Toronto doctor Danielle Martin is in Washington, D.C., this week to throw her support behind Sen. Bernie Sanders’ bid to transform U.S. health care into a single-payer system similar to the Canadian model.
Flanked by Sanders, Democrats and several American doctors, Martin took the stage Wednesday and spoke of a place “just north of your border” where all citizens are covered by a healthcare system that has lower costs and people don’t have to have worry about paying cash for delivering a child.
“I just handed over this card, my Canadian health-care card to my doctor, and that was it,” Martin said, while holding up her Ontario Health Insurance Plan (OHIP) card. “I wish that all of my American neighbours could experience the same simplicity in their moments of need.”
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Sanders invited Martin to Capitol Hill for the introduction of his “Medicare for All” bill, which aims to move the current U.S. health-care system of private and public insurance to a government-run single-payer system similar to Canada’s. It would give coverage to Americans with a government-issued ID card.
“I hope that the American people will seize this opportunity to declare to each other, and to the rest of the world, that you do believe access to health care is a human right,” said Martin, a vice-president at Women’s College Hospital and the former chair of Canadian Doctors for Medicare.
Martin came to Sanders’ attention in 2014, when the doctor garnered international headlines for an impassioned defence of the Canadian health-care system before a U.S. Senate committee.
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Several high-profile Democrats, including Elizabeth Warren, Kamala Harris, Kirsten Gillibrand and Cory Booker have backed Sanders’ bill. And while it’s likely to die before the Republican-controlled Congress, the move is a symbolic step for more progressive members of the Democratic Party.
Martin said that for many Americans there is still the possibility that some could face bankruptcy or go into debt to pay for medical bills, something that is “unimaginable” for many Canadians.
“When my patients are sick, I do not need to ask if they have insurance or if they can afford to pay for my services,” she told the crowd. “My generation of Canadians does not remember what it was like to worry about paying a doctor or a hospital bill.”
Sanders was short on details about how he would pay for his bill. His plan would also create a much more generous system than Canada’s as well as provide coverage to 28 million Americans who don’t have insurance. Unlike most provinces which do not cover dental or vision, Sanders’ plan would include full coverage for everyone — including undocumented immigrants — for vision and dental care, and partial coverage for prescription drugs.
Martin told Global News Thursday that Sanders’ proposed bill would put the American system “leagues ahead” of Canada.
“It would be a far more just and comprehensive system than the one we have,” said Martin. “Are we going to start that conversation in Canada about improving our system to match what they are aiming for?”
Many Republicans, and some Democrats, have vigorously opposed any move towards single-payer health care saying it would be too expensive and deliver worse care overall.
Speaking with CNN on Wednesday, Republican Sen. John Barrasso of Wyoming criticized the Canadian system saying that long wait times force people abroad for care. He referred to it as “trick-or-treat” medicine.
“Many are coming to the United States even though it’s free because in Canada the waits are so long,” Barrasso told host Wolf Blitzer. “And once they spend a certain amount of money — on cataract surgery, total joint replacement — for the year, they cut it off. Usually that is around Halloween, it’s why they call Canadian medicine ‘trick or treat’ medicine.”
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Under the Canada Health Act, which outlines universal access to hospitals and doctors, provinces and territories administer healthcare. Nowhere in Canada is insurance cut off Nov. 1.
Martin called Barrasso’s comments “absurd” and predicts more misinformation will continue to spread about Canada’s health care system in the coming months.
“To be here yesterday is to try and set the record straight without under playing our challenges,” she said. “Some of the stuff that gets said about Canadian healthcare in the media is actually preposterous.”
Wait times an issue in Canada
Many critics of single-payer health care have pointed to longer wait times and reports that many Canadians are travelling abroad for elective medical procedures.
A study from the Fraser Institute, a right-leaning think tank in B.C., found 63,459 people left the country for non-urgent medical treatments in 2016, up from 45,619 the year before, with the authors citing increasing wait times a possible reason.
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However, the Fraser Institute based their numbers on a survey which asked Canadian doctors to guess what percentage of their patients travel abroad for treatment. The report also acknowledges there is “no readily available data on the number of Canadians travelling abroad for health care.”
A separate study comparing healthcare systems in 11 developed nations released in July ranked Canada third-to-last beating out only France and the United States.
The study, from a New York-based private research foundation called the Commonwealth Fund, found persistent problems in Canada’s system that keep us lagging behind top-ranked countries like Australia, the United Kingdom and the Netherlands.
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Among some of the major issues are Canada’s comparatively higher infant mortality rate, long wait times in emergency rooms and to see specialists, poor after-hours care, and a lack of reliable coverage for things like dental work.
Martin said her biggest concern is our country’s lack of coverage for prescription drugs and that many Canadians have to pay out-of-pocket.
Does Canada pay more for health care?
One reason U.S. health care is so expensive is that competing insurers who deal individually with doctors mean a procedure can vary widely in terms of cost. As the Washington Post notes, an appendectomy can cost anywhere from $1,529 to $186,955.
Single-payer systems, like Canada, can help avoid those high costs.
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A 2011 study in the journal Health Affairs estimates American doctors spend nearly four times as much dealing with insurance companies compared with Canada. For example, the study estimated that doctors’ offices “in Ontario spent $22,205 per physician per year interacting with Canada’s single-payer agency — just 27 per cent of the $82,975 per physician per year spent in the United States.”
The non-profit organization Canadian Institute for Health Information (CIHI) says the federal government spent approximately $228 billion on health care in 2016. That’s 11.1 per cent of Canada’s entire GDP and $6,299 for every Canadian resident.
According to the CIHI, in 2014, the last year for which comparable data was available, Canada spent $5,543 per resident, higher than the U.K. ($4,986) and Australia ($5,187) but less than Germany, ($6,311), Sweden ($6,245) and far less than the U.S ($11,126).
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