Universal Health Care In Canada - The Labor Union and Public Accountability

The system of universal health care in Canada is founded on public trust and accountability. The labor union provides a solid foundation for promoting public accountability in the Canadian health care system by protecting jobs so that workers can always work in the interest of the public even when that conflicts with their employer's interest.
There are three stakeholders in the universal health care system in Canada. In the interest of the Canadian public all three groups must work together to deliver health care services.
These three groups are:
1. The government - the Canadian health care system is funded federally but administered by the each of the thirteen provinces and territories. All funds flow from the federal government, to the provincial government,and then to the employer. All provincial and territorial governments must maintain accountability to the federal government for the way that funds are dispersed and annual reports are necessary to ensure compliance with the Canada Health act.
2. The employer -Regional health boards administer local health care services. They employ people to deliver services to clients and customers who are the members of the community they serve. In smaller provinces and territories the provincial or territorial government may be the employer.
3. The workers - These are the people who provide patient care and services as well as the workers who support those services such as the cleaning staff, food services workers, carpenters, electronic data specialists and others.
Each of the stakeholder groups also has a self interest which could be described as:
1. The government - self interest is often directed only toward fiscal accountability and balancing the budget. Sometimes this means increasing taxes or even decreasing services if funds are limited. In most provinces in Canada governments have passed labor laws that put restrictions on a labor union strike in health care in order to protect the public they serve.
2. The employer - the employer's self interest is to maintain the flow of funds so that services to its customers can be maintained. The employer also has a self interest in maintaining the skills and education of its workforce so it can continue to provide services and meet present and future challenges.
3. The workers - people work in their own self interest. They have families to feed and mortgages to pay. People do not want to work for nothing. They want to feel valued and know that they are making a contribution to their organization and their own community.
All three of these stakeholder groups work in their own interest, but in order to provide health care in Canada they must all work together in the public interest. Therefore there has to be a strong public accountability framework that supports the Canadian health care system, because self interest and public interest are not always compatible.
It is only when the parties work together in the public interest that health care can be delivered in the way that the Canada Health Act requires.
Labor Union in Universal Health Care in Canada
The labor union provides a necessary foundation for the public accountability required within the Canadian health care system and this becomes especially important when the interests of the stakeholder parties are in conflict.
It is quite reasonable for an employer to direct an employee in their work and this is accepted within the labor union movement in Canada. However, it is not accepted that an employer can direct an employee to perform their work below an acceptable standard. In other words an employer cannot direct an employee to be a bad employee and do poor quality work.
Employers in the public sector in Canada know that labor unions must work to protect the social and economic welfare of members and therefore, they are aware that the public interest can only be served when employees and employers work together in a common interest. In universal health care in Canada that common interest is the public interest.
With labor unions protecting jobs, workers know they can work in the public interest and still fulfill their own self interests because they have confidence that there are mechanisms in place to resolve conflict and that employers cannot arbitrarily change the nature of their working conditions.

Why the Current American Does Not Work and Why It Should Be Changed

The preference for minimal government oversight and ideas of individualism are responsible for the way American health care system is structured. However, access to health insurance and health care has been a pressing issue in this nation for a long time; rated by the WHO as one of the worst among industrialized countries, the United States' health care system is too costly and fails to cover everybody. Despite president Obama's attempt to bring about change, many continue to question the effectiveness of the Patient Protection and Affordable Care Act the concerning both costs and overall coverage. The issues regarding health care reform directly affect the feasibility of the American Dream because adequate health care and insurance are necessary to full citizen participation and it is the government's responsibility to provide access. I believe that given this nation's strong anti-statist values it will be difficult to implement a federal health care policy; therefore it is more feasible for states to create health reforms like the one in Massachusetts and ensure universal health care.

In 2007, the US health system presented many problems concerning the amount of people who were both uninsured and underinsured and the fast rise of insurance premiums causing many Americans to report debts and problems due to medical bills (Commonwealth Fund Commission, 232). The cost of American health care is inarguably one of the major setbacks of the system; it is the highest amongst those of other industrialized nations but not necessarily more effective. For instance, a case study in the town of McAllen, Texas, shows how the overuse of medicine and the "fee for service" incentives available to doctors can really drive up the cost of medicine. McAllen is one of the most expensive health care markets in the country where most doctors focus less on preventive care and more on running extra tests, services and procedures out of fear of malpractice, influenced by differences in training, or simply to make a few extra dollars. (Gawande, 340-342). Although the situation in McAllen might be an extreme example, it does not fail to explain how the "culture of money" partly affects the cost of health care system. Unlike systems such as Canada and Japan, the American government plays a minimal role in bargaining down prices or setting price standards, this lack of control allows doctors and medical institutions to often purchase the latest technology, but not the most efficient (Klein, 256). Nevertheless, doctors are not to be labeled as the villains because private insurance companies add to the problem by expending a quarter and a third of their revenues on administrative costs (Weissert and Weissert, 350).

The high number of uninsured Americans (45 million in 2007), is another disconcerting fact regarding the downfalls of the American health care system; it is unfortunate that in an industrialized nation, once considered the most powerful in the world, people are often forced to put their career dreams on hold in order to gain access to employer based insurance. This has a negative impact on the nation's economic and political development because people who could create the latest technological innovations are "locked" at Wal-marts and the likes. Low income uninsured families like Greg and Loretta, who struggle to keep their children healthy, lose all faith in the American dream and essentially become a burden for the rest of society. Some argue that good health is a personal responsibility, and yes eating a burger everyday will obviously have negative impacts on a person's health and they should be held accountable for those poor choices. Consequently, some would blame Greg and Loretta for their unfortunate condition, but the question is; how can their children be expected to become productive citizens if they lack basic health care? The American Dream encourages individualism, but individuals cannot perform to the best of their abilities if they lack the necessary tools to do so.

In 2006, the state of Massachusetts passed an "ambitious" health care reform that improved access to care and lowered the rate of uninsured working age adults; in spite of its high costs, this plan exemplifies how reforms at the state level can perhaps be easier to implement and regulate, consequently having successful results. The plan is essentially composed of three parts: expansion of the state's Medicaid progress (establishing income-related subsidies), creating new private insurance plan open to individuals, and lastly it requires that both individuals and employers participate in the health insurance system or pay a fine. Furthermore, it provides individuals with the alternative to buy from private insurers if they do not have access through an employer (Long, 321). Mixing public and private markets achieves near-universal and gives citizens options.

Two of the most important elements of this reform are the certainty of having access to coverage in the case of unexpected unemployment and not having to worry about rejection due to pre-existing conditions (Kaiser Family Foundation, 325). The economic downturn has and continues to hurt many families, many jobs are uncertain and health insurance is no longer secure, therefore by making sure citizens continue to have access to health coverage, the state of Massachusetts is essentially contributing to the overall development of the nation's economy. When people are not worried about paying astronomical medical bills, they have more time and money to spend on purchasing houses, cars, etc which ultimately results in consumerism and more profits. Lastly, the Massachusetts provides citizens with high quality care that allows them to make regular doctor visits and access specialists, tests and medications as needed (Kaiser Family Foundation, 328). This approach is similar to the preventive care practiced in countries like Great Britain; essentially it is more beneficial for both the doctor and the patient to treat any conditions before they get out of hand.

Although the Massachusetts health care reform has proved to make significant improvements, like any other reform it has its downsides which may lead people to focus on the inequities and overlook the success. For instance many Massachusetts residents believe that more education about key aspects of the health reform would help better understand how the programs work. Residents are specifically interested in income limits to qualify and how to apply for coverage (Kaiser Family Foundation, 331). It is expected that citizens have questions about newly implemented programs and that they may not understand specific medical, political or economic jargon, but this is not a major concern because education can be easily provided. On the other hand, some would argue that the high cost of this plan is indeed a significant problem which must be addressed; nevertheless Massachusetts legislators are aware of the cost and are working to stabilize the finances. Firstly, they want a new payment of method that rewards prevention and effective control of chronic disease instead of paying according to the quantity of care provided. Secondly, the commission is looking to reimburse physicians for episodes of care rather than individual visits. Health experts agree that if Massachusetts is able to implement this changes, it will be as "audacious an achievement as universal healthcare" (Sack, 334-336).

Today, the future of president Obama's Patient Protection and Affordable Care Act is somewhat uncertain. Republicans want to repeal it and skeptics argue that it is not going to solve the existing problems. Although this reform promises desirable aspects like overall coverage and cost reductions, the results are solely based on projection, making it difficult to guarantee that it is going to be successful. The Massachusetts health care plan has already been implemented and proved to create significant improvement. Essentially this model presents an effective alternative for health care reform and it celebrates the values of anti-statism by allowing states to make their own decisions.