It’s an election year in the U.S. and the rhetoric about healthcare, Obamacare, and Medicare is in full flight.  Both parties say it’s time to reform U.S. healthcare, but can’t agree on how it should be done.  During this debate in the past, the Canadian healthcare model has been invoked,  either as a failed system, or a progressive healthcare system – depending on one’s political viewpoint.

One thing that the Americans don’t seem to have down about the Canadian healthcare system, is that it isn’t a national healthcare program at all.  The federal government sets out national standards for healthcare delivery as a condition of receiving just 20% of the funding transferred to provinces for their health care programs.  Yes, it is the provinces that provide most of the funding and administer their own healthcare programs, tailored to the demographics and needs of their citizens.   Trying to administer healthcare on a national scale would be a boondoggle for Canada with just 10% of the population of the U.S., so just imagine the disaster of doing it on a national scale south of the border.

In Ontario, the most populous Canadian province, the Ontario Health Insurance Plan (OHIP) is deemed to be the sole payer for medical services provided to its citizens.  Doctors, who are mostly private businesses (practices and clinics) bill OHIP and are reimbursed based on a fee scale negotiated (sometimes peacefully) with the Ontario Medical Association who represent practitioners. 

Sounds straight forward, but it isn’t the whole story.   About one-third of medical services in Ontario aren’t covered by the OHIP plan.  To access those, you need either a private health insurance plan (typically provided by employers), or a credit card.  From cosmetic surgery and various tests, to semi-private hospital rooms, the Ontario healthcare system also exists in the private sector.

Which brings me to my main point.  If the objective is to ensure citizens have access to the full range of affordable healthcare services, as well as protecting them from catastrophic loss in the event of serious illness, then we need both the public and private sectors working together and on the same page.   It’s sort of working in Canada, and it can work in the U.S.  In a way, it might even be a hybrid that blends the best of the Canadian model with its U.S. counterpart.

Here’s how it might work.   Leave to the private sector, the things they do best:  build and operate facilities (hospitals, clinics, other access points for healthcare), and innovate new treatments.   There is no need for governments to own or run hospitals as it simply drains public funding for healthcare services.  This would help end government administration practices of not providing services after hours and on weekends, or allowing private operators to keep those services after hours.

Leave to government health insurance plans what they have proven themselves able to administer:  basic protection for citizens from catastrophic economic loss due to the costs of treating illness and coverage for a reasonable menu of medical services.  People over a threshold income should pay an annual premium of less than $1,000; those under the threshold in any given year would retain their health insurance without premiums.   All other services would be accessible through private plans or pay as you go.

And here’s one more obligation for government.  Monitor service constantly (waiting times, quality of services, etc) and promote the development of new doctors, specialists, nurses, and other practitioners who comprise our healthcare force.  Offer tax incentives, not only to meet improved healthcare service standards, but also to bring more healthcare facilities and services to the market. 

It’s what I call a participative healthcare system, one that leverages the best that each sector can bring to the table. Healthcare simply can’t be the domain solely of government anymore.