Talking to Americans: The health-care debacle

Medicare for All Rally in Los Angeles - Feb 2017. Photo: Molly Adams/flickr

Karl Nerenberg is your reporter on the Hill. Please consider supporting his work with a monthly donation. Support Karl on Patreon today for as little as $1 per month!

Americans might not worry much about their deeply flawed election system. Americans and their media do, however, care about their health care and health insurance coverage. Barack Obama's Affordable Care Act, also known as Obamacare, was designed to fill the gaps in and regulate what would remain a private sector-dominated health insurance system. One way the Act does that is by compelling insurance companies to provide coverage to individuals with pre-existing conditions. The companies had historically refused to insure those high-risk people, and so, in exchange, the Act also sought to encourage healthy, low-risk people to buy private insurance coverage. Those new low-risk customers would provide insurers with the cash to cover the folks suffering pre-existing conditions, the people most in need of health care and health insurance.

It all must sound strange to Canadians. Here, private insurance only exists for the extra, largely non-essential stuff the public system does not cover. For the vast majority of Canadians, the idea that you could get sick and be denied basic health care is a completely foreign notion.

The sad truth, however, is that Obama's reform did not entirely work out according to plan. The Affordable Care Act fell short, in part, because of the venality of the private insurance industry, in part, because the incentives (positive and negative) for healthy, low-risk people to buy coverage were insufficient, and, in part, because there was no public insurance option.

Obama dearly wanted that public option, as a way of guaranteeing that everybody would have access to affordable coverage. But not only could he not convince any Republicans to support his proposal -- they called it the thin edge of the wedge to a government takeover of all health care -- he could not even get it past the so-called moderates in his own party, including former Connecticut Senator Joe Lieberman. Throughout the process, the Connecticut politician and one-time vice-presidential candidate acted as an active shill for his state's influential and powerful insurance industry.

And so, the Affordable Care Act was, at best, only a partial and inadequate reform, and, since implementation, has experienced its share of bumps in the road. The Act's problems made it an easy target for the likes of Donald Trump. The billionaire promised to repeal and replace Obamacare with an unspecified something better, without, to all appearances, having spent five minutes studying the issue.

As anyone who has been following recent happenings in Washington knows, efforts to accomplish repeal and replace now lie in ruins. Private sector health premiums continue go up, while, for many Americans, their insurance options have shrunk to near zero.

The result is that many Democrats -- and not just those of the Bernie Sanders wing -- are showing a renewed interest in a robust public sector solution. And their solution would go a lot further than Obama's, which would have seen a public insurer competing in a private sector-dominated marketplace. What U.S. health reformers are now calling for is what Americans have named the single-payer system. Put simply, they want the Canadian system, in which only one public sector insurer covers all basic health services, from doctors' visits to hospitalization to surgery to vaccination.

On Wednesday, September 13, the independent senator from Vermont, Bernie Sanders, introduced a bill that would create a single-payer, universal health-care system for the U.S. It has the support of at least 15 of Sanders' Democratic colleagues. In the words of the Washington Post, single-payer is an idea that was once "on the fringes" of U.S. politics. No more. It has now moved into the mainstream.

Canada has become a favourite target

While this is all happening on the progressive side of the political fence, the other side is not sitting on its hands. Renewed interest in Canadian-style single-payer is engendering a vicious campaign of slander and disinformation against Canada and especially our way of managing and financing health care.

We got a taste of that this past summer at a bar mitzvah in Ithaca, New York.

Ithaca is charming college town -- home to Ivy League Cornell University -- in the picturesque Finger Lakes district. It is a region of long, deep lakes and bucolic wineries on the surrounding hillsides.

The bar mitzvah took place in one of  Ithaca's two synagogues, the older one, founded more than 90 years ago and housed in a historic building downtown. It was followed, as is the custom, by a luncheon to which the whole congregation is invited. After filling our plates with cream cheese, lox, chopped egg salad and bagels, we found ourselves seated across from a doctor and her retired engineer husband who hail from Virginia, but have a home in the Finger Lakes. The husband struck up a conversation. When he discovered we were Canadian, he asked, in a non-confrontational way, our views of the Canadian health-care system.  

We explained that, overall, Canadians would not want the largely public system changed or diluted, although it has its share of challenges, such as wait times for elective procedures and shoddy care for Indigenous communities. The husband then turned to his wife.

"These people are from Canada," he said, "and they think their health care is pretty good."

The doctor wife was not in the least interested in our experience or perspective. She launched into an angry scold.

"Your system is terrible," she told us. "Patients die without getting treatment, and the doctors are not competent."

When we tried to offer an opinion based on a lifetime of actual experience, she was not interested. She cited the case of a distant relative who lives somewhere in Canada -- "Was it Montreal or Toronto?" she asked her husband -- and who is suffering from cancer. She claimed her relative's doctors had originally misdiagnosed his condition and only discovered how severely ill he was when it was too late to save him.

The story may or may not be true. It is typical of the U.S. health-care debate, especially when it comes to Canada. It is argument by half-baked, often false, anecdote.

Demagogues such as Trump routinely talk about Canadians flooding across the border for treatment, fleeing, in Trump's words, our "catastrophic" system. The fact is that even such sources as the neoconservative Fraser Institute report that the number of Canadians seeking medical care abroad (and not just in the U.S.) is tiny. It was about 45,000 in 2015, and that includes people who went to India for treatment and snowbirds, who live for six months of the year in Florida, California or Arizona.

This writer knows plenty of Canadians who have had both necessary and elective procedures in Canada, from chemotherapy to heart bypass surgery to hip and knee replacements, but not a single person who has crossed the border to seek treatment in the U.S. Readers can ask themselves if they know anyone who has gone south for medical care. The answer is almost certainly no.

Nonetheless, as the debate gets hotter south of the border we can expect not only Trump and his ilk but also legions of supposedly reasonable politicians and opinion leaders to dump more and more slander and calumny on Canadian health care. When the Harper government was in power it had queasy ideological motives for staying silent in the face of such nonsense. Deep down, Harper and his gang were not committed to our public system. They likely only acquiesced to it because they knew it would be political poison to propose measures that could weaken health care as we know it.

Notionally at least, the Trudeau Liberals do not suffer from similar ideological ambivalence. Given that, perhaps it is time they politely push back when loud voices in the U.S. tell bald-faced lies about Canada.

This article is the second part in a two-part series on American views about politics.

Photo: Molly Adams/flickr

Karl Nerenberg is your reporter on the Hill. Please consider supporting his work with a monthly donation. Support Karl on Patreon today for as little as $1 per month!

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