The Canada/US rivalry stymies health care reform
It was a beautiful day for a ball game, and some 20,000 fans filed into the Rogers Centre to watch the Toronto Blue Jays square off against their 1993 World Series rivals, the Philadelphia Phillies. While the game got off to a slow start, in one small section of the nosebleeds the trash talk began almost immediately. And with each round of $9 pints, the taunting grew wilder. (“It’s not pink. It’s salmon,” one fan said, defending his friend’s choice of polo shirts.) By the bottom of the seventh, a Jays devotee finally stood on seemingly shaky ground and bellowed, “You want to fight? Let’s fight. But when you go home, you’ll have to pay for your hospital bill, and I won’t.” In no time, a chant had broken out among his countrymen: “Free health care! Free health care!”
Policy and pop flies? Only in the thick of the US government’s efforts to overhaul its national health care system, extending medical insurance to the 40 million or so citizens who have none. More surprising is that last summer’s hooliganism was not limited to hooligans. As Amir Attaran, a University of Ottawa immunologist and law professor, noted in the editorial “America, Embrace Health Care Reform,” published in the Canadian Medical Association Journal a couple of months later, “It takes only a few comparisons to show how much better Canada’s health system is than that of the United States.” Maybe he assumed we’d all been glued to cnn, where conservative senator Hugh Segal had recently elaborated, “What [we] have is a longer lifespan, better outcomes, and about one-third less costs.”
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In Canada, the transition to government health care was neither quick nor easy; it followed decades of debate and incremental reforms that divided the country. During this time, Canadians looked to the United Kingdom’s new National Health Service as either an ideal or a cautionary tale. In 1949, CBC Radio aired a special on the “welfare state,” featuring a dramatized argument between office workers Bill and Frank. Frank’s wife needs an operation, but it’s “not the operation that worries him—it’s the cost.” “It’s too bad you don’t live in Britain,” Bill tells him. “Then your worries would be over.” Frank, voicing the position that would ultimately lose the debate, lets him have it: “There you go again, you and your socialism. Join the welfare state, and let somebody else do the worrying for me. Somebody else would end up doing my thinking for me, too… it’s a slave state, I tell you.”
Canadians attacked the US health care system en masse, a few adding insult to injury by criticizing the partisan sniping that threatened to trump any serious discussion of the issue. “Don’t let right-wing lies about Canada help derail health care reform in America,” ndp leader Jack Layton wrote in the Huffington Post in July, not long before Bob Rae called out the US for “a false debate” in The Mark. Looking ruefully at how things played out that fall, T. J. Murray, a Dalhousie professor emeritus who has served in a number of leadership positions with the American College of Physicians, said, “This is a time of potential change in the US, and I suspect it will be lost.”
And maybe it has been. The House and Senate bills were finally passed on November 7 and December 24, respectively, but even if the legislation does survive reconciliation there will be no public option—good news for Canada, at least, which has long relied on the differences between the two systems to bolster its national identity.
Perhaps the biggest surprise of the debate is that for once the situation was reversed: “Canadians love American healthcare debates because it means you notice us,” Carleton University political science professor Jonathan Malloy wrote in the Washington Post. Indeed, there’s something flattering about the attention, even when it’s negative. “The healthcare denial horror stories from Canada & Co. do resonate,” Republican political consultant Frank Luntz instructed the party faithful in a widely circulated memo. “But you have to humanize them.” The television newsmagazine 20/20 did so neatly in a segment titled “Canadian Health Care: A Viable Model? ” Conservative newsman John Stossel asked, “Want a CT scan in Canada? Private veterinary clinics said they can get a dog in the next day. For people, the waiting list is a month.”
David Gratzer, a Canadian doctor and senior fellow at the right-wing Manhattan Institute, made it official, testifying about wait times north of the border before the House of Representatives in June. Pointing out that some Americans don’t have access to any care at all, Democratic Representative Dennis Kucinich responded, “This gentleman has expected us to believe that rationing is worse in Canada. I don’t know how we can buy that.” His ally Phil Hare later reported that “97 percent of the people in Canada said that they wouldn’t trade their health care plan.” Rush Limbaugh feigned the last word on air, of course: “If you like socialized medicine, we can send you to Canada to get treated. Look at the money we’ll be saving, and look at the freedom we’ll be preserving, and look at the liberty that won’t be attacked!” His website features a photo of him holding up an Air Canada boarding pass that reads, “Limbaugh Option/L’option de Limbaugh.”
A handful of Americans managed to stop reacting long enough to see the pattern. “Policymakers debating health care reform should stop hiding behind the smoke screen of ‘American values,’” Allan S. Brett, a professor of medicine at the University of South Carolina, wrote in the New England Journal of Medicine. In subsequent correspondence, he added that “many American policymakers use the excuse that we’re different from everyone else—we’re exceptional—to justify certain policy decisions that run counter to what other developed countries do.”
Phil Levy, writing for Foreign Policy’s Shadow Government blog, concurred. “All of the major developed countries are trying to solve the same puzzle: how to construct a system that meets their population’s health needs. If another country has found the answer, it’s reasonable to ask whether that solution might work here as well.” In other words, a critical survey of health care systems around the world (minus the name-calling and chest pounding) could have been useful.
It’s a tactic Canadians might wish to keep in mind. Constant comparison with the US has made us complacent about our medical system, which will surely be tested in the coming decades. When the time comes, there won’t be any shortage of instructive models. (Heard much lately about Taiwan’s system, which not only provides universal coverage, including various alternative treatments, but has implemented electronic health records and slashed wait times?) Until then, perhaps we shouldn’t be quite so smug about the Americans’ resistance to reform. As an unsigned editorial in the July 27, 2009, edition of the Globe and Mail noted, “As imperfect as the debate is in the US, at least there is one.”