The Canadian Medicare for All Experience

 

The Bernie Sanders’ push for Medicare for All is gaining some steam as his presidential campaign ratchets up the rhetoric.

In a recent Fox News town hall appearance, Sanders said, “What we are talking about is simply a single-payer insurance program, which means that you will have a card which says Medicare on it, you go to any doctor that you want, you will go to any hospital that you want. You’re not paying any more premiums, you’re not paying any more copayments, you’re not paying any more deductibles.” He went on to say the plan, “would allow all Americans, regardless of their income, to get the healthcare they need when they need it.”

How do these statements by Sanders compare with the real world? The best comparison to his Medicare for All system is our northern neighbor, Canada. What has been their experience?

Regina E. Herzlinger and Bacchus Barua, discussed the answer to this question in a recent Op-ed for The Wall Street Journal. Herzlinger is a professor at Harvard Business School and Barua is associate director of the Canadian Fraser Institute’s Centre for Health Policy Studies.

They say the Canadian model follows Sanders’ Medicare for All single-payer plan but “is not the best way to achieve the goal of access to timely care.” Like the Sanders plan, it is universal, taxpayer funded without deductibles or copays, and excludes premiums for most users. But objective measures of performance show it’s a comparatively expensive system whose results are mediocre at best – and sometimes very poor.

A Fraser Institute study published in November, 2018, examined 28 universal healthcare systems across 45 indictors of performance. Canada’s system ranked among the top spenders – fourth highest as percentage of GDP and 10thhighest per capita. Yet it had less medical resources available for patients and painfully long wait times for specialists (emphasis mine).

Canada ranked:

  • 26thout of 28 for number of physicians
  • 22ndout of 27 for MRI units
  • 25thout of 26 for hospital beds
  • 11thout of 11 for waiting times greater than 4 weeks

Canada performed well on only five of the 12 indicators of clinical performance and quality included in the Fraser Institute’s study. Its performance on the other seven was poor or average.

Why these dismal results for Canada in comparison to systems in Europe? Unlike Canada’s single-payer system, the Swiss, Dutch and German systems rely on private insurers, whether nonprofit or for-profit. The Sanders Medicare for All system would eliminate private health insurers.

Unlike the U.S., with Medicare and its massive trillion-dollar unfunded liabilities, these countries cannot pass unreimbursed current expenses onto future generations. If the expenses of private insurers exceed their revenues, they face bankruptcy. There is also an advantage to private vendors who can access private capital to fund medical innovations – unlike government-run systems, which need bureaucratic approval to use tax revenues.

The Canadian experience is a lesson American voters should be learning. Medicare for All will not produce the utopian healthcare system of Senator Sanders’ rhetoric. His healthcare promises are no better than President Obama’s who famously said, “If you like your doctor, you can keep your doctor.” The American people should not be fooled again.

Middle Class Healthcare

 

The quality of your healthcare depends on your economic class. That’s a sad truth but reality. But it isn’t unique to America.

Progressives that support socialized medicine think that system eliminates this problem. They believe socialized medicine guarantees quality healthcare regardless of economic status. But single-payer systems in Canada and the United Kingdom still offer two levels of healthcare; one for the rich and another for everyone else.

The problem of poor access to healthcare for the poor is so well known in Britain that the press refers to the NHS as a “postcode lottery”. They mean a person’s chances for timely, high-quality treatment depends on the neighborhood or “postcode” in which he or she lives. The Guardian sums up the situation with this statement, “Generally speaking, the poorer you are and the more socially deprived your area, the worse your care and access is likely to be.”

In our country we have three levels of healthcare; the poor, the rich, and the middle class. Which one is getting the worst deal?

The Poor

Let’s look at the poor first. ObamaCare failed to achieve many of its promises but it did increase the number of people with healthcare insurance by about 20 million. Most of these people are on the expanded rolls of Medicaid and the rest are receiving private healthcare insurance they purchase on the ObamaCare exchanges at low, heavily-subsidized prices. You could say that all of these 20 million have benefited from ObamaCare. These people are all poor by definition because they are eligible for Medicaid or ObamaCare exchange subsidies.

 

The Rich

The rich will always be able to purchase the healthcare they need, regardless of the system. ObamaCare has not really affected them; most of them have employer-provided healthcare insurance, Medicare, or top-quality private insurance they can easily afford to purchase. They can travel to the best hospitals and doctors anywhere in the world for their healthcare. This is true in our country and in every other country, regardless of their healthcare system.

 

The Middle Class

The middle class is most affected by ObamaCare. The middle class makes too much money to qualify for ObamaCare exchange subsidies or Medicaid, but not enough to afford high-priced healthcare insurance premiums and deductibles. They must pay the full price of inflated premiums driven up by ObamaCare mandates and regulations. They bear the full burden of a system designed to make the young and healthy pay for the old and sick.

They can no longer customize their healthcare coverage for their specific needs due to ObamaCare regulations. The result is that many of these people have chosen to go without healthcare insurance because the premiums and deductibles are just too high for their budgets. ObamaCare has taken away their healthcare.

The irony of this situation is that the Democrats who designed and passed ObamaCare don’t understand its impact on the middle class. Recently, the Trump administration announced plans to replace ObamaCare with a better plan. In response, Senate Minority Leader, Chuck Schumer (D – NY) said, “Well, I say, ‘God help the middle class.’ What, dare I ask, is their plan?”

Clearly, Senator Schumer has no idea how badly his plan has treated the middle class. Anything Republicans propose would be an improvement over ObamaCare for the middle class.

 

Are You Overmedicating Your Child?

 

A pill is easier to give than your time and attention. That’s the conundrum of many parents as they deal with unacceptable behaviors in their children.

Clinical psychoanalyst Erica Komisar writes in The Wall Street Journal that American children have a drug problem. She says the use of psychiatric drugs to treat ADHA, depression and anxiety in children and teens has been increasing and is excessive.

When children have difficulty sitting still, can’t focus on school work, or become disruptive in class, the school is often quick to label the child as having attention deficit and hyperactivity disorder and urge the parents to seek a psychiatrist for medication. But Komisar says the problem is often disruption in the home, especially when parents separate or divorce.

A study published last year in the Journal of Clinical Child & Adolescent Psychology found that some 5% of American children were on stimulants like Ritalin and Adderall to treat ADHD and behavioral problems in 2016. The Centers for Disease Control and Prevention reported a nearly 400% increase in antidepressant use in patients between 12 and 19 from 1988 to 2008, the most recent year for which data are available.

Yet many of these young people are being inaccurately diagnosed. They don’t actually have ADHD, clinical depression or anxiety. A 2000 study found that the majority of children and adolescents who were being medicated for ADHD did not fully meet the diagnostic criteria for the condition. In fact, a 2018 study in the New England Journal of Medicine showed that the younger a child is relative to his classmates, the likelier he is to be diagnosed with ADHD. That finding strongly suggests the disruptive behavior is the result of immaturity, not illness.

Pediatricians seem to understand this better than schools. The American Academy of Pediatrics recommends behavioral therapy, not drugs, as the first line of treatment for mental illness in children. But a 2014 Ohio State study showed that the majority of kids aren’t being properly evaluated or being offered psychotherapy before being medicated. Again, pills are easier than behavioral therapy.

There is a place for medication of children with serious mental illness. But choosing drugs as a quick fix for emotional pain and disruptive behavior does not help children become emotionally mature or resilient to stress. It produces adults who continue to rely on drugs, alcohol, and disruptive behavior to deal with everyday life stresses.

There may also be another motivation for parents and schools seeking medication for children. Psychologist Stephen Hinshaw and economist Richard Scheffler attribute the increase in ADHD diagnoses in part due to changes in school funding to reward higher standardized tests scores. ADHD drugs are acknowledged performance enhancers.

Komisar concludes: “ It is much easier to blame our children for their behavior, or label them as organically flawed and medicate them rather than consider what we as parents and educators my be doing – or failing to do – to help them feel safe, protected and emotionally secure. We feel guilty, and rather than address our own part in the situation, we look for the quick fix of a pill.” 

What has been your experience? If you have or had a child on medication, tell me how that worked out for you and your child.