Single Payer Systems: U.S. Medicare and Canadian Medicare

I don’t know about you, but I often read a brief article that draws upon another. Sometimes those secondary articles are excellent in their own right. Sometimes, going to the original is the only way to actually get the original author’s slant.

Wendell Potter is a former Cigna executive turned whistle-blower on the private insurance industry in general and HMO’s in particular. In his position as Vice President of Corporate Communications, he participated in what he now considers disinformation about healthcare single payer systems and the U.S. insurance industry. He now works for the Center for Public Integrity, speaking and writing extensively.

An article Potter recently wrote, The Canadian health care system I disparaged, was cited in FierceHealthPayer, a newsletter I read regularly. Single-payer traits worth emulating found two such qualities the Canadian system would benefit from:

  1. Make their system more consistent across provinces, as does the U.S. Medicare system. Currently, Canadian Medicare operates like U.S. Medicaid in that the province has great discretion about the benefits provided, just as the states do with Medicaid.
  2. Provide prescription medication coverage like Medicare Part D. At present, Canadians must purchase separate insurance if they do not want to pay the entire cost of prescriptions out of pocket.

The Canadian system covers everyone; U.S. Medicare only covers those 65 and over, and some disabled individuals. In his article, Mr. Potter apologized to Canadians for his years of disparagement of their system. He noted that he and other insurance industry representatives routinely presented exceptional cases as the norm, denigrating the Canadian system. In his travels and speaking in Canada, he “didn’t encounter a single Canadian who didn’t talk about their Medicare program with pride”.

Over the course of a two-decade career as a health insurance executive, I spent hours and hours implementing my industry’s ongoing propaganda campaign to mislead people about the Canadian health care system. We spread horror stories about “rationed care” and long waiting times for medically necessary care. Our anecdotes were not at all representative of most Canadians’ experiences, but we spent millions of dollars to persuade Americans that they were.

FierceHealthPayer indicates that

Experts from Canada, Denmark and other countries have maintained that a U.S. Medicare-for-all system would alleviate high administrative cost. In Canada, administrative costs average 1.3 percent, well below the average 31 percent for the U.S. healthcare system, Danielle Martin, M.D., vice president of medical affairs and health system solutions at Women’s College Hospital in Toronto, Canada, told the Subcommittee on Primary Health and Aging last month. Martin also addressed U.S. concerns about socialized medicine, explaining that in Canada, insurance is public and hospitals and providers are private entities.

How would your organization function differently if there were a single payer for all services, covering your behavioral health services at the same level they are covered now (averaging across your current payers)? Would such a system work better or worse for you? I know what my answers are to those questions. I wonder what yours are. Please enter your comments below.


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