Sen. Bernie Sanders speaks about health care reform in Toronto, Canada, on October 30, 2017. (Photo: Broadbent Institute / Institut Broadbent)

This piece is part of Fighting for Our Lives: The Movement for Medicare for All, a Truthout original series.

For decades, myths about the Canadian health care system have been widespread in the US. Conservative think tanks, the for-profit health industry, Third Way Democrats and the dominant media have advanced falsehoods about Canada’s single-payer health system. In September, Vice President Mike Pence went as far as to cite Canada as the glaring case study “for the failings of national socialized health care.” All of this occurs despite the fact that Canada’s health care outranks the US health system by virtually every metric available.

“These are not misunderstandings,” said Sen. Bernie Sanders on October 29 in Toronto, during a weekend tour of Canadian hospitals. “These are very intentional lies [to] convince the American people that the current dysfunctional system we have now is the best that we can do.”

The tour of the Canadian health system by the country’s most popular politician is another reminder of how far the single-payer movement has come, in part due to the awareness Sanders’s 2016 presidential campaign raised. The single-payer movement has been gaining momentum: Sanders’s Medicare for All bill in the Senate now has 16 co-sponsors (up from zero in 2013) and a similar bill in the House (John Conyers’s HR 676) enjoys a record 120 co-sponsors.

Sanders is seizing this moment as an opportunity to educate the public about the merits of his Medicare for All proposal. Hence his decision to take a delegation of doctors, nurses and reporters to Canada, where he spoke with politicians, providers and patients. The goal: learn how our closest neighbor can cover its entire country at just over half the cost per capita that we spend in the US for a system which leaves 28 million uninsured and about 31 million more underinsured.

US medical providers in attendance were very much taken by the fundamentally different approach in Canada, where, as one doctor told Truthout, the billing departments in large hospitals are the size of a large broom closet.

“What stands out to me is that Canadians are really unified in the belief that people should take care of each other. There is a real comradery in the country,” said Dr. Richard Bruno, a Baltimore physician who spent the weekend with Sanders. “It is a striking difference, and one we can learn a lot from.”

Why the US Needs a Stronger Single-Payer System Than Canada

Countering the widely perpetuated smears against the Canadian system is important. Still, it should not be ignored that Canada’s system has its problems.

“Canada’s care is vastly superior to that in the US, but it also needs to be more equitable and comprehensive,” said Bruno, who is on the board for Physicians for a National Health Program (PNHP). “It is not some sort of utopian nirvana.”

Indeed, while the US ranked dead last in a Commonwealth Fund report ranking 11 wealthy nations, Canada was ranked ninth. The United Kingdom, which has the more pure single-payer system, ranks at the top. Canada’s subpar rank is due to what Canadian writer Andre Picard has called “a definition of universality that is dated.” The major issues are the failure to cover prescription drugs and dental care.

This is recognized by organizers and groups in Canada, such as Canadian Doctors for Medicare, who push to strengthen the system with improvements like universal pharma-care.

Canadian organizers must also work to protect the system from austerity efforts. For instance, in British Columbia, the Supreme Court is hearing a case that could dramatically weaken the equity of Canada’s system by allowing some doctors to charge patients additional fees. “The challenges to Canadian Medicare have always been ideological and political. But, as of this month, they are also legal,” wrote Danielle Martin in 2016 about the case, which is still being litigated.

Martin, a physician and vice president at Women’s College Hospital, played a key role in Sanders’s tour, hosting a discussion with the senator following his speech in Toronto. Martin became quite popular in the US when she memorably debunked deceptive GOP efforts to smear single-payer in 2014 at a Senate hearing. The video of the exchange has been viewed more than 31 million times.

Given the onslaught of misinformation about Canada, one can understand the temptation to underplay problems with the Canadian system, especially to an American audience. Most critics, absurdly, call for dismantling and privatizing the system. But the problems need to be understood for what they are: reasons for more comprehensive single-payer health care, not privatization.

“Mr. Sanders glossed over some of the obvious shortcomings [with] only mild rebukes over Canada’s lack of universal pharma-care and dental coverage,” wrote health reporter André Picard in Toronto’s Globe and Mail. “We would have all benefited from a more robust discussion of [Sanders’s] ‘Medicare for All’ plan, because it is, in fact, far more comprehensive than what exists in Canada currently.”

Indeed, Sanders’s legislation covers drugs and dental care — aspects of coverage that much of the media likes to portray as excess. While in Canada, however, Sanders stuck mostly to praising the Canadian system, save for the occasional reminder that “no system is perfect.”

The Truth About Canada’s System: Better Outcomes, Less Expensive

Nonetheless, those who accompanied Sanders on the trip say the benefits of a single-payer system became evident immediately in Canada.

Jessica Early, a nurse practitioner from Vermont, told Truthout the United States can learn a lot from superior health care systems in Canada.

“All health care systems can benefit from comparative analysis,” said Early, who is also health care justice organizer for Rights and Democracy, and was among those who attended the tour. “This is how we handle things in the medical profession. If someone is sick, we look at past examples and see what treatment was used, how the patient responds to it, what we can do to achieve a better outcome.”

In Canada, Early observed, it is much easier to take care of health problems early, before they become more catastrophic, and more expensive.

“People get regular care in Canada and it is extremely beneficial,” she said. “In the US, patients often put off getting treatment because of costs. By the time they come, it is sometimes too late. That was a big takeaway of the difference of providing care under a single-payer system.”

The lack of preventative care in the US is a byproduct of the patchwork health system and its heavy reliance on cost sharing, which is used with the morally questionable goal of dissuading people from using health care. It has catastrophic results in this country, where more than 45,000 deaths each year due to not having health insurance.

However, there are powerful forces that hope to keep it this way: The insurance lobby and other industry sources see a humane, rational health system as an existential threat. The drug and insurance industries fund (or even own) research institutions and think tanks. The industries even donate to liberal organizations such as the Center for American Progress and the Urban Institute, both of which have either ignored or undermined Medicare for All in recent years. This, in addition to poor media coverage and politicians compromised by donations from these industries, has kept discussion of the benefits of single-payer — supported by the large majority of Canadians — largely out of the national debate in the US until recently.

Therefore, much of the US public is unaware that Canada has a better system in terms of cost, access and outcomes. Canada has a higher life expectancy rate than the US, and a higher density of practitioners, according to a study on universal coverage by the Organization for Cooperation and Economic Development (OECD). Another OECD report shows Canada has lower infant mortality rates, while the US’s low rating is, as The Washington Post described, “a national embarrassment.”

Canada’s system has better outcomes despite spending just more than half of what the US spends per person (while the US leaves millions uninsured). Canada spends $4,569 per capita (10 percent of GDP), while the US spends $9,086 per capita (17 percent).

Despite drastically lower health care spending, Canada provides its citizens with universal coverage, has lower rates of preventable deaths and does not allow a single citizen to go bankrupt due to medical debt. In the US, medical debt is the leading cause of bankruptcy.

Corporate Media Coverage of Trip Reflects Bias Against Single-Payer

Several members of the media also attended the conference, which was covered widely in Canada. There was less coverage in the United States, but a few prominent reporters representing the corporate media — including Sarah Kliff at Vox and Margot Sanger Katz at The New York Times — made the tour.

The articles produced by both outlets were predictable. Corporate media have long amplified doctrinal neoliberal assumptions by narrowing the parameters of debate. The nation is warming up to single-payer, but it is doing so despite a steady barrage of dismissive coverage from the dominant media. Vox and the Times have both been guilty of egregious examples of this bias very recently.

A particularly misleading Vox article by Kliff tried to argue that the trip showed a “hard truth about bringing single-payer to America.” The reason, she argues, is because Canadians view health care as a right and “that belief doesn’t seem to exist in the United States right now.”

Kliff’s take is fundamentally flawed — and rather odd — for several reasons. First, her reading of the polling is curious, since a majority of Americans (per numerous polls) do support Medicare for All (ranging from 50-66 percent), and think the US should provide health care to all its people. Kliff does not dispute this, but argues it is an insufficient amount of support to make single-payer a reality. A Pew poll from January shows 60 percent have this view, as did a follow-up poll in June, which Kliff cites (although she claims the number is 57 percent). “Gallup finds 52 percent support this idea, and Pew estimates it is 57 percent,” she reports. The text from her link reads as follows: “Currently, 60 percent of Americans say the government should be responsible for ensuring health care coverage for all Americans.”

The number 57 does not appear in either the PDF or the website with the results of the poll. Either way, her point is that support for public health care is much lower in the United States currently than in Canada, where 91 percent support their public health care system and 86 percent want to strengthen the public role in it.

Kliff’s assertion that that the support in the United States is too weak is debatable. Polls showing 57 percent (or so) support for any health care policy is about as good as it gets in the US, surpassing support for the Affordable Care Act at the time of passage and beyond (a law which Kliff and others at Vox praise often as a tremendous achievement), the individual mandate or any version of Trumpcare. Only the public option polls comparably well to the Medicare for All, and that mostly breaks down with the same level partisan support. (However, Kliff does not point to a lack of public support when she writes, rather uncritically, about Tim Kaine’s version of the public option.)

The other pressing concern about Kliff’s methodology is that she is comparing US sentiment today to Canadian support today. But why is this a relevant metric? Canadians have lived under single-payer for decades and have seen better outcomes. Further, there is the impact of loss aversion. This is a concept in behavioral economics that shows “the pain of losing” something (in this case health care benefits) is “psychologically about twice as powerful as the pleasure of gaining” something (like health benefits). Loss aversion was often cited when the public opposed GOP efforts to repeal the Affordable Care Act this year.

The more sensible comparison is comparing US support for public health care to Canadian support for it before it was implemented. Kliff either didn’t know, or fails to note, that before Canada had health care as a right, and was subject to a rigorous public debate including massive opposition from the medical industry: Gallup showed 60 percent of the country approved of “a state-led (single-payer) medical care insurance plan.” Support has grown since then. These are factors Americans currently cannot relate to when polled on single-payer or a human right to health care.

This 60 percent number is identical to some polls showing Americans’ current support for Medicare for All, such as the Economist/YouGov poll from April. Polls have long shown majority support for Medicare for All, and even a plurality of Republicans support it.

Kliff does not say which health policy outside of single-payer better reflects the will of the US. Nor did she respond to an email from Truthout showing her the results of the Gallup poll that predates implementation of Canada’s system.

This approach is typical of a number of mainstream liberal writers at Vox and elsewhere, who seem to do backflips to portray Medicare for All as utopian nonsense, or — as Vox arch-liberal Ezra Klein called the policy — “puppies and rainbows.” A recent article on Fairness and Accuracy in Reporting observed how even their typical headline approach is tweaked when the policy is covered.

Yet single-payer is a popular plan, within international norms. It would reduce spending, and has a principle of universality, which virtually every liberal claims to aspire to achieve. It is worthwhile for journalists to raise relevant questions about single-payer and Canadian health care — but should they not put other policies introduced by establishment Democrats under even a fraction of this scrutiny?

The New York Times’ article about the Canada trip resorts to mockery, citing as “Lesson #1” that Sanders is a “rock star” in Canada.

“Ed Broadbent, the chairman of the progressive Broadbent Institute, called Mr. Sanders the most important social democrat in North America,” the article reports, “even though Mr. Sanders is not a Canadian social democrat, and is not even a particularly powerful member of the Senate.”

This is a baffling piece of reporting from the “paper of record.” One, Sanders is a self-identified social democrat (a distinction not often challenged since it is so uncontroversial). Two, he is in North America. Three, he is by many accounts a rather powerful senator, given he is more popular than any other senator and can raise money from the grassroots with the best of them.

The rest of the Times’ article is filled with the predictable tropes. It cites the aforementioned Commonwealth Report to critique Canada (which, as we note, ranked nine out of 11). Of course, this is not a real argument against public health care since the countries that finished ahead of Canada and the US have public systems — including the top-ranked UK, whose National Health System is literally government-run. In any event, despite Canada’s shortcomings, the report confirms that Canada covers everyone, spends less and has better outcomes from the United States.

Corporate Media Crusade Hurts Prospects for Universal Health Care

So long as corporate media rely on neoliberal platitudes to ignore or dismiss single-payer reflexively, they are — despite their claims of objectivity — serving to greatly diminish prospects for universal health care in the US. When the dominant media resort to this kind of reporting, the world’s biggest opponents of health care justice — the Koch brothers, the drug and insurance industries, the Republican Party — have a reliable ally in their battle against a rational, equitable health care system. The reporting on Sanders trip to Canada, which could’ve led to useful and nuanced coverage, is another sad example of this trend.