Former Democratic leadership candidate Bernie Sanders is in Canada this weekend, speaking at an event at the University of Toronto about "what the U.S. can learn from Canada's single-payer health care system."
Clearly, the Vermont senator believes deeply in the premise that health care is a basic human right — an idea that resonates with most Canadians, many of whom have only known a single-payer system. Sanders has recently taken on the mantle of "Medicare for All" in the U.S. by introducing a Senate bill with 16 co-sponsors, and he has enlisted the support of several Canadian academic physicians in this endeavour.
Yet when extolling the virtues of Canadian health care in the U.S media, Sanders cherry-picks only the positives of our system. Obviously this is a tactical decision — you don't sell a skeptical society on a radical idea by focusing on its failures — but his lack of balance is concerning.
Sure, there are some things that the U.S. can learn from Canada when it comes to health care, but our system has a long way to go before it reaches the status of international ideal. The problem with basking in this praise from a high-profile American politician is that it obscures the fact that there is still much work to be done.
Recently, a compelling and comprehensive study by the Commonwealth Fund ranked Canada third-last among 11 wealthy countries when comparing health care performance (which includes care process, access, administrative efficiency, equity and health care outcomes); we performed better than the U.S. and France, but were outperformed by eight other countries.
Interestingly, many of these better-performing countries are able to provide universal coverage to its citizens without a single-payer model through the provision of a hybrid or tiered medical system. And their citizens, like Canadians, do not file for bankruptcy as a result of exorbitant personal medical costs.
When extolling the virtues of Canada's system, Sanders, however, does not advertise our atrocious specialist wait-times, which have a significant impact on the morbidity and quality of life of patients I see every day. He does not mention the chronic lack of inpatient beds across our country, which has resulted in patients being relegated to places like hallways and even Tim Hortons. And while he has found some Canadian health care leaders with whom he can ally to push for change in the U.S., he seems to dismiss the view held by many other health care leaders that our underfunded system is broken.
I wonder if Sanders has ever spoken to a Canadian who suffers with debilitating pain from knee or hip osteoarthritis. These patients often have to wait upwards of a year for an operation. Meanwhile, there are scores of empty operating rooms sitting idle every night across Canada — a country with a penchant for training orthopedic surgeons, but not hiring them to treat patients on lengthy wait lists. This does not seem like a system to be overly boastful about.
It is clear that Sanders is using Canadian health care as a political pawn to advance his own agenda. The most cogent analysis of his political strategy comes from New York Times columnist Paul Krugman, who explains that Sanders, by rigidly supporting a single-payer health care system, is simply appealing to voters with unrealistic promises. This can become a huge problem when actually trying to govern, as Republicans are now finding out.
Admitting our deficiencies
Sanders will likely be treated to an exceptionally warm Canadian welcome this weekend, but let's not lose sight of the fact that this is really just his chance to test his message in a politically friendly environment. By using this moment opportunistically, he will perpetuate the fantasy — to both an American and a Canadian audience — that our health care is great, when, in reality, it is simply mediocre.
I am thankful for Canada and its health care system, and I know most Canadians feel the same way. But we need to be honest with ourselves: Canada can do much better. We should not be overly satisfied with outranking the U.S. in terms of overall health care delivery. Real political leadership would not be afraid to admit to our deficiencies, and ultimately strive to learn from many other countries that do better.