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.