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Two-tier health care
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Two-tier health care

Two-tier health care is a form of national health care system that is used in almost every developed country. It is a system where there is guaranteed health care provided by the government to the entire population, but where a private system operates in parallel. The private system has the benefit of shorter waiting times and more luxurious treatment, but costs far more than the public one. Thus their are two-tiers of health care, one for the majority and another for those who are wealthy enough to pay for better care.

The term is most often used in Canadian health discussions. Unlike the vast majority of countries Canada does not have a parallel system, free market health care being wholly banned. The term is generally used as a pejoratively description for how the right wing would want to alter Canada's healthcare system.

The phrase is also sometimes used in other countries and among health care experts. In Europe it often has the same meaning as in the Canadian context, but is used there used to describe the status quo. However, sometimes it has a somewhat different meaning relating to the expansion of private sector involvement through voucher programs or other initiatives.

The debate over two-tier health care has long been a central one in Canada. Moving to such a system is supported by conservative think tanks such as the Fraser Institute. The potential for vast profits has created a strong lobby in the health industry, which is today confined to the periphery.

The proponents of two-tier system argue that it would introduce more flexibility into the system, reducing wait lists and that competition from the private sector would make the public one more efficient. Opponents argue that a two-tier system would tend to draw many of the best doctors out of the public system, reducing the overall level of care. The Canada Health Act is also committed not only access to health care to all, but access to the best health care available for all. Many on the left consider access to the best possible care an important right of all citizens. Competition from the private sector would also almost certainly drive up the wages of doctors and other medical professionals in the entire system.

Many two-tier systems do attempt to resolve these difficulties. Australia, for instance, requires all doctors to work some of their time in the public system. However, if care is not superior in the private system no one would use it so a certain imbalance between the care received by the rich and the poor exists in all two-tier systems.

In part because of these issues, but also due to the belief that anything making Canada more like the United States is undesirable, the Canadian people are overwhelmingly opposed to the notion of two-tier health care. Alleging secret support for two-tier health care a common method of attacking Canada’s right-wing parties, and one that has been very successful, especially in the last two elections.

Some argue that even Canada does have a two-tier health care system as the very wealthy can go to the United States for treatment, and quite a few Canadians do each year.

See also: Canadian and American health care systems compared, health care system