Will Obamacare impact Canadian healthcare policy?
It's among the many questions posed to Trudy Lieberman, past president of the Association of Health Care Journalists and press critic for the Columbia Journalism Review. Lieberman visited four cities across Canada as a Fulbright Scholar and guest of the Evidence Network of Canadian Health Policy, commonly known as EvidenceNetwork.ca.
Lieberman's timely visit came just two weeks after the official U.S. government implementation of the Patient Protection and Affordable Care Act (PPACA), also called the Affordable Care Act (ACA) or "Obamacare." Signed into law by President Barack Obama in 2010, PPACA legislation initially inspired some to hope for a more "Canadianized," equitable version of American healthcare.
But closer analysis reveals this is far from the case. McGill University Associate Professor of Political Science Antonia Maioni aptly illustrates this in a recent Globe and Mail article informed by Lieberman's observations, "Obamacare vs. Canada: Five key differences".
Lieberman is quick to point out that Obamacare builds inequality into the system rather than legislating fundamental reform. Lieberman cites two major differences between attitudes toward health care in Canada and the United States:
1. Equity. Canadian healthcare ideology dramatically differs from how Americans view healthcare. Lieberman admits that a market-driven economy and powerful politics from stakeholders, particularly health care providers and insurance companies, are major obstacles to changing cultural attitudes toward equitable health care coverage. "If we (Americans) ever adopt a different system, the impetus would have to come from the business community. It won't come from advocates or academics, or the media," says Lieberman. "We have a largely employee-based system with 160 million people covered by their employers. The spark for wholesale reform of the system will have to come from employers.
2. Focus on Aboriginal health care. "I don't recall ever writing about the Indian Health Service," Lieberman muses. "In Canada, I've heard more discussion of aboriginal health than wait times.
Lieberman points out that the results of Obamacare legislation may take years to determine. In the meantime, there are ways our two systems have similarities.
1. Health care costs increasingly shifted to individuals. "We can see a shift in both countries toward making the patient pay for more," Lieberman notes. "Americans are paying more out of pocket for health care. In Canada, many services are not covered, and depending on the outcome of a court case in British Columbia, Canadians may pay more out of pocket, too."
2. Quality concerns. "Both countries have various problems with aspects of medical quality and both have to work on improving care, especially long-term care for the elderly," Lieberman points out.
3. Increasing Demand and Cost for Technology. "We still haven't figured out a way to reign in the cost of technology. Patients want the latest and greatest but the U.S. doesn't have anything like the United Kingdom's National Institute for Health and Care Excellence (NICE), which looks at the cost and efficacy of new treatments before recommending these to NHS doctors."