If the Democratic debate on Tuesday night proved anything, it’s that Medicare for All, Vermont Senator Bernie Sanders’ proposal for single-payer healthcare in the United States, is dominating the intra-party debate on how to move the U.S. healthcare system forward. In the midst of a heated exchange on the subject with former Maryland Representative John Delaney, Sanders defended his tentpole healthcare policy by pointing to a close neighbor of the U.S.
“Five minutes away from here, John, is a country. It’s called Canada,” Sanders said. “They guarantee healthcare to every man, woman and child as a human right. They spend half of what we spend. And by the way, when you end up in a hospital in Canada you come out with no bill at all.”
U.S. conservatives, on the other hand, claim the U.S. has the best healthcare in the world and have long criticized Canada’s system. In an article for National Review, Candice Malcolm wrote about “The pitfalls of single-payer healthcare,” calling Canada’s quality of care “poor” and pointing to long waits for care as an example of the system’s failure.
The truth about Canadian healthcare is a little more complex. To start, it’s important to understand what the Canadian system does differently than the United States. For one thing, Canada’s Medicare program is not a government takeover of healthcare, but instead, a public insurance plan that pays private doctors and hospitals for their services. All Canadians are covered under the program which guarantees basic healthcare with no out of pocket cost at the point of service. In other words, when Canadians go to the doctor, there’s no bill to pay when they walk out the door. Instead, Canadian Medicare is paid for through a payroll tax.
Malcolm describes the Canadian healthcare system as “failing,” but in truth, it outperforms healthcare in the United States in numerous ways. Unlike Medicare in Canada which covers everyone, the U.S. amalgamation of private and public insurance programs leaves some 44 million Americans uninsured, according to the Kaiser Family Foundation. One study published in the American Journal of Public Health found the number of people who die each year due to a lack of insurance in the U.S. is nearly 45,000.
“Everybody is covered to the extent that ‘medically necessary’ services are funded and provided insurance by our provinces and territories,” Professor of Emergency and Family Medicine at Queen’s University David Walker told The Globe Post. “We can debate what is medically necessary, but whether you need a knee replacement or a liver transplant or a vaccination you are covered.”
Janni Aragon, Political Scientist and Director of the Technology and Society Program at the University of Victoria, moved from California to Canada 15 years ago and told The Globe Post she’s thankful for Canadian healthcare and that her family would have gone bankrupt if she were still living in the U.S. when her husband fell ill.
“Frankly even in my own household, we had a serious scare seven years ago,” Aragon said. “I thought I was going to lose my husband and he was in the hospital for almost two weeks. I do believe in the U.S. this would have bankrupted us. His treatment probably was close to two million dollars. He was in ICU for 24 hours and the hospital for almost two weeks overall. To this day he’s taking medicine to stay healthy. We did the math and within six months it probably would have bankrupted us. We didn’t get a bill and so I was quite thankful for the Canadian health care system.”
On Fox Business, Jonas Max Ferris claimed doctors in other countries are underpaid compared to the U.S., but Walker pushed back against this idea and also pointed out that more doctors are coming to work in Canada than leaving for the U.S.
“Physicians earn well here probably as well as anywhere in the world,” Walker said. “So the average physician in my province earns $385,000 a year and that was four years ago. So the latest figures are probably up to about $400,000 Canadian dollars a year. In terms of migration for the last four years, there’s been a net migration of doctors to Canada from the States.”
Canada’s system does have some problems of its own, however. Walker said wait times are a real issue in the country and Medicare doesn’t cover pharmaceutical costs. He also noted Canada “lags behind” some other countries which perform better than Canada on a lot of the same metrics where Canada outperforms the U.S.
“Access is where we lag behind our competitor nations and that covers things like access to electronic communication with providers and systems which clicks into the next thing… we are way behind many other countries in terms of electronic virtual healthcare,” Walker said. “I think we’re the only country with a publicly funded health care system that does not have pharmacare program and that, of course, is something that will come up in the election.”
The federal Advisory Council's call for the establishment of universal, single-payer #pharmacare is a victory for Canadian patients. Check out my op-ed in @OttawaCitizen: https://t.co/UKKbS90yhq pic.twitter.com/KC4YlrZEXM
— Danielle Martin (@docdanielle) June 24, 2019
Canadians will vote in the next federal election in October and there’s not much of an appetite to privatize the Canadian system. In fact, public opinion polls find Medicare to be quite popular among Canadians, and Walker said Canadian politicians are pushing for ways to expand Medicare to include pharmaceutical care.
“I think it reflects Canadians’ social philosophy that you should not be placed in financial harm by paying for health care and we’ve become very very dependent on the fact that you never think about money when you get sick,” Walker said.