An holistic, comparative perspective from Canada #DAresists #Medicare4all

As a Canadian born US citizen who has spent time living and working in Europe I can comment from experience on life under four different systems -- one universal single payer (Canada), two universal multi payer (Holland and the UK) and on non-universal (USA). I would say, and international studies agree, that the universal multi payer option systems far out perform the others. Canada consistently ranks second last, and the USA last in rankings of healthcare outcomes in advanced nations and it's time we both stopped using each other as "the alternative" and looked further afield. Both our systems ration availibility, either through resource scarcity as a cost management measure or by effectively denying coverage to a large portion of the population. The universal coverage mixed payer systems offer both choice broad access. The NHS co-exists with private, at cost system and the Dutch systems mandates that all residents have coverage either through the government system or private coverage. Both operate as a smaller percentage of GNP than Canada's 12% or the US's 16% and deliver broader coverage. That said, let's review the Canadian health care journey to single-payer to make sure we understand it's evolution and current reality: 1) It is NOT a national system, it's a network of Provincial (State) systems that adher to certain national standards -- primarily -- universality, portability and (it's achilies heel) no additional patient fees -- in exchange for BLOCK GRANTS from the Federal level. (Constitutionally health Care is a Provincial, not a Federal responsibility) Most of the funding comes from the Provincial not Federal level (it's the largest Provincial budget item for most) and the decision on coverage is made Provincially not nationally. About 70% of all healthcare costs are government funded, the rest from private citizens directly or through insurance (I believe in US about 60% already government funded) 2) Costs are a major issue to provinces and smaller ones already require extra federal funding. Aging populations risk bankrupting the system unless costs are curtailed (governments are already fighting Drs over salary levels) or the obsession with a "one tier" program with no private coverage options and no co-payment is eliminated. 3) It took nearly 50 years to get to it's current state: - it was first introduced in Albert in the 1935 but scrapped the next year with a change in government (sound familiar?). It was introduced in 1936 in BC but pulled over opposition by Drs. - it was first successfully introduced in Saskatchewan in 1947 but not federally funded until 1957 and by 1961 all provinces had a program similar to Medicare Part A. - in 1962 Saskatchewan introduced the equivilant of Medicare Part B and there was a bitter strike by physicians. - but by 1966 federal funds were made available physician cost as well. Almost 2 decades of turmoil followed with issue like Drs. leaving the country, opting out of the program and billing privately or extra-billing in the system. - in 1984 the current "universal single payer system" was introduced. 4) Despite all the above, the difference between my aging Canadian friends, and my aging US friends, all of whom are getting new knees or a stent or managing diabetes is that the Canadians all have the peace of mind to know where and how they will get the treatment they need. Whether measured in longer lifespans or lower infant mortality rates, or just the minimization of iatrogenic bankruptcy, there is a measurable quality of life increment from universal access. So it's worth the battle. But it's a long complex road so here are some insights from the Canadian experience: - it's an incremental evolution, not a massive one shot reshaping of "one sixth of the economy" - focus has to be on addressing costs not just on "insurance" and access - long term sustainability means exploiting both government and private funding options - and the scale and complexity mean it needs to be State focused within national guidelines (which is why lthe current loss of Democratic stature at a State level is so dangerous) While the ACA was not perfect, I saw it as an important first step on the journey. Constant revision from the ACA core is the right way to go and setting the expectation that it's is a work in progress not the end in itself Loosing issue leadership to Bernie Saunders with an out of left field, scarey-to-many "single payer proposal" is a dangerous step backwards when, when the PR is spinning right, the voter middle ground is quite comfortable with an evolutionary ACA. While the GOP flounders with repeal and replace, the crime is that an active viable ACA v2 hasn't been visiably championed by party leadership. My two cents worth, Robert Thompson