A worker starts a new job and studies the benefits package, calculating what health services will be covered and which will require out-of-pocket payment. Dental is covered; vision has a cap; prescriptions have a deductible. A self-employed person purchases private health insurance, the premiums significant but the alternative - being uninsured for services outside medicare - unacceptable. A retiree loses employer benefits and discovers that many services she took for granted now require payment. A low-income person forgoes medication because the cost exceeds what she can afford and no insurance covers her. A traveler reviews their travel insurance policy, uncertain what would be covered if illness struck abroad. A family weighs whether to purchase supplementary insurance, the costs balanced against the risks of uncovered expenses. Health insurance and coverage, the patchwork of public and private arrangements that determine who pays for healthcare, shapes access and financial security. How coverage is structured determines whether care is available and affordable.
The Case for Expanded Public Coverage
Advocates argue that public health coverage should expand. From this view, gaps in medicare should be filled.
Medicare is incomplete. Prescription drugs, dental care, vision care, and mental health services often fall outside public coverage. These exclusions are arbitrary - dental problems are health problems. Coverage should be comprehensive.
Private insurance creates inequity. Those with employer benefits have coverage; those without do not. Coverage should not depend on employment status. Universal public coverage ensures equity.
Administrative costs are lower with public insurance. Multiple private insurers each have overhead costs. Single-payer systems are more efficient. Public coverage is cost-effective.
From this perspective, public health coverage should expand to include prescription drugs, dental, vision, and other services currently excluded from medicare.
The Case for Mixed Public-Private System
Others argue that mixed public-private coverage works. From this view, private insurance has appropriate role.
Private insurance provides choice. Different people have different needs. Private insurance allows tailored coverage. Choice has value.
Employer benefits are widespread. Most working Canadians have employer-provided health benefits. The current system works for many.
Public resources are limited. Expanding public coverage requires significant funding. Private insurance reduces demands on public purse. Mixed systems may be fiscally sustainable where purely public systems might not be.
From this perspective, mixed public-private coverage appropriately balances public provision with private options.
The Pharmacare Question
Prescription drug coverage is major gap in public insurance.
From one view, national pharmacare should be implemented. Prescription drugs are essential healthcare. Coverage varies by province and insurance status. Universal public pharmacare would ensure access and bargaining power.
From another view, existing coverage works for most. Disrupting employer plans and provincial programs for universal pharmacare may not be beneficial. Targeted coverage for the uninsured may be more practical.
How pharmacare develops shapes drug coverage.
The Dental Coverage Gap
Dental care is largely excluded from public insurance.
From one perspective, dental care should be publicly covered. Oral health affects overall health. Dental exclusion from medicare was historical accident. Universal dental coverage is overdue.
From another perspective, adding dental coverage to public insurance is costly. The federal dental care program is a targeted approach. Universal coverage may not be necessary if gaps are addressed for those without private insurance.
How dental coverage evolves shapes oral health access.
The Travel Insurance
Coverage when traveling affects Canadians abroad.
From one view, provincial coverage for out-of-country care is limited. Canadians should understand they need travel insurance. Public education about coverage limits is needed.
From another view, travel insurance is available and affordable. This is not a public policy issue. Individuals should purchase appropriate coverage.
How travel coverage is understood shapes traveler preparation.
The Coverage Portability
Coverage when moving between provinces can be interrupted.
From one perspective, waiting periods for coverage when moving provinces are problematic. No Canadian should be without coverage due to relocation. Portability should be seamless.
From another perspective, provincial insurance systems require residency verification. Some waiting period may be necessary. Existing arrangements generally work.
How interprovincial coverage works shapes mobility.
The Canadian Context
Canadian health coverage is a patchwork. Medicare covers hospital and physician services universally. Prescription drugs, dental, vision, and other services have varied coverage - some provincial programs, employer benefits for many, out-of-pocket for others. Federal dental program is expanding coverage for some. Pharmacare debates continue. Travel coverage is limited. Private insurance supplements public coverage for many. The uninsured face gaps. Coverage adequacy varies by employment, income, and province.
From one perspective, Canada should expand public coverage to make healthcare truly universal.
From another perspective, mixed public-private system with targeted gap-filling is appropriate approach.
How health coverage evolves shapes healthcare access and financial protection.
The Question
If medicare is incomplete, if private insurance creates inequity, if gaps harm those without coverage - why has universal coverage remained aspirational? When someone forgoes needed care because insurance doesn't cover it, what has medicare failed to provide? When coverage depends on employment status, what happens to those without employer benefits? When we speak of universal healthcare, which services are universal and which are not? When prescriptions and dental care are excluded, what logic justifies the exclusion? When we compare ourselves to countries with more comprehensive coverage, what explains the difference? And when someone asks whether they're covered, what should the answer be?