A Canadian Doctor Explains How Her Country's Single-Payer Health Care System Works

Originally published on December 7, 2017 4:11 pm

The idea of a single-payer health care system is getting some renewed attention in the United States as Sen. Bernie Sanders, I-Vt., and some Democrats are advocating for it.

Sanders' "Medicare for All" bill was co-sponsored by 16 Democrats, including Kamala Harris, D-Calif., Elizabeth Warren, D-Mass., and Cory Booker, D-N.J.

With a Republican White House and Congress, it's unlikely that a single-payer plan would pass in the near future, but the high-wattage support signals a major shift in the health care debate.

Recent polls suggest a growing number of Americans do support a single-payer system, which is the dominant model in other developed countries, including neighboring Canada.

While single-payer is defined and implemented differently in different countries, Danielle Martin, a Canadian physician, says there are a lot of misconceptions about how the plans work.

"What many Americans often don't realize about the Canadian system is that it's not a government delivered system," Martin says.

Martin, who is also vice president of medical affairs and health system solutions at the Women's College Hospital in Toronto, talked with All Things Considered host Michel Martin about how the services in Canada are paid for by the public, but delivered, in large part, by private doctors.

This interview has been edited for length and clarity.


Interview Highlights

On what single-payer means in Canada

People often talk about so-called government run health care or socialized medicine — we don't actually have that in Canada. What we have is a system where the insurance is paid for through a public plan. The services are paid for through general taxation, but the services are not delivered by government employees. [As] a family doctor, I am not an employee of the government. I deliver my services in a very similarly looking model to Americans physicians. But instead of billing a private insurance company or billing my patients directly, I simply bill the government plan.

On the issue of long wait times and physician availability

I think its critical for people to know that when Canadians are seriously sick — when the issue is urgent — they don't wait. So this myth that people are sort of dying in the streets, waiting for care is just that — a myth. Part of the reason that we know that is because our health outcomes are good. When compared to the U.S., outcomes for a whole variety of different diagnoses — including life expectancy, including infant mortality — all of these things actually, the Canadian system delivers as good or better care on average across the population than we see in the U.S.

But you are absolutely right, when people have a non-urgent issue in Canada, sometimes they wait. Sometimes they wait, in my opinion, too long. That's something we're really grappling with here is trying to figure out how we're going to deal with that.

On whether single-payer systems create a taxation burden

When we compare country to country, I think it's important that we do a complete arithmetic, and that in addition to considering taxation rates, we need to consider what Canadians are getting for their tax dollars, and what they're not having to pay for in terms of the private insurance market.

I mean here's the reality if you look internationally, the United States pays more per capita for health care than any other country in the world. You're closing in on 20 percent of your GDP in terms of what you spend. So there's a lot of money being spent publicly and privately on health care services in the U.S. It seems to me that ought to be more than enough to pay for health care for everybody.

We in Canada spend 10 percent of our GDP on health care services and we cover virtually every single resident of our land. That's what I think is the more important question ... not how much you pay via taxes, but how much you pay via taxes, plus out-of-pocket, plus for private insurance, and who's in and who's left out, and who's at risk of not having coverage when they need it most. The last thing you need when you're sick is to be worried on top of your illness, about how you are going to pay for your care.

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MICHEL MARTIN, HOST:

We'd like to turn our attention back to the health care debate in this country and focus on one system that's getting some renewed attention in this country, and that is a single-payer system. On Wednesday, Vermont Senator Bernie Sanders, the former presidential candidate, introduced his Medicare-for-all bill. Sixteen Democrats co-sponsored the bill. And what was particularly noteworthy is that these Democrats included Kamala Harris, Elizabeth Warren and Cory Booker, all being mentioned as possible future presidential contenders.

Now, with a Republican White House and Congress, this particular idea would seem to have little possibility of passing in the near term. But the high-wattage support signals a major shift in the health care debate as well as an attempt to start a conversation in the U.S. about implementing a health care system that would cover most Americans. Recent polls suggest that a growing number of Americans do support a single-payer system, which is the dominant model in other developed countries.

We wanted to hear experiences from one such country, so we called Dr. Danielle Martin. She's no relation to me as far as I know. She is a family physician and the vice president of medical affairs and health systems solutions at the Women's College Hospital in Toronto. And she was kind enough to join us now via Skype. Dr. Martin, thank you so much for speaking with us.

DANIELLE MARTIN: Thanks for having me.

MARTIN: So the single-payer health care system means different things to different people. I mean, places like the U.K. and New Zealand and Sweden all have systems that are described as single-payer. Could you just define what that means? And specifically, what does it mean in Canada?

MARTIN: What I think many Americans often don't realize about the Canadian system is that it's not a government-delivered system. So people often talk about some kind of government-run health care or socialized medicine. We don't actually have that in Canada. What we have is a system where the insurance is paid for through a public plan. The services are paid for through general taxation. But the services are not delivered by government employees. As a family doctor, I am not an employee of the government. I deliver my services in a very similar-looking model to American physicians. But instead of billing a private insurance company or billing my patients directly, I simply bill the government plan.

MARTIN: A lot of Americans who live in certain parts of the country will be familiar with, you know, Canadians who come to the U.S. for their health care. And they attribute that to long wait times or perhaps an inability to get in to see the doctor that you want to see because of, you know, the long wait times. So is that true?

MARTIN: As you've identified, I think it's critical for people to know that when Canadians are seriously sick, when the issue is urgent, they don't wait. So this myth that people are sort of dying in the streets waiting for care is just that. It's a myth. And part of the reason that we know that is because our health outcomes are good.

So when compared to the U.S. on outcomes for a whole variety of different diagnoses, including life expectancy, including infant mortality, all of these things, actually, Canadians - the Canadian system delivers as good or better care, you know, on average across the population than we see in the U.S. But you are absolutely right that when people have a non-urgent issue in Canada, sometimes they they wait. Sometimes they wait, in my opinion, too long. And that's something that we're really grappling with here is trying to figure out how we're going to deal with that.

MARTIN: Before we let you go, I do have to ask about the question of taxation. I mean, you said earlier that the notion that this is a government takeover of health care is false, that doctors are not, you know, government employees, you know, by and large unless they specifically work for the government, which I assume that some do. But what about the question of taxation? I mean, Americans are led to believe that the taxation burden in Canada is much higher, particularly on individuals, and that's largely due to the need to support the system. Is that true?

MARTIN: When we compare country to country, I think it's important that we do a complete arithmetic. And that in addition to considering taxation rates, we need to consider what Canadians are getting for their tax dollars and what they're not having to pay for in terms of the private insurance market. I mean, here's the reality. If you look internationally, the United States pays more per capita for health care than any other country in the world. You're closing in now on 20 percent of your GDP in terms of what you spend. So there's a lot of money being spent publicly and privately on health care services in the U.S.

It seems to me that that ought to be more than enough to pay for health care for everybody. I mean, we in Canada spend 10 percent of our GDP on health care services and we cover virtually every single resident of our land - on our land. And so that's, I think, the more important question is not how much do you pay via taxes, but how much do you pay via taxes plus out-of-pocket plus for private insurance? And who's in who's left out? And who's at risk of not having coverage when they need it most? And the last thing you need when you're sick is to be worried on top of your illness about how you're going to pay for your care.

MARTIN: That's Dr. Danielle Martin. As I said, we do not believe that we are related. She is a physician and the vice president of medical affairs and health systems solutions at the Women's College Hospital in Toronto. She was kind enough to join us via Skype. Dr. Martin, thank you so much for speaking with us today.

MARTIN: Thanks for having me. Transcript provided by NPR, Copyright NPR.