Sanders’s push for universal health care, which has already taken the Democratic Party further toward endorsing “single-payer” coverage than at any time since the 1970s, has often included praise for America’s northern neighbor. That’s rare in American politics, where talk of “American exceptionalism” is a cue for applause, and where branding an idea foreign can knock a few dozen points off its popularity. Last year, the Conservative Solutions super PAC turned Canada into collateral damage in an attack on Sen. Ted Cruz (R-Tex.).
“Cruz wants a value added tax, like they have in Canada and European socialist countries,” warned a worried narrator. (Cruz’s birth in Canada was an occasional point of controversy in the race.)
Democrats, wary of being accused of foreign schemes, have had their own complicated relationship with Canada. As he sold the Affordable Care Act in 2009 and 2010, President Barack Obama was careful to portray it as uniquely American. In Obama’s September 2009 speech to Congress, intended to jump-start the Senate’s health-care negotiations, he mentioned Canada to describe only what could not pass: “There are those on the left who believe that the only way to fix the system is through a single-payer system like Canada’s where we would severely restrict the private insurance market and have the government provide coverage for everybody.”
For decades, but especially since he ran for president, Sanders has flipped the script. If “every other major country in the world,” as he puts it, has an insurance program, America is falling behind by failing to provide the same.
“I live 50 miles south of the Canadian border,” Sanders wrote in a New York Times, as part of his legislative launch. “For decades, every man, woman and child in Canada has been guaranteed health care through a single-payer, publicly funded health care program. This system has not only improved the lives of the Canadian people but has also saved families and businesses an immense amount of money.”
It has taken some time for conservatives to adjust to the Sanders approach. In February, when Sanders faced off against Cruz in a CNN-hosted health-care debate, the Republican treated Sanders’s praise for foreign health-care systems as prima facie ridiculous.
“He often points to Canada, the United Kingdom; he says, why do we pay more?” Cruz asked. “Well, there’s a reason we pay more than those countries. We get a lot more and a lot better health care.”
It was an argument that conservatives deployed frequently during the ACA battles, but Sanders was not defensive. “He talks about rationing? We have enormous rationing in this country,” he said. “When you have 28 million people who have no health insurance, that’s rationing. When you have people who can’t afford to go to the doctor or can’t afford to buy prescription drugs, one out of five Americans can’t afford the prescription drugs their doctors prescribe, that’s called rationing. Except there’s no rule on that; there’s no law on that. It’s just people don’t have the money to buy what they need in terms of health care.”
This week, Sanders has gotten Canadian backup for his health-care pitch. Martin, whose Internet fame came from a 2014 Senate hearing on health care, appeared with Sanders at the bill launch, and sat with Sanders for a video that was viewed more than 250,000 times on Thursday. Across town, Ontario Premier Kathleen Wynne, a member of the center-left governing Liberal Party, took a detour in a speech about the North American Free Trade Agreement to praise Martin and the emerging American debate.
“Outcomes speak for themselves when we compare them to the U.S.,” Wynne said. “Better survival rates for those diagnosed with cancer, longer life expectancy in general and lower infant mortality. A higher percentage of people have a family doctor in Ontario than in the U.S. And working together, our health system achieves all of this while spending about half as much as the U.S. does per capita.”
In a brief interview after the speech, Wynne said she had focused on NAFTA, not health care, in her conversations with senators this week. But Canadians, she said, were happy to dispel myths about the pitfalls of single-payer. “I talk to thousands of people every year, and only once or twice do I meet a Canadian who’s gone to the States for care,” she said.
There are evident risks in Sanders’s embrace of Canada. The most obvious is that his plan, as Wynne and others point out, goes much further than Canada’s, paying for eye care and other policies that Canadians must obtain on their own. Another is that while Sanders proposes a federal program, Canada’s began in provinces and remains a partnership between provinces and Ottawa, with local governments managing their own programs and paying 75 percent of the bills.
“That’s not Medicare. It’s Medicaid. But with block grants,” said Michael Cannon, a libertarian health-care analyst at the Cato Institute. “If Bernie wants the United States to move in the direction of Canada’s health-care system, he should be advocating not ‘Medicare for all’ but ‘Medicaid block grants for all.’ Interestingly, it is actually Senate Republicans who are proposing to move in the direction of Canada’s health care system, while Bernie Sanders wants even more federal control.”
Another problem, which the Republican National Committee jumped on Thursday, is that Canadians are unhappy with their own wait times for elective procedures. In his interview with Martin, when Sanders asked about problems in Canada, Martin was honest: The waits are a problem. “Sometimes it’s a few months, sometimes it’s a year,” she said. “In some places, it’s sometimes it’s been even longer than that, that people wait for a hip or a knee replacement. And I think that is totally unacceptable.”
The RNC quickly captured that moment and sent it to reporters, though the clip cut off before Martin put the problem in context. “What we have determined is that although those waits are a problem, the reason that we have difficulties with waits is that we have done a poor job with the delivery systems,” she said.
Sanders nodded, and when the interview ended, his staff took to Twitter, to continue talking up Canada.