It's easy to laugh off the absurdity of Trump and his supporters' sentiments about the Canadian health-care system. But their ridiculousness doesn't make their impact any less dangerous. Canada is internationally viewed as a model of socialized medicine. So on October 9, 2016, when U.S. presidential candidate Donald Trump mentioned Canada in the debate with Hillary Clinton, it was unsurprisingly in reference to the health-care system. He claimed, "the Canadians, when they need a big operation, they come into the United States in many cases, because their system is so slow."
And then more recently, on Tuesday February 7, CNN hosted a debate between Bernie Sanders and Ted Cruz about the future of the Affordable Care Act (commonly known as Obamacare). As usual, Bernie mentioned Canada among countries that have universal health care and as usual, the right-wing politician, this time in the form of Ted Cruz, responded with the same misinformed claims Trump made months earlier. There is so much wrong with Cruz's comments that I felt the need to transcribe them all for you:
"Now Bernie mentions Canada quite a bit I know quite a bit about Canadian health care I was born there… But you know people vote with their feet. In 2014 over 52 000 Canadians left Canada to get health care in the United States and other countries. I'm reminded of a comment Ronald Reagan used to say about East Berlin, about the Berlin Wall. He said, 'The funny thing the leftists never seem to notice is the machine guns all point one direction. Everyone was fleeing Communism and coming to freedom. If you look at socialized medicine, people leave there, tens, hundreds of thousands, leave their socialized medicine country every year because they want to get a hip replacement, a knee replacement, you know, the governor of one of the Canadian provinces came to America to get heart surgery and he was a governor in Canada. And by the way the hospitals in your home state of Vermont advertise with Canadian flags come to American hospitals you'll get better health care. I don't want to mess up our health care, I want patients, all of us, to be in charge of our health care."
Canadians rightly pointed out repeatedly and vehemently that the "persistent myth" of Canadians fleeing to the U.S. for health care simply has no basis in fact. Also that Canada doesn't have governors and Danny Williams was in fact a premier. And as far as I can tell, no one knew what he was saying about Vermont. Ted Cruz is so confused about his birth country, if I had any nationalist spirit whatsoever it would be consumed in embarrassment about him. He treats Canada with the same hollow opportunism he demonstrated for patients and their questions during the debate.
But whether the Canadian health-care system is inspiring nationalistic pride in Canada, being used in debates to provoke fear by people like Trump and Cruz, or envy by international proponents of public medicine like Sanders, this is not the whole picture. Compared to the United States, it is true that Canadians are less likely to go bankrupt after a cancer diagnosis or stay in a job we hate just so we can access basic health care. But leaving the discussion here puts the bar for discussions about health depressingly low.
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The note Cruz finished on, that he wants patients to be in charge of our own health care, is especially misleading given the fact that insurance companies have been shown time and time again to be more interventionist about what coverage patients are entitled to for medications, procedures and providers than publicly provided care. A common and topical example is the current battle between public and private long-term care facilities. At a Vancouver "Defending Public Seniors' care" forum on January 28, panelists correctly pointed out that for residents to experience high-quality care they need to have relationships with the people who intimately provide that care. As soon as for-profit entities take over care they take cost-cutting measures which reduce one-on-one time between staff and residents. This idea that private industry gives us more choice or control through fictional promises of improved "access" is utter nonsense.
As Sanders said in his most memorable quote from the healthcare debate, "Access isn't worth a damn!" if it's contingent on having the money to pay for a service. But the frightening fact that is notably absent from all these comparative arguments is that Canadians' access to quality and timely care is intimately tied to that of our US neighbours. The current state of the Canadian healthcare system has left gaping holes that US-based corporate healthcare providers are jockeying to fill. This article from 2009 documents decades of Canadian governments delisting services from public provision and massively boosting insurance company profits as a result.
Sanders correctly argued that the single-payer system guaranteeing health care for all is the only reasonable and fair solution. But this style of health-care provision is deteriorating in Canada. In the most heavily populated province, Ontario, we have private MRI and colonoscopy clinics. In addition, we rely on private insurers to pay for things as essential as life-saving medications, ambulances and dental care.
On February 16 Globe and Mail health reporter André Picard addressed a new report on increased health-care wait times in Canada. He correctly points out that better coordinated systems of care in Nordic countries use nurse practitioners and other providers like occupational therapists to greater effect, reducing wait times. And perhaps most significantly, "In the Nordic countries…there is a particular emphasis on the socio-economic determinants of health, in tackling inequality, but spending more on education and social welfare, and less on health, with impressive results."
It seems clear to me that our problem is not too much socialized health care, but too little. From income levels that determine health before people even arrive in the doctor's office or hospital waiting room; to for-profit corporations encroaching on health-care provision across the country, Canada should not be satisfied with saying we are better than Trump says we are.