In the American health care debate, 鈥渟ingle-payer鈥 is hardly a new concept.
The idea has grabbed headlines and sparked countless political and policy discussions, not to mention campaign advertisements. Other countries with 听颈苍肠濒耻诲别 and Taiwan. But 鈥渟ingle-payer鈥 merely means that the government pays all the bills. The mechanics can vary from country to country.
Sen. Bernie Sanders (I-Vt.) recently visited Canada, touting that system鈥檚 benefits. How much do you really know about it?
Take KHN鈥檚 interactive challenge to test your understanding.
ANSWER: FALSE. The Commonwealth Fund, an American nonprofit, above America’s 鈥 but it fares poorly compared with some others, placing ninth out of 11 Western systems. (The United States is in last place.) The Commonwealth Fund used metrics such as equity, access to health care and outcomes in its rankings.
鈥淚t鈥檚 unclear to me that the Canadian model is necessarily the solution the United States wants. And I think there may be other models that can be considered,鈥 said Dr. Peter Cram, an internal medicine doctor and health care researcher who recently moved from Iowa to Toronto. 鈥淭he narrow focus on the Canadian system 鈥 it shortchanges the array of options.鈥
ANSWER: FALSE. For hospitals and doctors, Canadian patients won鈥檛 pay a dollar out-of-pocket. But Canada doesn鈥檛 cover dental and vision care, prescription medications, psychotherapists and physical therapy. About two-thirds of Canadians get private insurance to supplement Canadian 鈥淢edicare,鈥 as it’s known, which accounts for about 70 percent of Canada鈥檚 health spending.
鈥淚鈥檝e had patients who could not afford their diabetic medications, so they would become acutely unwell,鈥 said Dr. Ali Damji, a family medicine resident in Toronto. 鈥淭hey would become sick enough to go to the hospital, and [then] we would pay for the treatment.鈥
That being said, Canada does have price controls for medications. So, compared to the United States, prescription drugs tend to be far cheaper.
ANSWER: TRUE. The Canadian Institute for Health Information in 2017 the country will have spent about 11.5 percent of its gross domestic product on health care. The United States, by contrast, spends about . And life expectancy up north is greater, according to the World Health Organization. This constitutes one of Sen. Bernie Sanders’听. But still want to bring down the nation鈥檚 health care spending, especially as the population ages.
鈥淲e are seeing increased costs,鈥 said Ontario Premier Kathleen Wynne, whose administration is testing new programs to address health spending.
ANSWER: FALSE. On the 2016 campaign trail, then-candidate听 鈥淲hen they need a big operation, when something happens, they come into the United States in many cases, because their system is so slow.鈥 This doesn鈥檛 appear to be the case.
No evidence suggests Canadians are fleeing en masse for treatment in the United States. A suggesting this has come under scrutiny, with serious methodology concerns.
There are certainly circumstances when the Canadian government will transport a patient out of the country for care that is not available 鈥 or unavailable in a timely manner 鈥 in Canada. When this happens, it is covered by Canadian Medicare.
ANSWER: FALSE. Wait times in Canada are typically longer for non-emergency, specialty procedures 鈥 think knee surgeries, diagnostic MRIs or cataract surgery. But emergency care is prioritized and usually placed at the front of the line. In fact, that when Canadians are sick most experience wait times comparable to those of their American neighbors.
鈥淭hat鈥檚 one falsehood: that there鈥檚 these ridiculous wait times,鈥 said Nate Kreiswirth, a dual citizen who lives in Toronto. 鈥淚f you actually have something that鈥檚 a serious condition, or something that is urgent, you鈥檙e not going to wait. You are not going to die because you鈥檙e waiting.鈥
Comparing Canadian and U.S. wait times is difficult and an often-politicized discussion, Cram noted. The United States also doesn鈥檛 track wait times as rigorously听as its northern neighbor 鈥 especially for people who can鈥檛 afford medical care 鈥 so it鈥檚 difficult to truly compare.
ANSWER: TRUE. Everyone is equal under the eyes of Canadian Medicare. It鈥檚 illegal to buy private insurance that competes with the government’s, so wealthier Canadians can鈥檛 buy their way ahead of the queue. (In other countries with universal health care, such as Germany and Great Britain, people can opt out of national systems and buy privately.)
Of course, theory and practice aren鈥檛 in perfect sync. low-income Canadians may have more difficulty getting timely primary care, even though the single-payer system doesn鈥檛 give doctors a reason to prefer wealthier patients. It鈥檚 unclear how widespread this is. But, says Dr. Irfan Dhalla, a Toronto-based health quality researcher and general internist, insurance alone can鈥檛 fix that.
鈥淗umans are humans and there are always 鈥 in any system 鈥 humans with discriminatory attitudes toward indigenous people, or people who are low-income,鈥 Dhalla said.
ANSWER: FALSE. Primary care doctors work for themselves, but their fees are negotiated and paid by the government.
There was a serious exodus of Canadian doctors in the 1990s, but that has since reversed. In the mid-2000s, more Canadian doctors were returning from the United States than leaving. At this point, , southern migration is negligible.
And from the Canadian Medical Association suggests that more doctors may be moving the other way, leaving the United States to practice in Canada, to avoid headaches like insurance paperwork and claims processing necessary south of the border.
ANSWER: FALSE. Canada spends far less on health care than does the United States, but it too with the climbing cost of medical treatment. Health care accounts for of provincial budgets.
鈥淭he government gives provincial governments a bunch of money, and they pay the doctors and say, 鈥楢s long as people aren鈥檛 dying, and voters are happy, we鈥檙e OK,鈥欌 said Dr. Kaveh Shojania, a Toronto-based internist who researches patient safety and health care quality. 鈥淣ow they鈥檙e starting to realize there鈥檚 more that needs to be done.鈥
Meanwhile, left-leaning advocates are pushing to expand the single-payer system so that Canada also covers
