Two of the top three Democratic presidential front-runners — Bernie Sanders and Elizabeth Warren — are running on a platform of 'Medicare For All' with no private option. Sanders has hoisted up Canada's health care system as an example of a universal system that works for everyone.
Under the Canadian system, patients pay nothing out-of-pocket for surgeries, tests and child birth. And significantly less of the Canadian economy goes to health care than that of the U.S.
But it's hardly a perfect system, WBUR's Bob Oakes and Wilder Fleming found, at least in the province of Nova Scotia. Doctors, patients and advocates are saying their healthcare system is in a "crisis."
As in much of Canada's system, in Nova Scotia, medical practitioners are barred from accepting private forms of payment — meaning that if you aren't assigned a doctor by the government, you have no other choices available to you. You must put your name on a waiting list and sit tight — often for years. And as professor Katherine Fierlbeck of Dalhousie University in Halifax points out, Canada is one of only a few developed countries to prohibit the mingling of public and private insurance options for the same medical procedures.
There are, of course, major advantages to the Canadian system. If you have an emergency in Canada and can get to a hospital, you will get triaged to the front of the line and attended to by world-class healthcare professionals, with no out of pocket expenses; no matter the complexity of the surgery or the length of your hospital stay. And healthcare spending in Canada IS significantly lower than the U.S. (11% of GDP vs. 18% of GDP).
But delivering healthcare is always expensive: Nova Scotia's provincial government spends around 45% of its budget on delivering healthcare. Canadians also pay significantly higher taxes than people in the U.S., both on income and on goods and services like gasoline, coffee, etc. Also, Canadians see increasingly fewer returns on their taxation. Ambulances in Nova Scotia were once a "free" service.
This decline in services stem from government austerity measures that have bled the system of funding, a system of delivery that hasn't been updated in decades, along with global health trends affecting us all: the grey wave; younger docs unwilling to take on the massive roster of patients their older counterparts would.
As the U.S. contemplates how best to fix its own broken healthcare system, WBUR travels to Nova Scotia, where the "crisis" is particularly acute, to better understand the pros and the cons of a universal system that doesn't allow healthcare practitioners to accept private insurance/operate within a free market. A system that's essentially "free" to use, and treats emergencies exceptionally well (when the ER is open, anyway), but is arguably failing in its mission to provide long-term care for patients with chronic conditions or perform any kind of service/operation that isn't considered a time-sensitive emergency in a timely manner.
Listen to the full story that aired on Dec. 2 & 3 — here. Don't miss the panel discussion tomorrow, on Dec. 4, with healthcare experts here in the states, looking at the global healthcare trends affecting all of us, what needs to be done about it, and what in their view is the best-case scenario for healthcare reform in the states vs. what is politically feasible.
Get the week's most important personal health, medical research, and science news sent to your inbox with the CommonHealth newsletter. Sign up now.