What about all the patients who are euthanized in some provinces? http://www.patientsrightscouncil.org/site/canada/ Does that matter?
I have lived and worked in both the US and Canada, which means I have used both the US and Canadian health care systems. It is not even close----the Canadian system is so much easier to navigate and use; it makes our system feel prehistoric. I have now reached an age where I am trying to understand how to organize my participation in Medicare, and it is among the most confusing and difficult processes I have ever had to manage. So many countries have already solved the problems of a single-payer national health care system, so we do not have to reinvent the wheel. The only barrier is the unbridled greed of insurance companies who provide zero health care while skimming billions of dollars from the system.
2
Where are you going in a country that has one party effectively labeling "the death tax" as a social evil, and socialized medicine as a disdainful approach?
I mean, you can't talk to someone who thinks that way. They are more worried about a billionaire having to pay taxes after death than having inferior care and a "fend for yourself" idea of health insurance.
Is it coincidental that the Republicans are funded by the wealthy in all of this?
1
First - I invite any US citizen to visit my home and see first hand the Canadian health system.
Second - immediate family -
3 Cancer surgeries. Top notch.
Arrived home a few days after a biopsy to 15 voicemail messages all from my urologist asking me to come to the office.
Dr., “You have XXX cancer and you should have surgery. We can operate tomorrow or next week. You may wish another opinion - my administration assistant will set up the appointments.”
Over riding memory - the professionalism of every single person encountered on the way to the operating room.
Then - a jovial mood in the OR. A light conversation and a few questions. After about 3 minutes with me seated on the operating table two people entered the room - it was as if Mark Messier and Wayne Gretzky had just entered the dressing room. OK - game time. At that moment I knew without an ounce of equivocation that these people were people at the very top of their game and would hold my life for the next few hours. Perfect.
Again - a downtown Toronto bicycle crash. Ambulance ride. I walked into the busy emergency room - inside of 2 or 3 minutes I had x-rays, a treatment room and an IV started: all before the doctor arrived. Dislocated shoulder - mended. Perfect.
BTW - I have lived in and experienced the health care system in British Columbia, Alberta, Ontario, Quebec and Nova Scotia. All outstanding.
I believe the world would be better off if the United States had a similar system.
78
Puerto Rico. Canada. New York City...
Everywhere but the senate where Sanders not only has a lousy voting record (From Jan 2007 to Nov 2017, Sanders missed 226 of 3,256 roll call votes, which is 6.9%. Much worse than the median of 1.4% among the lifetime records of senators currently serving) but he does nothing to move his bills out of committee. Historically, he introduces bills with tons of fanfare then abandons them.
https://www.govtrack.us/congress/members/bernard_sanders/400357
The man is paid $500 a day to legislate.
Were the Senator serious, he'd be working the room in DC to move his much ballyhooed healthcare bills.
If he wants to be a peripatetic self-promoter, posing for cameras all day, he should quit the senate. He could do a lot of good in or out but not both.
As far as I see, Sanders is this generation's Clara Peller making the most of his late-found fame.
https://emcphd.wordpress.com
9
I just saw a patient in the ER few hour sago, she was seen at the local quasi-free clinic, had scope done by GI doctor 6 month ago, the biopsy from the scope was conclusive , she lost to follow up because she lost her health insurance, the clinic was able to arrange a second scope yesterday, second biopsy came back with diagnosis of adenocarcinoma of the stomach (stomach cancer). She was dumped to the local ER, who is going to take care of this patient cancer?, possibly the teaching hospital in Houston, if she lucky?. This patient will go through hell to get cancer treatment, the longer she waits, the likely the cancer will spread, and becomes incurable .
She is 56, female, US citizen, white. I bet she she wishes she is a Canadian
43
Please note that Bernie is an incumbent Senator from Vermont. He is the National leader of the progressives. He cares deeply about America,but does not cowtow to the ruling class ala The NYT and Charlie Ross.
22
Thank you for acknowleding the "huge crowds" that Sanders drew during his run for president in 2016.
Too bad you ignored them at the time.
Now we have Trump.
50
"And doctors, too, said they felt more comfortable recommending their patients get an operation or see a specialist than they might if those treatments weren’t free." In other words, hospitals don't charge for operations and specialist give free care? That IS some system!!
Also, the article got chopped off in my browser. I missed the last part:
"Lesson 6: You Can't Keep 'Em Down on the Farm
Build the Wall! Build the Wall! That may soon be the chant if the doctor shortage continues. Canadians welcoming immigrants? It's no wonder, if they have any medical training. (As long as they're willing to work north of 60 hours a week.) And don't even ASK for a general practitioner - everyone wants to be a specialist, to avoid being trapped as a G.P. (see 'free care' above)"
4
Thankfully I have little personal experience with our health care system - and I want to keep it that. But it is a great comfort to know it's there should I ever need it . . . that said, as a single person in a high tax bracket, I don't really mind paying taxes (part of which goes to fund medicare and many other social programs) because what I get in return is so much more: a safe and secure society, clean air and water, great infrastructure, and a social safety net (not perfect by any means) because I care about my fellow human beings (true, not all are deserving and there are cheats and lazy bums among them, but that is ok because a great many more are deserving and have suffered misfortune whereas I have been blessed and lucky). What pains me, however, is the disparity between rich and poor, the haves and have-nots - and Canada is not immune from such disparities; what pains me also are tax cheats, be it off-shore accounts or multinationals, because they enjoy the fruits of a safe and secure society but contribute little . . . a pox on them!
46
Let me rephrase the article: "Bernie Sanders took a carefully curated tour of the Ontario healthcare system, accompanied by the left-leaning, and heavily disliked Premier Kathleen Wynne. And he saw exactly what he wanted to see, and heard exactly what he wanted to hear."
I am actually a fan of the Ontario system, but lets not confuse anything Mr. Sanders and Mrs. Wynne do with "fact finding", especially when Mr. Sanders hears "... wait times ... are a problem ..." and thinks he hears "... waiting times are not a problem ..."
12
Tommy Douglas was voted Canada's favourite citizen,it's MVP. he wasn't a Prime Minister, hockey player, musician or a comedian (our most valuable exports), he spearheaded out health care system. You Americans might be familiar with his son in law Donald Sutherland and grandson Keifer Sutherland. Tommy worked hard and long, it ain't easy convincing people that they have a right to universal healthcare.
26
why are there over 150 trained doctors unemployed in Montreal ? Because there is no budget for them to practice medicine..so you get to wait your turn. Tis is called rationing health care in order to control costs rather than letting markets control costs. Having much experience with the Uk National Health System, the 3 month waits to have an MRI read are just something that makes me furious. All of this talk about Socialized medicine is an attempt to hide the truth about it. It is no different than the US VA healthcare which is miserable. Government run anything is miserable.
10
It's fine - unless you're the one that the system says is an anomaly.
Please make sure to ask all the many Canadians who come to the USA for their care WHY they did so.
And please talk with the doctors in the field who have not been primed to address a US Senator with platitudes and Canadian schmaltz.
You will get a totally different picture.
7
I so have to comment here! I live in Ontario now, but 9 years ago I came to the province of Quebec to meet my Canadian husband who was working, and therefore paying lots of taxes there. I did not know I was pregnant, so as soon as we found out, we applied for my legal residency, and of course I had no medical coverage, even though as I said, my husband was a tax paying Canadian. I had a scare early in my pregnancy, and NO hospital in Montreal admitted me, even on the grounds of human compassion, unless we paid hundreds of dollars up front. On the contrary, a few years ago we had an emergency in Miami, and the first thing we read in the emergency room was that we could not be denied of the service on grounds of lack of insurance, money or any other. So, I am sorry, but unless in other provinces is different, my experience of medical attention in Canada is that they are heartless and not compassionate, contrary to the United States. So, yes, all citizens, legal residents and asylum seekers have coverage, but if you happen to be sick in any other circumstance, be prepare to shine your credit card or perhaps die on the street, at least in the Province of Quebec!
7
Ask most RNs in the US about our current system. We can tell horror stories.Every floor of my community hospital has a "Utilization Specialist", their main job is arguing with an insurance company, as to why a patient needs to stay in the hospital.All of the MDs, have extensive staff in their offices, just to deal with billing.I see elderly patients all the time discharged too soon to home, with an elderly spouse with no supports, unless they personally pay.It is criminal. What we all pay for insurance, what MDs pay to have a practice, is criminal. Thank you once again Bernie, for being the voice of reason. The Insurance company lobbyists, the Hospital Lobbyists, (wouldn't want to stop those 3 million dollar salaries for the Hospital CEOs, and the 6 figure salaries for their support, sycophant staff).Have any of you known families that have had to claim bankruptcy, because of a Medical Emergency, totally out of no where? I have known too many.Let's get our Healthcare up to the standards of the majority of the world!
47
I am totally for Medicare For All, but not in one fell swoop. Americans, unless there is a sudden war, do not do big changes well. And the Republicans love the prospect of big changes. They will gleefully scare people on every level with imaginary catastrophes.
Most people who get their insurance at work will suddenly have to transition to something brand new. Most people are afraid of new. For every unfounded fear the Rs will have a new lie.
Young healthy people will have to pay increased taxes to support the new system even though they will get little benefit. “Well people shouldn’t have to pay for the sick,” go the Rs.
Explaining how new taxes will be a wash when old premiums are phased out is complicated. Oh, how Republicans love to scare people about complicated.
Our policy goal should be to improve Obamacare while transitioning to M.F.A. More immediate benefits to crow about there, and less for Republicans to lie about.
8
Be realistic, the healthcare industrial complex is just too powerful. Healthcare jobs are "recession-proof". The interconnected network of business people (MBAs), lawyers, administrators, doctors, nurses are all dwellers of the "swamp". The spending on healthcare is approaching 20% of GDP.
I really want disruptions in the healthcare industry. The lack of foreign competitions is the main reason for the high cost. Most ironically, healthcare professionals are more in line with the Democratic party and they look down upon the "America first" Trump supporters. How about opening the market to foreign competitions and outsourcing patient cares to Mexico and Thailand. Let's see how these people respond!
Opening up market and cutting wasteful spending should be the priority. Unfortunately, we only have crony capitalism today!
6
I appreciate this positive coverage from the NYT of Senator Sanders.
His message resonates with our country and I was missing this type of positivity from my favorite news source...almost exactly one year ago. Now look where we are.
20
A number of years a go on a cruise, being Canadian I was asked by a young couple from Texas about our "socialist" health system. When I tired to explain in detail how it worked, I got a puzzled look. So I boiled it down to this - in the U.S. individual rights trump (so to speak) the public good while in Canada the public good prevails.
Still got a puzzled look.
23
A resident of Washington D.C., I spent 4 summers in England in the 1990s. In the U.S., I was uninsurable because I had a pre-existing conditions (allergies, migraine headaches). Because I was enrolled in a U.K. college during the summers, I qualified for National Health Care in the U.K. while I was there. Hence, I tried to take care of all my health care needs when I was in the U.K. during the summers. I made multiple visits to hospitals and clinics in the U.K. during those summers. Was never charged a penny for the excellent health care I received in London and Cambridge. A friend who was a resident of Los Angeles was enrolled in the same U.K. summer program had emergency surgery in the U.K. that summer, with no U.S. insurance. She had surgery in a London hospital - she didn't have to pay a dime!
When I came home, I was back to spending $200 a month out of pocket just for a monthly supply of a migraine drug ($25 a pill - thanks for gouging me, Glaxo Smith Kline!) $200 a month in 1996. That was just ONE of my regular medical expenses in a country where I was blocked from buying an insurance policy.
Never let anybody tell you that these government health insurance plans in the U.K. don't work. They were a godsend for me.
28
Only one employee managing billing/hospital...
To the average geezer who deals with billing codes and "Please continue to hold; your call is very important to us," that statistic is nothing short of a miracle.
If the U.S. went that route, unemployment would skyrocket. Tens of thousands of healthcare bureaucrats would join coal miners in howling for a return to the good old days when coal was king and Healthcare, Inc. took the country to the cleaners.
13
a 'canadian' medicare card isn't shown....a provincial one is. each province has its own system. however, the card is accepted in other provinces. for example, my wife and I were in newfoundland when she had an eye problem. it was about 1700 miles from our home in Ontario. she just presented her card and we were done.
I have no problems with the Canadian system. wait times are annoying at time--I had to wait 11 months for an operation to give me complete hearing in my left ear. I could hear out of my right, I wasn't in pain and it cost me nothing.
I lived in japan for a number of years. state paid 75% of the cost--used to be 80% until around 15-20 years ago. also drugs and dental are covered.
20
Health care should be a basic human right. As Americans we are fond of sacrifice for the greater good. No one “needs” an MRI in 24 hours for a knee strain. A little kindness and empathy for others would go a long way toward healthcare reform.
18
Canada's system isn't perfect but it lessens the anxiety of affordability, job loss and medical bankruptcy.
28
Here in Ontario Canada we often hear or read that our system provides “universal” health care” , but it doesn’t because it does not include single payer prescription drugs, dental and optometry care including eyeglasses. It is good to read that this article does point out these deficiencies in our otherwise good system.
9
Canadian taxes as a percentage of GDP are more than double that of the US. You ignore this point as if it is irrelevant to Mr. Sanders' proposal
4
I'm Canadian, and while our health care system has some holes and inefficiencies, it is such a massive difference from what I see in the United States that I cannot begin to think of what it would be like to have a serious illness "south of the border".
I'm not going to go bankrupt or have to sell my house to pay my hospital bills here. Drugs are expensive, BUT they are a lot less expensive than they are in the United States, and having a government that can fight big pharma over pricing is a big help. Malpractice settlements are lower here, and that has a double effect. Yes, you may not get as high a court settlement for malpractice here, but the systemic costs are also lower. We don't have dental falling within the rubric of our health care system unless it is health endangering, so you are out of pocket for normal dental care here.
So let's take a look at a few numbers take from the CIA World Facebook. I'll show Canadian numbers then U.S. number on a few key stats:
Life Expectancy: 81.9 / 79.8;
Infant Mortality: 4.6 per 1,000 / 5.8 per 1,000
Maternal Mortality: 7 per 100,000 / 14 per 100,000
Health Care % of GDP: 10.4% / 17.1%
You can go to other sources and/or pull different measures, but this is a pretty good indication provided by some key statistics. Yes, there are economic and cultural differences which also effect life expectancy, but in many respects our societies are similar, so the life expectancy comparisons are reasonable.
11
Seems to me that the biggest obstacle to universal health care in the United States is cultural. As Mr. Sanders noted, “There really is, I think, a deep-seated belief in Canada that health care is a right, and whether you’re rich or whether you’re poor or whether you’re middle class, you are entitled to health care.” The corollary to that sentiment is most Americans fundamentally cannot conceive of such a belief.
19
Yes, it's only the Democratic party that can't stand Sanders' popularity, common sense and FDR values.
6
If you look more closely, not all countries that have Universal system do it by Single Payer. Canada is close by, since we speak the same language and watch the same TV (for some). But - most countries have a multi-payer private system. Some have no government control with the exception of a regulatory authority. Key - All have one set of prices - this is important. In japan, everyone contributing here (thank you) would pay the same price for an MRI. The providers in the USA can charge whatever if you have no coverage or coverage is insufficient. The providers in other countries must live in the restricted pricing environment set by the authorities. This is the only reason we pay 3 times more than other countries do. I realize the cost and time it took Mr. Sanders for illustrating the Canadian model and hope he could find the time to visit France, Japan and Germany and report the same comparisons. He may find that Medicine is cheaper and there are no wait times in some of the other countries.
6
In the case of cars, what we pay goes to the car companies and their success just depends on the free economy system. In the case of health care, what you pay goes to medical doctors and pharmaceutical companies, but nobody would say it should also depend on the free economy. However, the above equation for the money flow is still the same, so if we don't want to or cannot pay much, we need to control the income of the doctors and the drug companies. A simple math.
1
When I was 25 I was the victim of a hit and run and sustained a head injury. At the time, I had just finished university and was in the process of interviewing for my future job. I spent over a week in the hospital. I would not have had adequate health care at that time if I lived in the USA and would most likely still be paying for my medical costs to this day. Our system is not perfect, but I would not change it and I could afford to buy into a two tier system and benefit for shorter wait times. Excess to health care should be a right not an industry.
10
Will someone from Canada speak to the issue of disabled children? Understand that birth is fully paid for, but are all physical and other therapies the responsibility of parents? If they cannot afford the supplemental insurance, what happens to the children?
What about abortion? What is the Canadian law n that?
Thanks for any information.
2
One of my premature twins was born severely hearing impaired (though we didn't know it at the time). Both received physical therapy for months - free - and all later tests related to prematurity were also free. Hearing aids were partially covered under employer's extended medical, but we were often given long-term loan models. Now in his late 20s, he underwent cochlear implant surgery four years ago - free.
Abortions are legal; though not a snap to obtain, as doctor consultation is required, they are not blocked. However, not every hospital performs them; some rural areas may have less access, for example.
8
Mad,
Being Canadians we would consider being asked the question an insult. To consider charging for therapies seems immoral. Every day nurses and physiotherapists visit homes where the patients leaving the homes would be an inconvenience. There is no charge.
Abortion is no longer discussed it is a personal decision far beyond the state's involvement and the procedure is fully paid for.
A couple of years ago a province with the population of Burlington Vermont tried to make abortions difficult by closing down the few facilities on the Island but abortion discussions are pretty much ancient history and for private citizens it is simply not our business to impose our morality when society's welfare is unaffected.
16
(Taxpayers would, of course, finance the system.) you write almost as an afterthought. THe Canadian system des not function without heavily taxing the middle class as Canada does.INstead of focusing on who pays for American health care. let move to bring health care cost down to a level commensurate with other developed countries.
2
You have to have attained a certain advanced age now to remember the private insurance regimes which existed prior to the integrated national system of medical services provision we now have in Canada. It was, in the highlighted word, unfair. The medical profession and the private medical insurance companies fought tooth and nail to forestall universal care including famously the doctors' strike in Saskatchewan. All the nostrums about free enterprise which your American readers are no doubt well aware of were trotted out. In some respects they were dismissed with laughter.
Now, I am pleased to report that as of January 1st, my health insurance premium (and I pay the highest rate) will be cut in half possibly as the result of a huge $2 billion budgetary surplus in a province which has about 3 million citizens. Plans are afoot to integrate this remaining premium with the progressive income tax system as is already the case elsewhere in this country thus eliminating the costly collection system. Indeed, one of the main benefits of single payer is that multiple bureaucracies in private insurance vendors are completely redundant and disappear altogether.
Still to do? The non-coverage of prescribed drugs, the cost of ambulance trips in some provinces, and possibly the most important, routine dental care. Bringing them inside the big tent will again produce significant efficiencies, lower drug costs, and of course the general health benefits which dentistry provides.
12
What I hope from Bernie Sanders is that he will follow up his proposal of Medicare for all with a campaign to lower real healthcare costs, starting with a campaign to force Congress to bargain with prescription drug companies, to in turn, force the drug lords to sell Americans pharmaceuticals at the same price other advanced countries pay. Only by battling to bring down real costs can America hope to institute a universal healthcare system. I call on Mr. Sanders to lead the charge in the tough battles necessary to achieve his final goal, starting with the pharmaceutical drug lords.
8
“Real change always happens from the bottom up" no doubt is applauded vigorously everywhere. Yet this NYT Article, from the tongue in cheek Weekend with Bernie 2 title and subtle reminders that Sanders doesn't have a position in government today, shows how vacant the establishment would ever come to supporting universality in a capitalist minded system. US is a dog eat dog society, not a save every cat from every tree and save the tree too Canadian mentality.
The old rockers get their standing room only, multiple standing ovations often here. Your liking us, knowing us, respecting us, is not our problem to bear. Canadian's respect is owned and that is good for us and those who want to join us.
7
Ms. Sanger-Katz does not mention liability insurance that doctors and hospitals pay in Canada. What do the Canadians do to remedy medical errors or defective drugs and components?
1
We are not a litigious society here. I have never heard of a malpractice suit against a doctor here.
The federal government is responsible for vetting drugs, but citizens can be part of class action suits for defective products or deleterious effects. One recent suit that comes to mind is one against the manufacturer of Mirapex (a Parkinson's medication also prescribed for Restless Leg Syndrome) that had a side effect of creating impulsive and risky behaviours such as gambling.
Others may be able to provide more thorough information than this.
5
Whatever Canadians do about medical errors, defective drugs and medical insurance, it all costs far less per person than Americans are paying.
5
US Health Ins. Premiums are high because healthcare is treated as a profit center, "Charge as much as you want! It's what the 'market' will bear!" The US approach to healthcare, as a commodity, is fundamentally wrong, and it 'trickles down' to all of us.
Why does an MRI using the exact same equipment cost more in the US than anywhere else? Why does the same course of Rx treatment cost an American (and their insurer)$16K, yet that exact same drug can be dispensed in Canada for a fraction of the US cost?
This is because sensible countries negotiate these costs upfront; In the US Medicare is forbidden to negotiate drug or any other costs! These countries have lowered the overall price tag for healthcare. Based on current US prices, the costs would be astronomical. Hence, step 1 to any improvement is to stop the rape of US citizens with "free market" unchecked healthcare pricing! (Just this step alone would lower/help stabilize premiums).
Alas, that will not happen because our government ignores methods proven in other countries to espouse a several times over failed economic theory... Our "representatives" in both parties look out for their donors/ lobbyists, not the citizens they are there to allegedly represent.
Until the US gets the special interests/$$$ out of our government, no change to benefit We The People will occur, let alone any type of sensible affordable healthcare.
13
Tibial plateau Fracture. Surgery. 3 days in hospital. Cost $0.
Friend with melanoma told to get his affairs in order. Weeks to live. Then specialist offered to put him on a drug trial. Three years on enjoying watching his grandchildren grow up. Cost $0.
Wait times so what? When you urgently need the care, it is there for you. Baffled as to why Americans don't see the light on this issue.
18
Five laparoscopies (medial meniscus, both knees), SLAP repair (Tommy John surgery) on one shoulder, laminectomy L5 and the removal of a cystic Schwannoma from my spine, multiple broken bones (hockey), multiple MRI's/flouroscopes/x-rays/ultrasounds. Cost $0. Nevertheless I continue to play hockey.
7
Canadian vs. U.S. health care
Our health care system is neither rational nor moral, and it will almost certainly get worse under the present administration.
http://www.pnhp.org/news/2017/may/canadian-vs-us-health-care
4
PNHP is well-known as lobbying for "single-payer" theories that have already been rejected by Sanders' Vermont, Colorado, and California.
They are obviously biased in their politics and everything else.
I wouldn't change the health care system in Canada; for one reason because that's all I know, and we've gotten used to the almost 45-48% salary that goes to it (every pay check) and other services, but because we never have to worry about getting sick and paying for hospitalization. We've never had to see health care as a separate thing to pay--- it just comes out of our paychecks every pay period. But it's not cheap! AND, it doesn't cover medications and dental---we have to pay separate for that, whether in form of insurance or downright from our pockets. AND yes, there are long waiting periods for most things! Unless you pay privately.... So when you look at it, it's actually quite an expensive thing. But here, we have no choice; health care coverage is automatically taken from our salaries. We know that when we have a salary of 35.50$ an hour, a little bit less then half goes towards health care and other taxes.... So are you Americans ready to dish out over 40 to 48% of your paychecks to cover universal health insurance and other taxes, or is it cheaper to have a separate health care coverage????
3
The Canadians also value the protection the United States military provides them, being connected via the northern border. If Bernie Sanders loves Canadian healthcare so much, why doesn't he just move. Please do the citizens of the United States a favor and go enjoy life as a Canadian socialist.
1
Given that the most likely country to attack us when the quest for fresh water gets dire enough (roughly 50 years from now, thanks to your president - and to you for voting for him) is the United States, I wonder why you would think we "value" your "protection".
8
Protecting us from whom? Russia?
I gather your President rather likes the guy.
BTW, life as a "Canadian socialist" is sweet. You might want to give it a try.
9
A good friend of mine had an anaphylactic reaction while camped out in rural Canada this summer. He manged to make it to an Emergency Room in a town of 860 people. The entire bill, mailed after the fact, was under a thousand bucks. Access is not just a function of cost and waiting time. It is also a function of distribution. Rural America is hard put when it comes to medical facilities and personnel. I doubt a single community of 860 people in this country has a doctor, let alone an Emergency Room.
8
I am afraid I hated this article. Where are the figures, the data? For example, instead of vaguely muttering about how much a single payer system would spend, since she is talking about a particular one, why didn't she just give the numbers. Here are the per capita figures for health care costs in 2016 in PPP dollars from the OECD:
US - $9,892.3
Canada - $4,643.7
Lesson 1 is a total waste of space. Hey Maggie,this is the NY Times, not people magazine!
Lesson 2 starts out with a lie. I lived in London for a year. One Sunday evening I took a friend to the ER. Here is the conversation when I tried to pay:
I asked, "Where do we pay?"
"Pay?" she said, "There's no money in this hospital."
"You don't understand, " I said. "We are not British citizens. We are just guests."
"No, YOU do do not understand, This is England. This is a hospital.. We treat sick people. We treat all sick people, Brits, Frenchmen, Chinese, even Americans. And that's all we do. We just treat sick people."
Lesson 3 is totally useless since it has no actual data. And let me point our that in Canada EVERYONE who needs a knee replacement gets one. In the US thousands do not either because they have no insurance or they can't pay the deductible or co-pay. Their wait time is infinity. How do you average in infinity?
She also mention The Commonwealth Fund study and says Canada did only a little better than the US. But there was a huge difference between the US & the next one on the list.
Out of Characters
9
Yeah, and W.H.O. tried to appoint a dictator as a "good-will ambassador."
https://www.nytimes.com/2017/10/21/world/africa/robert-mugabe-goodwill-a...
That's how good, data from those groups are. Waste of time, useless, zero value.
I've been sharing a lot of my thoughts tonight on the Canadian health system, and here's a last one... A few years ago, my father in law (my husbands natural father), was hospitalized for angina. He was put on a waiting list, but was told that if he wanted it sooner, he would have to pay for it. This was in January of 1996. He refused to pay because as he told us " I already have paid a life time for it through my freaken taxes!" He had a major heart attack and died June 3 1996.... 6 months later, as he waited for his surgery....
One of my professors, about 55 years old at the time, died of a heart attack while on a waiting list for bypass surgery because his condition was deemed not to be so severe. Ironically, another professors father who was in his late ‘70’s had a heart attack and immediately had emergencey bypass surgery and survived. Both cases were in Montreal. Need something like the Canadian system here but with a little bit more funding. The administrative ćost savings in the U.S would be staggering. Of course the country would go into a deep recession with so many jobs lost in health care. The only part i would disagree with is all the shot up gang members getting repeatedly treated, at “my expense”. Still, it would be a better system but we would definitely need to fund it better- big savings too for companies the currently pay our health insurance
4
There are differences between the two countries. In the US, conservatives are greedy and mean, in Canada they are responsible. In the US voters are lazy, in Canada the voter is informed.
8
kirk,
Bill Buckley Jr, Barry Goldwater and Ronald Reagan were not conservatives they were fascists and anarchists as are their progeny.
Dr Samuel Johnson and the United Empire Loyalists were conservatives.
This is what Johnson the intellectual conservative of the 18th century wrote to the American Congress in 1775.
http://www.samueljohnson.com/tnt.html
Both countries have their share of informed and uninformed voters but most of us know that the government is our only defense against those that would have us believe the government is the enemy and the people who own the USA's government are our friends.
The only essential difference is most Canadians still believe in democracy.
5
I used to live in Canada. Now I live in America. It's fairly instructive.
For example, when many naysayers here sniff, snort and parrot "Where will the money come from?" -- the cry of the conservative -- as a reason the US could never have Single-Payer healthcare for all, let it be pointed out that the United States has 7,000 nuclear weapons that your taxes are paying for, never mind Afghanistan and Iraq.
If we weren't spending all that money to hypothetically maybe kill people, we could use it to definitely keep them alive and healthy longer.
Maybe ask yourself why, for your government, it's more important to spend money on maybe killing a kinda communist than it is to keep you, your family and the people you love healthy and happier and alive.
The difference between Canada and the U.S. isn't about 'fairness.' It's about a country that doesn't burn billions of dollars a year to maybe kill everyone on the planet vs. a country that does.
16
You must want to go back?
If not, can I have your passport?
4
You'd really be hard pressed to find a Canadian who would willingly give up our health care system. In fact, I suspect you'd have civil war if a politician even suggested we consider the American approach.
8
Naw, much better that out taxes continue to "spread freedom" around the world. Bunker busters for Saudi Arabia to use in Yemen--YES, THAT'S IT! Exactly how I want my money spent. Gross.
8
‘Breaking Bad’ wouldn’t be credible in Canada. When Walter White starts getting sick, if he was living in Canada, he would have been treated for his cancer for free. The show would have been over after one episode.
15
Five lessons from Canada on single-payer health care
http://www.pnhp.org/news/2017/september/five-lessons-from-canada-on-sing...
1
I have had a few major procedures in the last ten years or so, with terrific care and almost no waiting, and if this guy thinks I'll support a mediocre-treatment-for-all system he's nuts. This is for the young Americans to vote in; no old person with good health insurance and good doctors and facing who knows what any day now, is going to give up what he has voluntarily. We're not saints, doncha know.
While the idea of higher taxes throws many people off, it might just be worth it in the sense that most people may not need to buy private insurance, and thus several hundred dollars a month gets saved for taxes that are probably lower overall. The system should also bring down health care costs as the middlemen are removed and the government has real power to negotiate fair costs. Most, of not all, countries with a government provided health care system have a vast majority of people who like the system due to its fairness. And if you are wealthy enough to bypass lines with private care then it is your choice to do so. I actually studied abroad in Costa Rica for about 2 months (summer) and they have this kind of system. Every single person I asked about it (mind you I lived a a lower-middle class neighborhood, but also asked people in the rural areas) said they liked the system because they know that if something happens then they will get medical care without having to go into crushing debt afterwards. They don’t mind subsidizing other people, they know that others are subsidizing them. The only complaint- wait times are pretty long for non-emergency procedures. In the US it would translate into obscene wait times in most hospitals, especially those in major cities. It’s something to think about when considering these kinds of things. Maybe we could have a system where people can’t go to hospital unless it’s an emergency or they have a referral from their PC physician?
2
Having lived in Ontario for four years, It is important to point out that in Ontario that approximately one million Canadians DO NOT have access to a family doctor. That is a major problem in Canada. So much so, that when I took an academic position in a Canadian university my colleagues instructed me to ensure my employer would take responsibility for finding me a doctor.
4
Hoping that this report gets a wide readership.
2
Well, our current, and highly esteemed in his own eyes Dear Leader president will never have such a problem of meeting people with "rationed" healthcare. You never know what Canadian germs they could be harboring.
The American health insurance industry will be out with a hit job on this piece in the next few days. Remember, Michael Moore's "Sicko" scared the living day lights out of them as well and lead to a high profile counter campaign.
Insurance companies not only suck about 20% of health care dollars out of the system without inputting anything of value, but they also increase the cost of doing business by the providers by about 20 to 30%.
2
I haven't had much experience of the US system, but can tell you that when I had treatment for Stage III melanoma four years ago in Ontario, after all the diagnostic procedures, the surgery, the radiation, the Interferon treatment, and several months of home care nursing, my biggest single expense was hospital car parking. That experience is too common even to mention here.
But it's not just the absence of medical costs. It's the freedom from the financial predators and parasites that seem to accompany anything medical in the USA, that makes it so different here.
13
As an American who has lived abroad in France, Netherlands, Singapore, UK and obviously US, I can unequivocally say that the US system is broken.
The ease of access to healthcare and comprehensive coverage in most non US Western countries, especially France is fantastic. There is absolutely no stress about how people will pay for bills or hospital care. I'm not low income and can't imagine how horrible it must feel to worry about paying for medical bills or prescription drugs.
Even the private specialists, which you pay entirely or mostly out of pocket, in France or Singapore just do not cost as much (American Hospital in Neuilly, ENT specialists/professors at Mount Elizabeth).
When living in Holland, I once went to see a gynecologist for a regular Pap smear and check and it cost $500 usd for just the lab fees, plus the examination and doctor fees it was well over a $1000. Simply put if you do not have health care coverage in the US, you cannot afford the medical bills and most certainly cannot see a well qualified doctor.
We need some form of universal coverage with heavy regulation so that everyone can have access to health care services that people need, period.
3
I am a family physician in a suburban city north of Toronto for the past 24 years. I worked 8 of those in the ER. I currently own a clinic with 4 other family doctors, a nurse, and 6 admin staff. So I have some experience in this system. Let me tell my American friends that single payer is not the panacea you are seeking. And Mr Sanders visit to Toronto is definitely confirmation bias. The nice thing about single payer is that billing the government is a breeze, takes no time, and I get paid within 15-45 days. Patients love it as they just present their government health card. Nobody is denied care. Here's the bad part. Waiting. And lots of waiting. The average wait time from a family doctor to a specialist and then treatment, such as surgery, hit 20 weeks in 2016. It's worse now. An MRI at my local hospital takes 6 months. The total wait time at my local ER is 4.4 hours for minor ailments, (ankle sprains, etc) 14.4 hours for complex care, hip surgery, takes 3-9 months in my area to see the surgeon, then around 100 days to get surgery, in a smaller town, Chatham, Ontario, 249 days, Brant, Ontario, 494 days. Why is this happening? Not enough doctors, not enough operating rooms, not enough hospital beds. The government has decided to reduce spending in general and focus on certain areas like heart surgery or cancer or eye surgery to improve wait times but the rest of the services suffer. Single payer has benefits but be aware of the risks.
13
This is absolutely false. What this individual fails to characterize is the degree of urgency involved in the care. So over the past few years several of my family members have required an MRI for various problems. In some cases where the issue was relatively minor, a wait was involved. But in others -- such as when my infant son needed one -- the care was immediate. Individuals like this writer generalize to present a portrait that's simply not at all accurate.
And when someone shot a puck in my face at a shiny hockey game and I had to go to the ER for some stitches you bet I waited several hours. But I'd rather have the ER staff take care of the elderly lady who was suffering angina than deal with my stupidity. Anyone who argues that's a failure of the system is suffering from his own kind of bias.
6
The US insurance world has done a great job at smearing Canada's system.
In the US non-emergencies too have to wait---this happened to me, and my father (both dealing with cancer)---and I won't even mention the bills we had to pay compared to our friends to the north.
I am so glad my daughter is now living in Canada--and if I could wave a magic wand my son and I would live there, too.
5
The Canadian system would never be able to be transplanted to the US. Costs are controlled by the government bodies essentially owning the hospital complexes. The physicians are self employed and the patients have no payments other than taxes. There are no large nonprofit organizations that are incented to make high tech equipment readily available thus the long waiting times for elective procedures. Given the fact that hospital organizations are some of the largest employers in many communities I can't see anything getting through their lobby.
2
" had barely gotten off the plane in Toronto when an airport security guard chased him down the hallway, telling him, “You’re like a hero to me.”
I would do the same !!!!!!
A team of cardiac nurses at Toronto General Hospital asked to take pictures after he toured their unit. At a full 1,600-seat university auditorium on Sunday, he received repeated and sustained standing ovations. College students waited"
Why can't the US Democratic Party, not see where it's future is ???!!!!
Because of this
Top 10 campaign contributors, Charles E Schumer, Leader , Democrats, Senate, Contributors 2011 - 2016 , Campaign Committee & Leadership PAC Combined:
1 Paul, Weiss et al
2 Deloitte LLP
3 PricewaterhouseCoopers
4 Lockheed Martin Yes
5 NorPAC
6 Blackstone Group
7 KPMG LLP Yes
8 Citigroup Inc
9 New York Life Insurance
10 Lazard Ltd
STOP BEING FINANCED BY WALL STREET, HOLLYWOOD, AND SILICON VALLEY . None of these has the best interest of American workers at heart.
8
I moved from Canada to the US about 15 years ago. I am still troubled that in the US I get better health care than my US neighbors simply because my company coverage is better. To emphasize other posts, after I pay all my co-pays and deductibles in the US, the total costs in Canada (taxes) are actually lower
7
Personal experience over 10 years in Canada found the crucial difference between Canadians and Americans, both urban and rural, is the reported concern Canadians have for 'fairness' in healthcare and all aspects of society versus Americans who are more keen to raise 'individual rights' ahead of the group. The Canadian health care systems differ by province and funding them also differs by province. Example: British Columbia raise funding by a 107% tax on smokes and alcoholic beverages (that's $12 for a six pack of Bud lite) as wells as the GST and national high income tax rates (Canada offers free online tax calculation and payment).
The Canadian social model, to succeed in USA, requires a paradigm shift by Americans to one of embracing the idea of helping all and paying for it. Given the habitual whining of Americans about being 'over taxed' , the USA has much to change before progressing.
10
Americans pay about 3x as much per patient as we do in the UK. My cancer and related treatments over the last five years have been entirely free, I have never had to fill out any non-medical forms or pay any money. Even my public transport costs were reimbursed. All my treatments have been state of the art, including DaVinci surgery and IMRT computer-controlled radiation treatments. All my medications are 100% free (if over 60 yrs old). And if you count health-care as a tax in the USA, we pay lower overall taxes in the UK than you do in the USA.
12
You received no bill but the care was not "free"
No matter what the system may be, when you have everyone contributing into it proportionally to their incomes, then the system will flourish.
Not everything has to be privatized, nor should it be.
21
Well, it is not entirely true that we do not pay anything out of pocket at the hospital. I recently had a full hip replacement, and I had to pay $4 for telephone service for the two days I stayed in hospital after the operation... I waited for 3 months after my doctor decided it was time for surgery, which was about enough time to come to terms with the reality of the operation. I have received in-home nursing care and physical therapy since the surgery at no cost out of pocket. But best of all, every person here has access to the same care I do. Higher taxes? Sure, but they are worth every cent. I wouldn't trade my Canadian health care for what I used to have in the US for any price.
28
How many months would you have been willing to wait for the actual surgery in Canada once the pain became excruciating to the point even going to the supermarket was an ordeal?
1
“Several recent public opinion surveys show majority support for a government guarantee of health coverage, but support declines substantially when pollsters mention that government coverage would mean higher taxes. “
I wonder if those polls asked if people knew their taxes would be less then they currently pay in premiums, copays and deductibles and that they would never receive a bill for medical care and that all their fellow citizens would also be guaranteed health care, if support for government guaranteed healthcare would increase dramatically.?
25
It's the fellow citizens getting healthcare that trips everyone up.....
1
For almost fifty years I have spent about a third of my time in Canada, and while I have heard plenty of minor grumbling, I have heard nothing but praise for the system in general. Sure there are problems, but problems can be dealt with to make a system even better. Americans used to think we could make things work; adopting universal health care could benefit the nation, but we're told we can't do it. What changed?
22
I have one of the best health insurance policies available in the US, yet had to wait 8 months for surgery after injuring my knee last February.
There were many insurance-based hoops to jump (well, hobble) through before I finally got the MRI that qualified the knee for surgery.
If I'd been permitted an MRI the week of injury, I might well have been spared the months of severe swelling that appear to have become a permanent feature of that leg.
I doubt Canadian wait-times are worse than that.
39
Wanna bet??? :) A few years ago my doctor discovered a small mass in my abdomen and gave me a referral for an MRI. I faxed it in to the hospital and was told it could take a few months. I faxed it in to a private clinic and the very next day had the MRI done ( and paid over 700$ out of my pocket). It turned out not to be anything serious, well, at least not life threatening. But had I been waiting thru the usual lengths of time, imagine the stress??? And HAD it been more serious, imagine the time lost???
2
A good friend of mine had an anaphylactic reaction while camped out in Canada this summer. He manged to make it to an Emergency Room in a town of 860 people. The entire bill, mailed after the fact, was under a thousand bucks. Access is not just a function of cost and waiting time. It is also a function of distribution. Rural America is hard put when it comes to medical facilities and personnel. I doubt a single community of 860 people in this country has a doctor, let alone an Emergency Room.
20
Thank you NYTimes ! We needed this wonderful story on the front page. So many comments bringing hope.
This country loves your great newspaper.
22
About $70 a month for my monthly healthcare premium in BC (each province has a separate healthcare system so premiums can vary, and the premiums vary by age). Premiums vary slightly by age group and when income is below some level the premium goes way down; one year I got an offsetting tax break due to lower income.
Five years ago I needed a hernia operation. It was not an emergency so I waited about six weeks for the surgery. Two years ago I had stomach pain and, after two days I decided to visit a clinic "just in case" it was serious. The doctor suspected appendicitis, an X-ray was taken right away, and I was offered a driver to take me to the hospital but I chose to drive myself. The surgery was that night and I recovered and went home the next morning.
Cost me nothing, and the value of not worrying about the cost is priceless.
44
If it cost you nothing, who paid for it?
In addressing the wait times in Canada Sanders "points out that many Americans who are uninsured — or who have limited savings and insurance with high deductibles — may wait even longer than Canadians for elective, or even urgent, care". Quite right. But in America those people are usually lower income who, often as not, do not vote or otherwise make their voices heard and the right wing in America couldn't care less about them.
There are other realities we need to face. Wealthy Canadians can, if they want, have non-urgent surgeries done in America, often at provincial expense if not their own. In that sense the US does act as something of an escape valve. But more importantly, Canada doesn't have a political party as reactionary as the Republican Party nor a region that is as backward and so resistant to social progress as the American South. Finally, Canadians have a deep commitment to fairness and equity; some Americans do too but many do not. We can't even agree in this country on whether health care coverage is a right, something that most other democratic nations settled years ago.
Medicare for all would be rational, sensible, fair and potentially far more efficient than the chaotic, wasteful mishmash that passes for a system here. But it will never happen and Bernie Sanders is harming rather than helping our quest for universal coverage. There are many ways to achieve that but by evolution not revolution.
10
"Wealthy Canadians can, if they want, have non-urgent surgeries done in America, often at provincial expense if not their own."
No, they won't be covered provincially (by the government) unless it's a surgery that can't be done here in Canada. Most surgeries/procedures done out of country and paid by our healthcare (Canada) are things not done here, or, at times, experimental... OR, at the very worst, because there are unusually long waiting times, which is rarely a reason things get covered out of the country. It's very rare that a person gets government coverage for surgeries and procedures out of the country... Mostly, people pay out of pocket or extra insurances they have...
5
Most provinces that I am aware of do not cover out of country medical expenses. Ontario did. but that was a long time ago. The provinces have an agreement that one province's resident will not have to pay a fee if the province they have medical need in is higher in cost than their own. I had coverage for travel through my wife's workplace benefits, but we split up. If I travel out of Canada, and if my employment benefit does not cover out of country medical emergencies, I buy a policy for the time that I need, or on an annual basis if I travel a lot.
4
How is Bernie harming our quest for Universal healthcare? If it weren’t for him constantly talking about it the subject would probably never come up because politicians in both parties are bought and paid for by the healthcare industry.
Also you mentioned that wealthy Canadians come to the US for non emergency procedures like knee replacements. Well many Americans travel outside of the US for non emergency surgeries as well. Americans do it because it is so much cheaper in every other country in the world to have medical procedures done then it is in the US. Medical tourism is a viable option for people like me with a $6000 deductible. I could probably have the surgery and one hell of a vacation too.
4
I have lived in Canada 43 years. Other than my children births, fully covered by our provincial health care, I had a challenging 2010 year health wise. Three hospitalizations and various surgeries, my total bill was zero, and my only costs were the parking fees incurred by visiting relatives, 10 dollars or so. I did not have to wait to be treated and medical care was both first rate and caring. I would rather pay higher taxes than fearing losing everything after a serious illness. As our former PM Jean Crethien stated: " the last thing you need after defeating death is a home wrecking medical bill".
51
You and I (as Canadians) pay for it through our taxes... And I don't know about Vancouver, but here in Quebec almost half of our salary goes towards taxes, a large chunk for healthcare. Which doesn't include meds nor dental, nor certain procedures. We're used to paying such high taxes, but never worrying about getting sick or needing hospitalization because we already pay through our teeth, but the USA is not... It will be quite a change, and a heck of a difference in their paychecks if indeed universal healthcare comes to be there....
2
Here is a key sentence from this column: "His policy vision, decidedly from the left in the United States, matches mainstream Canadian views." This is why I no longer consider myself American, but instead Canadian, even though I live south of the Canadian border. If I were able to emigrate to Canada tomorrow and denounce my American citizenship, I would.
42
Homesick,
Social Credit is a far right wing Christianist party founded in the Early 20th century by an antisemitic, racist, bigot British engineer and economic and social theorist Clifford Hugh Douglas. Social Credit formed the government of Alberta from 1935-1971 and today the legacy Wildrose Party of Alberta makes Ted Cruz look like a liberal. Social Credit introduced free hospital care in Alberta 1948 months after Democratic Socialist Saskatchewan introduced free hospital care. All hospital care was free whether you needed a room or just needed a pill.
To Homesick Yankee: Me Too.
1
If only the Presidential election had turned out differently...
35
Bernie Sanders has gone to Canada? My dreams have come true.
8
People in my own party like to deride Bernie Sanders and call his supporters all sorts of horrible names, and yet here he is, once again, out there working for people and sticking to the issues that matter - thankfully. That is what works. People notice it. Take note, future candidates.
53
Very simple reason Slim. When you are not beholden to corporate donors, you can deal with issues honestly and without influence from those who wish you to fail. It is amazing what one can do under those circumstances, an extremely rare circumstance in American politics.
3
So long as Americans remain pathologically, monomaniacally averse to socialism, well, no will be the answer to wisdom. Never mind that though the American Heritage Dictionary defines socialism as a system where the state owns the means of production, our government owns the means of producing itself, defense, police, fire and utilities. Never mind.
22
Slipping,
It is 2017 and Bernie anywhere else in the democratic world is a centrist liberal. If it wasn't for their nationalism Bernie could join our conservative Parti Quebecois.
3
Try comparing vacation time, sick pay, aged pensions, gun laws, medication prices, maternity leave, and standard of living in other nations along with the cost of health care and you come to the fact there is no American dream.
49
Right and in part that is because we spend an inordinate amount of money protecting not only ourselves but others such as Canada and Australia as well as a more liberal international order - or at least that was our aim before installing the present incumbent in the White House. Not sure what he's doing but then neither does he.
You can certainly argue that we're saps for spending so much of our money on aircraft carrier battle groups whilst others invest in their health care systems but there's no question the world benefits.
2
That's the silliest thing I've ever heard. The US makes the world LESS safe, not more. You will spend 23 trillion on weapons in the near future, including more nukes. You already have 7500 of them. You don't need more killing devices. You need a lifesaving device...it's called universal healthcare.
3
800 bases around the world many of which within the continental U.S. that were designated for closure by the Pentagon several years ago, but, were needlessly kept open by "pork barrel" politics. How much is that costing the American taxpayer every year?
1
Ken Arrow thought a single payer system was the best among all other options. https://promarket.org/there-is-regulatory-capture-but-it-is-by-no-means-...
And Arrow was the best person to know this. So why not move to a single-payer: it is the most robust system that can withstand both political and market disturbances. (Oh, please don't ask usual questions like: who will pay? etc..the answers are pretty clear and have already been answered..)
11
It is short-sighted of the Canadian Medicare system, and of America's, to not recognize that being able to eat, to see, and to receive necessary medications are as essential to one's health and physical safety as emergency surgeries are to life itself. Without being able to speak to Canada's handling of dental and vision care, America's Medicare is pennywise and pound foolish. My only complaints with my Medicare are these areas.
Since Medicare was first created, the cost of glasses and the services of optometrists have largely gone the way of the cost of home computers since the first Apples and IBMs of the 1980's. Being able to see well is a matter of safety, for the patient and the community. Medicare does cover cataract surgeries, and Part D, of one elects it will help with medications for glaucoma and other eye problems. But to see well? The chain vision center I have used will put 3 pair of glasses in my hand for less than $100, and that's without any insurance whatsoever.
If dental care is not primarily about nutrition, then why go to the dentist at all. I'm not talking about teeth whitening. Essential care for broken or rotted teeth, missing teeth should be part of the package These can spell misery and poor overall health for anyone at any age, but especially among the elderly. Again, the cost of care for the sequelae of poor dentition is greater than the cost of prevention and treatment in the long run.
But even without these, Medicare for all.
13
I have to pay fully (in Canada- Quebec) for my eye exams and glasses (and I'm a nurse) and I have to have separate health insurance for dental, meds, and other things like physiotherapy (such as the time I hurt my back at work) etc... When you add it all up, it's actually quite expensive the healthcare here in Canada... But also true, because a large chunk of our salaries goes towards healthcare, I never worry if an accident happens and I or my family members need hospitalization. But would it be cheaper with private insurance????? As a Canadian, I never thought about it or questioned it, but I am now....
3
Well, Grace, if you can monetize the security you have vis a vis the worry of making stiff monthly premium payments for the barest of coverage, and then only after $5K-$10K co-pays, you could approach some sort of meaningful comparison.
2
Grace,
When my wife retired in Chicago I had to pay 1700 a month to keep my insurance you don't have to think about it. When my father-in-law died the van started being packed for our return to Canada the next week. In the USA your healthcare was a substantial part of your income and dental and optical plans don't come cheap.
Canada doesn’t ration care. People are triaged. If it an emergent or urgent problem, you go to the front of the line. People who are not as sick, wait a bit longer, but real needs are looked after. Self-advocacy and self-care are as essential as anywhere else but people complaining about wait times don’t see the big picture, which we have to do as part of a social network.
This system saved my life AGAIN this past winter and now I can put my life back together in the home I still own. It isn’t a perfect system, but when you are sick in Canada, you get what you NEED, which may not be everything you think you WANT.
Sometimes, for non-urgent problems we have to wait but I’m not complaining about waiting my turn, because inconvenience isn’t an emergency.
And please note: universal coverage isn’t about compassion. It’s economics, plain and simple. Keeping the population heathy enough to work and maintain a civil society keeps the economy going.
85
Five years ago I was not feeling well and took myself to the neighbourhood hospital emergency, just in case. I expected to have to wait quite bit in the emergency waiting room but the triage nurse who came after about five minutes took my pressure and said: treatment room right away! I eventually has a minor heart attack in hospital and stayed two weeks while they took care of me and my heart. Direct cost to me for this very prompt (and excellent) care and service; $0.00. Our favourite sushi chef in Toronto still talks with unbound appreciation about what he calls his million dollar baby (now 30 or so). The system may not be perfect but it is efficient and fair. No wonder it is considered by Canadians to be a foundation of our national pride.
13
My wife and I are of an age where caution means a trip to emergency any time day or night. If you are 60 plus the ambulance is free. We like to joke that being last in line at emergency is a blessing even knowing new arrivals may be served hours before we see the doctor.
If Americans learned these lessons, it would benefit our country beyond the health care arena.
1
Wow - I am just certain that Senator Sanders went to Canada with an open mind, and carefully consideedr the difference in the population, demographics, and actively sought out a variety of opinions. This is confirmation bias at its best. When the Senator gives up his own blue-plate special Congressional health care maybe it would be a bit believable. Just a typical campaign stunt by a hackneyed politico. And by the way, how about a single Paulo system for lawyers ?
5
At least he is trying. Can you say the same about the other corporate beholden Republicans and some democrats who want to take it away from you?
Population and demographics are irrelevant, it is about political will and a country doing the right thing for ALL of its people.
1
I wish that folks would get it through their heads that single-payer and universal health are different, that Medicare for All has zero chance of getting done in this country any time soon, that Canada rations care in a thousand ways, that Canada generally doesn't pay oharmacy or dental or vision, that Sanders has no plan for paying for what he wants and no details about what the system would and would not cover.
Am all in favor of universal coverage. Could even go for single-payer, honestly presented, without smoke and mirrors.
But gee, I wish folks would get a clue.
8
"Medicare for All will never happen" -- until it does happen.
"Sanders has no plan" to pay for it? Not true.
The people who say that are the same people who never had a problem raiding the treasury to pay for one godawful war after another. It's about priorities. How bizarre that we would pay for our own people's health rather than killing people we don't know.
23
I'm confused about your reference to "smoke and mirrors". Canada might ration care should one define rationing as a means of balancing the available resources with patient needs. We also have programs in place to assist those who can't provide for pharmaceutical, eye or dental care on there own. However, what we don't do is ration care on the basis of the patient's ability to pay.
We fund this services out of general public revenue, and the overwhelming majority of Canadians are perfectly happy to see our tax bills increase in order to provide the necessary funds. The United States -- the wealthiest nation in the world -- could easily do the same, should it so choose.
Whether or not the United States takes such a path is -- obviously -- entirely up to the American public. But please don't confuse the issue. Canadians enjoy the health care system which we do because of conscious fiscal choices reached at through open political debate. Absolutely no smoke and/or mirrors are necessary.
33
Fine. What are the costs, and what's your financing plan? What do you plan to do when about a half million people lose their job, and major health companies close? How toyou intend to get doc and nurse pay rates down to Canadian levels?
As a bonus, precisely what will the plan design be? Note: if you don't know what a plan design is, you should find out before opining.
P.S. No cheating on the finances, now. "Cut admin overhead and waste," won't git it.
Donald Trump may be president, but Bernie Sanders is the real leader of the free world.
Just imagine what he could have done if he were our president today.
68
With a republican congress? He'd been able to do absolutely nothing.
Given this Congress and his history of passing legislation?
Zip. We wouldn't have the loony deregulation and the foreign policy insanities, but zip.
If Bernie were president today, the world would be a happier place. Happiness...remember what that used to feel like?
1
Bernie learned in Canada what citizens of dozens of other countries have known for years about the need for universal health care. It's not problem free but it's possible, Why do Americans believe that they have to reinvent the wheel?
45
We are kinda stupid. That’s what people all over the world are saying.
5
ER, then why did Vermont reject single-payer?
https://www.politico.com/story/2014/12/single-payer-vermont-113711
... long silence ..
2
Back here, in the Capitalist States of America, mega drug store CVS just bought Aetna insurance company. Next up, medical centers and hospitals.
This has got to stop. Or we'll NEVER see a fair honest humane medical system.
49
" .. mega drug store CVS just bought Aetna insurance company .."
Absolutely untrue, per NYTimes --
https://www.nytimes.com/2017/10/26/business/dealbook/cvs-aetna.html
This is why Democrats lose -- cannot provide facts or workable budgets.
1
No Canadians do not value fairness more than Americans do.
The issue with that lack of fairness in America is that the republican party has systematically gone through our codes, laws, rules, regulations and any other aspect of government enforcement to remove fairness from it.
If you understood the premise of the founding of the United States you would understand that fairness is the central unifying concept behind "equal justice under the law".
Honestly how does one even let that thought leave the privacy of ones mind?
16
I'll go even further to state that where some person working for the people has authority to apply their own judgment the republicans have seen to it that the people placed in those positions are people who do not think it right for the government to assist the people it serves unless they have wealth.
14
Just saying it doesn't count for anything. Actions speak louder than words. And in terms of "actual" actions and results in this area, Canadians value fairness more than Americans.
1
Americans will never ever have universal healthcare. The government does not believe that all citizens are equal or should have equal rights. It's as simple as that.
31
I live in Canada, and though it has it's fault in terms of how long it can take to get service (even a visit to the hospital after hours, which is the emergency room, you can easily wait 3-4 hrs and then be told it's nothing or let's say to get some stitches for a finger cut).
My mom in her 70s fractured her hip. Got admitted around 8pm, and we didn't know how long should have to stay until around 1am. BUT, the most important thing is everybody gets access. My mom after, who went home the next day (had to pay private ambulance carrier instead of trying to take her home ourselves), had A+ treatment from follow-ups, offers of additional treatment from physio.
My parents as most seniors have their share of Rx. But there is no worry to paying for it! Other than a small dispensing fee.
Now I used to work in a position administering US Healthcare for a Dow Jones company, and wow, was it ever an eye opener. Bill Clinton was right, the bureaucracy behind it will ensure costs stay high. As for me, the idea of profit maximization helped by the State (especially for Rx) is also inherently just evil given it's profit at the expense of human suffering and angst.
23
People often wait longer than that in US ERs.
1
Canada has 13 health-care systems, not one. Their common virtue is reliance on a single-payer system that lowers administrative costs to under 2%.
But the single-payer system is no panacea for the issue of access to quality care. In fact, access and quality vary significantly across the country. When health budgets are cut, as they have been in Quebec, both can be severely compromised.
Wait times in emergency rooms are far longer in Quebec than in any other province and most OECD countries. (The minister of health responded to this finding by abolishing the office that produced it.) Surgery for problems that are not life-threatening but have a major impact on quality of life can take months, if not years, to be scheduled. Access to a GP is difficult (over 400,000 Quebeckers do not have a GP at all), regular interaction with a gynecologist is considered a luxury, and seeing other specialists can take months. The focus on efficiency over quality has undermined the doctor-patient relationship.
This is not to say that the Quebec government doesn’t do some things right. Its subsidized daycare system is universally seen as an excellent use of taxpayers’ money. Nor is it to say that health care is bad in every respect. Montreal has state-of-the-art medicine and medical facilities for children. And the city is a world leader in medical education and research. But underfunding and poor (centralized) management have left patients at the mercy of an unresponsive system.
17
For 30 years our small non-profit has proudly provided health insurance for all staff. For 30 years insurers have raised our premiums along with deductibles and co-pays while cutting back coverage (until the ACA improved coverage if not premiums). Did I mention their confusing (and often maddening) in and out of "network" rules and qualifications?
Small businesses and non-profits like ours cannot afford ever-increasing health insurance premiums, yet we are loathe to pass that burden to our employees. There is no other single issue that affects our costs as much.
A single-payer, Medicare-for-all type plan seems to us a no-brainer and we support it whole-heartedly.
21
It appears that there is much to like about the Canadian system and that, with some analysis and creativity, the United States, the greatest country on earth, might be able to come up with improvements to fill the holes pointed out in this interesting article.
5
Canada has had universal healthcare for over 50 years. Many countries have healthcare for all citizens. Even Cuba has better healthcare than "the greatest country on Earth"
1
A critical question not answered in this article is: In Canada how often are chronic conditions like diabetes and heart disease treated as crisis intervention. This is an important distinction as, using the American system, these and other chronic conditions are treated in ER's as a crisis rather than part of ongoing regular health care/maintenance.
My assumption (waiting on an answer) is that Canada, and other nations, spend less on these chronic conditions than America and thereby have lower costs and better overall health care outcomes.
9
Chronic medical conditions, here in Ontario Canada, are usually managed at the General Practioner (GP)/ Family Physician level of care with specialist referral & care provided as needed. All physician fees are included in the provincial health insurance plan. A lot of effort goes into avoidance of ER care for issues that can be easily managed at the GP level, although this is a challenge especially with recent immigrants who do not yet have a GP. You are correct, ER care is extremely expensive to provide, and people seeking unnecessary ER care do clog the system. Its not a perfect system but a person does get what they need and when they need it in emergency situations. If treatment of your condition can wait then you might wait a bit under the careful eye of your GP.
5
How does spending less on a chronic condition mean the patient will have better health? Couldn't it be that the patient dies sooner?
Over nearly a 45 year period I have lived and worked in 5 of the countries listed of the 11 countries mentioned in the study, and have made use of health care in 4 of them. These four being; UK, Canada, Netherlands and USA. By far the best was the Dutch healthcare system. Their critical care was directly responsible for saving my wife's life many years ago. Had it not been for a remarkable team of doctors and nurses and a remarkably responsive system, the result would have been very different. The cost to me? Zero.
Next I would rate the Canadian system, as a good balance between service and costs. Critical care is very good but you can wait a while for lower priority ops. Drugs, dental and optical care support varies somewhat between provinces, but are mostly subsidized by the government.
I would rate UK health care in 3rd slightly below Canada due to overworked hospital staff and stretched services.
USA was in last place, since when I was working there it was before Obama care and a couple of small visits to a local MO cost a fortune with no proper referral system for follow-up treatment. This may have changed now but I remember thinking I would hate to be really sick in America without a full (costly) medical plan.
50
I am a Canadian surgeon and have been in practice for over thirty years in a smaller urban community. Our healthcare system while far from perfect, relieves EVERYONE from the worry of financial disaster through illness. I send my bills to the government (Ministry of Health) which are paid on a monthly basis. No accounts receivable, and I have ONE office person.
Waiting lists for some procedures (hip and knee replacements) may be prolonged, however patients with urgent problems are seen and treated immediately. Patients always have the choice of Family Physician, and the specialist they wish to see if necessary. In all the years I have been in practice, I can count on the fingers of one hand, the number of gun shot injuries I have treated.
As I have often explained to my US colleagues, there is a basic philosophical difference between our two systems, in the USA you have the Healthcare INDUSTRY, while in Canada we enjoy the Healthcare SERVICES.
251
Without the US healthcare industry you would not have most of the drugs, technology, and skills you use to do your job. These things are being invented in the US and not in Canada or Europe precisely because there is a competitive US healthcare industry. A socialized healthcare services sector has little incentive to innovate or invent.
1
Having lived in both Canada and the US for more than twenty years each, I'll keep this simple: the Canadian system works. It's not perfect, it has problems and funding issues just like health care in every other country, but darned if it hasn't kept my extended family alive and kicking through every possible type of care over the years.
In the US, I'm fortunate because my wife has an excellent health care plan at work. But even, so every time I reach for my wallet for a co-pay I remember the money-free experience of visiting the doctor in Canada when I was younger. Are my taxes lower as a result? Probably, but I would rather pay more and have a Canadian-style system.
89
Your taxes are in fact *not* lower in the US as a result. In terms of public sector expenditures on health care Canadians pay slightly LESS towards health care than Americans do (And cover the bulk of ALL their citizens medical care needs in the process, whereas the US manages to only cover Medicate and Medicaid recipients and the like leaving most people still totally uncovered and needing extensive private insurance).
Canadian taxes are higher because of their decision to support more extensive other social programs and such, not because of their health care system... which is absurdly more cost effective than the American system.
19
Your taxes may be lower now, but if they increase by the amount of your health insurance premiums, that's a wash.
5
Lesson 5: Canadians value fairness more than Americans do
*******
And Americans value fairness more than the Democratic National Committee does.
23
We also value facts, though it is often hard to tell.
2
Canadians would never throw a temper tantrum because their preferred candidate lost the leadership race and hand their country to an incompetent, bigoted sexual predator to destroy. We also value rational thinking more than Americans do, and do not suffer from hysteria, gullibility and paranoia at anywhere near the rate Americans do.
3
I believe that the article is not accurate in terms of prescription drugs. At least in my experience, both the provinces of Quebec and British Columbia have government plans that cover prescription drugs. In BC, for example, PharmaCare covers a percent of the cost, which decreases in relation to the resident's income.
13
Quite right Michael,
In Québec, there is a mixed private-state system that pays 80% of prescription drug costs. There is a 20% co-pay but it is capped to approximately 1,000$ per year. The system is not financed directly by income tax (as health care is) but by premiums paid yearly when submitting the (Québec) provincial income tax return.
7
Sigh. In other words, single-payer doesn't cover it. You pay for an insurance rider.
By the way, there's a formulary, right? For those who don't know, this means that no, you do not get any drug you want; your generally get generics, not brand names; and some of the fanciest stuff isn't covered.
Canada has an excellent system. It's just not nirvana.
I just found out my costs for healthcare in 2018. The cheapest monthly premium is $935 with a $6500 deductible. The next level is $1240 monthly premium with a lower deductible. I will end up paying the Gold level which is $1469 every month but there is no deductible at that rate, though of course I have to pay co-payments for doctor visits and medications, which I need because of multiple medical conditions and chronic meds needed.
The monthly premium will now cost me more than my monthly rent.
73
Those insurance rates are completely outrageous! I'm speechless -- $935 a month, yet $6500 for the deductible. I'm afraid to ask the total out of pocket max for the year -- must be over $10,000! This is truly criminal.
10
You are lucky. Sounds like you have serious medical problems. You can pick a high
end plan to cover your medical expenses completely. Most people could not afford the $17,000.00 premium payment per year. A person earning say $50,000.00 a year, with the same medical problems as you have would be forced to select a policy that would not meet their medical needs. They would be forced pay a lower premium and in all likely hood receive inferior care.
1
It is a fact that, overall, Americans pay 18% of GDP for health care while other developed countries pay an average of 11% while picking up the costs of medical coverage for all their citizens.
Here's a short lesson in math. The 7% difference between 18% and 11% GDP would, in our economy, yield a savings of nearly $1 Trillion annually. That, I am sure, is a number that American health insurance companies do not want widely advertised.
106
A more relevant figure on how efficient a health care system is is per capita costs. Some data:
Here are the per capita figures for health care costs in 2016 in PPP dollars (which take cost of living into consideration) from the OECD:
US - 9 892.3
UK - 4 192.5
France - 4 600.4
Australia (similar obesity) - 4 708.1
Germany - 5 550.6
Denmark - 5 199.3
The Netherlands - 5 385.4
Canada - 4 643.7
Israel - 2 775.7
Switzerland (Highly regulated private insurance) - 7 919.0
10
There is nothing in the article to support the contention that "Canadians value fairness more than Americans do" unless, by Americans, the author is referring to the wealthy and their politicians. Americans are willing to pay more taxes for:
Social Security,
https://www.reuters.com/article/us-column-miller-socialsecurity/american...
better schools,
http://www.npr.org/about/press/990920.edpoll.html
And to provide for people in need, 69% want increased taxation of the wealthy.
http://www.pewglobal.org/files/pdf/Stokes_Bruce_NAF_Public_Attitudes_1_2...
10
Ed:
Then why do Americans continue to elect politicians whom circumvent all the things that you listed that Americans want? Ultimately, these are political decisions made by politicians. It makes no sense, Americans are the "poster children" for continually voting against their sel-interest!
14
Canadians absolutely value fairness more than Americans. Jumping the queue simply because you have more money is anathema to most of us. We wait our turn for healthcare. Popular support for universal healthcare is close to 90%.
14
Fairness...
With a tip of the hat to Ray Charles:
"Them That Got"
"That old sayin them that's got are them that gets
Is somethin I can't see
If ya gotta have somethin
Before you can get somethin
How do ya get your first is still a mystery to me
I see folk with long cars and fine clothes
That's why they're called the smarter set
Because they manage to get
When only them that's got supposed to get
And I ain't got nothin yet
Whoah, I tell you all
I ain't found nothing yet.”
Yeah, I know JFK said life isn't fair. How long ago was that? And why NOT try to remediate things?
"But a man's reach should exceed his grasp, Or what's a heaven for?" Browning was wrong...
10
I suppose many people still don't get it ( although I , as an RN, I most definitely do get it ) .
Health care is a very personal and paramount concern to every individual and family, so yes , Bernie IS a rock star , because he wants to HELP US with our present out of control Health Care profiteering scam !
103
Perfect description of our current health insurance (not care) system: A Health Care profiteering scam.
And what’s even more depressing is Americans willingly partipate in allowing themselves to be ripped off by insurance companies, hospitals, and the pharmaceutical industry.
When are we going to realize that our system is evil, inhumane and ridiculously expensive.
2
Realistically, or judging by Massachusetts and the ACA, there will have to be at least one state that could serve as a successful example before this could be plausibly proposed nationally.
7
Ed - There was such a bill here in our legislature - a statewide universal healthcare bill. Unfortunately, it got squashed by Democratic leadership. There's been a real battle here between the ho-hum, neoliberal Democratic leadership and the FDR/Bernie wing of the party. The battle is far from over. DNC nationally will not win until it adopts what Canadians view as middle-of-the-road policies, but the DNC and media in the states view as "too far left".
18
Ellen:
Like other states that are attempting to implement a similar system i.e. California, Colorado etc. much like the democrats in your state, you will find the answer to their feeble opposition by just checking their campaign donors list and then it will be obvious. Even the senior members and leaders from California i.e. Nancy Pelosi and Diane Feinstein have also refused to commit to implementing universal healthcare because if you check their donors list, once again,it will be confirmed that, over the years, they each have received hundreds of thousands of dollars in campaign donations from the healthcare industry.
It is always the same old story, "follow the money".
8
The bill got squashed because the conservative estimates said that the costs would be about twice the current state budget, and because there were no plans whatsoever for a transition or a oayment mechanism.
1
Just got back from a trip to Japan during which I had to visit a doctor for a bad cold that I thought might be pneumonia. The doctor's office was very apologetic about having to charge me a full fee, since I don't have Japanese medical insurance. The full cost of the visit, including urinalysis, blood pressure check, etc. was a whopping 3000 yen, which amounts to about 27 dollars. Seniors pay 10% of the charge, others pay 20 to 30% depending on coverage. My husband recently went to a doctor for possible sinus infection here in Berkeley, saw the doctor for a few minutes, was prescribed a nose spray. The charge for that visit was in excess of $500. We need to change the entire system here in the US. A good place to start is the insurance system, but there's something seriously wrong with the cost of healthcare here. BTW, the doctor in Japan had built a nice house with his clinic on the first floor, so he didn't seem to be suffering charging those amounts. He also had at least 3 courteous people working for him.
137
A large part of the problem is the MD mafia keeping US MD pay off the charts compared to the rest of the world. It will take RICO Act intervention to set things straight.
https://www.politico.com/agenda/story/2017/10/25/doctors-salaries-pay-di...
Yes it's best to get sick or injured when travelling outside of our country.
Get your dental work done there too.
1
Enough cannot be said about the Japanese system, and not just the healthcare system. There is poverty and wealth, but the great center of the curve is occupied by most, and income equality is the norm. Health insurance is not free - it's a whooping couple hundred dollars a year.
But how is this possible? They have two things we do not: people with generally healthful attributes (a lifetime of rice, pickles and seaweed for breakfast pays dividends!) and a culturally unified population. When your typical japanese is enjoying their seaweed for breakfast they know their neighbors are not poisoning themselves with froot loops and frozen waffles; if either gets sick it's just the vicissitudes of life. They all play by the same rules, and they're in it together. It is this way a healthcare system like theirs is politically feasible. Can we say the same of us?
2
- There are no alternatives to the government system, which means that there’s no way for patients with more money to get faster or better care in Canada. -
This is true, but many well off Canadians do head to the USA for procedures for which in Canada there are long wait lists, such as for hip or knee surgery, MRIs and many others.
Canada's system is far from perfect but I with a pre-existing condition would have died long ago without it. One could equate fairly I think Churchill's quote on democracy and apply it to Canada's health care system, in that it is the worst system out there except for all of the others.
23
"This is true, but many well off Canadians do head to the USA for procedures for which in Canada there are long wait lists, such as for hip or knee surgery, MRIs and many others."
This is a myth, at least numerically-speaking. I would not say "many". The numbers are very small relative to the Canadian population.
20
II work at a golf course in Naples Florida. Many members of the club were Canadian (20%). In the fifteen years that I have worked there I cannot recall any Canadian getting major treatment in Florida. They all schedule treatment and operations back in Canada.
1
It is absolutely not true that Canadians don't have options to visit pay for service doctors. Canadian doctors have a very limited amount of time they can spend with individual patients. There are also limits to the types of laboratory testing the system will pay for. I personally visited my doctor numerous times in an effort to identify the cause of my ailment. I was sent home and told nothing was wrong with me. I finally decided to make an appointment with a doctor whose services I had to pay for myself. It was 100% worth it. She was able to use a private lab for my blood work which immediately identified the problem. This testing is not provided by the provincial health plan. My sister now has a private team of doctors in Vancouver who operate a system that offers "memberships". This gives her access to most specialists working in the same location. Also in Vancouver, if you are willing to pay for private services you can get an MRI almost immediately. In BC, and I suspect in most Provinces, doctors have an allotted time they will be paid for seeing a patient. I believe its under 15 minutes. Also, many doctors will allow you to discuss only a single complaint. So if you have strep throat and a sore back, pick one or the other and make another appointment
Having said all that, I pay premiums of $70 per month and I'm able to use the system as I need. I don't always need the type of doctor I have to pay for but I'm grateful that option is open to me.
3
Demand for health care is essentially infinite, resources are not. The two are reconciled through price, rationing or some combination. Some health care delivery systems are more efficient than others, but constrains remain and 'free' does not mean unlimited access.
8
Demand for health care is not infinite, but is determined by the number of people served and the frequency of their need.
Resources to service them need not be infinite, but allocated sufficiently through taxation — the same taxation that wastes trillions on wars.
17
Why on earth would demand for healthcare be infinite? Who wants to spend all their time waiting in an MDs office or pharmacy line, getting poked by needles, dealing with side effects and medical errors, etc?
1
Don't let the "tax hike" argument fool you. An increase in taxes is easily offset by health care premiums being dropped altogether. Premiums for most middle and low income people are higher now than they would pay for additional taxes under a single-payer system.
In Germany, health care is only marginally funded by taxes, mainly by premiums at around 15% of your income (max. $800 a month). This way it is affordable for everyone.
31
Polls also show support for single payer goes up when people learn their costs will decline. Support declines if taxes go up, which people understand as their overall cost going up, which would only apply to the richest 1 percent. Funny how this is the segment the NYT focuses on.
20
I work in Healthcare and have for over 30 years in military, public and private hospitals and clinics- large and small. Our health insurance system is desperately dysfunctional and broken in ways that impact the care each and every American has available to them. We need a SIngle-Payer, Not for Profit, Universal Health Insurance system run from the Federal level- not the state level- so that every American has quality coverage and choices.
I work for a large integrated health system and am insured through work. Over my tenure we have seen the quality of our coverage steadily erode and decline from a fairly generous PPO system to a very tightly controlled HMO system. It is so bad that I am tempted to opt out and enroll via the ACA for my coverage.
Like many bugger employers, we are self insured. I realize the pressure to control costs for employers is immense, which is exactly why we need to get employers out of the health insurance business so that risk and costs can be spread over the largest pool possible. There is no more justification for employers to control your health insurance than it would be for them to buy your furniture.
The CEOs of our big companies should step forward and speak out on why health insurance and employment should not be joined at the hip. They should be spending money developing new products, new technologies, better manufacturing processes and investing money in the development of employees- not paying for your appendectomy.
93
Agreed. I don't understand why employers aren't on board with single payer.
36
When one listens to politicians talk about the need to make the American worker more competitive then should look for this answer in Universal Health Care.
One would think that any CEO of a large company employing Americans in the USA
would want to have Universal Health Care in place. This would lower there cost of operations dramatically. Allow them to be more competitive in the world market.
Thank you for publishing this travels with Bernie story. As is so true about our country, Americans know so little about other countries. If more Americans knew that we pay 40 percent more per capita on health care than any other country and still live a shorter life expectancy, you would think that maybe we would like to learn how they do it better?
But the media has done a piss poor job of informing Americans. Our healthcare financing system should be the annual recipient of the Golden Fleece award. Despite “free” health care, Canada has a smaller national debt as a percent of their GDP than the US. Maybe this could be the start of a NYT series of other countries who do it better.
35
A more interesting figures is the we pay per capita 2.5 TIMES the average of other developed countries (members of the OECD).
11
..." Every one among the patients and doctors selected to meet him said the trade-off was worth it because it made the system fair."
Funny how tribal we Americans can be: (USA!! Number One!!! Build the Wall!!! American Exceptionalism!!!! Fires those SOBs!!! and so on. Pick your favorite cheer. Except when it comes to our tribal health care where the American model is survival of the fittest and pay for play. Of course the ACA has cracked that model which is why I guess the Republicans hate it so much. It's fairness principle is against their religion.
21
Really, really hard to find a Canadian who disparages their health care, except maybe in some specific detail.
And except when you see someone identified as a Canadian in TV ads during US election campaigns. Anyone I've talked to about it says, "Where the hell did they ever dig up that person in the ad bad mouthing the Canadian healthcare system?"
The advantages of a single-payer system go beyond just accounting simplification. Good to have the management of such a system instead of the for-profit-first approach found in the US and third-world countries.
A challenge to serve a country as spacious and dispersed and diverse as Canada with hospital services near your door. For sure in big cities, access to every medical need is quick and providers are highly skilled while in rural areas - and in the fast growing suburbs of Toronto too - service isn't as good.
25
This is a generalization, but from my trips to Canada, and what I've read about them, they pretty much like each other. Yes, there is friction between Quebec and the other provinces. And, yes, there are conservative politicians who want to roll back the clock on social programs. But all in all, Canadians are proud of their country and are modest about their patriotism. And they welcome refugees.
No wonder a national health care system works for Canada.
The U.S. Not so much. A lot of Americans despite poor people. We are plagued by racism and widening economic inequality. Our current political regime wants to divide the country, and we constantly entertain draconian proposals to throw people under the bus on health care, taxes, and immigration.
The U.S. is not conducive to single payer. If people suffer or can't afford care, it's their own damn fault. And unlike Canadians, we have a virulent nasty streak imbedded in our psyche that equates guns with security.
102
The history of the introduction of single-user, universal care in Canada, and your own experience of Obama Care says you are incorrect, Paul, when you say "the U.S. is not conducive to single payer."
When our system was first introduce in Canada in my home province of Saskatchewan, the political battle was as divisive and wild as what the US is going through now. The doctors, in particular, were livid, assuming they were about to become indentured laborers, and the medical insurance industry was apoplectic. That provincial system went national when our socialist party had a minority in parliament, but that minority was essential to the ruling party. A simple act of wise "political blackmail" flip the switch in favor of sanity. (Not at all unlike "little Bernie" wielding an influence on this issue while beyond his senatorial credentials.) In took time; and it was only the actual experience of the system by doctors and patients and government that eventually won the heart of (virtually) all Canadians.
Similarly with Obama Care. Despite the slander and lies before and during and after implementation, many were converted by the actual experience. If that had been no Trump, I dare say more and more Americans would have come to appreciate that system, especially as the young who don't want to be forced to pay, grow old, and realize it was a good deal.
2
Americans have been haggling about healthcare for over 70 yrs. with still no real concensus and much of that has been caused by a continuing lack of education on this important subject and, of course, the usual industry propaganda barrage put forth by the lobbyists and their shills whom generally misinform or outright lie about the issues. Unlike the vast majority of U. S. politicians, I commend Bernie Sanders in going out to actually investigate and learn about an important subject about which he is so passionate and who feels the need for Americans to get the REAL facts, not disinformation.
As a Canadian, I can only assume unfortunately, at this stage, two reasons why America will more than likely never implement universal healthcare. As the article concludes, unlike the rest of the western industrialized nations all of whom who have such health plans in one form or another, the deep and growing divisions in America make the idea of fairness virtually impossible. Also, since many Americans still buy into the notion that "government and taxes are evil"(otherwise Republicans would never get elected), it seems the potential for bankruptcy from non-payment of medical bills and a forthcoming healthcare system whose costs will more than likely go "off the chart" with less people left with no healthcare coverage at all, is obviously still more palatable than the common sense alternative.
27
Canada looks more and more like a good place to live, as opposed to the USA, whose Republican government wants to turn us into a banana republic with the rich in charge.
35
Memo to Upshot: How about providing a reference for reading more about the upswell of support that led to passage of the Canadian Province-based national health plan. It started in poor provinces, like the American South.
9
Perhaps a link to the entertainment industry might be helpful. The man who started the ball rolling on the implementation of universal healthcare in Canada was Tommy Douglas, the Premier of Saskatchewan, an individual, by the way, for his efforts, voted Canada's greatest Canadian. He had a daughter named Shirley who was once married to actor, Donald Sutherland who, in turn had a son, "Kiefer".
Tommy Douglas is Kiefer Sutherlands grandfather.
18
Yes, he’s going to run for President. He and his wife are traveling worldwide telling the world. His plans for healthcare won’t pass anytime soon, whether he’s president or not.
3
sorry you have so little hope. for my kids' sake we are very hopeful.
2
I live a few hours from the Canadian border, but I might as well live on another planet.
I am a US citizen, served my time in the military, and led a productive, albeit simple, life (I am a barber) raising and educating my two children.
Now that I am 62, I realize that access to the health-care system in the US is a cruel joke; I feel abandoned.
Too bad the Dems worked actively to thwart Sanders campaign; too bad the Reps are mostly mean-spirited money-grubbers who foment divisiveness - even to the point of supporting white supremacists. Just too bad.
Beyond the question of access I believe the entire US healthcare 'system' is fundamentally perverted because it is predicated upon profit not the care of one human by another. It's all about the money.
I am disgusted to the point of nausea.
157
Every Canadian thinks that healthcare is a right and everyone including patients and doctors said that the trade-off of higher taxes was worth it because it made the system " Fair ". And Americans? The Rich and the powerful politicians get golden care with their golden insurances while the poor and the uninsured get poor and no care sometimes leading into bankruptcy. The tax system is based on a % of income. So why are the rich and the Corporations getting a tax break ( as announced today ) instead of paying more into the Exchequer? The trickle down has not occurred since Reagan years. Why is a tax system deliberately tilted towards the rich? The rich will stay rich even after paying more dollars because of the % system. But they simply refuse as they have the greedy politicians to do their bidding. And if the Canadians want supplemental insurance their Corporations pay for them. And that too with minimal contribution from the employee. I'm sure Bernie Sanders knows all this. But he is old and will never get a another shot at the Presidency having been branded as extreme-left, a socialist and even a communist even by his own Party ( independent Democratic!! ).
14
If we could figure out the answers to those questions, we wouldn't be in this mess.
Americans are penny wise, but a pound foolish when it comes to taxes. People will be paying a lot less in taxes for a subsidized healthcare system than they would for private insurance for a year. A commodified healthcare is inefficient because its designed to be. Healthcare is an inelastic good, because the supply is controlled by a few companies and the demand is high. So, the health industry has every incentive to make healthcare ridiculously expensive not efficient. Hence, life saving goods like the Epi pen and insulin have experienced large price hikes that put a strain on household finances.
21
I wish people like Bernie Sanders (I.e., respected advocates for improving the U.S. health care system) would quit saying Canadian health care is free. Sure, as the article points out, there is no payment at the point of care, BUT IT IS NOT FREE! Employees pay health care premiums directly through payroll deduction, employers pay a health care tax (1.95% of payroll in Ontario) and the remainder of the funding comes mainly from sales and income taxes paid by individuals and businesses. Bernie, I’m behind you 100% on this, but p-l-e-a-s-e stop using the word “free”.
14
exactly. the choice is between a system where those who can afford it pay premiums for care for themselves and their families, and a system where taxes pay for care for all.
nothing is free. the only thing free is the decision to live in an inefficient, expensive system paid through premiums, for a vastly more affordable and demonstrably more effective system supported through taxation. it still domes rom the same pocket, eventually.
12
We all use the word "free" when we refer to government services that are paid for with our taxes.
Free (as opposed to toll) roads and bridges. Free fire and police services. Free public education.
When universal healthcare is paid for out of general tax revenues, it will be just as colloquially correct to refer to it as "free."
9
Are Canadians being as inundated with propaganda from the drug companies as Americans? Is their food chain as polluted with GMO items as ours? Are they as addicted to social media? Maybe they're not as sick as we believe ourselves to be. It seems clear to me that the biggest players benefitting in this ecosystem of MD scarcity/drug tsunami are the insurance companies - totally superfluous middleman marketers of illness and cut rate medical care. So, eliminate the middlemen first, then fund more medical school scholarships and endowments for aspiring caregivers. Create a new economy of medical care. Tweaking the present ones won't work. Canada has long wait times, US has more fat cat physicians - some of whom are willing to experiment with pioneering treatments not available in other countries. Both are deeply flawed systems, not getting better anytime soon.
2
Canada has some long wait times for "some" elective non-emergency services. All other more serious services are handled promptly. Children's Hospital and Princess Margaret Hospital in Toronto are recognized as two of the top five hospitals in the world for dealing with children's diseases and cancer therapy.
The notion that researchers can only develop cutting edge technology and treatment in a private for profit system like America's is the usual nonsense propaganda that has been emitted from industry lobbyists for decades who are against any form of universal healthcare.
Their claim is also a "deeply flawed" myth.
65
@contrary
The mass media advertising of prescription level drugs is illegal in Canada, period. To say that the Canadian system is "deeply flawed" is deeply wrong, especially when you equate it to the actual "deeply flawed" system that exists in the US. True, I might have to wait 6-12 weeks for a knee replacement, but I have every confidence that should I require immediate life-saving treatment I would get it, immediately.
28
And with absolutely no bill to pay upon discharge!
Thanks Senator Bernie for sharing these lessons. We are confident the US will incorporate these lessons and help design the most exemplary health care system that works for every single American barring none. We will get there, with your blessings, Senator Bernie.
And Margot you should consider yourself lucky for being hand picked to accompany Bernie on this tour. Throughout his presidential run, he barely received a glance from folks like you but as you noticed first hand he is a hero to millions of people throughout North America. He spoke directly to our hearts and millennials were inspired by him, I dare say, even more than Obama who unfortunately slipped into the celebrity Wall Street Silicon Valley rarefied atmosphere, leaving swaths of Americans and their dreams, behind.
13
We are not Canadian. We have to look US Health care policy of our own. Canada is a small country with smaller population with different tax policy. America is not a socialist country , it is a capitalist care. We can change, fix and improve Obamacare and that is the best solution. I love Bernie but refuse to move to extreme left.
1
Single-payer is not really "left" at all. Viewing it this way is probably the result of exposure to decades of disinformation and propaganda. In Europe, even the extreme right-wing political parties don't take issue with universal care for being "left".
75
Andre - no, Single-payer is not really "left" at all. Sadly, though some of our politicians probably see its wisdom (in private), in public they cannot be for it because they are paid off, in campaign donations from corporations that profit from the healthcare "industry". And, also sadly, our media tout this line. Last year, a New York Times writer called Bernie's ideas (including universal healthcare for all Americans) "rainbows and unicorns".
4
Canada is a capitalist country as well. By your reasoning, The USA is also socialist as the government supports the military, police, fire department schools and some universities. We just choose what we think is necessary for the best outcome of the citizenry. For some strange reason, in the USA (alone among most developed nations) security, defence and education are considered important, but not health care. BTW in Canada public education is not at the whim of the local municipality which may be poor or rich. It is operated on the provincial level so that all schools receive the same funds. In fact poorer neighbourhoods get greater financial support to make up for the inequality.
5
As a Canadian, I find little surprising in this article. One might be able to find the odd Canadian who would favour the American system over our own, but they would be far and few between.
This has a significant influence over our choice of governments, at both the federal and provincial levels. One political club which commonly wielded by the left is the assertion that some individual or party on the right favours an "American-style" healthcare system. If the assertion can be made to stick -- as was the case in the most recent Ontario election in 2014 -- then it spells political doom for the victim.
9
Ontario licenses "Walk-in Clinics" opened by physicians to service patients that do not have a regular General Practitioner; need care sooner than booking an appointment with their regular G.P.; or not serious enough to need a visit to a hospital emergency. These walk-in clinics are associated with a group of regular practice GPs. The record of the visit can be made available to the patient's GP either directly, by the patient, or indirectly, with the patient's permission.
Ontario's Walk-in Clinics offer a faster method to see a doctor at strip-mall storefront or designated medical clinics that open for longer hours and weekends, including Sunday. It is also a welcome destination for American citizens to cross the US-Canada border to see a licensed physician for much less cost in Canadian dollars (CDN 1$ = 77 cents US).
The Walk-in Clinic I use is attached, by a doorway, to the cafe within a franchise supermarket store in a strip mall. I often see American plated vehicles parked outside the Walk-in Clinics. The province of Ontario's southern border offers several cross-border entry to: Minnesota, Michigan, Ohio, Pennsylvania and New York states. With one hour (or less) from the U.S. border, Americans can find a licensed physician and get their drug prescription filled same-day, both at reasonable cost: pharmacies are readily available in Walmart-style supermarkets as well as 7x24-hour designated pharmacies.
11
I should have mentioned that Physicians in Ontario Walk-in Clinics post their fees for services in Canadian dollars, available to those that are not enrolled in the universal healthcare insurance plan - i.e.) non-citizens and recent immigrants that need to wait 3 months, unless they are refugees, to get their "OHIP" cards - Ontario Health Insurance Plan. (Landed immigrants are eligible for OHIP after about 3 months residency in Ontario - each province has jurisdiction over healthcare but also must comply with the Canada Health Act - a federal law, to receive federal funding for provincial healthcare plans.)
If you are near a Canadian border, look for the larger cities nearest the border crossing. Search on Google for "Walk-in Clinics - 'city name'. Inquire if they provide services and prescriptions to non-OHIP cash patients from the U.S., and ask for the fee schedule they charge for a visit and a prescription - if needed, and open/close/day and busy times. Appointments are not necessary for 'walk-in health services'.
IF you live near the Canadian border and need basic fee-for-services medical assessment, prescriptions, etc., consider the full costs of driving across the border into Ontario (other province) to a Walk-in Clinic that services uninsured patients, many from the U.S. border states. That is the best way to inform yourself of healthcare options for basic fee-based medical care in Ontario, or other provinces, Walk-in-Clinics.
3
I went to one of these Canadian walk-in clinics, in Bracebridge (as a US citizen) while enjoying last summer in cottage country North of Toronto. I had ongoing hearing difficulty in one ear, and was worried I might have an ear infection, bought on by a lot of swimming.
No appointment necessary, I waited about 30 minutes at the strip mall, and then was seen by a Physician.
I ended up only having wax residue in one ear, blocking my hearing, and this was quickly cleared out. Total cost, for the 20 minute procedure, $50 Canadian. No follow up paperwork, no bills!
We would embrace a Single Payer Health Care system , here in the US.
(disclosure, we have a "Bernie" bumper sticker on our car.)
32
Dear NYT, please do a bottom line cost analysis on what an average Canadian spend on taxes and receives on government services versus that of an average American taxpayer. Right now, figures like 35% and 50% Canadian tax rates do not tell us if in the bottom line they are spending more in taxes and receiving less in the long run. Few know how much they pay in taxes because all the state, local, sales taxes are added in. Also please compare US Medicare and VA hospital care to the Canadian healthcare system in terms of costs and waiting times.
Otherwise people will be needlessly comparing tax rates out of context. We will continue to have knee-jerk reactions to 50% tax rates without figuring in health costs, college costs, and the final tally of which works better for an average citizen. I guess what I'm asking for is a study. If it's already been done, please print it.
18
Don't forget, individuals and employers would not be paying Health Insurance premiums to these soul-sucking Insurance companies, who skim off 20% for "overhead".
So that would be a huge savings, especially for individuals. My family of 3 was recently paying $1700 a month for non-group Health Insurance.
14
Great point. You can also add in Big Pharma charging the Federal Government full retail price. Paying insane college tuition, and an insane military budget. How much taxes are Americans really paying?
16
Bottom line figures:
Here are the per capita figures for health care costs in 2016 in PPP dollars (which take cost of living into consideration) from the OECD:
US - 9 892.3
UK - 4 192.5
France - 4 600.4
Australia (similar obesity) - 4 708.1
Germany - 5 550.6
Denmark - 5 199.3
The Netherlands - 5 385.4
Canada - 4 643.7
Israel - 2 775.7
Switzerland (Highly regulated private insurance) - 7 919.0
Polling numbers show that more and more Americans want some version of House Bill 676 - healthcare for all. The big stumbling blocks are the Bigs - the pharmaceutical and healthcare "insurance" industries, which will have to be reined in/eliminated when we finally take this long overdue step. These industries have bought a lot of politicians and won't give up easily.
13
I suspect that there are other "Bigs" who find reasons to obstruct fair, universal health care in the US: the 1%, the GOP, and anyone else who looks down their nose at those who haven't achieved a "certain" level of financial success as proven by their ability to afford private health insurance (or to have it funded by an employer). One problematic aspect of the American Dream is that those who attain it aren't always as eager for those under them to share in it.
2
The difference is that everyone in Canada pays for this. Not like in the US where many don't pay taxes at all. I am all for the right system as long as EVERYONE pays in. We'd likely have to up taxes significantly, add a VAT. Look at why CA, VT and CO axed their plans for universal coverage - the cost. NOTHING IS FREE. Someone has to pay for it. And until we bend the cost curve down dramatically we can't afford this. I already pay 45% of my income in taxes. At some point I have to decide if it is even worth it to work if I can only keep 40% of what I make.
9
You are absolutely right. But one way to look at it is this: whether it comes from taxes or from private insurance, someone does pay for health care. And U.S. costs are higher because people put off seeing their doctor for minor ailments that can become worse, and more expensive. Someone always pays, no matter what. Health care costs will be the same or less if an efficient government plan is in place-- like Canada's. But public perception, unfortunately, is that "taxes" are evil while "insurance" is nice.
13
I’d be Thrilled to pay more in taxes as it would mean I wouldn’t have to declare bankruptcy over medical bills ...and if non emergency I would gladly wait
17
A fraction of the US military budget combined with present taxes would easily pay for universal healthcare.
When you "everyone must pay" I hope you don't include people who depend upon every penny just to survive.
I paid my taxes for my entire working life and earned my right to my tax-free Social Security.
4
It's important to emphasize that Canadians with urgent, particularly life threatening medical needs do not wait. We are moved to the front of the line - right into surgery within minutes or hours of a diagnosis indicating intervention is required. Fortunately Ive never had that happen; my own experience is limited to waiting for minor, elective procedures and scheduling for lab tests - and none of those waits (usually a few weeks) has ever alarmed me.
Also without all the paperwork, and the people to process it, and fewer opportunities for providers to profit, our system is FAR more cost effective and economically efficient than the American system(s).
Don't believe commentators on American TV, (or the occasional nutty Canadian who is trotted out to complain) that single-pay system should be avoided. It should be embraced.
156
republicans of all people should get the math. cost vs benefits. in terms of life expectancy, maternal and infant health and preventable deaths, canada's system produces better results at a far lower price.
the only thing missing is corporate profit. and republicans seem stuck on that, without seeing the bigger picture. there can be no other explanation.
15
Betsy My cousin an EMT hot shot surgeon has made a very nice living in Florida removing cancers from Canadians who were not pushed to the front of the line, and would other wise die. Sorry But I call Bullpuckey the fact is medicine is finite we have a finite amount of Dr's and money to spend you either ration it with $$ or wait times. Thatt is a fact in every socialized medical plan in the world I'm not denigrating the Canadian system just stating facts.
2
Andy - I've heard enough about the myth of the Marching Canadians. Here is the definitive study:
http://content.healthaffairs.org/cgi/content/full/21/3/19?maxtoshow=&...
Here is what they say:
"the number of Canadians routinely coming across the border seeking health care appears to be relatively small, indeed infinitesimal when compared with the amount of care provided by their own system."
Here are some figures:
"These findings from U.S. data are supported by responses to a large population-based health survey, the NPHS, in Canada undertaken during our study period (1996). As noted above, 0.5 percent of respondents indicated that they had received health care in the United States in the prior year, but only 0.11 percent (20 of 18,000 respondents) said that they had gone there for the purpose of obtaining any type of health care, whether or not covered by the public plans."
And if you read the study, you will see that most of the Candaians who come to the US for Health care are sent here and paid for by their health care system because they have a rare problem that we see more frequently than they do because we are 13 time larger.
Enough already.
13
Ok gang let's go over it again.
Just about all our peer countries have a quality, affordable, universal health care system, light yrs. better than us.
Good people can differ on whether the Canadian or Germany or British plan is better but the bottom line is they are all light yrs. better than our system.
American is like in a reverse third world situation with this topic. Western countries go to Africa to show them how to treat diseases that have been wiped out in the western world. The rest of our peer countries are showing us how to get out of the Middle Ages with our de facto criminal health care system.
87
Good people could differ on the merits of the British, Canadian or German models if they had a clue about what those models are. Sadly our media has not bothered to explain them to us, finding it easier to leave us with the impression that they are all single payer systems. In fact the German ("Bismarck") model which is also used by Switzerland, the Netherlands and Japan with great success, primarily uses private insurance to achieve universal, affordable, high quality healthcare.
We could achieve similar results if we just gradually expanded the option to purchase a Medicare plan to the entire population. People could then choose between private or government insurance. In fact that is how Medicare already work. People can choose traditional Medicare or choose among private Medicare Advantage insurance plans. Allowing private insurers to manage Medicare plans take stem of the burden off of the already overburdened Medicare Administration.
If private insurers can not provide quality plans at the same price as Medicare they will gradually drop out and just provide supplemental plans and we will transition to single payer without forcing people onto Medicare.
The other change we need to make is to allow Medicare to negotiate drug prices.
The obsession with single payer rather than universal, quality, affordable healthcare is a disgrace. In a healthy democracy citizens would be informed by the media of the options they have, not given a simplistic picture of their choices.
14
Agreed Theodora, I do see some mention of them but by and large they are not given much ink.
As you mention most of our peer nations do not have single payer but any of the options are far superior to our de facto criminal system.
3
The government can easily manage expanded Medicare by hiring more workers.
Medicare's overhead is about 3-6%. Private insurance is 20%.
There's no reason at all for profit-making insurance companies to be administering healthcare.
4
“Real change always happens from the bottom up,” he said, to big applause. “You’ve got to struggle for it. You’ve got to fight for it. You’ve got to take it. And that is the history of all real change in this world.”
And as he essentially says, in his closing statement, “Healthcare provided as a “right”, is an indicator of whether a nation values its citizenry.
Which, as we all know here in the oft referred to “Exceptionalist” United States of America, is not the case.
Our every move, whether by a Republican or Democrat run administration, during the last 40 years, has resulted in the disenfranchisement and beggaring of the poor and the middle-class, for the specific further enrichment of the already wealthiest among us.
Here it’s all about the wealthiest Americans, “Government of the poor and middle-class, by the Wealthiest, for the sole benefit of the Wealthiest.
15
Of course doctors like free health care. So do hospitals and pharma. Everyone wants the government to pay for their customer. I'm a farmer, will the government automatically pay for my customers too? Yeehaw! What could be wrong?
I'll take a twittering narcissist over a party of socialist fools.
3
The Health Care in Canada is paid for by Taxes collected by the Provinces and Federal Government. In turn, Physicians and Hospitals are paid on a fee for service basis. No complicated Insurance Coverage, from multiple companies, that varies from patient to patient, and Insurers who won't pay Billings from Physicians for 90 days or later.
So the overhead costs for, say a Rural Physician are much lower, fewer staff needed to process multiple insurance claim forms.
Don't forget, no more huge premiums, that families have to pay every month; my family of 3 was recently paying $1700 a month (not an ACA plan).
12
that's the mistake made far too often. people pay for health care. here in 'socialist' canada, i pay a little over half what you pay - and yes, i pay for it through taxes - for demonstrably better results.
i'm ok with you calling me a socialist. at least, i don't have to worry about going bankrupt should i ever need major surgery.
17
You seem to forget that the government is us. Our taxes pay for the infrastructure we use every day. Our taxes will pay for healthcare too. Get over the idea that the "government" is some entity that is out to get you. We are the government. By the way farmers get about $20 billion a year in subsidies and that is another name for socialism.
33
Canadians are highly taxed to receive this health care, yet apparently the US has to lower their taxes to be competitive.
10
The health care system of Canada is not "free". EVERY employed person and every employer in Canada PAYS INTO THE MEDICAL SYSTEM EVERY PAYDAY. By spreading the cost of the system across the population, the Provinces have a core financing system. The details may differ from Province to Province but overall no one has to put money out for Doctors' Office visits, Emergency Room care or hospitalisation BECAUSE the employed members of the family are paying a monthly Premium deducted automatically from each person's pay. Additional care known as Supplemental Care for Canadian residents and Comprehensive Care for Canadians working or living overseas is available for an additional monthly or yearly fee. This additional coverage includes Optometric/Orthalmic examinations, procedures and things like prescription spectacles, Hearing Aids, Wheelchair rentals, Private Rooms (where available) in hospital, and things like Chiropody, Chiropractic, Therapeutic Massage and Physiotherapy, Psychotherapy, Orthotics, Crutches, Canes, etc. This additional insurance also covers 80% of the cost of prescription medications. Patients pay the remaining 20% and an annual Co-pay Fee. Private insurers provide the coverage. Canada's system is "single payer" in the sense that Practitioners, Specialists, Labs and Hospitals are paid directly by the Provincial Governments. Short-falls - up to a negotiated limit - are covered from the Federal Government Treasury. 1/2
15
pie in the sky assertions of how wonderful it is for everyone to have access to healthcare aside, I think you need to speak to more Canadians to see how they really feel about their system and what the realities are. I remember being a medical student in Syracuse when an elderly woman from Toronto was admitted with a stroke; seems she'd had a stroke many weeks before and since she'd had a stroke many weeks before and since access to MRI scanners in the province of Ontario was limited she hadn't had a scan yet. So she came to Syracuse where she got one. Today as a Neurologist I can tell you we consider such a practice inadequate for merely adequate, let alone good, care. Then there was the Canadian friend of mine who was diagnosed with prostate cancer. He was told he'd have to wait 3 months to have it operated on. Cancer! A wait like that can make a difference between a tumor that's still contained and one that's disseminated and might kill you. He went down to the Cleveland Clinic; there's a provision in Ontario law that says they'll pay for care somewhere else (like in America) if you can't get it in your own province. Bernie we love you; your heart is in the right place. But if you're going to promote something look into the realities and the details. Vague but grandiose plans; well that puts you in the same category as little Donnie Trump
5
a doctor relying in anecdotal evidence? seriously? i'd give you a wide berth, i can tell you that.
ok, i have an anecdote for you: a u.s.-trained physician moved to windsor from the u.s. because he was tired of the interference by insurance companies - bean counters overruling his recommended course of treatment.
he also found it far more convenient to hire one person in his practice to handle billing issues with a single point of contact, rather than 3 or 4. only to have up to 30% of his bills go unpaid by the insurance company. what incentive is there to provide proper care when there is a one in three chance you will go unpaid?
here's another anecdote: i walked into the hospital with chest pains, discovered to be the consequence of a congenital aortic valve defect. walked out a few days later without paying a dime for a valve replacement. going in for a tune-up in about a year - without worrying what i need to sacrifice financially.
still another anecdote? i'll be going in for cataract surgery in january. yes, january. i can live with that. at my income level, there really is no alternative. but, i won't lose my sight.
67
another anecdote;
I had a ongoing need for a spinal fusion; bilateral numbness in my legs, and increasing weakness on one side. Local Spine practice in Vermont wouldn't even move my Pre-Op appointment ahead. Meanwhile I went to the Montreal Neuro for a second opinion. The Canadian Neurosurgeon was so concerned about the increasing weakness in my legs, that he said he could get me in for surgery IN A WEEK. So I went to Canada, for my fusion, to reduce pressure on my spinal cord and nerves to my legs. As a US resident, I had to pay upfront, but I was charged a flat daily rate, including the Operating Room charges.
Excellent recovery, and while I was home, post-op the US Spinal practice called to remind me of my upcoming pre-op appointment. I told them I had already had the surgery in Canada.
7
As a Canadian, I can point you to a number of elections -- at both the federal or provincial level -- where someone has had the political naivety to suggest (or even hint) that we might tweak our system for something more like akin to that south of the border. It each and every incidence, it amounted to nothing more (or less) than an act of political suicide.
We Canadians see the way that our friends and relatives who live in the 'States deal their health care issues. We see the financial toll it takes. We don't like it. Those of use who live in border communities like Windsor or Fort Erie also see the desperate Americans who stream into our clinics every day, seeking to impersonate Canadians and receive the quality of care which we here all take for granted. We don't like that either, albeit we do sympathize with those Americans who have no other alternative.
So you don't really need to speak to more Canadians to determine our views on the merits of the two systems. We have expressed our views -- through our votes -- on any number of occasions. The results have been pretty conclusive.
33
The way Americans idealize complete socialization or complete privatization baffles me. Having lived in 3 countries, two with national healthcare systems, I can tell you that they all have their drawbacks that clearly Bernie doesn't seem to consider. Canada's work because it's in Canada, where there are less people and certainly less people concentrated in one area. Japan and the UK - two countries where I've lived in, and I was "behind the scenes", so to speak, in the UK - have problems that the US doesn't have, because the US healthcare is mostly privatized. What happened to "moderation"? The Ancient Greeks learned it but apparently we haven't.
I think what the US should be working on as the first priority is not "who foots the bill" but "keep the costs down". fMRIs are expensive, yes, but there's no reason why someone should get billed for latex gloves at the cost of $200.
15
In a for-profit system, hospitals, doctors and clinics will look to areas where they can maximize profits. Hence US patients pay $200 for latex gloves, innumerable unnecessary expensive tests, unwarranted surgical interventions and so on. People die all the time from intrusive procedures but the medical industry still gets paid and doctors are terrified of legal liability so the procedures continue despite the expense and questionable value.
I have lived under the medical systems of the UK, Canada and the US. The US is a nightmare to navigate. Yes, you can see a doctor and get surgery but the time spent on paperwork and the out of pocket expenses are horrendous. I do not know how a really sick person can handle it. The last thing a cancer patient needs is financial stress and hours of paperwork to sort out medical bills. I'll take a free public system with excellent care any day. The wait for elective procedures is a downside but a small price to pay for fair and equal access to all people and the peace of mind that my family and I can get all necessary care we may need at no out-of-pocket expense.
14
Medicare works just fine.
When I lived in New York City, which I left seven and a half years ago, I could walk into my doctor's office without an appointment and wait anywhere from 15 minutes to two hours.
In other words, despite the high concentration of the population, there was an adequate number of doctors to service us.
The differences between single-payer in Canada and the US would not be at all qualitative.
Maybe you shouldn't comment on Canada until you have lived there also, since you seem to be repeating American myths. While Canada is a smaller population, about the size of California, Canadians are actually more urbanized than Americans and most certainly are more concentrated into certain urban areas than many peer US cities.
And since Canadian health care is run by the provinces, it's pretty analogous to states -- Ontario is about the population of Pennsylvania, Quebec has more people than Massachusetts, etc.
As for "keep the costs down", that's the whole point -- it's related to "who foots the bill" (and all the middlemen inbetween).
1
Looks to me that what Bernie found in Canada was a better health care system. Not perfect, but way, way better. Every reason to push forward with Bernie’s agenda.
152
Gee, then why did Vermonters defeat Sanders' loony "single-payer" theories?
https://www.forbes.com/sites/theapothecary/2014/12/21/6-reasons-why-verm...
Sanders can't sell to Vermonters, there's no reason for anyone to spend one second with him.
1
The national Canadian system grew out of provincial systems that differed considerably from province to province at one point. We may have to undergo the same process. One move in the right direction might be for the states, as well as the federal government, to open to all citizens the comprehensive health insurance programs that they now offer only to state and federal employees. Another move might be to make health insurance premiums FULLY deductible from taxable income -- for individuals, not for employers
alone as is the case now.
18
Donald,
The people who don't have health care are the people who don't have taxable incomes, mostly.
Giving tax deductions to people who don't have anything to deduct from is kinda silly, don't you think. It is, however, a frequent flier in Republican policy circles. Is that where you found it?
14
I have lived in Canada all my life (I am 70 years old), in Ontario and Quebec. I have heard of very few cases of people having to wait to health care, and come to think of it, only one. I hold the Canadian health system in high esteem because it is grounded in fairness and a genuine caring for others that is built into the very core of Canadian social values. When you talk about what kind of health care system you want, you are really talking about how much you care for your fellow citizens. In summary: yes, the Canadian safety net is not perfect and has its problems, but by and large it works.
241
Fact: Sanders, of Vermont, could not convince Vermonters to approve his crazy theories. Because Sanders refuses to provide financial details.
And left out of this -- taxes are higher in Canada.
And is Canada paying its fair share of global medical research? Some think they do not, and CDN should pay more.
And who is paying for CDN's nuclear umbrella? Shouldn't CDN pay the real costs, of its defense?
Talk is easy. Reality is hard.
2
BDO - Vermont’s public failure is especially frustrating to single-payer advocates because, they note, the Shumlin framework, which had gotten approval of the state legislature minus that key financing element, wasn’t really a true single-payer plan. Notably, large businesses that operate in multiple states would have been exempt. And it was unclear whether or how enrollees in federal plans like Medicare and TRICARE could be integrated into the state’s plan.
Those exemptions cut into the funding base while adding administrative complexity, eliminating one of the potential cost-saving elements of single-payer: simplicity.
http://www.politico.com/story/2014/12/single-payer-vermont-113711
And what the heck does nuclear umbrella have to do with this? Their health care system cost LESS THAN HALF per person as ours.. They don't need our money
3
I have yet to meet a Canadian who would trade their health care system for ours.
7
Why no data on cost per person? What does a supplemental policy cost the average Canadian? Why are prescriptions so much cheaper in Canada than in the US. How does Canada prevent lobbying from derailing the system? How can little Canada pay for healthcare like this when we the big and powerful US can't? How many people could get healthcare if we bought one less jet or aircraft carrier?
59
The cost per capita in Ontario last year was $3887.85 (https://www.statista.com/statistics/436343/governmental-health-spending-....
I'm not sure how much you'd have to pay for supplemental coverage but I didn't have to pay any premiums for the coverage I got through work for the 20% copay plan. I know that couples can coordinate benefits where one spouse has a plan with 20% copay and the other has one that has 20% coverage so that between the two they have 100% coverage.
Ontario was having trouble keeping up with rising health care costs as the population ages so they added on a health care tax. It's income based so low income individuals pay nothing. I used to pay about $600 a year and being fortunate enough to be young and healthy I certainly didn't use $600 worth of services. No one really complains about paying the tax though because none of us are going to be young and healthy forever and no one really wants to live in a place where people need to decide between seeking treatment and bankruptcy.
17
There are many different ways to calculate the cost of health care, but these numbers (which Bernie Sanders once used) are in a line with the other calculations:
$8,000/year US
$5,000/year Canada
There's an easy Google search for "comparing canada and us healthcare systems" starting with Wikipedia:
https://en.wikipedia.org/wiki/Comparison_of_the_healthcare_systems_in_Ca...
4
The average supplemental policy is $1,200 for an individual. It's included in almost all employer benefits.
It's not that Canadian drug prices are low, US prices are ridiculously high. You pay significantly higher prices than most of the western world because your system lets it happen.
Lobbying by whom?
The doctors sometimes lobby for higher payment (as do all employees) but they love the fact nobody ever tells them a procedure or test isn't allowed - they decide on treatment. They also never have to chase down payments from their patients and every bill gets paid 100%.
The hospitals are private, but mostly non-profit
The insurance companies haven't had a stake in basic care since the 60s.
Being a single payer gives the government a lot of clout with private clinics, but they, like the doctors like how easy it is to get customers and get paid.
6
I'm Canadian, my boyfriend is American living here. 1 year ago i had a quadruple bypass, the only out of pocket expense i have is about $100/mo for a prescription. The BF has had 2 small surgeries here & ongoing physio therapy. He has paid $0. As he tells it, taxes are higher here, but he takes home about the same wage as he did in Texas (doing the same job) because he doesn't have to pay for private insurance. He was also amazed that after care/physio is free as that wouldn't be the case in Texas. Also, there were no long waits. We live in a large urban centre, i don't know if that would be the case in a smaller city/town, but the cost would be the same.
122
Philosophies aside, I wish more of our politicians could operate like Bernie: constructively inquisitive, congenial, curious. I think more of them would be greeted with the accolades that Bernie receives.
Instead, all too often, Mark Twain's famous observation is in operation.
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Kudos to Bernie for going, yes. However, when a doctor says 'you could argue that wait times are a problem', it isn't helpful to ignore that reality or minimize it. That's how programs get into bigger tangles. They are working on solutions, (good for them, that's how programs improve) because wait times ARE a problem.
3
The US is being strangled by greed and ignorance.
1
A Medicare for all system would produce an insurance pool made up of elderly and young; sick and healthy individuals. That is what is needed for health insurance to work. It would also simplify the system, make it more just, and eliminate many of the coverage loopholes and administrative costs associated with billing.
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M, inconvenient fact -- "boomers" have paid into Medicare for 40+ years.
You do something to goof that system up, you'll get riots. Bet the farm on that.
1
It is heartening that when people have an alternative, like Bernie Sanders, they embrace him. He gives people hope in times of a very dark future.
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He does well as a gadfly and idea source. He would never be elected other than in VT, and would therefore be a poor choice as a presidential candidate. We need someone very much younger and with much wider personal appeal. I lean toward someone like Seth Moulton.
4
We could have had him...its the saddest story you will ever hear...and Bernie was the perfect gentleman he is, to accept the whole thing. Makes our hearts weep. Please do read
https://www.politico.com/magazine/story/2017/11/02/clinton-brazile-hacks...
and
https://www.huffingtonpost.com/entry/donna-brazile-dnc-clinton-campaign_...
1
The Canadian system is an opportunity to learn how to do universal healthcare better. The US system has its merits and competition - even under Medicare - has its advantages in driving providers to constantly improve. Medicare has experience with the innovations that it has rolled out since the mid-80's. A single payor system that is based on "triple-aim" competition based on quality, cost and access and the right incentives for providers can easily work without the Canadian bottlenecks and delays. And Americans would net a lower cost in trading off premium-sharing, co-pays and deductibles for slightly higher taxes.
The question is whether Americans can get out of their "me first" shell, thinking that the only "right" way to manage care is at the lowest level of decision-making, and start to understand that in areas like healthcare there are greater advantages in innovation and cost that can be made when there is a balance between aggregating lives into one basket and allowing local and regional providers to compete based on quality, cost and access. The fear that Americans will lose "the best healthcare in the world" is unfounded. It is only the best healthcare if patients go to providers like Mayo Clinic, Cleveland Clinic and MD Anderson. Otherwise, medical care in the US is on par with, if not below, that of other First World nations, and payment incentives structure result in costs that are 2-3 times as much for healthcare as their peers. Seriously, people...
105
It seems self evident to accept that some societal goods are best met by organising them along socialist principles (like health care and police / military) and others (perhaps furniture choices) are best met through free enterprise. Still others are obviously best provided through a mix of free enterprise/ state regulation and citizens rights. I think it is the absolutist approach we see, sometimes on the left but usually on the right that is currently preventing meaningful progress in improving people lives. And I see this more so in the UK and USA than elsewhere in the developed world. Although I do think America is suffering more than Britain is.
51
There are private clinics for some procedures in Canada. Also, taxes are much higher in practice than the 35.6% quoted above. Purchases of good and services include a 15%-16% VAT.
3
About 13.5% combined federal and provincial versus about 10% combined sales taxes in the U.S......excluded (like the U.S.) for food, rent, medical services, financial services, etc. Also, in Canada, rebated to low income people.
15
@Matt - You give your location as Montréal, so for those readers of your comment who are not familiar with the People's Republic of Québec I feel the need to point out that yes, the taxes are staggeringly higher in Quebec compared to Ontario.
For example, when I lived in Quebec my tax as a percentage of gross income was easily 50%; I somehow I doubt that it has gone down much. Also, you quote a Goods and Services (GST) tax rate that is much higher than Ontario's combined (federal/provincial) rate of 13%.
But the icing on the cake is that in western Quebec you have a hospital that has been ranked as the WORST in North America (the stories are truly shocking); and the others are not much better.
In essence, Quebec health care is the poster child for high taxes, poor service and all the worst features of socialism. In this it is an outlier in Canada (except for maybe New Brunswick). By contrast, Ontario's system would look somewhat familiar to an American (like me), whereas Quebec is borderline developing world and is shocking to that same US sensibility.
Oh, and that 35% tax? That is on a six figure income, which compares well to the civilized parts of the US.
23
Canadians pay 42% of income in tax — more than they spend on food, shelter, clothing combined.
You can buy everyone else a great deal of services when you are giving away almost half of your paycheck.
But let me guess - ol Berns thinks that is perfectly fair.
2
The Canadian system works quite well for serious problems and routine things. The tax "burden" is a combined federal and provincial tax burden in Ontario of 35.6% of gross income, which compares favourably with high tax states. I love it.
I also love that I can afford to go to the US and pay my way to get the front of the line for those wait listed "optional" treatments, like when my wife cannot walk and is in constant pain because of a congenital hip problems.
Frankly, I do not see how the US will ever implement a system like Canada's because Republicans.
27
Good point about the GOP, D. Canada suffered through a Conservative Federal Government for nearly 7 years during which they cut Corporate and top income 10% taxes so much that the funding for health care was nearly decimated. Hence, the delays referred to i the article. Also, bear in mind that the US has ten times the Canadian population. That's a huge labour pool from which to draw monthly deductions for healthcare. BUT America must reverse the policies of Reagan voodoo economics that rewards corporations for moving offshore to escape paying taxes and to avoid having to pay foreign employees legally-mandated benefits. Until that matter is resolved, a system like Canada's will elude the U.S. The best way to ensure a sustainable system is to abolish all tax loopholes for Corporations, Industries, and the top income levels and to make it illegal for both Federal and Provincial Governments to ruin healthcare by underfunding it as President Trump and GOP governors are currently doing. But that's just my opinion.
29
It is patently false to say Conservatives "decimated" health care funding. In 2004 the Chretien Liberal government promised and then delivered 6% annual increases to health care spending. The Harper Conservatives continued this policy from their election in 2006 until their 2015 replacement present Trudeau Liberal government. True, in 2012, six years into office the Conservatives reduced the annual increases from 6% to 3% but the Liberals have not since raised it.
If you wish to opine in The New York Times, it's best to get your facts straight. They matter here.
2