If anyone had any doubts about how catastrophic our for-profit health-care system is, the past few weeks should set those doubts to rest. Unfortunately, many pundits, and even the front-runner for the Democratic presidential nomination, are still arguing that a single-payer health-care system would not improve our current circumstances, pointing to Italy’s situation as evidence that Medicare for All would not help during a pandemic — and might even result in worse outcomes.
This argument is absurd, of course. A single-payer system like Medicare for All is much better equipped to deal with exactly this sort of public health emergency, including in Italy, than the United States’ fragmented for-profit system. And the vision of a single-payer health-care system could not only help us guide our approach to the current crisis, but also leave us better prepared for the next one.
For an example of what a single-payer response to coronavirus could look like, we need look no farther than the United States’ northern neighbor. Politically, Canada shares much in common with the United States: an embrace of neoliberalism and free trade deals, the support of interventionist wars, centuries of unaddressed colonialism, and prioritizing the needs of fossil fuel companies over the planet’s. One stark difference between the two countries, though, is that Canada has a (mostly) single-payer health-care system.
This difference in health-care systems is leading to two increasingly different responses to the coronavirus pandemic, responses that make clear the benefits of addressing a public-health crisis with a single-payer health-care system.
A Coordinated Public-Health Response
I’m a dual American-Canadian citizen, and over the past weeks, I’ve read countless stories on social media of exasperated American friends seeking coronavirus testing who describe a complex journey navigating between primary-care providers, hospitals, and local health departments. The fragmented nature of the US health-care system has made it difficult to coordinate a response or testing strategy, especially between completely separate health-care providers that often have different testing equipment and protocols.
Meanwhile, in Canada, the provincial government is essentially the only financier of hospitals and health-care providers in each province, making it much easier to coordinate strategies. In Ontario, for example, anyone who suspects they have coronavirus is instructed to self-assess using an online tool, then either call a central Telehealth number, call their primary provider, or visit a dedicated assessment center. All three resources are receiving regular information from the provincial government and are able to determine what steps someone should take next: arranging testing, instructing the person to self-isolate, or providing reassurance. Each province has set up their own similar centralized system, and even before some of the newer resources were created, health departments at the local, provincial, and federal level were acting as central contact points for individuals and organizations.
This coordination stands in stark contrast to the confusing and contradicting information provided by different levels of government in the United States, especially in the earlier days of the crisis.
For example, on February 25, CDC officials warned that US communities should start preparing for the inevitable spread of coronavirus — while Donald Trump downplayed its severity. Then, on February 29, Trump gave national remarks stating that the coronavirus threat was well under control, even though Washington governor Jay Inslee declared a state of emergency that same day, and public health officials in Washington, Oregon, and California were warning of possible community spread.
Although some of these contradictions were undeniably due to Trump’s particular idiosyncrasies, it is notable that there is no central public-health apparatus in the United States that can facilitate the type of cooperation seen between different levels of the government in Canada during that same time.
The role of the Canadian public health units in coherently, efficiently responding to coronavirus can’t be understated. By March 12, the entirety of the United States had completed less than three times the number of tests as the province of Ontario alone — despite having twenty times the population. Meanwhile, public-health physicians at the local level were holding frequent consultations with universities, local governments, and other organizations while regularly addressing the media.
Although regional health units also exist in the United States, they can’t perform to the same degree as Canadian regional health units, because those units are not as integrated into the health-care system. Under a single-payer system, such as the one in Canada, the same party responsible for paying for doctors, nurses, and hospitals is also responsible for paying for public health. This means that the provider — in the Canadian case, the provincial government — has an interest in funding public health and preventative medicine in order to lessen the expense and burden on the rest of the health-care system.
In the United States, there is no incentive for a private hospital or private insurance company to fund public health measures, and the publicly funded health departments act entirely separately from the privately funded health-care system. This naturally contributes to a lack of coordination in the face of public health emergencies.
Accessing Health Care
Beyond the benefits of coordinating public health responses under a single-payer health-care system, such a system also better facilitates health-care provision itself. Universal health care is of the utmost importance during a crisis like this, because we need widespread, unimpeded testing and treatment to curb the spread of coronavirus.
Even after it was clear that testing, identifying, and isolating individuals with coronavirus was the only way to stop the disease’s spread within the United States, for weeks, the tests themselves continued to be prohibitively expensive. Even after it was announced that insurance companies would begin fully covering testing, the problem remained of how people with insurance would afford treatment for coronavirus — and how those without insurance could afford either.
Decades of an American health-care system in which emergency care meant crushing debt and often bankruptcy, and even receiving treatment covered by insurance can come with financially devastating hidden costs, has led to a fear of using health care. This means that even with free testing, and even if legislation is eventually passed to completely cover treatment, many people have been conditioned to avoid seeking health care — which is exactly what you don’t want in a pandemic.
And covering coronavirus treatment does nothing for those who desperately need health care for a reason not explicitly linked to the pandemic, including people faced with health-care issues that emerge as side effects of our current crisis. What happens when a primary caregiver catches coronavirus and their parent needs long-term care? What happens when families affected by coronavirus need mental health support? With the media discussing the sort of health-care rationing we’ve seen in countries where coronavirus patients have overwhelmed the number of ICU beds available to treat them, one has to worry what form this rationing might take in a country with a for-profit health-care system.
Beyond avoiding these problems, Canada’s universal health-care system also allows opportunities for swift reactions to the coronavirus pandemic. For example, more than a week ago, the Ontario government announced that physicians could begin to bill the province for video and phone appointments, and also took steps toward creating a virtual walk-in clinic for the province. This transition still comes with a host of concerns, such as the significant involvement of for-profit virtual health-care systems as part of a push toward further privatization, but it shows the kind of coordinated reaction that is possible under a single-payer system.
This shift to virtual care has the potential to significantly reduce the risk of exposure to coronavirus for patients seeking regular, ongoing health care. This would be more difficult to coordinate on a state or national level in the United States, as it would require negotiating with numerous insurance companies in order to convince them to start covering telehealth services.
Room for Improvement
To be clear, Canada’s health-care system is not perfect. For example, the scenario that Bernie Sanders outlined in the recent debate about a family member of a coronavirus patient being unable to afford mental health services would also exist in Canada. When it comes to mental health, dental, pharmaceuticals, and many other health services, Canada has a multipayer system almost identical to the United States. Even when it comes to primary care, the provincial government is not always the sole party responsible for paying for health-care services — health care for refugees, workers injured on the job, and certain indigenous communities are each funded from a different source.
The Canadian public health system has also faced significant austerity, especially recently, and is often underfunded. And the Left in Canada will need to grapple with many of the same political questions that the Left in the United States will as we move through this crisis. For example, what conditions will Canadians demand in exchange for bailouts of Canadian corporations, and how will we ensure the humane concessions granted to us during this crisis, like universal sick leave, are not revoked once the danger has passed?
Still, the crisis is revealing Canada’s political strengths, namely the benefit of combating a public-health emergency with a single-payer health-care system. If the United States had a single-payer health-care system right now, its trajectory of this pandemic would probably resemble Canada’s. A single-payer health-care system could have meant a more coordinated public-health response in the early days of the crisis, and would, at the very least, provide access to the health care that we need to get through it.