Last month, Vermont Senator Bernie Sanders visited Toronto as part of a "learning tour" about Canadian health care tied to the promotion of his own single payer health insurance plan. The cascade of laudatorymedia coverage highlighted a pet peeve of mine: our obsession with comparing our health care system to the system in the United States. Sanders's visit scratched not just one but two great itches of a phenomenon I call Canadian Smug: our sense of superiority to the U.S., and our delight when Americans notice how much better we are.
Even when articles looked unfavourably upon our collective back patting, and Twitter hashtags such as #CanadaWAITS and #InviteBernieToSee pointed out weaknesses in our system, people kept returning to the same question: "We're way better off than they are, so do you want American-style health care?" This implies there are only two systems, ours and theirs, and being unsatisfied with ours means coveting theirs. This false binary may flatter our national ego, but it does us a great disservice in terms of health care.
Listening to the hosts of the American podcast, The Weeds, discuss the Sanders visit was instructive in that it was free from both Canadian Smug and the pearl-clutching cries of "socialism" often heard in American rhetoric about Canada. The discussion focused on the ideological underpinning of the two systems and theorized that the national values holding Americans back from universal health care had historical roots in post-slavery ideology that viewed black Americans as lesser humans. This hindered the development of the kind of social unity needed to have people willingly pay into a system that would benefit their fellow citizens.
The podcast hosts were not too hopeful about the adoption of a single-payer system in a culture still coming to grips with that history of disenfranchisement. I would turn that argument around and say that the absence of such a history is protective against Canada developing an American-style system. This is not to say that we don't have our own historical legacies of racial injustice and disenfranchisement; however, we have already built a complex health-care system upon the ideological foundation that every Canadian deserves care.
More to the point, some of the "that's a slippery slope to an American-style system" arguments verge on fear-mongering, and have the effect of shutting down meaningful debate. We can decide as a nation that a formal two-tier system is not what we want, but we should be able to do so using international examples more similar to our system.
We have a long-standing tradition of ignoring the Far North, especially First Nations communities
Japan, France, Australia and Germany are countries with multi-payer systems, including a strong government-funded component. There are major differences between those countries in terms of how they design their systems, and unique weaknesses as well. But they are all better starting points for comparison than the U.S. given that they are rooted in a universal-style model of health care provision like we are. They all tend to rank better than Canada in various health measures as well, which is something we need to pay close attention to if we are interested in reforming and improving our system.
Canada also has unique geographic and demographic challenges. Outside of our cities, there is a relatively small population spread thinly over a vast expanse of land. Travel and transport in the Far North is limited for large blocks of the year due to our climate. Although our culture is not historically rooted in the dehumanizing philosophy of slavery and Jim Crow, we have a long-standing tradition of ignoring the Far North, especially First Nations communities, many of which were put in remote locations with that specific end in mind. So, while we ideologically support the notion of universal health care, historically we're not too bothered by the rationing and resource shortages chronically plaguing the Far North.
The true ideological problem of Canadian health care is our fondness for pretending we don't already have a two-tier system. Data on health outcomes indicates that people wealthy enough to live in, or drive to, the city have much better access to health care than those who don't. With the continued dismantling of rural hospitals and concentration of services in urban centres, this slippery slope of a trend will likely continue. At the bottom of that slope is not American-style privatization, but rather worsening of the geographic determinants of health, and further entrenchment of our hidden two-tier system.
We also need to be realistic about how flattering comparisons to the U.S. can be used a shield to avoid talking about pressing issues. The day of Sanders's visit to Toronto hospitals, Ontario Premier Kathleen Wynne canceled an engagement to speak at a meeting of orthopedic surgeons. This area of medicine faces a lot of challenges, particularly long wait times for joint replacements, and surgeon unemployment. Politics involves a certain degree of public relations glad-handling to be sure, but it's a particularly Canadian choice to do a feel-good tour with an American visitor rather than address our orthopedic quagmire.
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What happens when we move past our myopic focus on the U.S.? Canada ranks relatively low in health outcomes while our costs per capita are high. Multiple Canadian communities live without dependable access to clean drinking water, and you will have to wait four to five years if you need to see a neurologist in Kingston. When we focus so much of our conversation on how to avoid becoming the U.S., we miss out on talking about how our history, geography and climate inform our health-care system.
So, fellow Canadians, let's start small. How about a single conversation regarding international health-care systems that doesn't involve the U.S.? How about we tackle our own hidden two-tier system without mentioning the millions of uninsured Americans? Canadian Smug should not be a starting point for reforming our health-care system, and if we can abandon it we will be far better off.
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