When Bernie Sanders visited Canada’s national health care system on a fact-finding mission, he came away mightily impressed. “Somehow or another in Canada,” he said, “for a number of decades, they have provided quality care to all people without out-of-pocket expenses…And they do it for about 50 percent per capita of the cost that we spend.” His claims are not only debatable, they are fraudulent. Anyone who cites the Canadian model as a medical paradigm is guilty of special pleading.
For one thing, “quality care” does not exist in Canada; indeed, such “care” closely approximates Third-World levels, as we will see below. For another, according to a 2018 Canadian government survey, out-of-pocket expenses constitute about $36 billion or 15 percent of health care spending. As we know, government reports regularly underestimate in their projections. Out-of-pocket expenses are far higher, not only for dental and many pharmaceuticals—the Canadian system does not cover essential medications—but with regard to value-added surcharges.
For example, in Quebec where I lived for many years, health care consumes 45 percent of all provincial program spending, which did not prevent government tacking on an extra $200 annually as a “solidarity tax.” In Ontario I paid exorbitantly for non-prescribed drugs, including a whopping mandatory payment every June. In British Columbia where I now make my home, every person pays an extra $37.50 monthly, which for my wife and me amounts to $900 per year over and above extortionate ancillary expenses and a massive tax gouge. In more than one way, Bernie is out in left field.
Single-payer costs are ultimately prohibitive. The Canadian health care system is on the rocks. The Affordable Care Act, or Obamacare, is still an incendiary source of dispute, pro and con. While ensuring diminished quality of professional care, it demands new revenue from tax increases, surtaxes on the prosperous, and higher insurance premiums. The “Affordable” in Obamacare is an oxymoron. The National Health Service in the U.K. is unworkable, as the Staffordshire Care scandal alarmingly demonstrated—over 1000 patients needlessly died while hospital bureaucrats contented themselves ticking the boxes. Single-payer problems will continue to mount.
There are three major reasons why single-payer is a disaster, obvious to anyone with eyes to see and free of social justice ideology.
Reason no. 1: Single-payer is grossly expensive, an unsustainable burden on the economy, as Canada’s Fraser Institute soberly points out. It is inefficient, top-heavy with government central planners, and extraordinarily wasteful. As costs escalate from chronic over-prescription, the “one issue per visit” program adopted by some doctors who game the system by billing the government per appointment, the lack of intelligent foresight typical of remote, byzantine administrations and the galactic black hole that swallows government subsidies willy-nilly, budget cuts eventually become inevitable while taxation in its many different forms increases exponentially. The paradox is insoluble.
Single-payer is expensive in another way as well. Commenting on Elizabeth Warren’s proposal of Medicare for all, Rick Moran reminds us of “the profound ramifications of a total government takeover of health care.” It is not only that taxes, especially for the middle class, must go up, but that “Living in a high-tax, quasi-socialist state will alter the fundamental characteristics of American consumer society, meaning less economic growth, fewer new jobs, and a stifling of the American entrepreneurial spirit.” This is a sociopolitical danger for all free-market societies.
Reason no. 2: Quality care deteriorates to a point at which it becomes a mortal danger. Doctors are stressed out and nurses are harried while a lazy and ineffective administration bloats to gargantuan proportions. Doctors also tend to retire early or leave for greener pastures. Wait times stretch indefinitely with obviously dire consequences. Writing in the Financial Post, William Watson recounts how, having suffered a broken elbow, he “spent 12 hours in emergency in what became the first of three days waiting for final diagnosis and treatment.” He got off lightly.
Reason no. 3: The system is over-crowded with patients who, taking advantage of what they consider “free” medical care, enter with minor complaints that can be treated at home, as an overworked paramedic confided to me. Moreover, the wards are clogged with unemployed immigrants and unemployable refugees who have displaced tax-paying earners—the fruits of multicultural and sanctuary policy. Single-payer is attractive to those who take advantage of short-term ER accessibility and to those who have not paid for the maintenance of the medical regime. The system can no longer bear the weight of gratuitous numbers.
A two-tier medical system, a mix of publicly and privately funded health care, such as that practiced in many European countries, will have its problems, but it is certainly superior to anything we have here. The French health system, for example, which is at least an order of magnitude better than Canada’s, runs at the same level of expense, between 11 and 12 percent of GDP. According to The New York Times, which reviewed the performance of countries like France, Austria, Switzerland and Germany among others, medical outcomes in Switzerland “are hard to beat.” The other European countries came close. In the Times’ competitive accounting, Canada was eliminated in the first round.
The Canadian medical establishment is opposed to the two-tier arrangement—I suspect because it goes against the social justice consensus and the levelling politics of the left. Many individual physicians think otherwise, as I can attest. But two-tier certainly works for politicians, CEOs, entertainment and sports celebrities, and assorted plutocrats who need not fear poor quality and long waiting lists since they are able to jump the queue. Despite the difficulties that attend its implementation and the inescapable fact that any proposed health care solution will be far from perfect, a two-tier structure and increased privatization are the only reasonable alternatives for the populace at large. What is needed is genuine competition among health providers and a far more efficient apparatus, which patient choice and two-tier simplification are far more likely to deliver.
Polls and surveys inform us that “86.2% of Canadians surveyed supported or strongly supported public solutions to make our public health care stronger,” but such instruments should be taken with an entire salt mine. Like the American political polls, they are slanted in one direction and are by no means neutral or objective. Most people I have spoken to regarding single-payer over the last thirty years are skeptical or disenchanted or appalled.
Indeed, most people in Canada have either experienced or know someone with a distressing medical neglect story. Someone close to me had to wait eight months to be treated for a tumor on her cheek. After a multi-year wait period, a friend was forced to visit a clinic in the U.S. for hip replacement surgery—he was told that he was weeks away from being crippled for life. Another required treatment in Europe and the U.S. for recurrent Lyme Disease—Canadian medicine was not up to the task. My wife’s father was diagnosed with benign abdominal cysts; two months later he was dead of pancreatic cancer. Her mother recently spent two days in ER for severe back pain. She was misprescribed and returned to the hospital for corrective treatment, from which she emerged over a week later with a heart problem, a kidney dysfunction, an ulcerated leg, and pneumonia. She was subsequently admitted to another hospital where she spent the night in a gurney parked in a busy corridor, receiving no hygienic attention. A dear friend just underwent a triple bypass, after having endured multiple life-threatening delays. He is lucky to be alive. He is now suffering from peripheral neuropathy but will have to wait the better part of a year to consult a specialist.
In one’s bleaker moments, one can’t help thinking that a hospital is, far too often, a place where one goes to die. What we call national health care or single-payer is nothing short of a crime against humanity. Government officials are spared its depredations. The elite have other means at their disposal. The framers of Obamacare had nothing to fear; they were amply provided for outside the system. The major fiscal beneficiaries of this parasitic monstrosity are the bureaucrats who administer it.
As for Bernie, who, unlike my friend, underwent heart surgery on the same day that he experienced chest pains, there is apparently no conflict of interest. Socialists never worry about inconsistency. Ironically, although highly critical of Israel and sympathetic to its enemies, Bernie’s life was saved by stent implants developed in Israel, which makes him the cardiac hypocrite par excellence. But on second thought, most of those who sing the praises of national health care while profiting from parallel systems are equally hypocritical. Only the common folk, deluded or helpless as always, need suffer the terminal disease of single-payer medicare. As John Robson mordantly writes in the National Post, “we have the greatest health-care system in the world no matter how awful the results.”
Whenever I visit one of our hospitals, I see in mind’s eye Dante’s inscription over the Gates of Hell in Canto III of the Inferno: Abandon all hope, ye who enter here.