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How Canada Achieved Universal Health Care and What the United States Could Learn

Naresh Tenani loves her job as an infusion specialist at a hospital in the capital city of Saskatchewan. For her, monitoring a patient's blood levels, heart rate and body temperature during cardiac surgery and intensive care is a "privilege", "the ultimate interplay between human physiology and engineering mechanisms."

But Tinani was on the other side of the system too, like when her 15-year-old twin daughters were born 10 weeks ago and found an infection in life-support machines, or when her 78-year-old mother waited for the new months. On my knees amid the coronavirus pandemic. Despite the tension, those moments helped him "feel very proud" of his country's healthcare system, a cornerstone of Canadian national identity. He's proud that, in times of real emergency, he said the system took care of his family without adding cost and affordability to his list of concerns.

And at this point, few Americans can say the same.

Before the coronavirus pandemic hit the United States at full speed, less than half of Americans, 42 percent, considered their health care system to be above average, according to a PBS NewsHour / Marist poll. at the end of July. Almost many people, 49 percent, said the Canadian system was better than theirs. Compared to people in most developed countries, including Canada, Americans have paid for health care for many more years while remaining sicker and dying early.

In the United States, unlike most countries in the developed world, health insurance is often related to whether or not you have a job. More than 160 million Americans relied on their employers for health insurance before COVID-19, while another 30 million Americans did not have health insurance before the pandemic.

Tens of millions of Americans lost health care coverage when fears of the coronavirus triggered a recession this year. The numbers are still shaky, but a projection by the Urban Institute and the Robert Wood Johnson Foundation indicated that up to 25 million Americans have become incredulous in recent months. That study suggested that millions of Americans would go unnoticed and might not enroll in Medicaid, the national safety net health care program, which covered 75 million people before the pandemic.

When people discuss how to fix the crippled American system (a conversation that is especially common during presidential election years), Canada always comes up, an example that the United States should look up to and an example that should be avoided. During the 2020 Democratic primary season, Senator Bernie Sanders described the Canadian one-shot model as the antidote to the US health care system and offered his own version called "Health Care for All." Sanders' withdrawal from the race in April sparked speculation that Biden could adopt a more advanced platform, including healthcare, to attract fans of Sanders supporters.

Every healthcare system has its strengths and weaknesses, including Canada. This is how that country's system works, why it is admired (and sometimes undeserved) by some in the United States, and why the results in the two countries were so different during the COVID-19 pandemic.

How Canada Developed Its System

The Canadian health system has not always been like this; Born out of necessity in times of economic crisis. In 1944, voters in rural Saskatchewan, hard hit during the Great Depression, elected a democratic socialist government after politicians campaigned for the basic right to health care. At the time, people felt "the system wasn't working" and were willing to try something different, said Greg Marshildon, a health historian who teaches health policy and regulations at the University of Toronto.

Three years later, the politicians themselves, led by Saskatchewan Prime Minister Tommy Douglas, replaced the privately funded and insured healthcare system and instead used the taxes to cover all hospital care at the county level. The change was greeted with a reply. On July 1, 1962, doctors went on a 23-day strike in the regional capital, Regina, to protest UHC. Ultimately, however, Marshildon said, "the program has become common enough to become too politically destructive to be eliminated."

Other provinces took note. These efforts spread across the country and eventually anchored what would become the Canadian healthcare system, known as Medicare, through the Health Canada Act of 1984.

Under this law, all 13 Canadian provinces and territories control your health care, which means those governments must decide how to design and deliver their health care system, unlike Medicaid in the United States, which is administered by the states. To receive federal dollars, provinces and territories must meet five basic criteria: public administration, inclusiveness, universality, portability, and accessibility. If you move between provinces, from Toronto to Vancouver, for example, your insurance travels with you. Everyone (except unregistered immigrants) has a health insurance card that covers them. These plans cover essential medical care in hospital and primary care physician services, but do not include dentistry, out-of-hospital medications, long-term care, ambulance services, or eye care, one of the main pain points in the current Canadian debate on health care. To pay for exposed care costs, two-thirds of Canadians rely on supplemental insurance plans typically paid for by employers (as is the case in most of the United States).

Who has coverage?

Colin Flood, director of the Center for Health Law, Policy and Ethics at the University of Ottawa, said that serious job losses do not leave people completely disbelieving in Canada today. In the midst of a pandemic, Canadians can get tested for the virus when they need it and are not afraid that the cost of testing or treatment could ruin them financially if COVID-19 doesn't kill them first. Sahel, every Canadian has health insurance for him in case he gets sick. "

"For Canadians, the idea that access to health care should be based on need, not ability to pay, is a specific national value," wrote Dr. Daniel Martin, Medical Director of Women College Hospital and professor. from the University of Toronto. In an article published in The Lancet in 2018, he revealed the Canadian healthcare system.

Flood said Americans just don't live with this confidence. Losing a job "is bad enough, but imagine losing everything you have to qualify for Medicaid. Sell your house. Sell your car and be mostly on your butt bone before you get any health coverage."

"A person has the right to medical care," Flood said.

"It is a human right to have access to medical care."

Sherrill Camilo, former technical director of the Centers for Medicare and Medicaid Services, came from Maryland to the University of Regina in Saskatchewan to learn about the roots of the Canadian healthcare system and how the US and Canadian systems can benefit each other. Camilo said that Americans could benefit from the Canadian system "with less paper, less protein and definitely less costs, even after taxes, more convenience, more options, more work life opportunities, more time, happiness and more cohesion." Social and more value ".

Martin told NewsHour that most Canadians are aware that their system requires compensation, including months of waiting for a specific procedure or treatment. For example, to protect universal access, Canadian law prohibits individuals from purchasing additional insurance to cover hospital care.

It is a law that orthopedic surgeon Dr. Brian Day has fought in Vancouver in court since 2009. He has established private hospitals in Canada and the United States to offer elective surgeries and reduce waiting lists for hundreds of people wanting to undergo the procedures. . Day, who demands more private dollars in his country's health care system, said the Canadian system does not provide adequate coverage, noting that people should still seek private insurance for services not covered by Canadian health law. such as dentistry, medical care. Over-the-counter or mental health drugs in the hospital (although they cost less than in the United States). He says people are dying while waiting for treatment, citing data from the Canadian Institute of Health and Information, suggested that Canadian patients wait for some procedures four times longer than those in France, and believes those who are willing to pay should be able to get the ones. services before. . Even in Canada, he added, "the most important determinant of health is wealth." However, Dai doesn't see what happens south of his border as a better approach.

"Neither Canada nor the United States are models to consider."

He said: "Neither Canada nor the United States are models to consider." Where to look, he said: Switzerland. Dai said the state allows private health insurance, but if a person cannot pay, the government pays their premiums out of tax money and other money. "The bad thing about the United States is that it needs universal health care."


In 2019, healthcare spending drove more Americans to bankruptcy than for any other reason, according to the American Journal of Public Health. In the same year, health care consumed 17 percent of the United States' gross domestic product, a higher proportion than any other developed country, including Canada, which was 10.8 percent, according to the latest OECD data.

Canadians do not usually worry about medical bankruptcy. If you are hit by a bus and receive any type of hospital care, you will not receive anything that taxes cover the cost of hospital care, such as visits to the emergency room or removal of tumors.

Patient rights advocate Caroline Canfield, who lives in British Columbia, had to face a life-threatening cancer diagnosis, but not the never-ending medical costs that many face in the United States. Born and raised in the United States, Canfield immigrated to Canada after college. Over a decade ago, I noticed suspicious symptoms. She saw her doctor who referred her for the test. The biopsy revealed a tumor and her doctor referred her to a specialist.

"It cost me $ 0." "I never had any out of pocket charges," he said. "I never saw an invoice."


In early March, Naresh Tinani's mother, 78, waited four months for her kneecap to be replaced. Age and osteoporosis had taken their toll, she said, and she was prepared for the relief that elective surgery would bring. She underwent diagnostic tests and consulted doctors. Tinani said that within three days of her procedure, Canada went into lockdown due to COVID-19 and hospitals had stopped performing elective surgeries. Several more months passed. After the country began to loosen lockdown restrictions, the hospital called Tenani's mother to see if she wanted to continue with the surgery. However, given her age, concerns about the virus and the coordination of family members to care for her while she recovers, Tenani said her mother decided to postpone her knee replacement. It has been almost a year since I first sought surgery,

The amount of time Canadians wait to seek medical care depends on the type of procedure, and waiting times have changed over time. The Canadian Institute for Health Information measures data at the county level to maintain wait times for election procedures for non-urgent specialty outpatient services such as cataracts and hip replacement. Some provinces meet the standards better than others. However, Martin said, "Canadians don't die" as a result.

At the same time, an older person with severe or painful arthritis may have to wait a year for hip replacement surgery, Martin says.

"It is a real problem in Canada, not a problem that we have to cover with sugar," he said.

For nearly 20 years, Wendell Potter has instilled fear of the Canadian healthcare system, including long wait times like these, in the minds of Americans. As the head of corporate communications at health insurance giant Cigna, Potter said industry executives feel that Canadian law and order is exposing deficiencies in the US healthcare system and potentially threatening its bottom line.

This led Potter and his companions to perpetuate the notion that waiting times forced Canadians to forgo necessary medical care and to live in danger. Potter said he and his colleagues carefully selected the data and masked the big picture, but for this misrepresentation to take root in people's imaginations, "there has to be a grain of truth," he said.

In this situation, Canadians at the time faced longer wait times for elective, non-emergency procedures such as knee and hip replacements. Big health insurers poured money into promoting this idea until it thrived by misrepresenting the entire Canadian healthcare system.

The trick to correcting misinformation, Potter said, is to "repeat it over and over again, over the years, and get friends to repeat it."

In the end, Potter's consciousness washed over him. In 2008, he resigned from company communications after being asked to defend the company's decision not to pay for 17-year-old Natalin Sarkissian for a liver transplant, despite doctors saying the procedure would save him. life. she died. He is now president of Medicare for All Now, an advocacy group that promotes universal health coverage.

"In [the United States], many people wait and never get the care they need because they are uninsured or have insurance."

"We wanted people to believe that they should wait for life-saving care," Potter said. "This was not true at all. In [the United States], many people wait and never get the care they need because they are uninsured or uninsured."

Like Tinani's mother, many Americans have also delayed care amid the pandemic for fear of spreading the virus or being exposed to the virus while sitting in the waiting room or lining up to get medicine. Even routine vaccinations for children declined during the pandemic, prompting the U.S. Department of Health and Human Services on Aug. 19 to allow pharmacists to train and qualify to administer vaccines to children between the ages of 3. and 18, all in an effort to increase these rates and prevent a minimal escalation of epidemics amid COVID-19. .

Quality and results

When the US health insurance industry distorted the Canadian system, they chose carefully selected points of attack, Potter said. They have thrown into the echo room the fact that Americans have a better chance of surviving breast cancer than Canadians. They forgot to say that Canadians were more likely to live after a cervical cancer diagnosis than Americans. In fact, Canadians generally have better health outcomes than Americans, from infant mortality to life expectancy. The COVID-19 pandemic also belongs on that list.

Canada has about a tenth of the population of the United States. During the COVID-19 pandemic, Canada has seen fewer cases and illnesses, but the difference is disproportionate. More than 128,000 Canadians have contracted the disease, more than 9,100 have died and cases are beginning to stabilize, according to the latest data from Johns Hopkins University. But cases are accelerating in the United States, which has become the global epicenter of the virus, with nearly 6 million confirmed cases and 183,000 deaths, equivalent to one in five deaths from COVID-19 worldwide.

"It's really frustrating to have to shift so much political energy to what shouldn't make sense."

Martin said that one of the strengths of the Canadian system to shine during a pandemic is that everyone is a believer. There, patients admitted to hospitals do not have to pay bills with insurance companies or verify coverage before going to the hospital or seeking medical care. She said hospitals work with an insurance company, and that means better care is coordinated between institutions.

"Anyone who needs COVID care will get it," he said.

Dr. Ashish Jha, who headed the Harvard Institute for Global Health and now dean of the School of Public Health at Brown University, has a slightly different opinion. He said the discrepancy in results for coronavirus patients in the United States and Canada represents a "reflection that has nothing to do with the basic health system," but rather reflects the leaders, their political will, and their priorities. While America's healthcare system ranks among the best healthcare systems in the world in terms of innovation and technology, Jha said US political leaders have shown that they are unprepared to offset the short-term pain of lockdowns and loss of jobs due to a long-term public health crisis and economic instability. He said these officials had prematurely reopened the country before COVID-19 transmission slowed. They have also failed to step up testing fast enough to effectively monitor when and where the outbreak will occur and have repeatedly undermined the public health community in its efforts to respond effectively to the virus. He said that US leaders have not presented a clear and coherent message or decisive leadership to unify the country and move everyone in the same direction. He said that during pandemics and times of national crisis, the public should also not have to worry about becoming smart consumers of healthcare.

"It's really frustrating to have to shift so much political energy toward what should be irrational," Jha said. "This is when everyone who needs to be tested gets tested, everyone who needs care is seen." She said it starts with unified access to effective healthcare.

Why is reform difficult in both countries?

With the United States entering a lockdown due to the Coronavirus, Senator Bernie Sanders announced on April 8 that he would stop his presidential candidacy. A week later, he endorsed former Vice President Joe Biden. After competing in 28 states and two territories, the Democratic nomination was drastically reduced despite the initial supremacy. The following month, in a gesture designed to appeal to grieving Sanders supporters, Biden announced plans to expand Medicare. His campaign suggested introducing "a new option for every American, a public health option like Medicare" to make insurance affordable.

As Potter views COVID-19 with fury in the United States, the former CEO of Healthcare Communications said Americans live in fear of "pulling large bills out of their pockets without a guarantee that we will cover our expenses." With the number of uninsured Americans nearly double what it was before the new coronavirus, by some estimates, Potter said this is not sustainable. In a recent PBS NewsHour-Marist poll, 56 percent of Americans believed that the United States' response to the coronavirus pandemic was below the average, if not the worst, in the world.

Potter said this pandemic could push the country to breaking point, prompting more Americans to call for a healthcare system that goes beyond reforms to the Affordable Care Act, which the Trump administration has repeatedly attacked and tried to dismantle.

But if that happened, he said, the same private health insurance system that paid him for the lie would reignite disinformation campaigns and he would fight hard to preserve what he had.

"You will see this campaign reappear in an effort to drive people away from change," he said. It happens every time there is a great push to change the healthcare system. The industry wants to protect the status quo. "

Flood said that no healthcare system is perfect and that the Canadian system is not without its flaws. For years, discussions have emerged about expanding that country's healthcare system to include broader benefits that fill some gaps as patients remain exposed to costs. In June 2019, New Democratic Party leader Jagmit Singh proposed expanding coverage of pharmaceutical drugs in Canada. The ultimate goal of these changes that have been debated to varying degrees for years is to incorporate dentistry, vision, hearing, mental health and long-term care to create a "head-to-toe health care system."

However, it is natural for Canadians to compare the regulations with their neighbors and simply "be grateful for what they have." He says that this kind of laxity has insulated the Canadian system from new improvements that generally produce better results at lower costs, such as the UK, the Netherlands or Switzerland.

"As Canadians, we don't push hard enough to improve the system because we always feel comfortable because at least it's not the American system," Flood said.