Perspectives: United States. Learning from the Canadian experience.

Abstract

Sometime during the next decade the United States will probably embark on major reform of our pluralistic system of health care finance. The growth of the uninsured and the failure of the so-called competition revolution of the 1980s to stem the rise in health care spending are just two of the factors pushing the nation toward more radical change. In seeking to develop new approaches, health policy experts inevitably will attempt to draw on the experiences of other countries, especially those such as Canada that have managed to implement universal coverage while simultaneously containing costs well below U.S. levels. In doing so, it would be wise to resist simplistic notions about the easy transfer of health care systems across national boundaries. “The organization of medicine,” law professor Walton H. Hamilton wrote in 1930, “is not a thing apart which can be subjected to study in isolation. It is an aspect of culture, whose arrangements are inseparable from the general organization of society.” But even if it is impossible to reproduce another country’s experience, it should be possible to learn from it. The potential for learning is particularly great in a comparison of Canada and the United States because of both the differences and the similarities between the two countries. In 1986, Canadians spent approximately 8.5 percent of their gross national product (GNP) on health care, while Americans spent approximately 10.9 percent. If U.S. spending had been held to the Canadian ratio, the savings would have amounted to about $100 billion. This large difference between Canada and the United States has emerged only since the 1970s. Before then, the percentages of GNP spent for health care were similar in the two countries. This was not surprising because the United States and Canada are similar in many respects, including training of physicians and other health professionals, political and economic