To fully appreciate one of Canada's greatest success stories, pay attention to America's endless health-care fight. Now in its third decade of hand-to-hand combat, the battle is once again consuming Washington.
The United States of America has the developed world's worst health-care system, and the Senate Republican leadership is this week trying to pass a bill to make the situation a bit worse. Canada had this debate 50 years ago, around the time of the centennial of Confederation. This country decided to take a very different path, and the results are plain to see.
The U.S. spends far more on health care than any other country – 16.6 per cent of gross domestic product, compared to just 10 per cent in Canada. In return for all that spending, the average American gets less care, and has worse health.
For example, the number of Americans without insurance equals the population of Canada. The Senate health bill, if passed, will nearly double the number of uninsured. That would roll back all of the gains made under the Affordable Care Act, a.k.a. Obamacare, the previous president's baby-step toward universal coverage.
In addition to the uninsured, tens of millions of Americans are precariously insured, leaving them at risk of losing coverage because of rising premiums or unemployment, or seeing their insurer refuse a necessary treatment, or finding themselves facing bankruptcy because of illness – 1.5 million Americans declared bankruptcy in 2010, unable to pay their medical bills.
A truly awful health-care system is one of the reasons the World Heath Organization says the average Canadian can expect to live three years longer than the average American.
Yes, Canadian medicare is imperfect and incomplete. Yes, wait times are too long. Yes, in some areas, it's hard to get a family doctor. Yes, in some fields, there aren't enough specialists.
And yes, Canadian medicare doesn't fully cover pharmaceuticals, an increasingly important part of medical treatment. When it comes to drugs, Canada's patchwork of public insurance, private insurance and zero insurance looks a lot like American health care. But that only highlights why Canadian medicare is superior to what Americans live with.
In absolute terms, Canadian health care is not nirvana. But graded on the curve, it gets solid passing marks, while American health care gets a big, red "F".
How did the average Canadian end up with better health care than the average American? Because of choices made 50 years ago, by the Centennial Generation.
In the early 1960s, the Royal Commission on Health Services, appointed by a Progressive Conservative government and chaired by Justice Emmett Hall, discovered that more than 40 per cent of the population – 7.5 million Canadians – had no health insurance. It recommended changing that, by following the model of NDP-led Saskatchewan.
As a result, between 1960 and 1970, Canadian governments made health insurance public and universal.
Universality is at the heart of the Canadian system. It means that you don't lose coverage if you're laid off, or suffer a drop in income, or fall ill. One of the absurd paradoxes of the American system, which Obamacare aimed to fix, is that people risk losing insurance or being denied insurance because they're sick.
Tommy Douglas, when he first proposed "a comprehensive health insurance program that will cover all our people," said that medicare would lead to "a more just and humane society." It was originally pitched as a moral choice. It has also proved to be an economical choice.
It turns out that Canadian universal health care is more efficient, and less costly, that the U.S. free-for-all. Does more; costs less.
Opponents of universal coverage in the U.S. insist that it would make overpriced care even more expensive. But the Canadian system has done the opposite. Not only do Americans spend far more out of pocket and on private insurance than Canadians, American governments also spend more on health care than Canadian governments, while leaving millions uninsured.
It's the U.S. system that has become unaffordable. The choice Americans face is between increasing government involvement – expanding coverage yet lowering costs – or paying for the status quo by reducing coverage. The Democrats to one degree or another back the former. The Republican leadership is pushing the opposite, involving various degrees of less government spending and fewer coverage obligations on insurers and health-care providers.
No, Canadian medicare isn't perfect. It can be improved, by learning from countries in Europe and Australia, some of which offer excellent service and more patient choice, at comparable or lower cost.
But it remains centennial Canada's greatest gift to Canada 150.