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Spotlight on Canada’s health-​care system during Bernie Sanders’s visit to Toronto this weekend

October 26/2017

By: Noreen Ahmed-Ullah, Associate Editor and Senior Reporter, UofTNews

As he tries to build a movement for universal health care south of the border, U.S. Senator Bernie Sanders’ much-anticipated trip to Toronto this weekend is meant to be a fact-finding mission on Canada’s health-care system.

The most popular politician in America, according to a new poll released in the summer, Sanders arrives in Toronto Saturday for a whirlwind trip of hospital visits, roundtable discussions, meetings with patients and this weekend’s hottest ticket — a talk at University of Toronto’s Convocation Hall on Sunday.

Professor Gregory Marchildon

Professor Gregory Marchildon

Professor Gregory Marchildon of U of T’s Institute of Health Policy, Management and Evaluation, based at the Dalla Lana School of Public Health, said Sanders’ appeal – especially for young millennials – lies in his populist message.

“The event sold out in less than a minute — I wasn’t surprised by that, in part because of his high profile during the presidential campaign,” Marchildon said. “I think he captured many Canadians’ attention during that time. The substance of his message appealed to a number of Canadians. They saw it as being more reflective of their values.”

Sanders, who proposed a Medicare-for-All health care bill in September, said he hopes to learn about Canada’s health care and how we’re spending half as much as the U.S. per capita in providing services. In addition, he noted how Canada’s cost of prescription drugs is “substantially less” than in the United States.

“The United States is the only major country on Earth not to guarantee health care to all their people as a right,” Sanders said via email. “In Toronto, I look forward to speaking with Canadian doctors, patients and administrators to see what we can learn from the Canadian system.”

Sanders, who hopes to reshape American health care into a government-run, single-payer program — kind of like what’s in Canada – has taken his bill on the road to different U.S. states. His trip to Canada – organized by Danielle Martin, a vice president of Women’s College Hospital, Broadbent Institute and Marchildon – is an opportunity to learn more about the pros and cons of Canada’s health care system.

Martin, an associate professor at IHPME, first met Sanders after he invited her to Washington D.C. three years ago to talk about the Canadian health-care system. Her defence of Canada’s health-care system before a U.S. congressional committee session debating Obamacare caught media attention. Sanders’ endorsed her recent book of challenges in Canadian health care, titled Better Now: Six Big Ideas to Improve Health Care for all Canadians, and she in turn showed up to support Sanders when he launched his bill last month.

“We thought it would be terrific for him to come and see the Canadian system for himself and to learn more about what’s working and also our challenges, to hear directly from patients and health care providers and policy experts,” she said. “We’re all clear and he understands very well that in a single day or two visiting the city of Toronto, he’s not going to get a complete picture of everything to do with the Canadian health-care system, or the particular challenges of rural communities, Indigenous health disparities, or a wide range of important issues. He’ll get a flavour of what’s working, although it won’t be exhaustive, and he’ll also get to see several different kinds of hospitals within the U of T system, and I think he’s really looking forward to that.”

Martin emphasized that the trip will also present some of the challenges.

“I certainly don’t think he believes for a minute that everything is positive and glowing, and neither do we. We all know that there’s very significant challenges in the Canadian health-care system,” she said.

“This is not a public relations exercise. It’s a learning exercise, and that means he’ll be hearing about what works and what doesn’t.”

She added that at the same time Canadians shouldn’t underestimate our accomplishments.

“It’s very Canadian to downplay your accomplishments and focus solely on the distance yet to be travelled. So, we won’t solely be highlighting the challenges, we will also be celebrating our successes. From the perspective of many of the patients that I know he’ll be meeting when he comes to Toronto, many of them, if they had been in similar life circumstances in the U.S., would have almost certainly had a far inferior experience in the health-care system than the one they had in Canada. And that is also an important message for our neighbours south of the border to hear.”

Though considered dead-on-arrival in a Republican-controlled U.S. Congress, Sanders’ bill is meant to build a movement in support of universal health care – potentially for the next election.

“This is about more than just passing a bill,” Martin said. “It’s about engaging citizens in a conversation. Senator Sanders is known for his capacity to build movement and not just campaign on a particular legislation. That’s what he’s trying to with this bill is to build a movement for universal, single payer health care in the United States, and part of his journey to Canada is to understand how that movement may or may not cross borders.”

Marchildon added that Sanders’ bill is intended to be a critique of both the administration’s approach and as an alternative to current health care options, including Obamacare, whose multi-payer approach has proven to be expensive.

“[Sanders] sees his bill as a symbol of where the U.S. can go down the road and as a critique of the current approach,” said Marchildon, who is the founding director of U of T’s North American Observatory on Health Systems and Policies, which studies and analyzes health systems in the U.S. and Canada.

He’s speaking this week at another health care conference in the U.S. about the Canadian system. Does he believe a health care proposal like Sanders could ever get passed in the U.S.?

“It’s more likely now than it would’ve been five years ago,” Marchildon said. “The experience of the Affordable Care Act is that it has been good in some respects. It covered gaps in coverage, but it has very little cost control. It is extremely expensive from an administrative standpoint, and therefore single payer could work. Some states have tried it, so I think there’s more openness about it now.

“It’s more possible, but it would be a huge battle. I would warn that the demonization of Canada is part and parcel of a campaign to derail any movement to a single-payer system by a broad range of interests who do not want this to happen. Right now, insurance companies play a very important role in the U.S. system, and they would lose that position with the creation of a single payer system. There are numerous other powerful interest groups that are against this.”