Field Report: Canadian Health Care System.

Universal Health Care.

If they can do it in Canada, why can't we do it in the USA?

Canada is pretty much plain old America. Right?

Universal Health Care

Sure, most voters in the United States can think of reasons we aren't like Sweden, those socialists. Or France, with its French-ness. Or tiny Austria and Belgium, or rationally efficient Germany, or rich neutral Switzerland.  Sure, those places have universal health care, but their situation is different.

And yet Canada has universal health care. Americans--i.e. US citizens--barely think of Canada as a foreign country. We don't have much of a border because we don't need a border. Toronto is just another big Great Lake city.

In the American mind, the notion and reality of "California" seems more special and separate than does the idea of Canada. Ted Cruz said we sure don't want Texas to become California. Jan and Dean sang their wish they all could be California girls, and it meant something. Canadian girls would be just regular American girls and the song wouldn't make sense. 

Florida is more different than Canada, what with all the geezers. Utah is more different, what with the concentration of Mormons. Mississippi is more different, with its racial history. West Virgina is more different, what with Appalachian poverty. Canada is plain vanilla America, more American than much of America.

Maybe it's cheaper to provide health care in the frigid north? Actually, the population center of Canada is just north of Toronto, which is at 43.6 degrees north latitude. That puts it right about the same level as Chicago, Cleveland, and Detroit, and well south of Minneapolis and Portland and Seattle. 

Universal access to health care has not bankrupted Canada. My conversations with Canadian snowbirds is that they like their healthcare system. A comment I do hear is that Canada is generally slower to perform semi-elective surgeries--e.g. knee replacements and other orthopedic interventions. The US system incentivizes going ahead and doing the procedure, if it is medically plausible; there is money to be made and almost always someone else is paying. The Canadian system incentivizes waiting and pain management for longer. 

Every system has pros and cons and tradeoffs, but the Canadian system has better outcomes judged by net cost, life expectancy, maternal and infant mortality, and overall satisfaction. Very wealthy Americans would have reason to prefer the US system; cost isn't important, and it is almost always being paid pre-tax by someone else, but as a system for an entire country, the Canadian system seems to work.

Here is a field report from Sandford Borins, a college classmate. He is "Medicare age," about 70. Borins is a political science professor at the University of Toronto. He is still teaching and writing, with a special focus on narratives in politics.

He just wrote me about his experience as a patient:

Sanford Borins 

Field Report by Sanford Borins:

     "I just saw your blog about Medicare so here is my experience with single-payer universal health insurance (i.e. Medicare for all, though as you know I am of Medicare age).

     In Canada, health care is entirely paid out of taxes, so I'm not billed directly. A quick estimate would be the percentage of my Ontario taxes spent by the Health ministry (40 % of my Ontario taxes of $34,000 or $ 14,000 (CDN), or $10,000 US). Because the tax system is progressive, as you earn more you would pay more for health care (and conversely if you earn less). But the key point is that, as a citizen or permanent resident, you receive the same care regardless of income.

     I tore my rotator cuff and biceps tendon in a skiing accident in mid-February. I was initially seen by the emergency clinic at a major teaching hospital, had an ultrasound a few days later, and was seen again at the orthopedic clinic ten days after the accident. The doctors determined that I needed shoulder surgery and because the injury was due to an accident (as opposed to a chronic condition) I would have the shoulder surgery quickly. With shoulder surgery, best practice is not to operate immediately but to wait a while for recovery from the immediate trauma. In any event, I had the surgery in early April, a 2 hour day surgery performed at an orthopedic clinic associated with the teaching hospital. 

     No money changed hands between me and the providers in the entire process. The doctors and hospital were paid by the government. (I required a sling that would have cost $200-$300 but I wasn't charged for that because I am a senior). I have been having weekly physiotherapy sessions since the surgery which cost $75. I have supplementary health insurance through my employer that pays most of the cost of the physio up to an annual maximum of $1250.

     So that's my comparable personal experience from one of the n-1 economically advanced countries with some version of Medicare for All."

A note on Sandford Borins. His insights on narrative helped this blog better understand the effort of each political actors to define themselves as heroes of a political story, and to define political opponents as Fools or Knaves. Trump does this in plain sight. Foolish "Little Marco" and recently "Alfred E. Neuman" Buttigieg. Knave "Lyin' Ted" and "Crooked Hillary."  

Here is a link to his website with information on his books, articles, and courses: http://www.sandfordborins.com