In order to examine Medicare in Canada, you first have to look at Canada’s overall  medical system. The Canadian health care system has evolved over four and a half decades. Unlike the United States, all hospitals and physician’s services are paid for by the government, and funded by assorted taxes. The United States, on the other hand, has a medical system largely based on private insurance plans. While the government in Canada pays for hospitals and doctors,  the costs of long term care and home care are also paid by private insurers and individuals - a situation very similar to that found in the United States.
    Both Canada and the United States can expect to face tough Medicare - health care choices as the age wave surges.  By 2011, Kiplinger’s newsletter forecasts health care will claim an amazing 12 percent of this country’s gross national product.  By 2030, Medicare will be the primary insurer for one in every four Americans. Unlike America, however, Canada is already beginning to have a public debate about Medicare.
     On a recent trip across Canada, I was fascinated to read and hear Canadians discussing the pros and cons of what Medicare has delivered in return for the enormous sums of money spent on it. Canadian senior citizens presently make up 12.5 percent of the population but consume 42.7 percent of Canada’s total health care expenditures. It seems that the prodigious amounts of money Canada spends on Medicare, hasn’t resulted in its citizens living longer. It only ranks tenth among other countries when it comes to life expectancy. The U.S. ranks fourth.
      People are also talking about the relative lack of high-tech equipment in Canada’s hospitals and emergency rooms. For example, Switzerland, Finland, and Austria have five times more MRIs than Canada.  Also, there aren’t enough Canadian doctors to use the new and expensive equipment. Canada has one of the thinnest inventory of doctors in the developed world with fewer than two doctors for every 1,000 Canadians, Canada ranks 17th out of the top 20 countries.
     The biggest complaint I heard from Canadian citizens who were on Medicare was the waiting lists for routine surgery or diagnostic procedures. Some of the provinces do send patients who need urgent medical services to the U.S.
      Many hospitals in Canada have been closed in an effort to cut costs. This has caused a great deal of hardship for many older Canadians. One of them who complained was told that no Canadian was more than two hours away from a good general hospital with operating rooms. How would Americans react if they were told the nearest hospital was two miles away? I must add that every town has some type of medical clinic, where serious cases can be stabilized and transported. 
     Americans and Canadians who are on Medicare do share one very important  concern: the high cost of drugs. Drug costs were relatively small for Canadians in the early years of Medicare. Now the government is paying a diminishing share of people’s out patient drug bills. Those who are in the hospital, however, get all their drugs free. The result, lots of patients are staying longer in the hospital in order to continue their free drug therapy.   
      Canada is presently discussing two plans to deal with the high costs of drugs. One is a national drug plan for all its citizens. It would be means tested. Benefits would be linked to one’s income. The rationale for the plan is that the government would have more clout dealing with the drug companies. Presently Canada’s 10 provinces each administer different drug plans
     The other drug plan being considered is one that would help pay for catastrophic drug costs for people who would have to give up other basic necessities in order to pay for their medications. 
    Canadian Medicare spending is currently operating in the red. The logical question then is how are officials going to not only make up the shortfall, but also expand drug payments and services such as home health care?
   A few of the suggestions given for making up Canada’s Medicare’s shortfall and improving its services include:
    National health-care-premiums for Medicare. They could either be in the form of  a flat rate or a graduated one that would charge people with higher incomes 
more.  
     A consumption tax on people who use Medicare, similar to the GST tax used by some countries, including Canada.
    Making Medicare a taxable benefit, so at the end of the year individuals would  pay tax on the value of the health services they have received up to a maximum amount.
      In conclusion, I want to say that as our own aging population grows along with increased health care costs, Medicare reform must take place. If we want to add other Medicare benefits, such as prescription drugs, we should certainly look at what other countries such as Canada are doing. We need to have a national debate on how Medicare is going to operate in the 21st century. Equally important, this debate must be fueled by facts - not emotions.