Q & A
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Philosophy students from Long Island College, Brooklyn Campus watched The Healthcare Movie and submitted questions to us. Thanks to Professor Noam Mor.
Here are their questions and our responses.
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It is true that Canadian free health care has hidden costs?
Actually, Canadian health care is not “free”. It is paid for by progressive taxation, meaning that people pay taxes to the government at increasing rates according to their level of income. The government (federal and provincial) provides money to each province to be allocated to health care.
From the consumer’s point of view, health care does seem to be “free”. Anyone can go to a doctor or hospital and no one asks them for money. They just have to show their provincial health care card, which everyone gets if they are a resident of the province for more than three months.
There are some things that are not covered by the Canadian Health Care system (although the founders of the system recommended they be covered). Dentistry is not covered. Pharmaceuticals (medicines) are not covered, unless they are part of treatment at a hospital, in which case they are covered. Canadians can buy extra insurance for dental care or to reduce the cost of pharmaceuticals. Cosmetic and plastic surgeries are not covered if they are not considered medically necessary.
The Canada Health Act, which was passed in 1984, makes it illegal for doctors or hospitals to charge money to patients for medical services. Prior to that time, some doctors tried “extra billing” patients so they could make more money than the government allocated for their services.
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Is health care in Canada only for citizens?
Can residents obtain health care as well?
Any legal resident of Canada is eligible for health care after living in Canada for three months. One doesn’t have to be a citizen. Some Canadians are also advocating for illegal immigrants to receive health care. No one is turned away if care is needed. Also, as you could see in the film, Canadians can receive treatment in any other province, at the expense of their own province. This “portability” feature is part of the Canada Health Act passed in 1984. This act is endangered, however, because some aspects of it (for example, the aspect that says doctors are not allowed to charge extra or charge patients for services) are not being strongly enforced.
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How dramatically is Canada health funding dropping?
Beginning in 1962, the federal government paid 50% of the cost of health care to each province. Currently, it is around 14%. Each province is responsible to fund the remainder itself. This is probably leading to inequities, because some provinces have more natural resources than others and are more able to generate their share of funding.
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What is the exact reason the US doesn’t want to provide its citizens with nationalize health care?
Initially it was because doctors were concerned that their autonomy would be compromised, and that the government would interfere with their relationship with their patients. Also, they didn’t want restrictions placed on what they charged for their services. The public was afraid of communism and socialism, and even today there is not a public demand for national health care because of continued fears of government intervention. As health insurance became privatized (since the 1950’s), insurance companies were able to profit by “cherry picking” healthy people (workers) and by encouraging businesses to buy insurance from them because they could offer lower prices than non-profit health plans. Now the health insurance companies stand to lose billions of dollars and a lot of people employed by insurance companies would lose their jobs if health insurance was nationalized or government-run. Insurance companies spend a lot of money trying to keep the public opposed to national health insurance. There is also an apparent culture in the United States of “every man for himself” rather than a moral value of looking after one another.
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Do Canadian citizens feel the tax deductions tremendously, since health care is offered to all, through tax deductions? And what’s the percentage deducted?
Here are some figures about taxes in Canada and the US (from 2005):
Canada income tax
31.6% single
21.5% married 2 children
US income tax
29.1% single
11.9% married 2 children
So as you can see, Canadians do pay more taxes. Even so, the experience I had as a Canadian was this: Everyone pays taxes (according to income level), so it never occurred to me that there was anything “unfair” about the taxation. The taxes came out of my paycheck, and I was very accustomed to the fact that my take home pay was mine to use as I needed or wished. I never had to pay a doctor or hospital out of my take home pay. I never even thought about it. As far as I was concerned, any medical attention I needed – preventive, or treatment oriented – was “free”. And, I might add, very good quality. I was able to choose any doctor or even any specialist that I wanted (by asking my doctor to refer me to the specialist of my choice).
Since we all “owned” the health care system, if any one of us had a complaint about it, by voicing our complaint we were speaking on behalf of everyone. Canadians take great pride in their universal health care, even though it is not perfect. A wealthy or famous or well informed person gets the same health care as everybody else, so they take action to improve the system for everyone.
I would also like to add that by the time people in the US pay their co-pays, deductibles, premiums, etc., especially if they have any health issues, the total amount of money they put out is probably very close to what Canadians pay in taxes. Sick people, of course, pay more.
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Do you think that the politics who are against nationalizing health care in the US are aware of the positive and long lasting effects?
If politicians are aware of the positive effects of nationalizing health care, they also seem to be weighing these advantages against the problems that would have to be faced in trying to implement it. For example, what would happen to the billion dollar insurance industries that now have a monopoly on providing health insurance to people? (The new health care bill will actually require people to buy insurance from these insurance companies). What will happen to the thousands of employees that are now required to manage the administration of all the different health insurance plans? How much campaign financing comes from people involved in the health insurance industry? What would happen to the political popularity of a politician who embraces the idea of national health insurance when the insurance industry spends millions of dollars lobbying the public to make the idea of a “government takeover” distasteful?
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Do you think that nationalizing health care would have the same if not similar positive effects as those in Canada?
Yes.
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While creating the movie, did you find anyone in the United States that was happy with the health insurance that they had?
We can’t say that people report they are happy with their health insurance in the US. Many (healthy) people are complacent about the health care insurance they have, which we think prevents them from taking any kind of action. However, a lot of people are pretty sure they don’t want a system like Canada’s, because of what they have heard: long waits, government between doctors and patients, and low quality care (based, we think, on the idea that low income people in the US who are on government health care (Medicaid) get poor quality care – they think that’s what government health care looks like – and they don’t want that).
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Who’s responsible for purchasing new medical equipment?
It is our understanding that in Canada doctors or private labs are responsible for purchasing their equipment as a part of their business expenses, just as a baker is responsible for purchasing his or her own oven.
Hospitals purchase their equipment out of their annual operating funds, which they negotiate each year with the provincial/federal government.
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Is the equipment that is being used now outdated?
There seems to be a myth here in the United States that Canadian medical services and equipment are outdated and lower quality than in the US. I did a quick Google scan of articles that warn of the “dangers” of outdated equipment in Canada, and it looks to me like these articles are mostly written by people and organizations who are trying to dissuade Americans from a government-based system or to encourage more privatization in Canada.
One of the articles talks about replacing equipment every 10 years. This implies that equipment used over 10 years ago is not longer accurate or reliable. As long as equipment is in working order, why should we assume that if it is older than 10 years it is no longer safe but is in fact dangerous? In my opinion, this is another attempt to generate fear of government intervention and to create profit for companies that manufacture medical equipment. Is a stethoscope that much different today than it was 50 years ago? Sure, there are some medical advances that require new equipment, but does that mean that every x-ray machine or other standard equipment becomes dangerous after 10 years? What a waste to think that standard medical equipment is built for such obsolescence, and that everyone should suffer the cost of replacement when it may not be necessary.
In Canada, everyone has access to the same medical treatment. Because of the universal system, people who are very rich or very well informed are served by the same medical services and equipment as everyone else. As a result, they take responsibility to make sure that medical services and equipment are kept up to date, and to express and publicize their concerns if they discover any issues or “dangers”. Publicized concerns get the attention of everyone who then puts pressure on the system to improve. That is how it works in Canada. As Michael Rachlis, M.D. said in the film, “The health care system belongs to all Canadians, and it is their responsibility to improve it.”
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What cause of action you think the movie would have on the US government? Was there any sort of response or recognition from any political figures that would support a health care system like that of Canada? Were there any that opposed?
Since we have not to date received any feedback from US government representatives, we can only guess what their response might be. We can only surmise that since the US government did not include the idea of a single payer system or a public option in the health care discussions and debate of 2009, that there is not government support for a Canadian-style system in the United States. Certainly there are a few politicians in favor of single payer (for example Dennis Kucinich, and the late Ted Kennedy). But it seems that the US health insurance industry had a large influence on the discussions that occurred, leading to the resulting bill that was (barely) passed in March of 2010.
We think that The Healthcare Movie may not have a significant impact on the US government, but we sure hope it will have an impact on the American people, who, in turn, will lobby the government to provide universal, comprehensive, single payer health care to all Americans.
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What’s the catch because nothing is free?
In Canada, health care is not free; in fact it is expensive, as is health care in any country. However, because it is fully funded by taxes paid according to level of income, the people of Canada have the perception that it is free. No one has to pay anything when they visit their doctor or go to a hospital. No one has to worry about whether they can afford to get treatment for an illness or injury.
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If it’s the taxes, then how much? What percentage?
Here are some figures about taxes in Canada and the US (from 2005):
Canada income tax
31.6% single
21.5% married 2 children
US income tax
29.1% single
11.9% married 2 children
Taxes are higher in Canada. However cost of health care per person is a lot less than in the US (let’s say about $4,000 per person per year in Canada, and about $7,000 per person per year in the US – these figures are a few years old). If you divide these amounts by 12 months in a year, the average cost for Canadians is about $333 per month; in the US it is about $583 per month. Americans pay a lot for co-pays, deductibles, premiums, and if they have a major health incident or accident, they pay their portion (for example 20%) of what insurance doesn’t cover.
Americans must constantly worry (whether they realize it or not) about the possibility of being financially impacted by unexpected illness or accident. Those who are employed and have good health insurance are tied to their jobs and lack the freedom to consider a different job or career even if they don’t enjoy their work. They also live with the fear that if they lose their job they lose their health insurance. Small businesses pay increasing premiums to provide health care for their employees, and this cost is becoming too much, so many employers are cutting back or not providing health insurance. In Canada, businesses don’t have to pay anything for health insurance for their employees, because everyone is covered. The auto industry in Canada, for example, saves $6 per hour per worker because they don’t have to pay for health insurance. Workers in Canada can choose whatever job they like, with no worries about losing their health care coverage.
In our personal experience, the peace of mind of living in Canada by FAR outweighs the higher taxes. There is no price you can put on peace of mind.
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When you made this documentary, what was your purpose?
Having experienced the peace of mind of living in Canada, followed by the anxiety and constant undercurrent of worry when living in the United States, and hearing the lies and myths that Americans believed about Canada, we HAD to make this film.
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Did it help any?
Yes. Making this film really helped us understand the reasons why Americans are so afraid of national health care. While we don’t have answers about how to overcome the power of the multi-billion dollar health insurance industry in the United States, we do hope that the film will help ordinary people understand the roots of their misunderstandings about the Canadian system. There is little doubt, in our minds and based on our research, that a tax supported universal, single payer system has far better outcomes for the economy and for the well being of the people.
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Do Canadians often cross the border for treatment?
Canadians get “free” high quality treatment at home, and are in fact, able to go anywhere in Canada to get medical treatment because of the “Portability” clause in the Canada Health Act of 1984. Dr. Bob Evans, a health care economist from the University of British Columbia, Canada, told us about some interns who took on the job of contacting hospitals all over the United States to see if they were treating Canadians. Some of them said, “Yes, we had one last month”. As it turned out, the Canadians getting care in the US were there because they were vacationing, and they happened to get sick or injured. A few wealthy Canadians may spring for the costs of having their knee or hip surgery in the US because they might get it sooner there, however this is rare. Most of the stories about Canadians going to the US for care are exaggerated for media effect.
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Does the Canada ration care? Does the US ration care?
I’m not sure what it means to “ration” care. This term seems to be related to the fear of Socialism Americans have – about not getting what they need when they need it – like the bread lines during the depression, when people’s food was “rationed”. People get medical care that they need when they need it. Those with life-threatening situations are treated immediately, then others receive treatment, according to availability of medical staff. Is this rationing?
I think in Canada, doctors are less inclined to use any-and-all life saving measures if they feel that the treatment will be intrusive and will not significantly extend or improve someone’s life. They are not concerned with lawsuits – as in America – and they are more realistic with regards to quality of life. Some people have called this “death panels” – as if the doctors are condemning certain patients to death. Actually, death is quite a natural process and part of life, and in Canada decisions are made with family members to preserve the dignity of dying patients.
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I know in Canada, if people want to get a MRI they have to wait for 7 months to get it done, but in US getting a MRI exam is faster than in Canada although they still need to wait. So my question is: what are the big differences between these two? Do we really need to wait a long time for the examination in US?
In the US, how long you have to wait may depend on what you can afford or how good your insurance is. In Canada, everyone has the same access and the same wait time, there is no preferential treatment for the wealthy.
“A report published by Health Canada in 2008 included statistics on self-reported wait times for diagnostic services.[52] The median wait time for diagnostic services such as MRI and CAT scans is two weeks with 89.5% waiting less than 3 months.” (from Wikipedia)
“In the United States, access to health care is primarily determined by whether a person has access to funding to pay for treatment and by the availability of services in the area and by willingness of the provider to deliver service at the price set by the insurer. In Canada the wait time is set according the availability of services in the area and by the relative need of the person needing treatment.” (from Wikipedia)
“Indeed, while waiting lists [in Canada] certainly do exist for certain non-emergent procedures, it is not at all clear that the “waiting list crisis” that is so often talked about by the media and opponents of single payer actually exists.”
(from “Waiting Lists in Canada: Reality or Hype?, American Medical Student Association, Prepared by Kao-Ping Chua, AMSA Jack Rutledge Fellow 2005-2006)
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What are the differences between socialized and nationalized medical systems?
In socialized medicine, the government hires the doctors and nurses, and is essentially their employer. In nationalized medicine, money from the government pays the doctors and nurses, but they are not employed by the government.
England has socialized medicine. Canada has a socialized financing system. In both cases, money is raised through progressive (according to income level) taxation, and distributed by the government to cover costs of medical services.
In Canada, doctors operate their own private practice. If they work in a hospital, they are paid by the hospital, which receives a block of funding each year from the government. Hospitals are typically non-profit organizations, and are funded but not operated by the government.
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In Canada, have you found any other negative feedback of having nationalized health care other then high percentage of tax deduction?
Canadians generally love the idea of national health care, and most of them prefer to pay higher taxes to get it. Some Canadians find that they have to wait a while for non-emergency surgery (for example, knee and hip replacements and cataract surgery), and this fact seems to really impress Americans as a negative of the Canadian health care system. The fact is, the wait times in Canada are related to inefficiencies of the system, not to the fact that the system is nationalized. An example of increased efficiency would include having better long term care facilities so that sick elderly people are not using hospital beds for such a long time. A good reference for this topic is “Prescription for Excellence: How Innovation is Saving Canada’s Health Care System” by Michael Rachlis, M.D., available on-line: http://www.michaelrachlis.com/product.pfe.php
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Would nationalized healthcare in the US affect health care providers’ salary?
Nationalized health care would prevent health care providers from charging whatever they want for their services, and from increasing their fees whenever they want. Prices for services would be set by the medical association(s) based on budgets negotiated with the government. Note: It will be the doctors that determine the price of services, not the government. The government just provides the overall funding.
Health care providers in Canada and in the United States are typically in private practice. The idea of the “Second Stage of Medicare” would be to have cooperative community clinics that are “owned” by members of the community who hire doctors on a salary basis. (This currently happens at Group Health in Seattle, which was started as a cooperative in 1949). Salaries would be set by the clinics.
In Canada, doctors’ incomes are not as high as in the United States. However, their income is still considered very high compared to most other professions.
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What do most healthcare providers in Canada think about their health care plan? Is it affecting their salary by having nationalized healthcare?
Health care providers in Canada generally like the health care system. Physicians earn a good living and they aren’t faced with the same administrative hassles that American doctors complain about. When universal health care was first introduced in the province of Saskatchewan, doctors were worried that it would reduce their income. Actually, at first their incomes rose quite a bit, because they were able to collect money for each and every time they treated a patient. Prior to that, there were a lot of patients who couldn’t pay their doctor bills. After a while, the doctors’ incomes leveled off. Over time, the income of doctors in the United States grew larger and larger. There was a time (in the 1990s) when Canadian doctors moved to the US so they could make more money. That trend has not continued.
“The Canadian Institute for Health Information has been tracking doctors’ destinations only since 1992. Since then, between 60 and 70 percent of physicians who emigrate have headed south of the border. In the mid-1990s, the number leaving for the US spiked at about 400 to 500 a year. However, in recent years, this number has declined, with only 169 physicians leaving for the States in 2003; 138 in 2004; and 122 in each of 2005 and 2006. These numbers represent less than half a percent of all doctors working in Canada.”
Source: http://www.washingtonpost.com/blogs/ezra-klein/post/meme-busting-doctors-are-all-leaving-canada-to-practice-in-the-us/2011/06/03/AGVdAuHH_blog.html
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What inspired you to create such a documentary?
I grew up in Canada, and Terry (who is American) and I lived in Canada for 10 years after we got married. Our two children were born in Calgary, Alberta, and so we had first hand experience with the health care system. When we moved to the United States in 1992, I was shocked at the difference in the systems. I was not used to thinking and worrying about what was covered, and living in fear that a health care issue or accident could be financially devastating. I had never before had to think of health care as something that cost money.
At about that time, we were hearing a lot of (derogatory) stories about Canada’s health care system. That was around the time when Hillary Clinton was trying to make changes in US Health Care, and apparently there was a lot of opposition. Terry and I could not understand where all these stories came from, because they certainly did not reflect our experience in Canada, which had been very positive.
I completed a college program in Advanced Track Video/TV Production in 2004, and had produced a number of educational videos and television programs. In the fall of 2009, Terry and I found ourselves saying “Someone should make a documentary about Canadian Health Care for Americans.” Then we realized that this someone was us!
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What do you think of President Obama’s healthcare bill? What do you think are the disadvantages and advantages of the bill?
We think that President Obama was not able to create the kind of health care reform that he really wanted to implement. The idea of a public option, where people have the option to pay into a government fund instead of paying an insurance company to get health care coverage, was not included in the discussion. The health insurance companies felt that this kind of option would mean the government would be in competition with them, and as a result, this idea was not pursued. The idea of having a single payer system in the United States was also not discussed.
As a result, the healthcare bill that was passed was limited in its scope. Even so, it was a tremendous victory for Americans because of some of its important provisions: it limits insurance companies from refusing to treat children because of a pre-existing condition; it allows young adults to stay on their parent’s insurance plans until the age of 26, and it requires insurance companies to cover preventive health services. It also stipulates that in the year 2014, insurance companies may no longer refuse service to adults with pre-existing conditions.
Since the passing of the bill, we have personally already seen a huge increase in premiums charged by our health insurance company. Cost of health care is continuing to rise, and in our opinion it is not sustainable, or even moral.
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Do you think the US Affordable Care Act is similar to the healthcare system presently used in Canada?
No. The healthcare bill that was passed in the United States “enshrines the insurance companies” (in the words of Dr. Michael Rachlis when we interviewed him on March 30, 2010). The bill will soon require every American to buy insurance from a private insurance company (remember, there is no public or government option). This is a great boon for insurance companies, who will gain a lot of customers, especially from the healthy base of young adults. There are many Americans who are opposed to the government “forcing” everyone to buy health insurance, so there is some question as to whether this mandate requiring everyone to buy it will be enforced or sustained.
In Canada, there are no private health insurance companies for medically necessary services, and in fact it is illegal to offer such insurance. All medically necessary services are paid for by the government. (There is supplemental insurance for services not covered by the health care system such as dental services and medication).
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The movie solely focused on the positives about Canada Healthcare – it seem pretty biased. What are some complaints Canadians have about Canada’s Healthcare system?
You are right, the movie is biased. Our intention was to counterbalance some of the negative propaganda about Canada’s national health care system that has been prevalent in the United States for decades.
That said, it is pretty clear that Canadians generally love their health care system:
On November 4, 2009, the Institute for Research on Public Policy (Canada) issued a news release entitled “90% of Canadians support public health care.”
Canadians do have a lot of complaints about their health care system. They don’t like having to wait for (non-emergency) diagnostic procedures and surgeries. They don’t like it when they have difficulty finding a primary care physician, because, like in the United States, most doctors want to be specialists so they can get higher rates of pay than primary care physicians. They don’t like it when inefficiencies cause inconvenience or even medical mistakes.
But Canadians know their health care system belongs to them. Rich or poor, if they voice a complaint, especially collectively, their complaint has to be addressed. For example, recently measures have been taken which have successfully reduced wait times for a number of procedures.
Health care is a hot issue in Canada. In politics, among the public, and even (now) among medical practitioners, almost no one is opposed to national health care. In fact, Canadian politicians have said it would be “political suicide” to speak out against universal, comprehensive health care. The reason it’s a hot issue is because some politicians and private companies are wanting to offer medical services for a fee to those who can afford it, so they can get it sooner (this is called a two tiered system). In the film, Tommy Douglas explained why this would not be a good idea. (The rich would get great services, and other people would take what’s left).
Consider the possibility that the reason the movie focused on the positives in Canada is because there are so many of them.
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Why doesn’t the US adopt the Canadian system?
As the documentary points out, here are the reasons why the US does not have national health care:
a) Because the American public has been “hoodwinked” or duped into complacency. They don’t want “socialized medicine”, they don’t want government interference, they don’t ask questions about the Canadian system, and they don’t know anything about it except that people have to wait a long time for care and they don’t want that – so that’s the end of the conversation. It is our observation that most Americans know very little if anything about Canadian health care. (Well, okay, several have seen the movie Sicko, by Michael Moore, but that’s about it.)
b) Since the 1950s, insurance companies have moved into the health care industry, cherry-picking healthy customers – those who are employed – and attracting the business of employers by undercutting the prices of doctor sponsored, prepaid health care plans. They are making a LOT of money. The new health care bill passed in March of 2010 gives them even more business, because now all the healthy young adults who are going without health insurance will be required by law to buy it from these companies! This is a windfall for the health insurance industry. Why adopt a different system?
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What are some of the factors we would undergo if we had universal health care in the US?
• No more bankruptcy from medical bills.
• No more deaths because of not having insurance.
• No more uninsured people.
• No more denial of medical and health care services for any reason.
• No cost to employers of providing health care insurance,
• saving small businesses thousands of dollars a month.
• No more people tied to jobs they hate because they are afraid of losing
• their health insurance.
• No more chronic worry and stress, or fear that an illness or accident could
• financially ruin one’s family.
• Peace of mind.
• Taking care of one another.
Need I say more?
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What are some other places in the world that have universal health care?
Thirty-two of the thirty-three developed nations have universal health care, with the United States being the lone exception.
Norway, New Zealand, Japan, Germany, Belgium, United Kingdom, Kuwait, Sweden, Bahrain, Brunei, Canada, Netherlands, Austria, United Arab Emirates, Finland, Slovenia, Denmark, Luxembourg, France, Australia, Ireland, Italy, Portugal, Cyprus, Greece, Spain, South Korea, Iceland, Singapore, Switzerland, Israel. Also Brazil. South Africa plans to unveil universal health care in 2012.
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Re: undocumented immigrants –
Are they covered under the healthcare bill as well?
Illegal immigrants in Canada are not eligible for having their health care paid for by the government. They would be responsible for medical costs.
There are many Canadians who feel that undocumented immigrants should also be given free health care. As it stands, the health care system is available to legal residents of Canada who have lived there for three months or more.
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Do you think the United States would ever adopt a universal health system like the one in Canada?
We wish we could know the answer to this question. The US is the only developed country without universal healthcare, which leads to many personal and financial tragedies for Americans. Yet the powers that keep the current system in place (profiteering and propaganda) have a strong hold.
Yes, we think eventually it will happen. What it will take is a strong demand from the people of the United States. It may happen when one state at a time begins to adopt a universal health care plan. It looks like this may start in Vermont. Also Montana is now considering having a health care plan like the one that was started in Saskatchewan in the 1960s. California has placed a single payer proposal before the government on several occasions, and it has not been passed. Oregon has a lot of universal health care advocates and activists in general.
When people’s eyes are opened, and they awaken from the fog of ancient and contemporary publicity campaigns designed to keep them asleep, then maybe things will begin to change. We think it is up to the people.
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One of the questions that has come up at our screenings is the cost of medical school in Canada. Do Canadians leave medical school in debt the way Americans do?