Wayne O'Leary

Myths About Medicare for All

After months, if not years, of deliberate lies, half-truths, rumormongering, and mythmaking about single-payer health insurance, it’s time for a little straight talk on the subject. This won’t be easy in the bizarre climate of political discourse created by the self-proclaimed “very stable genius” occupying the White House, but here goes.

The best way to unpack the web of distortions regarding single-payer, or “Medicare for All,” is to look north at the existing model established in Canada a half-century ago and still working extremely well; this is despite Donald Trump’s hysterical assertion (in a New York Times op-ed published last October) that a similar program established here would be catastrophic, leading to massive rationing, long lines, loss of doctors, and diminished health. It’s a false scare. Our present Medicare system, a single-payer arrangement like Canada’s, already serves 60 million Americans over 65 more than adequately; that’s twice as many people as the 35 million included under the Canadian universal system.

Trump’s over-the-top critique can’t be taken seriously; it’s Donald Trump, after all. But other people who should know better have also made ridiculous comments about single-payer. Two congresswomen, Sen. Amy Klobuchar (D-Minn.) and Rep. Kim Schrier (D-Wash.), are on record recently claiming Medicare for All would take too long to establish in a time of urgency. Tell that to the architects of Canadian Medicare, who passed their enabling legislation through Parliament on Dec. 8, 1966, implemented it starting July 1, 1968, and finalized ratification and financial arrangements with Canada’s provinces (which share the costs) by 1971 — in all, a four-year process to completion.

There are other prominent naysayers to single-payer health care. Among the most vehement is New York Times columnist and PBS “NewsHour” commentator David Brooks, who’s been a consistent crusader against the concept since the 2016 Sanders campaign. As a purveyor of mythology regarding the transition to Medicare for All, which he deems “impossible” to achieve, Brooks has few media peers. His litany of supposed horrors includes the destruction of the American insurance industry beyond recognition, widespread unemployment among insurance-company employees, disruption of the hospital sector, the impoverishment of doctors and other health-care workers, and long waits for patient care — in short, the end of the American way of life, medically speaking.

Let’s examine the Brooksian claims — he’s not alone, incidentally — by comparing them with the Canadian experience, Canada being the single-payer nemesis to marketplace medicine in this case. As regards insurance, the Canadians do disallow duplicative private health insurance for core services covered by public Medicare, but they permit supplemental insurance (banned under single-payer, according to President Trump) for perks like cosmetic surgery or private hospital rooms, and for uncovered or undercovered expenditures like prescription drugs, dentistry, optometry, physical therapy, and home care. About 12% of Canadian health care is financed by private insurance, and it includes travel policies used by wary vacationers as emergency cost protection abroad, especially for those “snowbirds” visiting the medically expensive US for extended periods.

Contrary to scare stories about the insurance industry under single-payer, Canada has a thriving insurance sector. There are 11 major companies, three of them (Manulife Financial, Great-West Life, and Blue Cross Canada) specializing in health coverage. In 2017, 29 million Canadians held private policies, mostly life and health, and the $860 billion industry handled $92 billion in claims. As of that year, 155,000 Canadians worked in insurance, which (according to Canadian Life and Health Insurance Facts, 2018) has been increasing its total employment an average of 2.5% per year over the past decade.

But don’t Canadian doctors impatient with low salaries and Canadian patients frustrated by long waiting lines and substandard care flock to the US for relief? Sorry, but no. For starters, a 2006 New England Journal of Medicine article (by national correspondent Dr. Robert Steinbrook) pointed out that Canada had 2.1 practicing physicians per 1,000 population versus 2.3 for the US, a difference hardly worth mentioning, and despite spending twice as much per capita on health expenditures, US life expectancy (77.2 years) was less than of Canada (79.9 years).

Canadians did wait a bit longer than Americans for some elective surgeries, but outcomes were statistically identical. For all specialties, NEJM noted, two months was the standard Canadian waiting time for treatment. (I’ve waited as long for an American specialist myself.) This includes that bane of the elderly, hip replacements, which are supposedly being rationed by “death panels,” even though a St Louis Post-Dispatch investigation revealed that thousands were performed in Canada in 2008, 1,500 on patients over 85. So much for that canard.

In fact, according to the journal Health Affairs (November 2010), Americans self-ration by cost (avoid undertaking expensive care) at a rate double that of Canadians. And Canadians don’t head south for treatment. Studies done in 1995 (for The American Physician) and 2012 (for AARP) indicated that only 0.5% ever obtain care in the US.

What about all those unhappy Canadian doctors rumored to be packing their bags and chomping at the bit for a chance to earn more money on the American side of the border? Well, they don’t exist. Canadian doctors migrate to the US at the same rate (0.5%) as do Canadian patients. A study by the Commonwealth Fund in 2009 found that from 2003 to 2006, between 122 and 169 doctors left Canada yearly for the US, barely noticeable among the 800,000 physicians in practice here. Moreover, 75% of those staying home were “satisfied” (25% “very satisfied”) with their Canadian practices, a higher percentage than American doctors (64%) satisfied with their own.

The shortcomings of Canada’s Medicare system are not only highly exaggerated, but bear little relationship to its being single-payer in structure. They emerge periodically when the country’s Conservatives take power and try to cut the health-care budget or engage in creeping privatization. This has been the case ever since Saskatchewan’s provincial democratic-socialist government introduced Canada’s first single-payer system in 1962 over the objections of the medical establishment and the private-insurance industry, setting the stage for national implementation. The ongoing entitlement debate, essentially ideological, is something America’s Medicare for All proponents will also have to deal with, assuming legislative success, in coming years. Any problems single-payer has (or may have), in other words, are not medical; they’re political.

Wayne O’Leary is a writer in Orono, Maine, specializing in political economy. He holds a doctorate in American history and is the author of two prizewinning books.

From The Progressive Populist, June 1, 2019

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