Democrats Need To Nominate A Credible and Sensible Candidate for the 2020 Presidential Election

Posted February 8, 2019

The Democratic contenders for the 2020 presidential nomination are providing remarkably ill-informed advocacy for national health insurance.

Nova Scotia’s publicly funded health care costs about C$4,500 per person. That covers almost everything that happens in a doctor’s office or hospital visit, but not much for dental or prescription drugs.

Nova Scotians pay 15% sales tax on almost all goods and services. This only covers two thirds of the cost of government funded health care. The rest is covered by a portion of income taxes.

American public spending in 2017 on Medicaid (health coverage for some low-income people, families and children, pregnant women, the elderly, and people with disabilities), Medicare (65 and over), and military families amounted to just over US$5,000 (C$6,600) for every American, but only provided benefits to 37% of them.

Including privately funded health care, Americans spent US$10,200 (C$13,400) per person.

Americans’ spending on health care is substantially larger than any other advanced economy, yet their population health numbers are worse than most developed countries.

Into this troubled picture, Senators Sanders, Gillibrand, Harris, and Warren, among others, are proposing various versions of “Medicare for all” or other single payer systems.

Senator Kamala Harris’ declaration of support for Sanders’ proposal, “It’s just the right thing to do… Someone should tell my staff…” does not inspire faith in the depth of her analysis.

A single payer system has some big advantages. Administratively, it costs a lot less, not just because there are no insurance companies involved, but also because there is far less work for the legal community disputing how much doctors and hospitals should be paid.

American hospitals spend 25% of their revenue on administration; Canadian hospitals spend 12%. Canadian doctors spend a quarter of what their American counterparts spend on billing and administration.

The cost of health care in a single payer system should be funded by some combination of sales and income taxes, and possibly an annual per person charge. Americans already pay more taxes for programs that cover 37% of them than Canadians pay for a system that covers everyone. It is the largest destination for tax dollars in both countries.

That said, there are some hard truths that must be recognized.

  1. In a single payer system, the only way the payer can keep control of the budget is by limiting supply. In most European countries with national health care, the patient pays some portion of the cost, with further subsidies for people with low incomes.
     
    In Canada, the government pays 100% of the cost, so there is no financial deterrent to demand. In that circumstance, there will always be an excess of demand over supply, often resulting in substantial wait times for care that is not urgently required.
  2. The single payer system must cover everyone. In the context of limited supply, the best care must go to the sickest patients, not the richest. It should not be possible to buy privileged access to the publicly funded system.
  3. Canada unwisely makes it difficult to buy government-insured services outside the system. Americans would do better by following what other developed economies do. Allowing people to buy care outside the public system, either directly or through insurers, reduces wait times for everyone.

Choosing to ignore these realities may endear candidates to the hard left Democrats, but it will open up their presidential contender to withering criticism in the 2020 campaign, and not just from Republicans.

Bernie Sanders energized many Democrats with his 2016 campaign, but some of his ideas—free college and university tuition; unlimited single payer health care including prescription drugs, vision, hearing, and dental care; universal child and prekindergarten care—are fiscally untenable. This year’s contenders are endorsing these and other expensive ideas without providing any credible plan to pay for them.

Losing to Donald Trump in 2016, a candidate many voters found repulsive, was not an easy feat. Trump maintains a 55% disapproval rating in February 2019. But the Democrats could lose again in 2020 if they are not able to offer a candidate who is relatable to the average voter.

That would be a great disservice to the American people and a disappointment to leaders around the world (well, perhaps excepting thugs such as Putin in Russia, Sisi in Egypt, Duterte in the Philippines).

The Democrats will do a good service to themselves, to their country, and to the world if they nominate a sensible, thoughtful, credible candidate for the 2020 election.

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  • Today I noted your article. First off I am always amazed that pundits in our little backwater paper in Halifax always have to write silly articles ending in predictable attacks on Trump. As you are aware Americans care less about about what Canadian pundits think! Down here Trump is not thought of as the antichrist. Republicans are very happy that Harris is now on record as being all in for our Canadian one payer government run medical coverage, Republicans will tear her and Bernie apart in 2020. You are right the Democrats need to produce a viable candidate but they will not. They will nominate another McGovern and get wiped out!
    It is not wise for Democrats to act like Canadian politicians where government is always good and when it fails like it always does in NS the solution (supported by the CH) is always more government. At no time is it thought that the problem is government!
    Mr Black I would recommend you stay out of American politics and spend more time on why SNC Lavalin gets protected by Justin!
    That would be more useful to your readers.

    Response from Bill Black:
    Thanks for your note.
    The article was not written for Americans but rather for Nova Scotians who I find to be quite interested in what is happening Stateside.
    There are sharp divisions about Trump in the US and I do get to listen to those who are supporters. You are right that there is a material risk that the Democrats will nominate a candidate like McGovern and if so will probably lose.

    Graeme Tweedie | February 10, 2019

  • Mr. Black. Having been under Medicare since 1997, when I became eligible, I can tell you that Medicare is the best health system I have experienced. By the way Medicare once started at age 65 for everybody, but an increase to age 67 is planned.
    I never had to wait for appointments, by that I mean no longer than a month, and mostly within a week, maybe two. Care was excellent.
    I have dual citizenship and moved back here last year, so am now under the Canadian system.
    I was fortunate enough to get a GP almost immediately, and have never to date had a problem getting an appointment, although it’s now a month or two, instead of a week. I do recognize that if you don’t live in this local area, it is much more difficult beyond metro boundaries.
    Care here is excellent, and in my experience both countries medical staff do what the patient needs.
    Now having said all that, there is no way that Americans will ever accept a one state, country or whatever medical system.
    The private health system has the ears of Americans, and the private sector is much too large to accept a universal system. Any why is that? Because they have a very large advertising budget, and that is why the annual costs per person are so high compared to Canada, or England for that matter. The problems in other countries universal systems that are brought to the ears of Americans is too heavily ingrained in the American psyche.
    And the red tape for Medicare. Unbelievable. I received each month a statement of everything medical I had had, and once every three months a consolidated statement covering all that had happened the three months previous. If that stopped, our forests would be safe!
    Oh, and by the way, one of the private health insurers favorite points, is pointing out the problems with Canada’s system. If you think NS’s issues are not noticed, well think again.
    To be honest I’d take the US’s system over Canada’s as it is at present, but only because here in Nova Scotia, one cannot be sure what the NS administration is going to do next. In Florida, the right to know of the patient is paramount. I’m not convinced that our bureaucracy is on that wave length.
    And so far, from my vantage point, do not appear to be concerned about the affect on the population of some of their decisions.

    Response From Bill Black:–
    John thank you for this.
    The Canadian system is good for acute care but for everything else the limits on supply often mean long waits.
    The American system is very expensive. There are lots of people for whom it is good but many others for whom it is not. That is why population mortality is so high compared to other advanced economies.

    Response from John Bassett:–
    Thanks for the response. I should have added that while there is a universal US government plan implemented by Barrack Obama available to all pre-age Medicare citizens, it is, as far as I can discern, quite costly. On the other hand it does fit the bill for a lot more Americans, who had no reasonable choice before. And a lot has to do with individual states, whether they want to opt in or not. If not, then there is really no choice for most middle class income citizens. It’s a work in progress interrupted by too many Republicans and Donald Trumps being elected at the last election. The coming mid-term elections may resolve some of these problems. But there is still the medical insurance companies to deal with, no matter who wins.

    Response from Bill Black:–
    Thanks again.
    We have a place in Florida for part of our winter. I and many others had something like this conversation when “Obamacare” came into being:
    American : “Well, now we have Canadian-style Medicare.”
    Canadian: “ We don’t understand what you have but it is not Canadian-style Medicare.”

    John Bassett | February 10, 2019

  • Hi Bill: Have been very supportive of our health care system, but:
    single payer removes any real opportunity for competition,
    current popular physician payment methods stifle incentive, leading to “physician-centred care” as opposed to patient centred care and to generic medicine.Time for a major re-think.The Dems had better be careful!

    Ron Gregor | February 9, 2019

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