Why are Canada and US outliers on health care?

[mileslunn]

For health care, norm in most of developed world is you have a universal system available to all at little or no cost which US lacks.  By same token it is not illegal for those who wish to pay to do so, which Canada is only industrialized country to ban.  Any reason why two take extreme approaches and not the middle in between?  I can see US with few of exceptionalism and more libertarian culture maybe even though health system a disaster.  But Canada while big on equity and idea health should be on need not ability to pay, I don't think that is any more important to Canadians than it is to most Europeans who have universal access like Canada (and often cover a lot more) but allow those who wish to pay to do so.

[Upper Canada Tory]

I guess the simplistic (but still accurate) answer is you have ideologues on both sides of the border who don't want to take flexible and innovative approaches to solving healthcare related issues.

With that said, with the Canadian system, another factor is that our system functions with and creates a lot of weird incentives. The Canadian system doesn't cover as many services as European systems do. For example, most European systems have universal coverage for pharmacare, but in many Canadian provinces pharmacare isn't covered, and when it is, it often isn't completely covered (eg, in Ontario, universal coverage for pharmacare is only covered up until age 25). One somewhat legitimate fear is that introducing private delivery options could reduce the incentive for covering things that are considered medically necessary, since so much still isn't covered. If we had a system more like European countries where virtually any healthcare-related service is covered, the argument for private delivery options would be much stronger. Another likely concern is how the Canada Health Act would work if private delivery were allowed to occur for things meant to be covered without transfers being taken away from provinces. If private delivery were allowed for medically necessary stuff, transfers would essentially be unconditional, which could create an incentive to completely dismantle single payer.

Basically, I still think the core issue is ideologues on both sides of the border, as most of these issues could likely be fixed if the ideology were tossed aside, but also because the Canadian health care system is organized in a strange and unusual way.

[mileslunn]

I think with Canada, unfamiliarity with other systems as well as it being a distinguishing future separating us from US means many treat it like a national religion and take a black and white approach.  And you are right European countries do tend to cover a lot more than Canada, but due to how our politics is largely ideological type who want to expand coverage on left generally oppose private options while type on right who want private options are generally opposed to expanded coverage.  No one really has made case of universal pharmacare and dental care but in exchange allow a parallel private system for basic health care.  It would mean leaning right on one side and left on another and it seems in Canada nowadays party bases who choose leaders hate those who are left wing on some issues and right wing on others and prefer purity.  Reason Tories haven't touched this is probably more fear of electoral loss than opposition to parallel private system.  Types of Liberals in past who would have been open to it generally aren't welcome as those would be more your business type Liberals which party lacks.

For United States, also ignorance plays big role.  But another I think is taxes and military spending.  For a universal health care system, US would either have to increase taxes or dramatically cut military spending and I don't think public is interested in either.  Really the time for US to develop a universal system was under FDR's New Deal to Lyndon Johnson's Great Society.  As US moved right under Reagan revolution and population got older making it more expensive, that made developing such system a lot harder.