How to Think about “Medicare for All”
by James Morone - The New England Journal of Medicine - October 25, 2017
In April 1946, President Harry Truman introduced a single-payer health plan and met the same reaction that would greet Senator Bernie Sanders (I-VT) and his colleagues when they proposed “Medicare for All” in September 2017. “It is believed by competent Congressional observers to have little chance of approval,” reported the New York Times back in 1949. Newsweek was blunter: “No chance at all.” Neither Truman nor Sanders even bothered to include financing for their plans. Truman had no more success with a scaled-back proposal to cover only people over 65 years of age, but 13 years later President Lyndon Johnson signed the Truman revision into law as Medicare, declaring that the United States was finally harvesting “the seeds of compassion and duty” that his predecessor had sown.1 A proposal with no chance in one era had become law in another. Medicare proved so popular that it came to be a third rail of American politics — dangerous to touch. What lessons does Truman’s success hold for today’s “no chance” Medicare for All?
The usual metrics for evaluating policy proposals — vote counts, Congressional Budget Office scores, and tax calculations — are misleading because Medicare for All is an idea for the long run. For a more accurate assessment of its prospects, keep an eye on four key questions.
Is there a right to health care? The Affordable Care Act and the efforts to repeal and replace it raised fundamental ethical questions about whether Americans have a right to health care and, if so, whether government should secure it. The Medicare-for-all proposal responds with a strong claim for a right to roughly equal health care coverage for everyone. The American patchwork — superb health insurance for some; no health insurance for 30 million others; and shaky high-deductible, high-premium plans on the individual market and in many workplaces — is not just poor policy. It is wrong. It violates the norms of communal decency. Late-night talk-show host Jimmy Kimmel distilled this view when he tearfully responded to the House repeal-and-replace plan: “No parent should ever have to decide if they can afford to save their child’s life. It just shouldn’t happen. Not here.”
Medicare for All is, first and foremost, an exercise in moral persuasion. It will become a serious policy proposal if it creates a major surge in public opinion. That’s how “no chance” reforms win in the United States, whether it’s the passage of Medicare or the right of same-sex couples to marry. On this measure, Sanders is making progress. Last time he proposed his plan, he stood alone; this time, 16 Democrats crowded beside him — including some leading contenders for the next presidential nomination. The difference sprang from the 12,029,699 votes Sanders racked up in the Democratic presidential primaries. To handicap the future prospects of the plan, watch what happens as candidates take it to the voters.
Won’t the cost savings eventually convince skeptics? International comparisons reveal that other wealthy countries cover most of their populations with much lower spending. Although every country is unique, no other nation supports the sprawling administrative, insurance, and billing bureaucracies that reach into every U.S. clinic and practice; moreover, single-payer systems offer budgetary levers that our own fragmented nonsystem does not have.2 The results are striking. For example, Canadian health costs were indistinguishable from those in the United States until Canada finished introducing its national health insurance program in 1971; then, health care’s share of the Canadian economy flattened out dramatically. By 2014, according to the World Health Organization, Canada spent 10.4% of its gross domestic product on health care, as compared with the 17.1% we spent in the United States. Closer to home, our own single-payer plan, Medicare, appears to constrain rising costs more tightly than private insurers do.3
The data tempt advocates to push Medicare for All as an efficiency fix for U.S. health care. However, mere efficiency arguments are unlikely to propel a change this big through the multiple checks and balances of U.S. politics. In politics, good data are not enough. They are a necessary but not sufficient condition for winning major legislation. Proponents will first have to create a movement.
Still, the efficiency claim always lingers in the middle distance: like Charles Dickens’s ghost of Christmas yet-to-come, single-payer plans challenge us to change our ways. If more conventional approaches fail to control costs and offer Americans more reliable access to health care, Medicare for All will continue to beckon as the fairer, less expensive, cross-nationally tested alternative.
But what about the taxes? Skeptics emphasize the new taxes that Medicare for All would require. In a white paper accompanying his proposal, Sanders fills in some vertiginous details: raise marginal income tax rates to 40% on incomes from $250,000 to $500,000; raise rates to 52% for incomes above $10 million; and tax capital gains and dividends like income from work. Do those kinds of increases doom Medicare for All? Perhaps just the reverse, for this is one of the few policies that directly confronts American inequality.
No other country has experienced a rise in inequality as steep or as high as the one we’ve seen in the United States. In 1970, standard inequality measures pegged the United States at roughly the same level as France and Japan; almost 50 years later, U.S. inequality levels are closer to those of Mexico and Brazil than to those in Northern Europe.4 Today, the top 1% of households control 38.6% of the country’s wealth, far more than the bottom 90% (which controls just 22.8%). The median white family (in the exact midpoint of the income distribution) is 10 times as wealthy as the median black family. Intergenerational economic mobility has stagnated.5 Political scientists generally believe that rising inequality and slowing mobility have a destabilizing effect — and they may be driving the angry populism that is now stirring on both the left and right ends of the political spectrum.
Medicare for All offers politicians a way to squarely address the issue. It would lift a substantial financial burden from low- and middle-income families — their health insurance premiums — and shift the weight to wealthier Americans by raising their taxes. In reversing inequality, taxes are not a bug but a populist feature. Disruptive populism ended past American gilded ages, and it shows signs of challenging the current one. If so, Medicare for All is on a short list of available policies designed to push back on inequality.
Isn’t Medicare for All politically implausible in antigovernment America? It is easy to forget how dramatically U.S. politics changes from era to era. New issues rise onto the agenda, different national values grow more (or less) important, underlying political assumptions evolve, and an entirely new coalition grows influential. What seems impossible in one generation is taken for granted in another. The kind of turbulence we are experiencing in contemporary party politics often signals precisely this sort of sea change. One necessary condition for a breakthrough change is already in place: a righteous band of reformers, deeply committed to a cause, pushing against all odds.
Medicare for All fits awkwardly into the Washington conversation because it is more than a health policy prescription. It aims to foster changes on three different levels of analysis. It is a policy proposal designed to improve health care delivery, an ambitious claim about equality and social justice, and an effort to usher in a more progressive era in American politics. Each is a long shot, but Medicare for All and its advocates stand in a venerable reform tradition that has rewritten U.S. politics many times in the past. It would be a mistake to dismiss them now.
The Governor Blocked Medicaid Expansion. Now Maine Voters Could Overrule Him.
by Abby Goodnough - NYT - October 27, 2017
PORTLAND, Me. — Night after night, in the sharp autumn air, canvassers are knocking on doors across Maine in hopes of getting tens of thousands of poor adults insured through Medicaid. Gov. Paul LePage, a Republican, has five times vetoed expanding access to the program under the Affordable Care Act. Next month, voters here will be the first in the nation to decide the issue by referendum.
But even in this liberal city, canvassers have encountered resistance from some as they stood on creaky porches and leaf-strewn steps to argue, as Lily SanGiovanni did the other night, that “health care is a human right.”
“My only question is where is the money coming from?” asked Michael Bunker, 35, a gym owner who spent 10 minutes debating the issue on his doorstep with Ms. SanGiovanni, a volunteer with Mainers for Health Care, the lead pro-expansion group. “I agree everyone should have free health care, it sounds great. But I can’t sign anything that’s just going to add to the federal debt.”
The referendum on Nov. 7 represents a new front in the pitched political battles over health care. Maine is one of 19 states whose Republican governors or legislatures have refused to expand Medicaid under Obamacare, and the other holdouts — particularly Utah and Idaho, where newly formed committees are working to get a Medicaid expansion question on next year’s ballot — are closely watching the initiative, whose outcome may offer clues about the salience of the issue in next year’s midterm congressional elections.
After President Trump and Republicans in Congress spent much of the year trying to repeal the health law and cut spending on Medicaid, a half-century-old entitlement program that covers one in five Americans, the pro-expansion side in Maine is hoping to benefit from energized public support for it.
Turnout may be the biggest challenge for the advocacy groups leading the effort. There are no national or statewide races here to drive people to the polls this year. And Mr. LePage’s stance on government safety net programs appeals to many voters in the state’s more rural regions. He derides Medicaid expansion as “pure welfare” that would burden the state’s taxpayers.
Senator Susan Collins of Maine, one of the few Republicans who firmly opposed the Obamacare repeal bills, is not taking a position on the ballot measure — she never does on referendums, according to her staff. But leaders of the campaign are hoping her outspoken support for Medicaid during the repeal battles will help.
About 80,000 additional Mainers would become eligible for the program if the ballot measure were to succeed, according to the nonpartisan Maine Office of Program and Fiscal Review, although those with income above the poverty line currently qualify for subsidized coverage through the Obamacare marketplace. In all, more than 2.5 million poor uninsured adults across the country would gain access to Medicaid if the holdout states expanded the program, joining about 11 million who have already signed up under the law.
Kari Medeiros, 40, of Eastport, a tiny town in the state’s poorest county, earns less than $5,000 a year cleaning houses and pet sitting, and has back pain that has worsened to the point where she can barely mop and sweep.
“With MaineCare I believe I’d be able to find a provider who would see me,” she said, referring to the state’s Medicaid program. “But a lot of people here don’t vote. So many families here are having addiction problems with their loved ones, and they’re not focused on going to vote — even though those are the people that need it the most.”
Under the Affordable Care Act, the federal government picked up the entire cost of new enrollees under Medicaid expansion for the first three years and will continue to pay at least 90 percent. (States cover a significantly larger portion of the expenses of the regular Medicaid program.) The law allows any citizen with income up to 138 percent of the poverty level — $16,642 for an individual, $24,600 for a family of four — to qualify.
The main arguments for expanding the program here are that it would help financially fragile rural hospitals, create jobs and provide care for vulnerable people who have long gone without it.
But Mr. LePage and other opponents say that Maine should know better. The state undertook a more modest expansion of Medicaid in 2002, under former Gov. John Baldacci, a Democrat. Afterward, Maine struggled with budget shortfalls and fell behind on Medicaid payments to hospitals.
“People don’t want to acknowledge the unintended consequences that Maine has already experienced,” said Brent Littlefield, a political adviser to Mr. LePage who is serving as the spokesman for Welfare to Work, the committee leading the opposition. He said that even with the federal government paying most of the cost — a situation that could change if Congress eventually succeeds in repealing Obamacare — the state could owe close to $100 million a year, according to estimates from the LePage administration.
The Office of Program and Fiscal Review has estimated a lower state cost, about $54 million a year once the federal share drops to 90 percent in 2021. Maine would not receive the full 90 percent match for parents of young children because many already qualify for the program.
Maine’s legislature, which is controlled by Democrats in the House and Republicans, by one vote, in the Senate, could move to block the referendum if it were to pass, but since it voted for Medicaid expansion five times already, supporters and opponents alike believe it is unlikely to meddle. And the governor would have no authority to veto the outcome. The only other threat would be if Congress succeeded in repealing the Affordable Care Act and ended the Medicaid expansion program.
Supporters of the measure have knocked on 150,000 doors since July and have run four television ads statewide. Mainers for Health Care had raised about $480,000 as of early October, including $375,000 from the Fairness Project, a left-leaning group founded in California. It is putting out national appeals for donations, including through Organizing for Action, the political group that grew out of former President Barack Obama’s campaigns.
Welfare to Work had raised $192,500, with its contributions coming from a handful of frequent Republican donors in the state. Mr. Littlefield would not discuss the opposition’s strategies, but the group has at least two ads running on television statewide and Mr. LePage has been blasting the initiative on talk radio and in other public comments.
Canvassers for the measure have found one of the biggest obstacles is lack of knowledge about the issue, even among those who would benefit. Nicole Simard, 33, interrupted Ms. SanGiovanni a few seconds into her pitch, saying: “I agree, I agree. I have friends that are suffering right now, that don’t have insurance. My sister is one.” Like many people Ms. SanGiovanni encountered that night, Ms. Simard said that she had not been aware of the referendum but that she would vote for it.
“Absolutely, 100 percent,” she promised.
The following night in Bangor, about two hours north, canvassers encountered Robert Schmidt, a veteran who said he was conflicted about free coverage for low-income people regardless of whether they worked.
“I had to sign my life away to get my free care,” he said of the government coverage he receives as a veteran. “I can’t do handouts. On the other hand, with all the money we spend across the world, why aren’t we taking care of our own people?”
Mr. Schmidt, who is 53 and works at a big-box store, said he was not sure how he would vote.
A few houses down, his neighbors Kirsten Reed and James Smith told the canvassers that they would eagerly vote for Medicaid expansion now that they had been reminded about it. Both uninsured, Mr. Smith, a carpenter, and Ms. Reed, an artist and writer, said they had seen a pro-expansion ad on television but had forgotten about it.
“I could have easily been someone who believes in this but didn’t get out and vote,” Ms. Reed, 44, told the canvassers, Cokie Giles and Cynthia Martinez-Edgar, both nurses.
State Representative Heather Sirocki, a Republican active in fighting the ballot measure, said the uninsured could always sign up for charity care at hospitals, which are obligated to provide it to people under a certain income level.
At the Oasis Free Clinic in Brunswick, which sees about 450 uninsured patients a year, R. J. Miller, 33, who suffers from psoriatic arthritis that causes severe joint pain and swelling, said he worried about relying indefinitely on free care to control his condition.
“I’ve lived in other countries where nobody’s going to let you fall all the way down,” said Mr. Miller, a jazz drummer. “We buy into the American legend of, ‘You can take care of yourself anywhere, kid.’ That’s a bad lesson to teach everybody.”
Obamacare’s fate looms over Maine Medicaid expansion vote
by Christopher Cousins - Bangor Daily News - October 21, 2017
Few issues have received as much governmental and media attention in recent years as Medicaid expansion, yet Mainers are poised to decide Question 2 on the November ballot amid confusion in the present and uncertainty about the future.
Whether Maine will expand its Medicaid program as the Obama-era Affordable Care Act intended, as a means to insuring millions of low-income people’s health, is a concept that has been rejected ad nauseam in the Legislature, ranging from numerous proposals killed in committee to six expansion plans that were supported by slim majorities in the Legislature but stopped by vetoes from Republican Gov. Paul LePage.
The arguments for and against Medicaid expansion in Maine are the same as they have been for years and they’re being made by many of the same groups and people. Despite that, health care has emerged as a crucial ideological and political issue. Mainers will head to the polls Nov. 7 amid an intense national debate about health care.
With health insurance premiums on the rise and insurance companies struggling to survive, particularly in the Affordable Care Act’s individual markets, President Donald Trump and most congressional Republicans support repealing the program. Though they have so far been blocked, the debate continues and the future of our national health care system is uncertain.
Question 2, which will appear on the statewide ballot, reads as follows:
“Do you want Maine to expand Medicaid to provide healthcare coverage for qualified adults under age 65 with incomes at or below 138% of the federal poverty level, which in 2017 means $16,643 for a single person and $22,412 for a family of two?”
What does expansion mean?
More adults would be covered based on their income. Currently, MaineCare covers a range of groups, such as pregnant women, parents with children younger than 18 and disabled people. Qualifying income thresholds vary. Parents and disabled adults, for example, qualify if their incomes are below 100 percent of the federal poverty level. That’s $12,060 a year for a single person, $20,421 for a family of three and $28,780 for a family of five.
Expansion would raise the threshold to 138 percent of the federal poverty level. That’s $16,643 a year for a single person, $28,180 for a family of three and $39,716 for a family of five. The initiative would also expand coverage to adults who are not disabled and don’t have children, which would be a change from current law.
Why does it matter what happens at the federal level?
It’s about the money. The 2010 Affordable Care Act encouraged states to expand their Medicaid programs, which in Maine is called MaineCare, and promised heavy subsidies to cover part of the cost of expansion — specifically, 90 percent by 2020. Without that guarantee, the cost to states would be significantly higher and probably unpalatable. So far, proposed cuts to Medicaid have helped sink attempts to repeal the Affordable Care Act. Opponents of Medicaid expansion have used uncertainty at the federal level as an argument in the past; that argument is only stronger now.
The initiative does not reference the Affordable Care Act. The referendum expands Medicaid in Maine regardless of what Congress does or doesn’t do.
The cost would be high but how high is under debate. The Legislature’s Office of Fiscal and Program Review, which puts price tags on proposed legislation, published its findings in the Maine Secretary of State’s 2017 Voter Guide. It breaks down as follows:
— A $2.6 million appropriation to the Maine Department of Health and Human Services’ Office of Family Independence, which would have to hire 103 new eligibility specialist caseworkers to handle the new MaineCare enrollees. The federal government would cover 75 percent of the cost for 79 of those positions and 50 percent of the cost for the rest. Each new caseworker is predicted to have a caseload of about 700 people. It is estimated that expansion would extend coverage to approximately 70,000 more Mainers.
— A $50 million appropriation to DHHS to cover medical costs for the newly eligible childless adult population. That figure represents the state’s estimated 10 percent share of the total cost. The rest would be paid by the federal government.
— A $28 million appropriation to DHHS for medical costs for newly eligible parents. That figure represents 35 percent of the total cost; the federal government would pay the rest.
— A $410,000 appropriation to cover medical costs for children whose families opt to join the program. That represents 2 percent of the total cost, the rest of which would be paid by the federal government.
— On the positive side of the tally sheet, OFPR estimates that existing programs would generate $27 million a year in savings, mitigating the total cost.
IN SUMMARY, expansion would require an annual state appropriation of nearly $54.5 million, and federal costs would be approximately $525 million a year. Those numbers would fluctuate, depending on whether the estimate of 70,000 new Mainers covered is high or low.
We’re being watched
Maine’s Question 2 is somewhat of a litmus test for the Affordable Care Act. As Trump and congressional Republicans persist in efforts to repeal Obamacare, constituencies for and against that concept have thrown every argument they can at the debate. Medicaid expansion by referendum is rare, which offers repeal proponents — or opponents, if the referendum fails — a rock-solid poll, of sorts, in the form of next month’s election. National media are taking notice and it’s certain Maine will garner national headlines and provide talking points in Congress following the vote.
In Maine, LePage has a lot on the line. Although term limits will force him out of office in 2019, the governor’s legacy will be shaped by whether he can convince a majority of voters that his stance on expansion is best for Maine. He has spent much of his time as governor trimming social service programs, including Medicaid, Temporary Assistance for Needy Families and food stamps, behind the argument that taxpayer resources should go to the most vulnerable and not what he repeatedly calls “able-bodied adults.”
This is likely the last time the matter will come up during LePage’s tenure, so a “no” vote will help cement his legacy of reining in the cost of public assistance programs. A “yes” vote would be a clear rebuttal of the governor’s stance but would electrify health care as an issue in the 2018 gubernatorial and legislative elections.
The vote won’t be a bookend for the debate. By January 2019, when a new Legislature and a new governor submits his or her state budget proposal, Medicaid coverage and its costs and benefits to the state will again be at center stage, regardless of what happens on Nov. 7.
American Doctors Join Sen. Bernie Sanders for Canadian Health Care Tour
by PNHP - October 27, 2017
WASHINGTON - This weekend, American physicians Claudia Fegan, M.D., and Richard Bruno, M.D., M.P.H, will join Sen. Bernie Sanders on a fact-finding delegation to Toronto, Canada. On Saturday, the delegation will tour three Canadian hospitals and speak with Canadian health care providers and patients. On Sunday, they will join Dr. Danielle Martin at the University of Toronto for a public event.
By exploring the Canadian system, the doctors hope to learn how a single-payer health system contributes to quality, access, equity, and cost efficiency. Canada spends $4,569 per capita (10% of GDP) on health care, while the U.S. spends $9,086per capita (17% of GDP). Despite drastically lower health care spending, Canada provides its citizens with universal coverage. Canada also enjoys lower infant mortality and lower rates of deaths that could have been prevented with timely and effective health care.
“As a doctor who cares for uninsured patients, I’m especially curious to see how Canadians get their health care,” said Dr. Richard Bruno, a family physician based in Baltimore, Md. “The data suggests that Canadians enjoy better benefits and health outcomes for less money. How do they do it and how can we do it even better?
Dr. Claudia Fegan, a Chicago-based internist and chief medical officer for the Cook County Health and Hospital System and John H. Stroger Jr. Hospital of Cook County, wants to learn how doctors practice medicine without having to deal with a fractured, profit-based health care system. “A majority of American doctors now support a single-payer health program,” says Dr. Fegan. “We can look to the experience of other nations to figure out how to get there.” She notes that 54% of American doctors say that time spent on administrative issues related to insurance or claims is a major problem, versus 20% of Canadian doctors.
Drs. Bruno and Fegan are both board members of Physicians for a National Health Program, a nonprofit research and educational organization of more than 21,000 doctors and health professionals who support a single-payer national health program.
ITINERARY (in Eastern Standard Time)
Saturday, October 28:
- 1:00-1:30 p.m.: Tour of Women’s College Hospital (WCH) family practice clinic & chat with WCH family doctor & patient
- 1:30-2:30 p.m.: Round table discussion with Canadian health professionals and hospital administrators
- 2:45-3:45 p.m.: Tour of Mount Sinai Hospital; Overview of Mothers & Babies Program & Neonatal Intensive Care Unit
- 4:00-5:00 p.m.: Tour of Toronto General Hospital and University Health Network (UHN); overview of Cardiac Centre
Sunday, October 29th:
- 11:00 a.m.-12:30 p.m.
Sen. Sanders’ speech and discussion with Dr. Danielle Martin on what the United States can learn from Canada's health care system.
Richard Bruno, M.D., M.P.H. is a family physician at an underserved clinic in Baltimore, Maryland. His clinical focuses are on obesity and opioids, with involvement in community public health interventions and policies. He attained a bachelor's degree from Princeton University, doctorate of medicine from Oregon Health and Science University, and a master of public health from the Johns Hopkins Bloomberg School of Public Health.
Claudia Fegan, M.D., CHCQM is national coordinator of Physicians for a National Health Program and chief medical officer for the Cook County Health and Hospital System and John H. Stroger Jr. Hospital of Cook County. She is also president of the Chicago-based Health and Medicine Policy Research Group. She is a co-author of the book “Universal Healthcare: What the United States Can Learn from the Canadian Experience” and a contributor to “10 Excellent Reasons for National Health Care.” Dr. Fegan received her undergraduate degree from Fisk University and her medical degree from the University of Illinois College of Medicine. She is also certified in health care quality and management and is a diplomate of the American Board of Quality Assurance and Utilization Review Physicians.
Canada's health system serves as model for Sanders – but faces troubles of its own
by Ashifa Kassam - The Guardian - October 28, 2017
Bernie Sanders will arrive in Toronto this weekend for a crash course in an unrivalled point of pride for most Canadians: the country’s healthcare system.
The visit – which will include roundtable discussions, facility tours and meetings with patients – is aimed at better understanding how Canada provides universal healthcare that yields a longer life expectancy and lower infant mortality rate than the US while spending about half as much per capita.
What Sanders learns will probably inform his push to provide publicly funded healthcare for every American, forming the backbone of a movement that has repeatedly cited Canada as an example to be followed. But as Sanders heralds Canada as a place where health care needs consistently trump the ability to pay, some are sounding the alarm about the inequalities that plague the Canadian system.
Some of these are blatant, thanks to the stream of for-profit medical clinics that have set up shop north of the border in recent decades.
“I think privatisation is a major threat to public health care in Canada,” said Natalie Mehra of the Ontario Health Coalition.
Earlier this year, her organisation released a report documenting 136 private clinics across the country and highlighted that 71 of these were selling faster access to services covered by the country’s health care system. What’s more, the report suggested that many of the clinics were charging patients while also billing the public health care system – a practice that runs contrary to Canadian law.
Relying on volunteers to pose as would-be patients, the report documented prices of up to C$10,000 for minor knee surgery and C$5,000 for cataract surgery. “We found that costs for patients in the private clinics are exorbitant – up to five times or more than those in the public system,” said Mehra.
The report was careful not to overstate the role of these clinics, noting that the vast majority of hospital and physician services in Canada continue to be provided within the publicly funded system. “But the threat is real,” it continued. “In the majority of provinces, private clinics have set up shop and are charging user fees to patients.”
Since the report’s release, several groups have pushed the federal government to take action, including Canadian Doctors for Medicare. “I think the report was shocking for a lot of Canadians who were seeing some of this information for the first time,” said Danyaal Raza of the organisation.
Those behind private clinics have defended them as a necessity, describing them as a means of relieving pressure on a system that suffers from some of the longest wait times in the developed world.
Raza pointed to jurisdictions that most resemble Canada, such as Australia, where the introduction of private providers diverted doctors’ time and attention, resulting in longer wait times in the public system. “The only people who benefitted were people who were able to buy their way to the front of the line,” said Raza.
An alternative solution may lie in the growing support among Canadians to expand the country’s coverage – which currently only covers hospitals and physician care – to areas such as pharmacare and dental, he said.
The merits of doing so were hinted at in a recent ranking of health systems in wealthy countries by the Commonwealth Fund.
The US-based thinktank ranked Canada near the bottom – but still ahead of the US – highlighting the relatively narrow range of coverage and the resulting struggle by many to afford necessities such as vision care or home care.
Sanders’ plan for Medicare – which goes much further than Canada’s to include aspects of care such as psychological services and rehab – laid bare the many gaps in Canada’s system, said André Picard, who for three decades has reported on Canada’s health care for the Globe and Mail.
Since the 1970s, the amount Canadians spend on private healthcare has remained stable, making up about 30% of all health spending, compared to about 15% in most European countries. “Everybody says we have a public system and I say not really: we have a private system just like every other country,” he said.
“The public view is that we have public Medicare and it’s wonderful, it covers everything,” he added. “And then when you actually go to care, you realise: it covers my hospital stay but if I need a wheelchair, I’ve got to rent that. And if I need home care, I’ve got to pay for that. And if I need drugs outside of hospital then I need to pay for those.”
As the Vermont senator touts plans for a far more comprehensive and equitable system south of the border, Picard is among the many in Canada who hope it will prompt Canadians to revisit the glaring gaps in their own system.
“I don’t think we’re ambitious enough,” he said. “Canada has limited ourselves to doctors and hospitals, and there’s no reason like the rest of the developed world that our public plan couldn’t cover all kinds of things, from dental care, home care to long term care.”
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