadian health care system.
  https://www.heartland.org/news-opinion/news/failings-of-canadian-health-care-hit-close-to-home?source=policybot

• Health Care Forum: US v. Canada: Read about the pros and cons of America’s and Canada’s health care in this debate between Adam Gopnik and Malcolm Gladwell.
  www.washingtonmonthly.com/features/2000/0003.gladwellgopnik.html

• Comparing Health Care Systems: What makes sense for the US?”: This article provides information that compares the strengths and weaknesses of the current US system of healthcare, with plans in Canada, Japan, Germany and Hawaii, and then with what is known about the new darling of reform, “managed care.”
  www.context.org/ICLIB/IC39/CoopTalr.htm

[NOTE: This lesson may take more than one class period to complete.]

After the introduction, students will answer the following questions. After writing their answers, the students will share their answers with the class.

Activity 1
Answer the following questions about your thoughts on health care and print your responses:

View Interactive Activity

1. Do you believe health care is a right that all Americans should have?
   [Answers will vary.]
2. What is your current opinion (drawing from your own experiences) on the health-care system in the United States?
   [Answers will vary.]

Website 1
The students will then visit the following websites and answer the questions.
Read this PBS article Health Care Crisis: The Uninsured to answer the following questions (print responses when finished):

View Interactive Activity

1. What is the number of insured people in the United States? [There are 44 million insured people in the United States.]
2. Why do many uninsured end up in hospitals to treat a condition that could have been avoided? [The uninsured have no regular doctor and limited access to prescription medications; they are more likely to be hospitalized for health conditions that could have been avoided.]
3. How does delaying health care lead to higher costs for all of us? [When people cannot afford health care, they seek out the care they need at the last minute. When they wait to the last minute, they are in an emergency situation; in this crisis, the burden falls on the insured population, the hospitals, doctors, and government.]

Website 2
Using the graphs from Health Care Systems: An International Comparison, the page numbers are listed, answer the following questions. Print responses when you are finished.

View Interactive Activity

1. What percentage of Canadians have public health-care insurance? Americans? (p.4) [100 percent of Canadians have public health-care insurance; Only 45 percent of Americans have it.]
2. What percentage of the GDP does Canada spend on health care? America? (p.7) [Canada spends 9.2 percent of the GDP on health care; America spends 13.9 percent of the GDP on health care.]
3. Why does the U.S. spend more of its GDP on health care? (p.7) [The United States spends more of its GDP on health care because of their higher labor, malpractice, and insurance costs in the health-care industry.]
4. What is the income of physicians in the U.S.? In Canada? (p.16) [The income of physicians in the United States is $199,000; The income of physicians in Canada $100,781.]
5. What is the average life expectancy in Canada? In the U.S.? (p.16) [The average life expectancy in Canada is 79; The average life expectancy in the United States is 76.7.]
6. What is the infant mortality rate of people in Canada? In the U.S.? (p.17) [The infant mortality rate of people in Canada is 6.0; The infant mortality rate of people in the United States is 7.8.]
7. How many magnetic resonance imaging machines (MRI’s) does Canada have per one million persons? (p.15) [There are 1.7 magnetic resonance imaging machines per one million persons in Canada.]
8. How many MRI’s does the U.S. have per one million persons? (p.15) [The United States has 16.0 magnetic resonance imaging machines 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. [Canada has less availability of new health technologies.]

Website 3
Speak Up, America! Health Care Is Our Right!
Use the above website for questions 2-4. Print your responses when finished.

View Interactive Activity

1. When you think of uninsured people, who comes to mind? [Answers will vary.]
2. How many children are uninsured in the United States? [There are ten million uninsured children in the United States.]
3. According to the article, how are they characterized? [According to the article, uninsured children are characterized either lazy individuals looking for government handouts or healthy individuals who freely choose not to purchase insurance.]
4. Approximately what percentage of uninsured live in homes where at least one person works full time? [Approximately 77 percent of uninsured people live in homes where at least one person works full time.]

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

View Interactive Activity

1. In a single-payer system like Canada’s, how do patients drive the cost of health care up? [Since there are no limits on demand, patients seek as much care as desired, and this drives costs up.]
2. What have Canadians had to do to deal with the “budgetary squeeze” in terms of health care? [Canadians have rationed the supply of medical care by closing hospitals, reducing medical payments, and limiting the number of hours a doctor can spend on surgery.]
3. According to the chart on “average wait times,” what is the average wait time in Canada for heart by-pass surgery? [The average wait time in Canada for heart by-pass surgery is 18.2 weeks.]

Conclude the lesson by discussing the following questions with the students:

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.

1. Read one of the stories with your parent from the Cover the Uninsured website. Be sure to select a link that has a student’s first and last name as the title.
2. Ask your parent the following questions and record his/her answers:
   Do you know anyone who is uninsured? Why doesn’t that person have health coverage?
3. In reference to one of the stories on the uninsured:
   What (if anything) should be changed in our health-care system to help uninsured people (like the one you read about)?
4. Also read with your parent https://droughtmonitor.unl.edu/ .
   According to the article, how did Canada’s health care system contribute to this particular Canadian citizen’s death?
5. Did either of these articles change your opinion about which country has the better health-care system? Why or why not?

For more information on health care look at the following websites:

Health Care Forum:
US v. Canada: Read about the pros and cons of America’s and Canada’s health care in this debate between Adam Gopnik and Malcolm Gladwell.

Comparing Health Care Systems:
What makes sense for the US?”: This article provides information that compares the strengths and weaknesses of the current US system of healthcare, with plans in Canada, Japan, Germany and Hawaii, and then with what is known about the new darling of reform, “managed care.”