Thanks for your question. First of all, Canada does not have completely u201cfree healthcare,u201d (we u201cpayu201d indirectly through our income taxes, of course, among other sources) nor do we have u201csocialized healthcareu201d like the U.K. Our universal healthcare is more like a nationwide group insurance policy that benefits from huge economies of scale and the efficient use of resources that follows from a more planned, centralized approach, and our doctors are not employed by the government. They have their private practices or are employed by hospitals, and bill the government per service.Our healthcare is as mentioned partly subsidized by income taxes, and then each province or territory has other means of funding their own system. For example, in Ontario, most alcohol sales are controlled by the Liquor Control Board of Ontario, and their revenue is one of the chief sources of funding for our provincial system (amounting to $2+ billion as of 2017u201318).Each province or territory then receives a transfer payment from the federal government. The provinces have a certain degree of freedom to deliver the services that best suit their needs, but there are limits to this. To receive their federal transfer payment they must adhere to the five core principles set out in the Canada Health Act. These are: Public administration, universality, portability, comprehensiveness, accessibility.Canadau2019s taxes per capita are comparable to U.S. tax rates, by the way, not significantly higher.Costs of drugs are considerably lower, because the provincial governments negotiate directly with drug companies (economies of scale). A nationwide prescription drug plan is planned to roll out in 2022.Canadian hospitals are not public, but 95% are non-profit organizations and are bound by strict budgets.Canadians are guaranteed free care for medically necessary procedures and tests and surgical dentistry. This means that care not deemed necessary by each province may be charged for or involve co-pay.Regular dental care outside of a hospital setting is generally not covered, except for the very young and for seniors, people have private insurance or insurance through work for dental care. (My personal opinion is that the lack of coverage for dental care is a significant flaw in the system, and should be addressed. However, when I needed urgent wisdom tooth surgery twenty years ago, my surgery took place in hospital, under general anesthetic, and therefore the costs were completely covered.)Medications mostly involve a small co-pay, but a doctor can also admit a patient to hospital, in which case the drugs are free. Each province has its own program for medications and list of drugs covered. These programs are usually geared to your income after tax. For example, there are usually different programs for Seniors (65+), people on social welfare, diabetics, those needing expensive drugs (e.g. HIV-related illnesses or palliative care) and even over-the-counter meds if your doctor states they are necessary. Co-pay is often only $2 per prescription. Where there is an exact equivalent generic version of a drug, this is provided as they are normally a lot cheaper. However, if you have had adverse reactions to generics, they will prthe brand name versions.Also letu2019s address the topic of wait times, often given as a reason that Canadau2019s system is u201cbroken.u201dOur system is not broken. One of the ways we keep costs down and are fiscally conservative is by limiting supply of elective and non-essential procedures. Sure Americans might get a hip replacement or MRI scan a bit faster, but with the result that their health care costs are much higher. (Americans also ration healthcare: with high fees. Unfortunately, this amounts to limiting demand, but health care isnu2019t something you can decide not to haveu2024 if you need heart surgery you need heart surgery. No one in Canada will ever go bankrupt because of medical bills, because there essentially arenu2019t any.)We could reduce wait times if that was our primary goal. Itu2019s not.So the answer is: Through efficient use of taxes, by covering only medically necessary procedures and drugs, by rationing supply of non-necessary procedures, by negotiating drug prices at the provincial level and by not running on a for-profit basis, but on a strict budget.No system is perfect, but Iu2019m grateful for my countryu2019s system. I have always received excellent care and canu2019t imagine living without this. Itu2019s part of the Canadian identity, really.
