Ask any Canadian, and they'll gladly enumerate all the ways in which our health-care system is not perfect. But compared with the United States, home of the developed world's most expensive, least effective, bafflingly complex and unfair health-care setup, Canada might as well be heaven.
And thanks to the election of President Donald Trump and Republican majorities in both houses of Congress, and their desire to "repeal and replace" the Affordable Care Act, otherwise known as Obamacare, America is about to fall even further behind.
For Canadians, this should be more than just another opportunity for smugness. It's also a chance to consider why the Canadian system is better than the U.S. model, and how, instead of resting on our laurels, Canadians can make it even better.
But first, a little gloating.
Canadian care is less costly: In 2014, total Canadian spending on health care, by governments, businesses and individuals, was $5,543 per person. Americans spent nearly twice as much, or more than $11,000 per person.
In fact, the U.S. system is so screwed up that, despite leaving insurance largely in the hands of the private sector, and despite leaving millions of Americans without insurance, American governments spend more taxpayer dollars for Swiss-cheese coverage than Canadian taxpayers spend to get universal coverage.
The American health-care system's slogan might as well be: Delivering Less, Costing More.
Every Canadian is insured: In Canada, if you're breathing, you're covered. In the U.S., health insurance is far from universal. When Obamacare was passed in 2010, nearly one in five non-elderly Americans were uninsured. Thanks to Obamacare, that figure has fallen to 10 per cent. But that still means that the number of Americans without health insurance is almost as large as the population of Canada.
According to a Kaiser Family Foundation survey, nearly half of Americans without health insurance say they can't afford it. But the Republican bill to rewrite Obamacare, supported by President Trump, will likely raise costs while shrinking the safety net. It could cause six to 10 million Americans to lose coverage, according to ratings agency Standard and Poor's.
Canadians are healthier: According to the World Health Organization, the average Canadian can expect to live three years longer than the average American. A recent study in the medical journal The Lancet predicts that, in the decades to come, the gap will increase.
For seven years, Republicans have been railing against Obamacare – America's baby-step toward universal health care. During those seven years, Obamacare added 20 million Americans to the ranks of the insured. It encouraged the states to expand Medicaid, which covers low-income people. It subsidized individuals to get private insurance. So that insurers couldn't cherry-pick healthy customers, it made it illegal to deny coverage for pre-existing conditions. And in an attempt to discourage the young and healthy from forgoing insurance until they got sick, it fined those who chose to remain uninsured.
Obamacare's public-private model, with enough complexity to befuddle even health-policy experts, to say nothing of Joe Sixpack, has generated its share of frustration and confusion. It was a politically expedient attempt to evolve America's private-based health system, not completely revolutionize it. And it has made a flawed system less imperfect.
But Obamacare, and its tinkering with the free market, drove Republican legislators crazy. They've consistently promised to kill it at the earliest opportunity. That opportunity would seem to be at hand.
However, Mr. Trump and his fractious party are in a bind. They and their voters are of one mind on their hatred for the "Obama" in Obamacare. But when it comes to "care," there's disagreement. On the campaign trail, Mr. Trump instinctively understood that many of his voters want more economic security in their lives, not less. Unlike many conservatives, he did not promise to just put everything back into the hands of the market. He did not promise to take away people's benefits. Instead, he hinted that he'd somehow ditch the "Obama" while keeping the "care."
The bill introduced this week in the House of Representatives does not do that. Critics on the right mocked it as "Obamacare 2.0" – the former president's policy dressed up in new clothes. Critics on the left dismissed it as "Obamacare 0.5" – a health-care half-loaf. The latter are closer to the truth.
The challenge for Republicans is that many of their voters tell pollsters they like their newly acquired health benefits. They'll punish politicians who take them away. Last year, Mr. Trump got this. But this week at least, the loudest voices in the Republican Congress were coming from those who believe the Republican bill to gut Obamacare, rather than going too far, does not go far enough.
As Americans get ready to fight it out over how to make their world-trailing health-care system slightly worse, Canadians should be thinking about how to make ours a bit better. It's time to talk seriously about expanding – yes, expanding – medicare.
All provinces offer universal coverage for hospital and physicians' services. But what about universal drug coverage? When medicare was created in the late 1960s, a comprehensive pharmaceutical plan was supposed to have been the next step. Repeated studies have suggested it could improve health outcomes while lowering costs.
As the Americans shift into reverse, Canada should be looking to move forward.