As the debate about Obamacare rages on in the United States, a Toronto doctor calmly defended her country’s health-care system before a partisan U.S. Senate committee in Washington this week and explained that the single-payer model is not to blame for wait times — and that Prime Minister Stephen Harper is not a socialist.
Dr. Danielle Martin, a family physician who is also vice-president of medical affairs and health system solutions at Women’s College Hospital, was the Canadian voice on an international panel at a committee studying what the U.S. can learn from other countries.
“I do not presume to claim today that the Canadian system is perfect or that we do not face significant challenges,” Martin told the committee on Tuesday. “The evidence is clear that those challenges do not stem from the single-payer nature of our system. Quite the contrary.”
Martin outlined the benefits of Canada’s health-care structure and contrasted it with the American one, while noting the strong public support in Canada for the idea that access to care shouldn’t depend on one's ability to pay.
“We do not have uninsured residents. We do not have different qualities of insurance depending on a person’s employment. We do not have an industry working to try to carve out different niches of the risk pool. This is a very important accomplishment and as we watch the debate unfold as to how to address the challenges you face, we are reminded daily of its significance,” said Martin.
Martin, who also holds a degree in public policy and is an assistant professor at the University of Toronto, said a lot of work is being done on reducing wait times in Canada. Moving away from a single-payer system and introducing more private health care is not a solution and would likely exacerbate wait times in the public system by drawing health-care resources away from it, she told the senators.
Conflicting views on Canada
Sitting next to Martin was another Canadian, Sally Pipes, who is now an American citizen and leads a think-tank in San Francisco that advocates for the free market. Pipes gave a decidedly different view of Canada’s health-care system.
“If you’re looking for lessons from health-care systems abroad, Canada shows us exactly what not to do,” she told the senators, citing wait times and government control as major problems. “I think this is no way for us to run a health-care system, a single-payer system.”
She cited former Newfoundland and Labrador premier Danny Williams as an example of one of the thousands of Canadians who have paid for care in the United States. He underwent a heart valve surgery in the U.S. in 2010.
Pipes also said her mother died of colon cancer because she had to wait too long for a colonoscopy.
Martin faced some tough questions about Canada’s system from Republican Senator Richard Burr, who opposes the Affordable Care Act, more popularly known as Obamacare, that overhauled the American system.
“On average, how many Canadian patients on a waiting list die each year, do you know?” he pressed her.
“I don’t sir, but I know there are 45,000 in America who die waiting because they don’t have insurance at all,” Martin shot back.
What about Williams going to Florida for surgery, he asked her, what does that signify? Martin noted that the doctors who pioneered the surgery he had done actually work in Toronto.
“Sometimes people have a perception, and I believe this is fuelled in part by media discourse, that going where you pay more for something that that necessarily makes it better. But that’s not borne out by the evidence on outcomes from that cardiac surgery or any other,” she responded.
Burr clearly was not a fan of Canada’s system, unlike Senator Bernard Sanders, an independent, who posted Martin’s testimony on YouTube. He playfully suggested that despite the government in power in Canada, there are no efforts to follow America’s example on health care.
Hearing included some political theatre
“Is your prime minister a socialist?” Sanders asked Martin.
“No sir, our prime minister is quite conservative.”
“So obviously as a conservative he wants to implement the American health-care system that the Canadians are very aware of, I gather that is the first thing he did when he took power is that right?”
“Support for single-payer Medicare in Canada goes across all political stripes,” Martin explained.
Reflecting on her appearance at the committee in an interview on Thursday, Martin said she was honoured to be asked to testify. She said some of the panellists were definitely on the defensive and that she was not there to be an apologist for Canada’s system.
“I tried very hard to be resolute in not painting the Canadian system as being without challenges or without problems, but still maintaining that I think there are some pretty significant learnings about how health care can be better administered that Canada has to offer — if the American administration were really truly interested in learning from it,” she said.
Canada also learns from the U.S., she said, and there shouldn’t necessarily be a debate about which system is better. Canada is “not a threat” to the American system, Martin said.
Though the committee meeting was partisan at times, she said it is a positive sign that the U.S. is looking at international examples.
‘It’s a good thing that they did that, even if it was in part a bit of political theatre.”
Senator Bernard Sanders was identified as a Democrat in an earlier version of this story. He is an independent who is listed among the Democratic senators on the health, education, labour and pensions committee.Mar 13, 2014 2:08 PM ET