TORONTO, Canada – It’s a bit of a sport in Canada to watch Americans at war with themselves.

There’s nothing malicious about it: We’re a generally bored and inward-looking bunch, so when our neighbors unleash another full-blown clash over ideology, we’re grateful for the distraction and the front row seat.

Pure entertainment value is part of the attraction — like the congressman who, during a town hall meeting on health care reform, said he refrained from pissing on a protester’s leg for fear of wasting his urine, or Rush Limbaugh huffing and puffing about socialist hordes at the gates.

Laughs aside, the American tendency to treat policy debates as life and death struggles over “the American way of life” reminds many Canadians, rightly or wrongly, of how lucky they are to be living north of the border. It’s hard not to feel civically more evolved when, in some U.S. states, people can legally show up at presidential speeches sporting handguns or assault rifles.

U.S. culture wars, in other words, often reinforce Canada’s national identity.

The latest to have that effect is U.S. President Barack Obama’s attempt to extend health care coverage to the 47 million, mostly working Americans, who can’t afford private medical insurance.

The move has unleashed a ferocious defense of private insurance companies by Americans scandalized at the notion of the government providing its own health insurance as a competing alternative. For Canadians, the debate highlights a key difference between the two countries: In the U.S., health care is a commodity to be bought and sold for profit; in Canada, it’s considered a human right.

Canada’s publicly funded health insurance, known as Medicare, covers all residents. In other words, except for the taxes Canadians pay, the health care they receive is free. They’re also free to choose their family doctor and to get second opinions.

Under the 1984 Canada Health Act, the federal government transfers health funds to provinces — which have constitutional jurisdiction over health care — that meet certain conditions. The conditions include the need for provincial health insurance plans to be administered on a non-profit basis, to cover services provided by hospitals and doctors, to set the rate charged for those services and to maintain coverage when the resident of one province uses the medical services of another.

The federal government enforces the law by withholding funds if the conditions aren’t met. Still, the law leaves plenty of room for private enterprise, despite charges of “socialist” medicine by American opponents.

Canada’s “single-payer” public insurance system covers medically necessary interventions — including visits to the doctor, laboratory tests, surgeries and hospital stays. That accounts for 70 percent of all health expenditures. The rest — including dental work, eye care, cosmetic surgeries, prescription drugs and home care — is covered by private insurance or out-of-pocket expenditures for most Canadians.

A mish-mash of provincial laws makes it difficult for the private medical sector to expand. Some prevent doctors from billing more for services than the rate set by the government, others ban private insurance companies from covering the medically necessary services protected by the Canada Health Act.

But while hospitals are publicly funded, most are privately owned and run by a board of directors or religious institution. The difference with the U.S. is that they’re run on a not-for-profit basis. Stories of insurance companies cutting off customers in the middle of treatment, ostensibly for undisclosed previous conditions, are unheard of in Canada.

As for outcomes, here are some comparative statistics:

•  The World Health Organization, in an assessment of the health care systems of 192 countries in 2000, ranked Canada 30th and the U.S. 37th.
• In 2007, Canada spent 10 percent of its GDP on health care; the U.S. spent 16 percent, according to the Organization for Economic Cooperation and Development (OECD). Per capita, Canada spent $3,895 compared to $7,290 for the U.S. (Makes you wonder who the big spending socialists really are.)
• Thirty-one percent of U.S. health expenditures go towards administrative costs. In Canada, it’s 16.7 percent, according to a study in the New England Journal of Medicine. In 2005, the OECD used a different calculation and arrived at 7.3 percent in the U.S. and 2.6 percent in Canada.
• In 2007, 7 percent of Canadian adults with above average incomes and 18 percent with below average incomes, went without medical care due to costs, according to the OECD. In the U.S., medical costs prevented 25 percent of adults with above average incomes and 52 percent with below average incomes from getting care.
• In 2006, life expectancy was 80.7 years in Canada and 78.1 years in the U.S. Canadians are as likely as Americans to survive heart attacks, breast cancer and childhood leukemia.
• Infant mortality rates in 2006 were five deaths per 1,000 live births in Canada and 6.7 deaths in the U.S.
• Obesity rates among adults are 15 percent in Canada and 34.3 percent in the U.S.
• Sixty-five percent of Canadians view their health care system positively while only 31 percent of Americans view their own system that way, according to a cross-border poll in July by the Angus Reid firm.
• Canada ranked 4th this year as the best place to live in the United Nation’s quality of life index for 182 rated countries. The U.S. ranked 13th.

Canada and the U.S., proportionately, have the same number of acute care hospital beds. The U.S., however, has more doctors per capita, more MRI units and more CT scanners.

The more serious concern in Canada is the length of time it takes to get medically necessary surgery. Since 2000, public anger forced governments to increase funding and make reducing wait times a priority. In Ontario, average wait times for general surgery is 99 days, for breast cancer surgery 33 days, for angioplasty 18 days and for a knee replacement 181 days. Still, pressure to widen the private sector’s role in delivering medical services is increasing. As a result, supporters of Medicare are keeping a close watch on Prime Minister Stephen Harper.

Critics say Harper has done little to defend Medicare in the face of gross misrepresentation of it south of the border. Some even question his commitment to it. In 2001, while head of the National Citizens Coalition, a staunchly conservative lobby group, Harper advised the western province of Alberta, which wanted more private medical care, to break away from the national program and set up an autonomous system.

Polls indicate Harper is on the verge of a majority government if his shaky minority one were to fall soon. If, as some fear, he opens the door to more private health care, American-style culture wars might be coming here.

http://www.globalpost.com/dispatch/canada/091013/canadas-front-row-seats-the-american-war-over-health-care