He came, ostensibly, to learn.
He visited three of the shiniest, most advanced hospitals in Canada. Each of them fundraises more money than the total budgets of many smaller hospitals.
Wealthy people donate hundreds of millions to fund hospitals close to wealthy neighbourhoods. Sanders saw only the best, and he liked what he saw.
After his tour, he said Canadians were too quiet about our system.
“I know that Canadians are well-known throughout the world as gentle and kind people,” he said.
“Be a little bit louder!” “Stand up and fight”
Canadians love being better than Americans at something. And the media loved Bernie:
Bernie Sanders praises Canadian health care during Toronto talk – Globalnews.ca
Bernie Sanders awed by Canadian health care – Toronto Star
Sanders says Canadian health care system a ‘strong example’ for US – Winnipeg Free Press
Should a US Senator use Canada to promote his own political aspirations? What would the media say if a US politician did the same thing with Canada’s oil and gas industry?
Why do the same people who decry American attempts to influence other countries' politics promote Canadian interventionalism? @DrJacobsRad
— Moshe Weinstock, MD (@TORONTOCARDIO) October 29, 2017
Hyperbole around Sanders’ visit ruled out rational debate. I planned to ignore his stunt, until I saw this, in the New York Times:
A. He’s a Rock Star
“At a full 1,600-seat university auditorium on Sunday, he received repeated and sustained standing ovations. College students waited for hours to get into the auditorium and see him speak.”
B. Doctors like the system as much as patients do
“What I think stuck out to me was from both the patients and the physicians, the importance of not having to worry about money in terms of the doctor-patient relationship,” [Sanders] said in an interview after his trip on Tuesday.”
C. Sometimes you have to wait
“‘Wait times, you could argue are a problem for certain procedures,’ said Dr. David Urbach, before discussing the ways the province and hospital were working to shorten the lines.
Mr. Sanders quickly turned to the glass-half-full interpretation. “What you are arguing — correct me if I’m wrong — is that waiting times are not a problem, and it’s an issue you are dealing with,” he said.”
“On his weekend tour, Mr. Sanders didn’t see the places where patients might wait. “
D. Even Canada’s system has holes
“I’m on my own going to the dentist,” said Naomi Duguid, a patient, sitting across the table. “It’s the only time I get to experience what it must be like to be an uninsured American.”
E. Canadians seem to value fairness more than Americans do
” Fairness. Throughout the weekend, Mr. Sanders kept asking Canadians what they thought about the higher taxes they’d paid to finance their system. Every one among the patients and doctors selected to meet him said the trade-off was worth it because it made the system fair.”
Sanders said the uniformity of this message really stuck out to him
“There really is, I think, a deep-seated belief in Canada that health care is a right, and whether you’re rich or whether you’re poor or whether you’re middle class, you are entitled to health care.”
“When you talk about health care, you’re not just talking about health care,” he said in his Toronto speech. “You’re talking about values, because how a society deals with health care is more than medicine. It’s more than technology. It is about the values that those societies hold dear.”
What Bernie Should Have Learned
A. Wealthy Canadians get more care and wait less than the poor.
Politicians keep saying that everyone gets care regardless of ability to pay. But this is not true. We have known it’s false for almost two decades. Despite our single-payer system, people with a higher socioeconomic status get more care and wait less for it.
A New England Journal article showed that wealthier patients got 23% more heart procedures and had 45% shorter wait times than poorer patients, in Ontario. There are many other articles like this.
B. Wait times are long, painful and expensive.
Study after study shows that Canada often ranks dead last in wait times and near the bottom overall, for care, compared with OECD countries. Our hospital hallways overflow with patients waiting for beds.
C. Our system is expensive.
Economist Don Drummond said that healthcare will consume 80% of provincial budgets by 2030.
Healthcare is not free. On average, Canadians pay $12,000 per family of four and $4,600 per person. Families earning in the top 10% pay up to $40,000 per year for single-payer healthcare.
D. Many doctors are burned out and want to quit.
According to the 2017 CMA Physician Work Force Survey, 31.5% of physicians in Ontario plan to reduce their weekly work hours over the next 2 years.
The CMAJ also reports that 2/3 of Canadian physicians feel that their workload is too heavy, and over 50% of Canadian physicians show at least one feature of burnout.
E. Patients leave Canada for care.
Over 63,000 patients left Canada for care in 2017, according to an estimate by the Fraser Institute.
In my last blog, I explained Why Medicare Survives Unchanged. It will not improve until we change our fixed, firm belief that it is an outstanding system.
It once was great. Now it is not.
Leading healthcare journalist, Andre Picard, of the Globe and Mail, said:
— André Picard (@picardonhealth) October 31, 2017
To Picard’s credit, he started a movement on Twitter in response to Bernie’s visit: #CanadaWAITS
— André Picard (@picardonhealth) November 2, 2017
It opened a flood feedback:
— André Picard (@picardonhealth) November 6, 2017
A Kick in the Pants
No one in the world copies Canada’s restrictive system anymore. We can change. We can do better.
But there isn’t much hope for change if American politicians tell us how wonderful we are in an effort to boost their own career ambitions.
Photo: modified from www.TheStar.com