Perhaps the tightest race of the 2018 midterms, Ted Cruz vs Beto O’Rourke has caught the attention of pundits and ordinary pundits across the US alike. Recent polls show conflicting conclusions, with some putting Cruz ahead by wide margins, and others portraying the race as close. At this point, it is impossible to accurately predict the outcome of this election. Considering how uncertain the result of Texas’s Senate election is at this point, it is important that libertarians rally their support behind the incumbent, Republican Junior Senator Cruz to ensure that up-and-coming Democrat Beto does not achieve election to US Senate. If he is elected, liberty will be much more at risk than it is now.
Another day, another article by an opponent of universal health care publishing lies about Canada’s single-payer health system. That’s right, lies. There’s no point anymore in giving the people that publish these articles the benefit of the doubt given both the evidence and people’s experiences with the health care systems they are attacking are so radically different from what they describe.
There’s a list of talking points critics of programs like single-payer work from. I’m sure at some point they were written down somewhere, but by now everyone on both sides of the universal health care debate can recite them from memory: single-payer is expensive, there are long wait times, patients are denied their choice of doctor, and of course people suffer and die needlessly as a result of one or more of the above problems.
In an article appearing in The Hill on July 28, Dr. Dean Waldman follows the talking points to the letter. He offers us a list of assertions, but no data to back any of them up. He makes a number of claims about the Canadian and British health care systems without once telling us how they compare either in terms of cost or outcomes to the US system, all the while implying the US system is far superior to both. My family’s experience is limited to the US and Canadian systems so I won’t spend much time on the UK’s National Health Service other than to cite some data.
No health care system is perfect. By its very nature health care delivery involves difficult choices. These choices are often forced upon health care providers and insurers (whether the insurer is the state or a for-profit company) under very difficult circumstances. If you’re looking for situations where the outcome was less than ideal, or even tragic, you can find examples in doctors’ offices and emergency rooms around the world.
But if you’re going to use these examples to tear down a country’s entire health care system and to hold your own up as superior at the same time, intellectual honesty demands that you show the examples you are using occur with less frequency in your own system than in the system you’re attacking. So, for example, you don’t allege one problem with the Canadian health care system is a lack of patient choice without also showing that there is a greater degree of choice under the American model. If it turns out there is less choice in the US than in Canada, you have to admit that the Canadians have at least done a better job of providing choice to patients than the US.
The same is true when it comes to cost. Telling people over and over again that single-payer is too expensive without providing any comparisons to the cost borne by consumers and society as a whole under the American model is being dishonest.
Dr. Waldman, like so many before him, makes a number of assertions without providing his readers with any comparative data. He claims, “The British and the Canadians pay a very high cost for their systems, and not only in monetary terms. Single-payer health care systems take away individual choice, they discourage life-saving research and innovations, and they exchange quality of care for a balanced budget.”
It’s worth noting here that the first sentence and the second appear to contradict each other. On the one hand “The British and the Canadians pay a very high cost of their systems” in, among other things, dollars, but on the other “they exchange quality of care for a balanced budget.” Either the government in these countries is spending a lot on healthcare or they are skimping on it to avoid deficit spending. Which is it?
Regardless, both in Canada and in the UK the amount of money spent per capita on health care is far below what Americans spend on it. In Canada’s case that was $4,752 in 2016. In the UK the amount was $4,192 for the same year. Dr. Waldman rightly points out that in the United States that amount is over $10,000 annually, but his failure to provide any context is troubling given he wrongly implies healthcare is incredibly costly in both Canada and the United Kingdom. Indeed, Dr. Waldman goes so far as to claim the single-payer system being advocated by Senator Bernie Sanders would cost a whopping $18 trillion, or roughly 90% of the total current US economy. Given Canada currently spends more than 50% less than the US per capita, that’s an obvious falsehood.
Dr. Waldman and other critics of universal health care programs would likely respond that it is precisely this lack of spending that is the problem. Setting aside the fact that such an argument directly contradicts their claim that universal health care programs are too expensive, this objection raises the important question of what the citizens of countries like Canada and the UK are getting for their roughly $4 — $5,000 in per capita health care spending when compared to the average American’s more than $10,000 investment in the same product.
Given Dr. Waldman’s unsupported assertion that “There is death-by-queueing in single-payer systems, where sick persons die from treatable conditions because they could not get care in time and succumb ‘waiting in line’ for care,” we would expect to find that Americans spend less of their lives suffering from disability and disease than Canadians, the British, or others living under the heavy hand of government-run healthcare systems. But instead, the US leads the developed world by a wide margin when it comes to the number of years lost to disability or premature death.
Dr. Waldman works for the Texas Public Policy Foundation. By itself, this is an unremarkable fact, but one has to wonder if being from Texas is the reason he’s not so keen on drawing attention to the shortcomings of America’s healthcare when compared to other nations. Texas has the highest maternal mortality rate in the developed world. According to an NBC News story on the crisis in Texas, “Texas’ maternal mortality rates are 35.8 per 100,000 live births as of 2014, according to a study in Obstetrics and Gynecology. By comparison, the maternal mortality in Japan was 5 per 100,000 live births, according to UNICEF’s 2015 data. In Poland, it was just 3.”
What about life expectancy? Given Americans are spending so much on healthcare relative to everybody else, surely they get a few extra years for it. Nope. According to the Organization for Economic Cooperation and Development (OECD), as of 2017 life expectancy in Canada was 81.9 years, in the UK it was 81.2, and in the United States it was 78.6. In fact, Chile and Costa Rica had higher life expectancies than the United States.
Finally, a note about choice. My wife and I have lived in Canada for seven of the last eight years and will be returning within days of this article. During our time in Canada, we’ve had several direct encounters with the health care system and have gotten to know a number of Canadians that have been dealing with it their entire lives.
Because my wife has type 1 diabetes, finding and keeping affordable healthcare in the United States was always a struggle. Group insurance through an employer was the best option, but this meant that every year as her employer signed on to a new plan she often had to find a new doctor because her old one was not part of the new insurer’s network.
As the name implies, single-payer means there’s one insurer for everyone. No doctor is outside a Canadian province’s network. If a Canadian travels to a new province, agreements between provincial governments guarantee coverage will be maintained. The only reason a doctor might turn someone away is because he/she is no longer accepting new patients.
My wife has been able to find a specialist she likes in Canada. There’s absolutely no danger that at the first of the year British Columbia is going to decide to drop her doctor from their network because every doctor is paid through the same network. In other words, Canadians have by far greater choice than Americans. Americans insured through their employer have no say in who the insurance carrier will be from year-to-year and the pool of doctors inside any given insurer’s network will always be smaller than the total number of doctors available. It is simply false to speak of American healthcare as an example of choice in this context.
Healthcare delivery always involves tough choices. Triage requires individual doctors and entire healthcare systems to prioritize the treatment patients will receive according to the staff and other resources available and the demands being placed upon the system on any given day. That’s true in every country in the world.
But Dr. Waldman and other critics of universal coverage are simply wrong when they say that countries like Canada and the UK are doing a poorer job of handling these choices than the United States. The statistics don’t support their claims and haven’t for quite a while. The fact that Dr. Waldman failed to provide data for Canada or the UK in his article should make clear he knew the data didn’t support his argument.
Speaking from personal experience I can say without hesitation that the cost to us of the Canadian system has consistently been very small relative to what we spent on healthcare in the US. Test results have been available to us within 24 hours every time and our treatment at doctor’s offices and hospitals have been excellent. In the US, getting test results required a return visit to the doctor’s office which usually meant another bill. The amount taken out of our pay-checks in the United States to cover our personal portion of the monthly insurance costs would have paid for roughly 6 months of premiums in British Columbia.
It’s time Americans stop listening to the critics of universal healthcare and start looking at the data. By every measure the American health care system is failing to deliver the kind of care so much spending should guarantee every single citizen. When it comes to health care the United States lives in one very big glass house. It should stop throwing stones at other countries and start taking a good hard look in the mirror.
Perhaps my problem is that having just spent seven years in Canada, single-payer universal healthcare ruined any possibility I would ever accept the Obamacare model. Be that as it may, after just a few minutes reviewing my employer’s healthcare package, I couldn’t help but feel I would be better off financially going without coverage in the US, at least in the short-term.
Paying $256 a month for a high deductible plan means that during the four months or so we have left until hopefully returning to Canada, we will need to spend more than $3,000 on healthcare before most services either my wife or I could possibly need even begin to receive coverage. For insurance to kick in for both of us, we must meet the family deductible. This pushes our total figure to somewhere just north of $5,000. Welcome back to the United States, where healthcare costs and in network/out of network headaches just might cause more strokes and heart attacks than the system prevents.
Even if we were staying full-time in the US, our plan would be a disaster. With it, our annual healthcare spending would have to be extraordinary for it to make any sense. We are unlikely to reach the $2000 individual/$4,000 family deductible alone, never mind the $5,000 to $7,000 in health related costs we would need to incur over the course of the year before this insurance plan finally began saving us money (deductible plus nearly $3000 in premiums). As people are fond of saying when stark financial realities confront them, just do the math.
In addition, it’s important to keep in mind the expenses described above represent a huge percentage of annual income for anyone doing the job I’m currently doing. Because we don’t plan on remaining in the United States for long, I haven’t sought jobs in my field here. I’ve just taken a temporary job at a convenience store to hopefully save up a little money before returning north. At that point, I will pursue a master’s degree and permanent residence in Canada. However, for many of my co-workers, the job is much more vital in both the near and long term.
I suppose some would say I should feel lucky to have any insurance at all under the circumstances (a very American response). As you might expect, working in retail doesn’t pay well. Frequently, it doesn’t come with any benefits at all.
I would argue that for all practical purposes, my job still doesn’t come with benefits. The insurance premiums alone knock roughly 15% off the earnings of a typical convenience store clerk. If that clerk or a family member were to experience serious health issues, the $2000 minimum they will have to pay out of pocket before the insurance even begins to provide some relief will quickly bump the cost of this “insurance” into the 25% of annual income range. This amounts to an extremely regressive tax on low income workers. There’s nothing economical, let alone right, from either an individual or social perspective about any of it.
Obamacare provides health insurance subsidies to those purchasing individual coverage through the marketplace created by the Affordable Care Act (ACA), but not to those receiving health insurance through their employer. It did, however, require people to sign up for their employer’s insurance to avoid paying a tax penalty. However, even taking the tax penalty into account (about $695 in our case, assuming we’re in the US all year), the hit to a low income worker, making what I earn, is far greater. Regardless, the so called “affordable” plans offered via the ACA tend to also have high deductible policies. It’s difficult to justify huge government subsidies for plans that don’t really provide true coverage.
As was the case with the uninsured before healthcare reform, high deductible plans still often leave low-income workers choosing between food, shelter, and healthcare. No one in a nation as wealthy as the US should have to face those kinds of decisions. Medicaid might pick up some of the slack in many cases, but this imposes yet another layer of bureaucracy onto American healthcare that the poor are required to navigate and that healthcare providers must bill. This alphabet soup of private and public plans is primarily responsible for the high administrative costs of the US healthcare system. Yet, it just leaves patients feeling frustrated and confused.
Before my employer took it over, health coverage in Canada for my wife and I totaled $135. Enrollment, as I recall, involved a single double sided page of paperwork. Then, we got the same healthcare card that everyone gets, rich or poor. We also got the same benefits. There was no monthly, quarterly, or annual renewal. Our healthcare provider just swiped the card at the front desk and that was that.
Our monthly premium was high by Canadian standards. Because we lacked permanent residency or citizenship, we didn’t qualify for lower cost options. However, we did still qualify for Pharmacare, a benefit which reduced the expense of Canada’s already relatively cheap prescription drugs. Supplemental insurance, provided through my job, picked up whatever drug costs that remained.
As for hospital bills, while living in Canada I paid three visits to the emergency room and never saw a single bill. My wife had a specialist to help facilitate the best management of her Type I diabetes. We likewise never had to pay a dime for her doctor visits. In other words, that $135 a month was for a zero deductible plan, which is the only plan in Canada.
I did have to pay $80 for one ambulance ride, the maximum that a hospital can charge for this in British Columbia. It took them six months to get around to sending that bill, and there appeared to be no urgency on their part about seeing it paid. That said, we were happy to pay, given that we knew a similar ride south of the border would likely run over $1000.
For obvious reasons, and contrary to popular belief, Canadians aren’t exactly flocking to the US for non-essential services they might have to wait a little longer for at home. Even the single-payer system’s harshest critics estimate that only tens of thousands off Canadians come south to receive treatment. This amounts to a fraction of 1% of the entire Canadian population. Of course, no critic of the single-payer model ever cites the number of Americans that have moved to Canada at least in part because they find its system of universal coverage far preferable to the balkanized and expensive US alternative.
Regardless, virtually every Canadian we spoke with about healthcare during our time in their country could not grasp why so many Americans favor the right to go without health insurance altogether. It’s possible some of them insist on that right for the same reasons we’re exercising it, but most seem opposed to health insurance mandates on ideological grounds rather than out of financial necessity or practical budgetary reasons. Canadians, in our experience, were equally puzzled by the apparent willingness of so many of their southern neighbors to pay so much for coverage that provides so little in return. Indeed, government has told us the plan we’re being offered is “normal” both in terms of monthly premiums and benefits received in return, and that we should accept it. Again, having experienced Canadian healthcare, normal to me has become something quite different.
Sometimes it was necessary to explain what a co-payment was to our friends up north. The whole idea of networks was something of an enigma to them as well, given that Canada as a whole is just one big healthcare network. Explaining the benefit of a healthcare network to a Canadian is like trying to explain the benefit of a fish tank to a creature that’s spent their entire life swimming in the ocean. Why you and your neighbor should each have to choose different doctors because you have different insurance plans makes no sense at all from a Canadian perspective — or really from any serious perspective for that matter.
For all the talk about maintaining the right to choose your own doctor in the United States, it’s in America, not Canada, where your choice of doctor is limited by your insurance provider. In fact, unless you’re buying individual coverage, even your insurance provider is likely to have been chosen by your employer instead of by you. In other words, among the world’s developed countries, America probably offers patients the least freedom of all when it comes to choosing a physician.
So, it’s official: we’ll be keeping our fingers crossed until we return to our adopted home and resume following our chosen path to permanent residence and ultimately citizenship in Canada. It simply makes no financial sense to pay an arm and a leg for both health insurance AND visits to the doctor at the same time. As with millions of other Americans, the healthcare options for us seem little changed since our initial departure in 2010 before Obamacare had taken effect. Given the kind of choices US health policy still forces tens of millions of citizens to confront daily, I’ll take the “lack of choice” Canadians enjoy any day and look forward to getting back to not having it again very soon.