By: Cassidy Henry
With this recent NPR article on “What China Can Teach The World About Successful Health Care,” it might be more interesting to look at two capitalistic countries and the lessons learned from them. Both Canada and Russia have universal coverage for their citizens. In these two countries, while initially appearing similar, political culture and institutions affected the outcome of healthcare for their citizens.
|Who can provide medical care?||Only government can provide basic health services||Public or private, but 4 major polyclinics in Moscow can’t accept the health insurance required by the state.|
|Profit based?||strongly disagree “that the profit motive has no place in Canadian health care; it is ‘both inconsistent with a view of health as a public good and moreover leads to high administrative costs and inequities in access and quality.”||Profit motivated|
|Who pays for the services?||The provincial government, minus a small co-pay||Private insurance market that receives funds from the provincial government to pay for care of patients in public hospitals.|
|Who chooses the doctor?||Patients choose their doctor and care facility||Patients choose their doctor and care facility|
|Patient payments?||a small co-payment, which the government tries to keep down after they pay the deductible.||services are guaranteed to be free, but patients often have to make under the table payments to receive services|
Canadian Benefits and Weaknesses
The biggest benefit of the Canadian policy is that its citizens receive quality healthcare at the most affordable prices that are available to the Canadian government. Prices are not free for consumption because that would raise the level of service demands so high that the Canadian system would not be able to cover all healthcare demands. There is a large negative effect for the Canadian government, in that they have to maintain an extensive healthcare bureaucracy. When the provinces have to devote much time and energy to maintaining the healthcare system, rather than let it be managed by external sources, it takes away the money that they could devote to other social services, such as maintaining security, roads, government buildings, etc.
Russian Benefits and Weakness
The negative effect for Canada is the benefit to Russia. By basing their healthcare system through a private insurance market (and possibly private polyclinics) Russia does not have the problems of maintaining the healthcare system, and thus diverting resources from other services provided by the state. In Russia, there exists a black market which artificially raises the prices that consumers have to pay. However, the Russian people suffered (and still suffer) from the mass transition to a market based system from the Soviet system overnight, which has caused problems in both coverage and availability.
Comparing the policies of Canada and Russia is an experiment in how much political culture, which is the commonly held beliefs, feelings and values that influence politics in a country, can affect public policy. Canada has always been a democracy, or ruled by democratic leaning leaders from afar. Also, no single catastrophic event (like revolution) led to the formation of the Canadian state. These factors have led to a political culture in which individuals have rights, things are done democratically, and there is an emphasis on community rights. Canada is a very corporatist society (where society is thought of as groups, for example: builders, Catholics, French) as can be seen in their use of consociational methods, which are “broad consultation and bargaining among elites representing the most important groups in a society,” (Weaver) to solve their governmental problems. The main problem that Canada had was how to incorporate everyone into the governmental process to amend their constitution.
The rugged individualism and collective ideals of the Canadian people, supplemented by the governmental organization, have created a system in which the citizens are the most important people. A system of this sort has created a healthcare arrangement where people are guaranteed free health care, just because they deserve it. That people receive something just for being “the people,” is a form of democracy. Anthony Arblaster, renowned political scholar, states “At the root of all definitions of democracy…lies the idea of popular power, of a situation in which power, and perhaps authority too, rests with the people.” By creating a system that is responsive to the people, their interest is more likely to be honoured.
The political culture of Russia, authoritarian and formerly communist, tinged the expectations of the Russian citizens of their new healthcare system. They expected the same level of health services provided by the Soviet State to be provided by the Russian state; when these services were not provided, the political system had fallen apart and was unable to provide answers to the citizen’s questions about their failure. Most citizens are just required to pay for services under the table. This mirrors the authors own experience at a polyclinic- the payment machines were broken and she paid the doctor in tea and chocolate. The market based system is what caused this problem, along with the lack of clearly delineated responsibility in the Russian government. The Russian state builders thought that since they had created the foundation of capitalism, all of the good that comes from capitalism was to follow.[i] Since the political culture at the time was to just ignore the 74 year communist period, as if it was not important, the new state builders did not learn any lessons from previous state builders. Citizen’s health was not the objective of the Russian law makers, free market systems were. In other words, in the Canadian system the people were first, in the Russian system the market was first.
The make-up of each of the political and institutional structures of Canada and Russia influenced their eventual outcomes in creating a national healthcare system. Both countries wanted to make their healthcare system universal. Russia also wanted to make the system free of charge, for most services. Canada did not, but they wanted to keep the prices as low as possible. However, Canada has a functioning democracy, in the form of a constitutional monarchy that, while de-centralized, allows for a safe guarding of the citizens interests. Russia does not a have a well-functioning democracy that, while centralized, allows for the health of the population. Many of the problems of the Russian system can be traced back to the way that it was formed, and thus the atmosphere of when it was formed- when they were creating the whole state. The atmosphere of 1993 was in rejection of everything Soviet. When Canada was creating their system, the major problems of regional autonomy and nation building were solved, for the time being. This allowed the Canadian Health Forum to create the best system that they could, without politics playing a large role, with their best ideas. When transitioning from one system of government to another, one must leave some issues aside. Canada was able to do this when creating their healthcare system, because they had already solved the other issues. Russia was unable, because they were in the midst of solving all of the issues of a transition. So many issues were on the table that many of them didn’t receive the time that they deserved to be properly formatted, and healthcare was one of them.
People support their governments because the government helps its citizens attain something, be it security, some degree of predictability, or freedoms. The Canadian system provides healthcare to its citizens, so they have no incentive to complain (about healthcare). The Russian system is providing a degree of stability, which the people value highly. They value that more than healthcare, so they do not question the current system of healthcare. In general, a system that has a better foundation in popular democracy is more likely to respond to its citizens and create programs that benefit the citizen, even if it is at the expense of the state.
Quotes from this blog are taken the following sources:
Cassidy Henry is a Master’s Candidate at the Patterson School studying Diplomacy and National Security. Her focus is on Eastern Europe/Russia, where she has spent 19 months living and studying. Cassidy is currently looking for an entry level career position and can be contacted at www.linkedin.com/in/cassidyhenry