How Canadian politicians, doctors and bureaucrats fueled a California push for single-payer health care

Eric Hoskins is not exactly the most popular figure in Ontario health care these days, with doctors angry at fee cuts calling almost daily for the provincial health minister’s firing.

But the advice he and other Canadians gave an official fact-finding mission of California senators recently has buoyed the Democratic law-makers as they pursue a daunting task: trying to implement single-payer, government-funded health care in the state.

Their bill proposing such a system crossed its first legislative hurdle last week — winning approval in the chamber’s health committee — with the senators citing Canadian evidence to support their cause.

Experts in Ontario and Quebec were “enthusiastically supportive” of the initiative, said San Francisco Sen. Scott Wiener.

I hope that they are also looking at the overwhelming evidence of the failures of our system

“It made me feel better about what we’re doing,” he said an interview. “We learned it’s not just some fairy-tale, unattainable system that Canada has … People were really earnest about trying to give us advice about what to do and what to avoid.”

The California bill, introduced in February, is partly a response to the Republican push to repeal Obamacare. It also proposes a tectonic shift away from the private-insurance model that has long prevailed in the U.S.

The legislation would set up a government-funded system covering medical, dental, mental health and vision care as well as nursing home services, giving it a far-broader scope than Canadian medicare. There would be no co-pays or deductibles, and – like here – private insurers would be barred from providing coverage for services offered under the state plan.

Democrats have large majorities in both state houses and hold the governorship, but the idea has faced stiff opposition from the business community. With a yearly cost estimated at $250 billion, it would bring increased payroll taxes and ultimately be a “job killer,” not to mention decimate the health-insurance industry, charges the California Chamber of Commerce.

The head of a Canadian group fighting some aspects of medicare suggested those pushing the legislation seek out less-flattering views here, too.

The Canadian Constitution Foundation, a conservative legal-advocacy group, is helping fund a for-profit surgery clinic’s constitutional challenge of the B.C. government and its ban on private funding of health care.

“I hope that they are also looking at the overwhelming evidence of the failures of our system,” said Howard Anglin, the foundation’s executive director. “What they could expect, based on our experience in Canada, is hundreds of thousands or millions of patients on unacceptable wait lists, with no outlet and no option to seek care while they’re suffering.”

Ricardo Lara, the bill’s sponsor, Wiener and fellow Democratic state senator Nancy Skinner travelled to Canada in mid-March, meeting with government officials and doctors in Toronto, Quebec City and Montreal.

Their hosts included Hoskins, Ontario deputy health minister Dr. Robert Bell, Dr. Barry Rubin of Toronto General Hospital’s Peter Munk Cardiac Centre, as well as various officials with the Quebec Health Ministry.

Wiener and Skinner said the individuals they met with offered a generally positive view of Canada’s system, while conceding there are problems, such as persistent wait lists. Lara could not be reached for comment.

“The real issue for me is ‘Can someone get urgent or critical care when they need it,’ and my impression from the meetings is that that is delivered,” Skinner said. “In the U.S., that is achieved if you have money, but not if you don’t.”

Interestingly, most of the Canadians also expressed admiration for Kaiser Permanente, a private “managed care” plan in the States that has its own doctors who are paid a salary, not fees for each service like most physicians in Canada and the U.S., she said.

And the senators learned that provinces typically funnel half their budgets into health care, a sobering thought for the California bill’s proponents. They’re working now on how to pay for the proposed system, an issue that even Jerry Brown, the state’s Democratic governor, has said concerns him.

Regardless, it was “lovely” that everyone the Americans met in Canada shared their belief that health care is a “fundamental human right,” said Skinner.

Anglin said he wouldn’t discourage the Californians from setting up a single-payer system, but warned against banning private insurance or barring doctors from working in both the public and private sectors, saying people stuck on wait lists need a non-public escape valve.

Dr. Brian Day, the private-surgery clinic owner behind the B.C. challenge, noted that Canada was only one spot ahead of 11th-place U.S. in health-care rankings by the Commonwealth Fund think tank.

To examine this country’s experience “displays an unusual trait of pursuing mediocrity,” he said by email.