Politics of each country
More imaginative solutions in both countries have come from the sub-national level.
Canada
In Canada, the right-wing and now defunct Reform Party and its successor, the Conservative Party of Canada considered increasing the role of the private sector in the Canadian health care system. Public backlash caused these plans to be abandoned, and the current minority Conservative government has re-affirmed its commitment to universal public medicine.
In Canada, it was Alberta under the Conservative government that has experimented most with increasing the role of the private sector in health care. Measures have included the introduction of private clinics that are allowed to bill patients for some of the cost of a procedure. After the 2005 Supreme Court of Canada ruling that the Quebec government cannot prevent people from paying for private insurance for healthcare procedures covered under medicare, private healthcare in Quebec began to grow rapidly.[citation needed]
United States
In the U.S., President Bill Clinton attempted a significant restructuring of health care, but the effort collapsed under public pressure against it. The 2000 U.S. election saw prescription drugs become a central issue, although the system did not fundamentally change. In the 2004 U.S. election health care proved to be an important issue to some voters, though not a primary one.
In 2006, Massachusetts adopted a plan that vastly reduced the number of uninsured making it the state with the lowest percentage of non-insured residents in the union. It requires everyone to buy insurance and subsidizes insurance costs for lower income people on a sliding scale. Some have claimed that the state's program is unaffordable, which the state itself says is "a commonly repeated myth".[138] In 2009, in a minor amendment, the plan did eliminate dental, hospice and skilled nursing care for certain categories of non citizens covering 30,000 people (victims of human trafficking and domestic violence, applicants for asylum and refugees) who do pay taxes. [139] [140]
In July 2009, Connecticut passed into law a plan called SustiNet, with the goal of achieving health-care coverage of 98% of its residents by 2014.[141]
Private care
The Canada Health Act of 1984 "does not directly bar private delivery or private insurance for publicly insured services," but provides financial disincentives for doing so. "Although there are laws prohibiting or curtailing private health care in some provinces, they can be changed," according to a report in the New England Journal of Medicine.[142] Governments attempt to control health care costs by being the sole purchasers and thus they do not allow private patients to bid up prices.[citation needed] Those with non-emergency illnesses such as cancer cannot pay out of pocket for time-sensitive surgeries and must wait their turn on waiting lists. According to the Canadian Supreme Court in its 2005 ruling in Chaoulli v. Quebec, waiting list delays "increase the patient’s risk of mortality or the risk that his or her injuries will become irreparable."[143] The ruling found that a Quebec provincial ban on private health insurance was unlawful, because it was contrary to Quebec's own legislative act, the 1975 Charter of Human Rights and Freedoms.[144][145]
Consumer-driven health care
Republicans in the U.S. have enacted laws to promote consumer driven health care. By that they mean Health Savings Accounts (HSAs), which were created by the Medicare bill signed by President Bush on December 8, 2003. HSAs are designed to provide tax incentives for individuals to save for future qualified medical and retiree health expenses; the money placed in such accounts is tax-free. To qualify for these tax-deferred accounts, individuals must carry a High Deductible Health Plan (HDHP). The higher deductible shifts some of the financial responsibility for health care from insurance providers to the individual consumer. This shift towards a market-based system with greater individual responsibility may increase the differences between the U.S. and Canadian systems. Some economists who have studied various proposals for universal health care are concerned that the main effect of the consumer driven healthcare movement will be to reduce the social redistributive effects of insurance that pools high-risk and low-risk people together
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