Canadians Have Universal Health Insurance. Why Not the U.S.?

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Canadians Have Universal Health Insurance. Why Not the U.S.?

Ask Queens College professor Joseph Cohen when he knew that health care was broken, and he’ll tell you about the $4,000 bill he received a few years back. He had no idea what the specific charges were, but he was determined to find out. Nearly two years and one lawsuit later, he had his answer to both the bill’s particulars and the depths of his outrage.

Turns out that Cohen is Canadian. And for Canadians, he said, “This is a fear story. This is, like, ‘wake up in a bathtub filled with ice and your kidneys are gone’ type of story.”

Why is it that Canadians like Cohen would never see a medical bill like this, but Americans are routinely suffering sticker shock? The answer can be found in a few pivotal moments during 1962.

That spring, the day after President John F. Kennedy celebrated his birthday with a serenade by Marilyn Monroe, he returned to Madison Square Garden for a very different event — a nationally televised pep rally for Medicare. At the time it was limited (as in 60 days of hospitalization) health coverage for the elderly. Kennedy took to the stage and made the same arguments many progressives make today: that elderly Americans deserved health coverage, that their children shouldn’t be obliged to pay for it and that other countries already provided this for their citizens.

He talked about something else, too: a group of physicians in New Jersey who had threatened to go on strike if this health care law passed.

“Doctors were scared it was the first step,” said Theodore Marmor, the author of The Politics of Medicare. The first step towards nationalized health care, that is. And the reason they were so scared is because of what was going on in the Canadian province of Saskatchewan.

A few weeks after Kennedy’s speech, Saskatchewan was scheduled to roll out what a leading politician, Tommy Douglas, also called “Medicare.” Only his plan wasn’t just for seniors. It was access to a doctor for everyone. And it was every bit as controversial as President Kennedy’s legislation. In fact, when the plan went into effect, the province’s doctors went on a three-week strike, refusing to treat anything but emergencies.

Canadian leaders were able to break the strike by promising that doctors would continue to be paid, as they had in the past, by the procedure. Doctors went back to work and over the next decade, all other Canadian provinces created health insurance plans like Saskatchewan’s.

Meanwhile, in the United States, President Kennedy’s law failed spectacularly. It wasn’t until after his assassination that Washington was able to pass Medicare along with Medicaid. But that landmark legislation guaranteed healthcare for some, not all.

What explained the different outcomes: Canada started small, with just one province. And Douglas focused on health care as a universal right. By contrast, the conversation in the U.S. focused on which groups of people deserved health coverage. Opponents of Kennedy’s plan spoke about wealthy people being able to get health care free of charge. It was an unfair distribution of services that Americans wouldn’t support and couldn’t sustain.


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