I have personal experience with single-payer health care, directly contrasting treatment for the same medical diagnosis under the U.S. for-profit private insurance formula with Canada’s single-payer paradigm.
It happened in the late-oughts after decades of targeted barbs in the media about Canada’s healthcare system. In retrospect, studies found this narrative of long “wait times,” medical “refugees” and substandard, even rationed care to be mere propaganda.
It has been my personal lived experience in the U.S., as a survivor of several head and neck tumors, to be excluded from any employment not bundled with the benefit of large-group insurance, which accepts preexisting conditions. By necessity of my very existence, my lifelong work experience from the get-go has been limited to enormous institutions with premium insurance contracts, e.g., academia, government. The fiction of “choice” afforded by the free market has quite simply been a permanent, existential, cruel tease.
In my 40s I developed neurological problems treated with ganglia blocks and then surgery. Subsequent to this I was diagnosed with a pain condition I concluded to be like “phantom limb” syndrome, where perception is of a physical reality that does not exist—and there is no way to “fix” what isn’t there. The very real, excruciating pain I felt was an interpretation, not a reality.
The prognosis is poor and treatment is inexact. Medical appointments with expensive, never-ending copayments appropriated a significant fraction of each session to gathering metrics for the insurance company rather than physical therapy to address my pain. After one such session devoted entirely to nontherapeutic measurements, I dragged myself into a stairwell and just sobbed. I could not have explained my anguish to concerned passersby if I tried. I was out of options. And when the insurance company refused to pay for more treatment I agreed that assuming full responsibility for such tenuous care could well be pointless.
Then my husband accepted a sabbatical position in Canada. As a guest of the government, his family was entitled to their national insurance coverage. I was inducted into the Canadian medical system following a serious bicycle accident. And when they undertook to treat me for my unrelated, preexisting condition, to my skepticism regarding appropriateness and return on investment, they responded, “It does not matter how or when you acquired this problem, the task is to address it.”
In fact, I was lectured with all solemnity, that my responsibility was to work hard, and to miss no appointments because this would displace others in need, thereby contributing to the efficiency of the system. They covered all the monetary expense.
In contrast with the U.S. facilities, the Canadians’ treatment was not high-tech, without fancy water baths and physio tape, deluxe measuring, or evaluative equipment. The benefit was derived through my own exertion, internally, with external resources as simple as coffee cans and pencils. There was no magical cure promised or conferred beyond the physical therapist’s skillful guidance and a system focused on addressing pathology, not paying for an army to deliver it. This system worked, and without personal cost to me apart from my responsibilities as human being and citizen.
The story of rationed care and unobtainable therapy turned out to be just so much misinformation—variously irrelevant, inappropriate, wrong, deceitful, distracting. Unless resources are infinite, constraint is inescapable. In Canada, management is achieved internal to the system, minimizing displacement to all; the alternative simply imposes hidden limitations. For example, constraint existed in this incident in the form of mandating personal responsibility for treatment, or by accepting “triage” from an independent gatekeeper who assigned physical therapy as needed, subject even to censure if you were not putting in your part. In the U.S. it was unilaterally imposed through cost shifting from the system to one’s own personal pocketbook.
Canada gave me my life back. Canada’s single-payer healthcare system cared about my physical challenges while a guest in their country. Under for-profit insurance in my own country, my value is measured in capacity to extract treasure for the corporation, even while my freedom and “choice” are imprisoned within this serf status.
I tried earnestly to discuss this with a Canadian friend, to question the tales of Canadians flocking in droves to our northern hospitals, the reported complaints, and dubious tales of malaise we were fed in the U.S. My friend point-blank refused to engage: “You are all crazy. I just don’t want to talk about it; what’s to talk about? Why would anyone willingly choose an expensive, inadequate system? Why choose to pay for what should come to you for free as a right of citizenship? There just isn’t anything more to say; you all are simply crazy.”
On February 19, 2021, California State Assembly members Kalra, Lee, and Santiago introduced for consideration AB1400, Guaranteed Health Care For All. If you live in California, please contact your state legislators to request their support for this legislation. California’s Governor Newsom must apply to the federal government for waivers to implement the proposal. If it is true that as goes California, the fifth-largest economy in the world, so goes the nation, then it is everyone’s prerogative to urge that he apply for this vital waiver here.
If you don’t live in California, check out AB1400 and suggest to your legislators how it could work in your state.
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