Lessons From the Canadian Experience With Single-Payer Health Insurance

Abstract

n the fall of 2017, US Sen Bernie Sanders (Independent, Vermont) visited Toronto to learn about health care in Canada. His warm welcome by large crowds prompted the question: Why is Bernie Sanders so popular in Canada? Perhaps by advocating universal single-payer health insurance in the United States, Sanders gives voice to a core aspect of national identity for many Canadians. He reaffirms their belief that provision of health care should be equitable-delivered according to need rather than wealth. Critics, however, felt that Sanders missed the challenges in the Canadian system. 1 Although proud of its ideals and appreciative of its achievements in certain areas, many Canadians, including some of the greatest current champions of Medicare, the unofficial name for the system, strongly advocate for change. 2 Complaints about wait times are increasingly expressed and disseminated via social media, 3 and there are frequent calls to address ongoing inequity, particularly in coverage for outpatient medications. 4 With singlepayer public health insurance again on the political radar in the United States at both the state (California) and federal (Democrat party) levels, the performance of the Canadian health care system during the last 50 years and the lessons it may offer should be considered.

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“…The differences between the Canadian and US health care systems have been described extensively. [44][45][46] Canada spends roughly 11% of its gross domestic product on health care, whereas the US spends about 18%. 47 Canadian health care has been praised for providing equal access to all legal residents without copayments or private sector competition, but criticized for problems with access and wait times.…”

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“…The 'patchwork quilt' was harmonized with federal law in 1984 ('Canadian Health Act'). Some authors define it as 'single-payer health insurance' ('single-payer') rather than a real system 5 , not to mention that provincial autonomy produces multiple 'systems' .…”

“…Family doctors (FD) are the system's backbone and roughly correspond to half of the country's medical professionals (122 family doctors/100,000 inhabitants vs. 119 specialists/100,000 inhabitants) 5 . The same report shows that the increased number of doctors since 2014 was twice the population growth, which tends to favor access.…”

“…Taken together, these indicators show an apparent problem of access, although some of them refer to secondary or tertiary care. However, some of these indicators can be questioned (for example, consultation on the same day, or the next) since access to this appointment does not necessarily imply adequate care with improved quality of life for those seeking care 5 . Furthermore, while studying only people who had an FD in the province of Ontario, a broader assessment of access showed that this population mostly has positive impressions of that access 12 .…”

“…Canada is the only country in the world with a universal health system without this coverage. 13 The importance of incorporating free medicines into the system is widely supported by experts 4,5,11,[13][14][15][16] , with demonstration of economic advantages. The Liberal Party of Canada is currently holding a minority government since last October's elections.…”