One thing Americans and Canadians can agree on is that we don’t want each other’s health care systems. In truth, most Americans don’t know how Canada’s system works and Canadians don’t know much about the U.S. system.

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Reprinted with permission of the Association of Health Care Journalists

First of an on-going series resulting from thge author's recent monthlong visit to Canada as a Fulbright Senior Specialist where she lectured about the American healthcare system and learned much about Canadian medical care.

One thing Americans and Canadians can agree on is that we don't want each other's health care systems. In truth, most Americans don't know how Canada's system works and Canadians don't know much about the U.S. system.

What Americans know has come mainly from the negative talking points of politicians and others who have argued for years against national health insurance. Two decades ago The New York Times reported that Canadian women had to wait for Pap smears, a point vigorously refuted by the Canadian ambassador who shot back in a letter to the Times editor: "You, and Americans generally, are free to decide whatever health care system to choose, avoid or adapt, but the choice is not assisted by opinions unrelated to fact."

Yes, there are waiting lists for some services -- as I will explain in another post -- but, no, Canadians are not coming across the border in droves to get American care.

There's misinformation among Canadians, too. Wherever I went, Canadians told me they thought, mostly based on what they said they heard on CNN and Fox, that Obamacare meant America was getting universal health coverage like their country has.

When I explained the law was simply another patch on a patchwork quilt of coverage, and the Congressional Budget Office had estimated last year there would still be some 30 million people without insurance, the reaction was "the news media didn't tell us that." A former deputy health minister in New Brunswick said to me, "After all that, you will still have 30 million people without coverage!"

Separating fact from opinion as the Canadian ambassador long ago urged was something I tried to do as I made my way across the country. In some ways the Canadian system is very different from U.S. health care. In other ways it's very much the same and faces similar challenges in the years ahead.

What we don't share

Although the Affordable Care Act calls for more people to have health insurance by offering subsidies and mandating all Americans have it or face penalties, the concept of universality is still a far distant goal. The Canada Health Act, on the other hand, calls for universality -- all residents must be covered by the public insurance plan run by their province on uniform terms and conditions. They have coverage wherever they are treated in the country, and there's none of this stuff about limiting the doctors and hospitals that patients can use as a condition of getting full benefits. In Canada there are no financial barriers to care at the point of service as there are and will continue to be in the U.S.

Canadians don't pay coinsurance of 30 percent or 50 percent if they have an outpatient procedure or go to an urgent care clinic, charges that are becoming increasingly common here. They don't worry about paying a gigantic bill if they happen to use an out-of-network doctor or hospital. The publicly funded system north of the border bases patients' access to medical services on need, not on the ability to pay. To use the word "ration," Canadians ration by need; Americans ration by price and will continue to do so as the ACA is implemented.

Because it's publicly funded, Canadian health care is more equitable. There's no such thing as buying a platinum plan and getting first-rate coverage or a cheapo bronze policy and paying 60 percent of the bill yourself. The tiered policies available in the state exchanges further bake inequality into the U.S. system. People have wildly varying benefits depending on where they live, how old they are, where they work, and how much they can afford to spend on health insurance.

That's not the case in Canada, except when it comes to prescription drug coverage. Drug benefits are quite unequal in Canada, and the lack of them is a pretty big hole for about 10 percent of the population. There is no universal drug benefit, although two provinces have mandatory drug insurance -- you can get it from an employer or buy it from a public plan. About 40 percent of the population gets coverage from their employers. If you can't afford the premium, there are subsidies. In that sense, Canadian drug coverage in those provinces resembles Obamacare. Still, having drug benefits does not necessarily mean adequate coverage, says Globe and Mail health columnist André Picard. "The big difference from the rest of Canada's system is there is very little first-dollar coverage of prescription drugs."

On this trip I heard much more about the social determinants of health than I hear in the U.S. Almost everyone I interviewed mentioned the dismal health stats for aboriginal populations and the need to improve access and quality of care. I tried to remember the last time I heard anyone discuss the medical problems of Native Americans or quality of care provided by the Indian Health Service.

I asked Michael Decter, a health policy expert and a former deputy health minister in Ontario, what was his wish list for Canadian health care. Topping his list was not more money for the health system; it was more for education aimed at improving the lives of aboriginal peoples. Better education correlates with better health. The second was drug coverage. Canada's infamous waiting times were not high on his list of priorities. In fact, he didn't even mention them as a problem.

Coming up

In my next post, I'll share what the Canadian and U.S. health care systems do have in common with a look at the cost and quality of care, the challenges of meeting the needs of vulnerable populations, caring for aging populations and more.

Authors Bio:
Trudy Lieberman, a
journalist for more than 40 years, is a contributing editor to the Columbia Journalism Review where she blogs about health care and retirement
at www.cjr.org. Her blogposts are at http://www.cjr.org/author/trudy-lieberman-1/
She is also a fellow at the Center for Advancing Health where she blogs about
health at http://www.preparedpatientforum.org/.   Her blog posts are at http://blog.preparedpatientforum.org/blog/category/author/trudy-lieberman/   Lieberman has had a long career at Consumer Reports specializing in
insurance, health care and health care financing.   She was also the director of the Center for
Consumer Health Choices at Consumers Union.  
She is a contributor to The Nation,
and has written a column about health and the marketplace for the Los Angeles Times.   Lieberman began her career as a consumer
writer for the Detroit Free Press
where her reporting became a model for consumer writers across the country.

She has won 26 national and
regional reporting awards and other honors, including two National Magazine
Awards, 10 National Press Club Awards, five Society of Professional Journalists
Deadline Club Awards, a John J. McCloy Fellowship to study health care in
Germany, a Joan Shorenstein Fellowship from Harvard University to study media
coverage of medical technology, an honorary doctorate of humane letters from
the University of Nebraska, and two Fulbright Fellowships---a senior scholar
award to study health care in Japan and a senior specialist award to
participate in training conferences in the United Kingdom for European health
journalists.   She is the author of five
books including Slanting the Story the Forces That Shape the News and
the Consumer Reports Guide to Health Services for Seniors, which was
named by Library Journal as one of
the best consumer health books for 2000.

Lieberman is an adjunct associate
professor of public health at City University of New York where she teaches
courses on the media's influence on public health.   She was director of the health and medical
reporting program at the Graduate School of Journalism, City University of New
York, has taught media ethics in the Science, Health and Environmental
Reporting Program at New York University, and has been an adjunct professor of
journalism at Columbia University.   In
2006, she was a Beamer-Schneider SAGES Fellow at Case Western Reserve
University where she taught courses on media ethics and the ethics of health
care delivery.   In 2007, she was
appointed the James H. Ottaway visiting journalism professor at SUNY New Paltz
where she taught a course on the media and the marketplace.   In 2011, Lieberman was named the Soderlund
Visiting Professor in the College of Journalism and Mass Communication at the
University of Nebraska where she taught public affairs reporting.

Lieberman served five years as the
president of the Association of Health Care Journalists, a professional
organization of over 1300 journalists who cover health and medicine, and
continues to serve on the board of directors as immediate past president.   She is currently a national advisory council
member of the California Health Benefits Review Program.   She has served on the board of directors for
the National Committee for Quality Assurance, the Medicare Rights Center, and
Village Care of New York.   Lieberman
appears on many panels and lectures widely on health care in the U.S.   She holds a B.S. with distinction from the
University of Nebraska and earned a certificate in business and economics
journalism from Columbia University's Graduate School of Journalism where she
was a Knight-Bagehot Fellow in 1976-77.

She can be reached at trudy.lieberman@gmail.com
and can be followed on Twitter at trudy_lieberman.