Born in the States but living in Canada, I've always been amused by some of the silly things said by those who reject "Medicare For All" in the U.S., describing health care in Canada as being all about long waits, lack of choice of doctors, and of course, "death panels." In the last few years I've watched mothers die and grandaughters born and I have nothing but good things to say about the care they received — and it didn't cost a cent or require a single form to be filled out. My own doctor is a talented young woman in a new clinic that just opened a few blocks away from my home, a new initiative that lets doctors have more flexible hours and lets me have access to a wide range of services, almost on my doorstep.
But I know this isn't universal; there are many places outside the cities where it's hard to find a doctor. My first cousin, born in Canada but living in the U.S. where she works as a medical specialist, tells me that she's often finding other specialists for people who can't get access to them in Canada. So, it's complicated.
That's why a recent article called What Medicare for All Really Looks Like in The American Prospect is so interesting and timely. It's written by Caitlin Kelly, an expat Canadian living near New York.
She starts with the story of a young freelance production designer who gets injured a lot in sports, and who has been to the emergency room "so frequently he jokes he had an E-ZPass."
It's something he takes for granted, as do all Canadians, comforted by knowing that whatever their age, health, or employment status, they're entitled to comprehensive medical care, most of it at no additional cost beyond their taxes.
This is a point that's often missed in discussions in the States: the freedom and flexibility this gives people. Entrepreneur Ken Rother, the former CEO of TreeHugger, has noted that it's so much easier to do a start-up in Canada, where people don't worry about leaving a job because they'll lose their insurance. Want to go freelance? Don't worry. I haven't worked as an employee for anyone for 15 years and never give health insurance a moment's thought. However, Kelly notes:
But the system is far from perfect. Outpatient care, like physical and occupational therapy or prescription medicine, is paid for out of pocket. In some places, there's no mandate to use electronic records, so patient information can be difficult to access. And medical care of impoverished and remote First Nation and Inuit communities is openly acknowledged as abysmal.
Where I live it's pretty good, and "contrary to persistent American partisan mythmaking, no government officials sit in doctors' offices or haunt hospital hallways with a checklist of all the services they'll question and deny. They don't dictate hands-on care." But they do determine overall policies, and the family doctor has to do referrals; this can cause delays. Globe and Mail Health reporter André Picard says "The Canadian system is characterized by waiting."
In fact, every skier I know who popped their ACL went straight to Buffalo for surgery, because the longer you wait, the harder the repair will be. When I was recommended for cataract surgery, I waited more than a year, but it wasn't exactly urgent.
Waiting for diagnosis and treatment can feel neglectful and frightening. But surveys show repeatedly that the system still remains a source of deep national pride and shared identity. Canadians like knowing that, under federal law, everyone is entitled to equal access. Unlike in the U.S., the wealthy and powerful can't pay extra or pull strings to jump to the front of the line. This lessens the sting of waiting and contributes to a sense of solidarity.
The wealthy and powerful do sometimes sneak off the the U.S. to jump the queue; there was a scandal a few years ago when the premier of Newfoundland went to Florida for heart surgery. (André Picard had something to say about that!) But it works both ways; U.S. Sen. Rand Paul of Kentucky came to Canada for hernia surgery because one of the world's best hospitals for that condition is located near Toronto.
What about tests?
Another major difference that Kelly notes is in the tests that doctors do. "Doctors don't see Canadian patients (with a few miscreant outliers) as a source of personal profit. Rounds of tests that fatten a doctor's wallet mostly don't exist in Canada." There are also different approaches to some surgeries; An old friend of mine, one of the top urologists in the country, told me that in the States, many surgeons bought million-dollar machines to treat prostate cancer and have a vested interest in doing lots of surgery and treatment, where in Canada it's much more of a "watch and wait" approach.
Caitlin Kelly finally asks: Could this work in the U.S.? The biggest question appears to be whether there would be a private option, like there is in the United Kingdom with the National Health Service. Canada never allowed this because there were worries it would lead to two tiers of care, but as I noted earlier, the very rich can shuffle off to Buffalo because the U.S. is our very expensive, rarely used first-class tier.
Kelly speaks to a lot of people and gets a varying answers; I like the one from health policy analyst Greg Marchildon:
"It's a huge battle, and will polarize the American public, but it was the same here in Canada at first. But within four or five years Canadians came around. This will always polarize people and there will always be interest groups fighting it. But if you don't make radical change, you're just fiddling."
Read the full article in American Prospect.