with Paulina Firozi


Democrats trying to sway voters to embrace Medicare-for-all could just send them on a trip to Canada.

Sens. Bernie Sanders (I-Vt.) and Elizabeth Warren (D-Mass.) often cite America's northern neighbor as they argue on the presidential campaign trail for a single-payer system. Sanders’s Medicare-for-all bill proposes much more generous coverage than Canada’s system, but the country is still a tangible example of what happens when every citizen has a basic threshold of health coverage.

“As middle-class Americans express growing anger about skyrocketing drug prices and mounting co-pays, premiums and deductibles, the Canadian health care system has emerged as a shadow player in the 2020 Democratic presidential primaries — offering a window onto a parallel reality where 37 million people’s health care needs are largely covered from birth to death,” my colleague Yasmeen Abutaleb writes.

Yasmeen recently visited Alberta to hear from patients there what it’s like to use the system. Unlike many Americans, Canadians don’t have to agonize over whether they can afford to see a doctor or take their kid to the emergency department. They don’t go bankrupt or lose their homes over medical debt.

A few of the people Yasmeen spoke with:

  • Bryan Keith, diagnosed with prostate cancer three years ago. He paid no out-of-pocket costs for a slew of tests, specialist consultations, a month of radiation treatment and a surgical procedure.
  • Samantha Ellen Gordon, whose premature daughter needed three surgeries and a nearly six-month hospital stay two years ago. In May, her second daughter was delivered via emergency C-section.
  • Rick Zroback, who underwent eye surgery to remove “floaters,” or spots in his vision.

“By all accounts, Canada’s system, called Medicare, is simpler, more equitable and consumer-friendly than America’s patchwork of public and private plans that leaves millions without sufficient coverage,” Yasmeen writes.

“Every resident of Canada has guaranteed access to covered benefits through provincial- and territorial-administered public insurance plans — and pays taxes to support that system,” she notes. “There are no premiums, co-pays or deductibles for a broad menu of care that includes doctor visits and emergency care, hospital stays, surgical care and maternal and newborn services.”

Sanders, the original author of Medicare-for-all legislation, has spotlighted Canada repeatedly. Over the summer, he took diabetic patients on a bus trip from Detroit to a pharmacy in Windsor, just over the border, to illustrate the lower insulin costs compared with the U.S.

He has invoked the Canadian system during the debates.

“I’ll tell you what I believe in terms of democratic socialism,” Sanders said during the September presidential debate. “I agree with what goes on in Canada and in Scandinavia, guaranteeing health care to all people as a human right.”

Yet all is not rosy in Canadian health care — something single-payer opponents have been quick to point out. Canadians tend to face longer wait times to see specialists or undergo elective procedures, especially hip and knee replacements and cataract surgery. An analysis of 2016 data found 39 percent of Canadians reported waiting at least two months to see a specialist, compared with 6 percent in the United States. Specialists also comprise a larger share of the U.S. total health workforce.

Those waits cost Canadians $2.1 billion in lost wages in 2018, with average wait times about 20 weeks from referral to receipt of treatment — 113 percent higher than in 1993, per Yasmeen.

“Meekly accepting excessive wait times as the price of a functioning health care system in Canada is the exact opposite of what we should be doing,” the Toronto Sun editorialized after the studies were released.

Here’s another catch: There are a lot of health-care services — including prescription drugs and dental benefits — the Canadian plan doesn’t cover. That’s why about two-thirds of Canadians pay premiums for supplemental private insurance, typically through their employers, to help with those costs.

The limits on coverage are partly why Canada is able to maintain its system — and raises questions about the no-limits plan Sanders wants to provide in the United States, which experts across the political spectrum have said would be enormously expensive.

Canadians don’t necessarily pay many more taxes than Americans to fund the system. The United States collected $14,794 in taxes on average from its citizens in 2015, while Canada collected $13,771, according to the Organization for Economic Cooperation and Development.

Despite the shortcomings of Canada’s system, here’s perhaps its biggest selling point for Sanders and Warren to tout: It has better health outcomes than the United States, even though it spends far less money on health care per person.

“Canadians’ life expectancy is 82 on average — more than three years longer than Americans’,” Yasmeen writes. “It also boasts a far lower rate of deaths from treatable causes, at 59 per 100,000 residents, compared to 88 per 100,000 residents in the U.S. The infant mortality rate in Canada is 4.5 per 1,000 live births, compared to the U.S. rate of 5.8.”


AHH: California is suing e-cigarette maker Juul Labs, alleging that it marketed its products to teenagers and fueled a youth vaping crisis.

“The lawsuit from California’s attorney general is the latest legal action against Juul, the multibillion-dollar vaping startup that has been widely blamed for helping spark the teen vaping craze,” the Associated Press’s Matthew Perrone reports. “California is the second state to sue the company, following a North Carolina lawsuit in May. Illinois, Massachusetts and several other states are also investigating the company.”

At a news conference yesterday, California Attorney General Xavier Becerra said the company used “Big Tobacco’s playbook and the results were predictable — millions of teens and young Americans now use their product. … In California, we will not allow kids to be lured in by deceptive practices.”

The lawsuit also comes on the heels of reports that President Trump is backing away from his pledge to ban most flavored e-cigarettes. With a proposed ban all set to go and cleared by regulators, the president reversed course “because of worries that apoplectic vape shop owners and their customers might hurt his reelection prospects,” our Post colleagues Josh Dawsey and Laurie McGinley wrote.

OOF: South Dakota Gov. Kristi L. Noem (R) unveiled a new anti-meth ad campaign yesterday that immediately went awry.

The mind-boggling message from the nearly $450,000 campaign: “Meth. We’re On It.”

The campaign includes advertisements with images of people alongside the “Meth. I’m On It.” motto and a website: onmeth.com. Instead of addressing what the governor described as a growing crisis in the state, the ads appeared to suggest all South Dakotans are addicts, our Post colleague Michael Brice-Saddler reports. By last night, social media had a field day with the slogan, which many said made it sound as though everyone in the state is using the drug.

Bill Pearce, assistant dean at the University of California at Berkeley’s Haas School of Business, told Michael that the “poor strategy and poor execution” took away from any sincere effort. “I can’t imagine this is what they intended to do; any good marketer would look at this and say: ‘Yeah, let’s not do that,’” Pearce said. “I’m sure South Dakota residents don’t like being laughed at. That’s what’s happening right now.”

Noem seemed to respond to the backlash in a tweet:

“South Dakota’s anti-meth campaign launch is sparking conversations around the state and the country,” Noem said in a statement to The Post. “The mission of the campaign is to raise awareness — to get people talking about how they can be part of the solution and not just the problem. It is working.”

OUCH: Congressional Democrat are asking the White House to explain why it appears to be reversing course on a potential ban on flavored e-cigarettes.

Rep. Raja Krishnamoorthi (D-Ill.), who leads the House Oversight and Reform subcommittee on economic and consumer policy, sent a letter to the Food and Drug Administration and the White House Office of Management and Budget to ask about the status of the proposed ban. “The strong promises made by the President and his Administration to address the youth vaping epidemic were incredibly encouraging,” he wrote, the Wall Street Journal’s Thomas M. Burton and Alex Leary report. “Now, however, the delay in finalizing the Administration’s compliance policy raises deep concerns.”

Meanwhile, Sen. Patty Murray (D-Wash.), the top Democrat on the Senate Health, Education, Labor and Pensions committee, told the Journal she plans to ask Stephen Hahn, Trump’s pick to lead the FDA, who will appear before the committee this week, about “whether he will implement the strong policy that was originally announced — or cave to political pressure.”


— Republican lawmakers are releasing a video series to break down their view on the impact of House Speaker Nancy Pelosi’s (D-Calif.) drug pricing measure, which would allow the federal government to directly negotiate lower prices with private companies in Medicare’s prescription drug program.

In the first video in what is set to be a three-part series over three weeks, Rep. Dan Crenshaw (R-Tex.) sits down with Rep. Greg Walden (R-Ore.), the top Republican on the House Energy and Commerce Committee, to discuss “what the talking points are and how to debunk the talking points.” In it, Walden in part explains concerns that the bill could “stifle innovation.”

“Speaker Pelosi's partisan bill is packed with bad policy that will drive out innovation and result in fewer cures available to patients suffering from diseases like cancer, Alzheimer’s, or ALS,” Walden and Crenshaw said in a news release sent to The Health 202. “The American people deserve the truth — not misleading talking points from Democrats — about how this bill will impact their lives. That’s why we released this video series.” 

Pelosi is eyeing a December vote on her signature drug pricing plan.


— Aetna is rejoining America’s Health Insurance Plans, the powerful insurance trade association. The nation’s third-largest insurance company had exited from AHIP back in 2016 — the second major member to do so after UnitedHealth left in 2015.

“Working together, we will continue to focus on solutions to improve health care for every American,” AHIP spokesperson Kristine Grow told Politico about the move.


— The Democratic Attorneys General Association announced it will only endorse candidates who support advancing abortion rights. It’s the first national party committee to impose such a requirement, the New York Times’s Lisa Lerer reports.

The group, which helps recruit and fund candidates, will require them to make a public statement of support on the issue.

“The new standard is unlikely to have an immediate impact on incumbents: Of 27 Democratic attorneys general currently in office, just one — Jim Hood of Mississippi — describes himself as a ‘pro-life Democrat,’” Lisa writes. “But officials believe it could have a ripple effect through the Democratic ecosystem, reflecting the changing mores of a national party that has moved sharply to the left in the Trump era and embraced a set of purity tests on divisive social issues.”

“Attorneys general are on the front lines of the fight for reproductive freedom. They have the power to protect your rights and we have the power to elect them,” New York attorney general Letitia James said in a video from the group. “It’s your body, your family, your choice, your vote.”


— Improper payments to health providers in the traditional Medicare program have fallen to their lowest levels since 2010, the Centers for Medicare and Medicaid Services announced yesterday. The agency estimates Medicare made $28.9 billion in improper Medicare payments in fiscal year 2019, $7 billion less than in 2017.

“At a time when Medicare’s ballooning costs are threatening the long-term sustainability of the program, President Trump is taking action to protect the program,” CMS Administrator Seema Verma said in a statement. “Under President Trump’s leadership CMS is pulling every lever at its disposal to safeguard precious resources and direct them to those who truly need them — both today and in the future.”


— In a perspective piece in The Post, Simon Fraser University professor Jeremy Snyder argues there’s minimal evidence of success from the “Right to Try” law often touted by President Trump. The bill Trump signed in May 2018 sought to allow terminally ill patients access to drugs not fully approved by the FDA if they’re out of other options.

“Unfortunately, Right to Try appears to be helping very few people,” he writes. “ … The idea of letting people take a gamble like that has intuitive appeal. But almost a year and a half after the law’s enactment, scholars and reporters looking for evidence of its effectiveness have turned up only a small number of people who have used the law to obtain treatment.”

He specifically criticizes the president’s “boasts” about the law — at a rally in Louisiana last month, Trump said: “I tell you, it’s a miracle — so many people have been saved.”

“But Right to Try has done little, if anything, to increase access to investigational drugs, and it’s a cruel falsehood to tell terminally ill people that the law has led to hundreds or thousands of ‘miraculous’ recoveries,” Snyder writes.

— And here are a few more good reads: 





Coming Up

  • The Senate Health, Education, Labor and Pensions Committee will hold a hearing on the nomination of Stephen Hahn to lead the Food and Drug Administration on Wednesday.
  • Senate Finance Committee Chairman Charles E. Grassley (R-Iowa) will participate in a Committee for a Responsible Federal Budget event on health care on Thursday.


After promising to ban most flavored e-cigarettes, President Trump has reportedly backed off the ban. Here is what he has said previously on vaping. (The Washington Post)