The Price We Pay for Health: US and Canada


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Is America's health care system better than Canada's? With over 40 million people in the United States without health care and many others dissatisfied with health care service, many believe we need to have a system more like the one used in Canada. Canada has a single-payer health system. In Canada, instead of paying insurance premiums to different insurance companies, the government is only the insurer. Citizens pay 'premiums' or taxes to the government, and the government, in turn, provides health coverage for everyone. It is against the law in some areas to pay out of pocket to receive better service; the government is thus able to ensure that wealthy people don't get better care than others.

doctorShould the United States adopt the Canadian system? Many argue that if our health care system were like Canada's, the quality of our health services would go down. They fear that if doctors are told what to charge, then doctors will no longer compete for services, and they will no longer try to give the best care so they can make the most money. Furthermore, if the government pays for health care, then the health care system will be competing with other government run programs. Health care services then might need to be rationed to stay within the budget.

Canada's government rations its health services by cutting out much of the highly technological and experimental procedures. People may have to wait longer for hip-replacements or longer to get MRI's. Canadians choose to put their funding into the basic health care of all citizens. The trade-off is the advanced technology that a person may need when faced with serious health condition or rare disease.

Americans do not face the problem of rationing in the same sense. But Americans are rationed out of the system by not being able to pay for it. With the current health care system in the United States, most people are insured by their employer. Researchers point out, however, that this system of insuring people may keep the very people who need insurance from getting it. For example, if you lose your job or become too sick to work, you lose your (employer-provided) health insurance. If you do not have a job that offers health insurance or if you work only 35 hours a week, you are not eligible for health insurance. Many people say that the government already provides for people who cannot pay for their own health care (through a program called Medicaid). The problem is that many people fall between the two categories: they don't have a job that provides affordable health care, yet they are not poor enough to receive Medicaid.

  US FlagWhat is America's responsibility to these people? Are all Americans responsible for caring for the uninsured? Our economy is a modified free enterprise economy in which the government does intervene and provide certain services such as Social Security, Medicare, and Medicaid. The government issues safety regulations for products we buy and it acts to keep competition alive in our economy. Should it be more? Where should we draw the line with government intervention? If we allow the federal government to become the insurer of all Americans, do we risk losing the quality of health care that we now have? What is more important, making sure all Americans get basic care, or ensuring that when one receives health services, she/he gets the highest quality of services?

These are some of the issues we will be discussing. As you look at the facts regarding the different health-care systems, ask yourself which system you think is better, the American system or the Canadian system? What economic goal do you think is most important--economic freedom (e.g. doctors setting their own fees and patients choosing their own doctors) or economic security (e.g. making sure everyone has basic health-care coverage)?


Your job is to examine the health-care systems of Canada and the United States. You will be directed to websites in whichCanadian Flag you will review research on both systems. You will determine the advantages/disadvantages of each system and decide what is the better trade off: (1) basic health-care for all with limited access to specialized procedures and advanced technology, or (2) some people go uninsured, but others - through insurance provided by employers and government programs - receive health-care services without rationing and benefit from advanced technology and access to specialized procedures.


Activity 1
Answer the following questions about your thoughts on health care:

  1. Do you believe health care is a right that all Americans should have?
  2. What is your current opinion (drawing from your own experiences) on the health-care system in the United States?

Website 1
Read this PBS article Health Care Crisis: The Uninsured to answer the following questions (print responses when finished):

  1. What is the number of insured people in the United States?
  2. Why do many uninsured end up in hospitals to treat a condition that could have been avoided?
  3. How does delaying health care lead to higher costs for all of us?

Website 2
Using the graphs from Health Care Systems: An International Comparison, the page numbers are listed, answer the following questions. Print responses when you are finished.

  1. What percentage of Canadians have public health-care insurance? Americans?
  2. What percentage of the GDP does Canada spend on health care? America?
  3. Why does the U.S. spend more of its GDP on health care?
  4. What is the income of physicians in the U.S.? In Canada?
  5. What is the average life expectancy in Canada? In the U.S.?
  6. What is the infant mortality rate of people in Canada? In the U.S.?
  7. How many magnetic resonance imaging machines (MRI's) does Canada have per one million persons?
  8. How many MRI's does the U.S. have per one million persons?
  9. After comparing your answers for numbers 9 and 10, explain what you think these statistics reveal about Canada's technology.

Website 3
Speak Up, America! Health Care Is Our Right! [2]
Use the above website for questions 2-4. Print your responses when finished.

  1. When you think of uninsured people, who comes to mind?
  2. How many children are uninsured in the United States?
  3. According to the article, how are they characterized?
  4. Approximately what percentage of uninsured live in homes where at least one person works full time?

Website 4
Go to this website on National Health Care .
After reading this article, answer the following questions and print your responses when finished:

  1. In a single-payer system like Canada's, how do patients drive the cost of health care up?
  2. What have Canadians had to do to deal with the "budgetary squeeze" in terms of health care?
  3. According to the chart on "average wait times," what is the average wait time in Canada for heart by-pass surgery?


ambulanceNow that you have seen the advantages and disadvantages of both systems, which system do you think is better? Why do you think so? Is this opinion different from what you said when you started the lesson? Why or why not?

Important Points:
All Canadians have health-care coverage. Over 40 million Americans are uninsured. If we moved to a universal health-care system (single-payer system), we might have to give up some of our high-tech research and experimental procedures. Choosing one system over the other means trading off between the goals of economic freedom and economic security.


Answer the following questions:

  1. How does Canada ration its health care services? How does the United States ration its health care services?
  2. What are the trade-offs involved in choosing between the Canadian health-care system and America's?
  3. Write a paragraph explaining why choosing between the health-care systems of Canada and the United States involves a trade-off between the economic goal of security and the economic goal of freedom.


  1. Read one of the stories with your parent from the Cover the Uninsured website. Be sure to select a link that has a student's first and last name as the title.
  2. Ask your parent the following questions and record his/her answers:
    Do you know anyone who is uninsured? Why doesn't that person have health coverage?
  3. In reference to one of the stories on the uninsured:
    What (if anything) should be changed in our health-care system to help uninsured people (like the one you read about)?
  4. Also read with your parent "The Failings of Canadian Health Care Hits Close to Home" .
    According to the article, how did Canada's health care system contribute to this particular Canadian citizen's death?
  5. Did either of these articles change your opinion about which country has the better health-care system? Why or why not?

For more information on health care look at the following websites:

Health Care Forum :
US v. Canada: Read about the pros and cons of America's and Canada's health care in this debate between Adam Gopnik and Malcolm Gladwell.

Comparing Health Care Systems :
What makes sense for the US?": This article provides information that compares the strengths and weaknesses of the current US system of health care, with plans in Canada, Japan, Germany and Hawaii, and then with what is known about the new darling of reform, "managed care."