The governments of both countries are actively involved in health care. The main structural difference between the two is health insurance. In Canada, the federal government pledges financial support to its provincial governments for health care costs as long as the province in question complies with the affordability guarantees set out in the Canada Health Act, which explicitly prohibits end-user billing for procedures covered by Medicare. Although some refer to the Canadian system as “socialized medicine,” health economists do not use the term. Unlike public delivery systems such as the U.K., the Canadian system provides public coverage for a combination of public and private delivery. Princeton University health economist Uwe E. Reinhardt says single-payer systems are not “socialized medicine” but “social insurance” systems because the providers (e.g., doctors) are mostly in the private sector. Similarly, Canadian hospitals are controlled by private boards or regional health authorities rather than being part of the government.
In the U.S., direct government funding for health care is limited to Medicare, Medicaid, and the State Children’s Health Insurance Program (SCHIP), which cover the eligible elderly, the very poor, the disabled, and children. The federal government also runs the Veterans Administration, which assists retired or disabled veterans, their families, and survivors through medical centers and clinics.
The U.S. government also runs the Military Health System. In fiscal year 2007, MHS had a total budget of $39.4 billion and served approximately 9.1 million beneficiaries, including military personnel and their families and retirees and their families. MHS has 133,000 employees, 86,000 military personnel and 47,000 civilians working in more than 1,000 locations worldwide, including 70 inpatient facilities and 1,085 medical, dental and veterans’ clinics.
One study estimates that about 25 percent of the uninsured in the U.S. are eligible for these programs but remain unenrolled; however, extending coverage to all who are eligible remains a complex financial and political problem.
For everyone else, health insurance must be paid for privately. About 59% of U.S. residents have access to health insurance through their employers, though this figure is declining, and coverage as well as expected employee contributions vary widely. Those whose employers do not offer health insurance, as well as those who are self-employed or unemployed, must purchase it themselves. About 27 million of the 45 million uninsured U.S. residents worked at least part-time in 2007, and more than a third were families who earned $50,000 or more a year.
