Question about health care

[Lydia Leftcoast]

I've heard about how your system works on a day to day basis, but I'm unclear on how it's funded. Is it through income taxes, excise taxes, VAT, or something else?

Thanks! I'm preparing ammunition for facing doubters who say, "Yes, single-payer sounds good, but how would we pay for it?"

[shoelace414]

1. how about this..

"how do we pay for it?"

your question implys you're not paying for it now. you are.

how are you paying for health care now? perhaps it might be they put the price of health care for workers into the price of the goods?

[Lydia Leftcoast]

2. I know that argument, but I'd like a specific example of how

Canada actually finances its health care system.

[iverglas]

3. combo

The health care plans are provincial, and arrangements vary from province to province.

Income tax is the basic source -- including what we call "transfer payments" from the federal government. By exercising its spending power, and paying for a big chunk of health care spending, the federal government has a stick to wield to ensure that all provinces comply with the national standards set out in the Canada Health Act:
http://www.hc-sc.gc.ca/medicare/chaover.htm
The basic ones are: public administration, comprehensiveness, universality and portability (province to province).

Some provinces, e.g. BC, charge sliding-scale premiums in addition, ranging from $0 to around $100 (last time I looked, the max for a family of any size) per month.

I live in Ontario, but I've failed to pay attention to recent developments under the new Liberal provincial government. There have been payroll taxes and high-earner income tax surcharges and self-employed extra charges in recent years, generally not amounting to much over $1000/year at the top end, as I recall.

You should look into what's happening in Maine. I imagine they're still dithering, but they did vote in a single public payer system a couple of years ago.

I think you've probably seen my favourite source for comparing household expenditures in this regard in Canada and the US; it doesn't break down the Cdn income taxes by amount going to health care, but it demonstrates that the average Washington family pays about as much in income tax + medical expenditures as the average BC family pays in income tax:
http://www.policyalternatives.ca/index.cfm?act=news&do=Article&call=222&pA=BB736455
From the news release (the full study is linked from that site):

BC's tax system is much more fair than WA's, which is the most regressive tax system in the US. "Low income families in WA pay almost three times more of their income in state taxes than high income families. And although an average BC family pays $1,633 more per year in provincial taxes than a WA family pays in state taxes, BC spends $1,118 more per person on public programs. The tax savings in WA are more than wiped out by higher private spending by families for important goods and services like health care and university tuition.

Another point that should always be mentioned is that what you'd be paying for will be less: administrative expenses (including the costs to individual doctors of dealing with all of the multiple payers) are far lower in the Canadian system than in the US.

http://content.nejm.org/cgi/content/short/349/8/768
- the New England Journal of Medicine, no less.

Results
In 1999, health administration costs totaled at least $294.3 billion in the United States, or $1,059 per capita, as compared with $307 per capita in Canada. After exclusions, administration accounted for 31.0 percent of health care expenditures in the United States and 16.7 percent of health care expenditures in Canada. Canada's national health insurance program had overhead of 1.3 percent; the overhead among Canada's private insurers was higher than that in the United States (13.2 percent vs. 11.7 percent). Providers' administrative costs were far lower in Canada.

Between 1969 and 1999, the share of the U.S. health care labor force accounted for by administrative workers grew from 18.2 percent to 27.3 percent. In Canada, it grew from 16.0 percent in 1971 to 19.1 percent in 1996. (Both nations' figures exclude insurance-industry personnel.)

Conclusions
The gap between U.S. and Canadian spending on health care administration has grown to $752 per capita. A large sum might be saved in the United States if administrative costs could be trimmed by implementing a Canadian-style health care system.

Include insurance industry personnel and imagine what you'd have. Private insurers in Canada cover things not covered by the public plans: drugs in most provinces, non-medically-necessary treatment (two that come to mind are bunion surgery and vasectomy reversal), corrective lenses, dental. I don't know what services the study included, but I'd think that a comparison of costs only for those services that the Canadian plans cover -- all services that it is reasonable to cover and that are not purely elective (remember that abortion is covered) would show an even greater discrepancy between the two countries.

[Hand]

4. It varies from province to province.

BC, I think, charges an individual annual premium (that's also how they finance provincially-administered car insurance). Here in Nova Scotia, it's financed through the sales tax primarily. I think Ontario is considering adopting the BC approach as well.

The federal government also shares in the financing, but they've cut back their contribution in the past decade. The provinces are pissed about that, needless to say, but, well... shigata ga nai, neh? :evilgrin:

ON EDIT: The post above is much better and more accurate... wish I'd seen it.

[iverglas]

5. simultaneous great minds

It's usually the other way around ... by the time I get through finding my bookmarks and tracking dead ones down, and cutting and pasting it all, somebody else has beat me to it. ;)