U.S. Senator Bernie Sanders tossed a political grenade last week, introducing the Medicare for All Act of 2017, legislation that, if it were to be adopted, would guarantee publicly funded health care to every American and turn the world's biggest health-insurance market on its ear.
In stumping for universal health care, the Vermont senator repeatedly pointed to Canada as an example to follow and even turned to charismatic Toronto physician Dr. Danielle Martin to help make his pitch.
The case he makes for radical reform is a compelling one. The U.S., Sen. Sanders notes, "has the most expensive, bureaucratic, wasteful and inefficient health care system in the world."
Per-capita health spending exceeds $10,000 (all figures U.S.), compared with $4,644 in Canada. Most galling of all, the U.S. – one of the richest countries on Earth – has 28 million citizens with no health coverage and Republican plans to gut the Affordable Care Act (also known as Obamacare) would increase that number to 60 million.
But what Sen. Sanders is pitching is not Canadian-style medicare, but something much more comprehensive. Under the proposed law, there would be 10 categories of "essential health benefits" that are publicly covered: hospital services; ambulatory patient services, including home care; primary and preventive services (including chronic-disease management); prescription drugs, medical devices and biologics; mental health and substance abuse treatment services; laboratory and diagnostic services; comprehensive reproductive, maternity and newborn care; pediatrics; oral health, audiology and vision services; and short-term rehabilitation services and devices.
In Canada, only hospital and physician services are considered "medically necessary" and 100 per cent publicly funded. Unlike Canadian medicare, U.S. Medicare-for-all would – like most European countries – also cover prescription drugs, vision care, rehab, dental care and psychological services. The one missing piece is long-term care, but Sen. Sanders said that would be covered by separate legislation.
Currently, U.S. Medicare is a national program that provides comprehensive coverage for everyone over 65 and people with disabilities. Medicaid is a state program (funded federally) that provides health coverage for people on social assistance. The U.S. also has a state-funded health service for military veterans, a separate system for Native Americans called Indian Health Services, a state-funded insurance program for federal government employees (including politicians) and a Children's Health Insurance Program, which subsidizes health insurance for families with children.
In fact, of the $3.4-trillion (with a T) the U.S. spends on health care annually, more than $2-trillion is spent on publicly financed programs. In other words, almost 60 per cent of health spending is public; in Canada, it's 70 per cent.
Should the Medicare for All Act be enacted, the U.S. would have a far more affordable and equitable public health-insurance system than Canada.
In fact, Sen. Sanders' proposed law would ban all cost-sharing, such as premiums, co-payments and deductibles (which are commonplace in Canada), and it would outlaw "balance billing" (what Canadians call extra-billing).
Medicare-for-all would be expensive – but not appreciably more expensive than the dysfunctional system the U.S. has now. In a separate white paper, Sen. Sanders outlined a financing plan that includes a combination of payroll taxes, tax hikes for the wealthy and savings from efficiencies.
For example, a modest 7.5-per-cent payroll tax would raise $390-billion a year, and actually save employers money. Providing private health insurance to an employee with a family of four and a salary of $50,000 costs an average of $12,685; a payroll tax, by contrast, would cost $3,750.
Another option is a 4-per-cent premium on income. That would cost the $50,000 employee $844 a year, compared with the average $5,277 they currently pay in private insurance premiums. That would raise $350-billion.
Sen. Sanders estimates the efficiencies of a centralized system would save $420-billion a year. For example, centralized purchasing of prescription drugs alone could save the system $113-billion.
A more progressive tax system (read: eliminating a lot of tax breaks for those earning more than $250,000) would raise an additional $180-billion, and a wealth tax on the top 0.1 per cent of earners another $130-billion.
Even if the political zeitgeist is changing in the U.S., it is unlikely that Americans would embrace fairer taxes and more government control of health care, despite the obvious benefits.
Still, Medicare-for-all should leave us drooling with envy – because the proposals for reform are long overdue in Canada.
Bernie Sanders' home is only 80 kilometres from the Canadian border. And Prime Minister Bernie has kind of a nice ring to it.