As an American living in Canada for nearly 10 years now, I can say definitively that my wife and I are much happier with the single-payer system than we ever were with the private insurance we received in the US. That said, Medicare for all advocates make the transition from the current system to something like Canada’s single-payer sound easy: just pass a bill and in two or three years everyone will have Medicare. That’s not how it happened in Canada, a country with about 10% of the population of the U.S. and far fewer jurisdictions (10 provinces and three territories as opposed to 50 states). Canada began moving toward universal coverage in the late 40s with reforms implemented in Saskatchewan by Tommy Douglas (Kiefer Sutherland’s grandfather). From there the policy spread over the next few years to other provinces as they began adopting health plans of their own. Initially, health coverage was limited largely/exclusively to hospital care. The coverage has since expanded to include doctor visits and some other medical expenses. However, vision and dental still aren’t covered. Nor are prescription drugs though there is some assistance for low income people in at least some provinces. In addition, because the government negotiates directly with the pharmaceutical companies prices are much lower on average than they are in the states. Nonetheless, some supplemental insurance is still required for certain services and about 25% of Canadians lack such additional insurance.
The lesson from Canada, therefore, is that something like a public option is probably inevitable even if only as a transition to some larger public system in the future. Canada didn’t get where it is today overnight and Bernie Sanders and Elizabeth Warren are not helping the Medicare for all cause by pretending the kind of transformation they are advocating can happen within a few years. Indeed, they could be setting Americans up for a huge disappointment by making such promises. Furthermore, advocates of single-payer need to stop attacking candidates that are taking a more cautious/realistic approach as ‘sell outs’ or framing this as a debate between centrism and progressivism. The public option was the radical idea ten years ago when Obamacare was first being debated. Now, virtually every Democratic candidate is on board with it. That’s significant progress. Even many public option proponents are arguing it puts the country on a path to single-payer or some other similar and far more affordable universal system. Building a coalition means listening to people’s concerns and addressing the issues they raise rather than attacking them for not accepting your ideas without reservation. Single-payer is a means to an end (universal coverage), not an end unto itself. If, in the end, America gets to affordable universal coverage and the system isn’t just like Canada’s it will hardly be the end of the world. Save your moral indignation for politicians who are refusing to accept that everyone deserves healthcare instead of wasting it on candidates who share with you the conviction that they do deserve it.