Sep 18, 2017

How Bernie’s single-payer plan stacks up against Canada’s

Sen. Bernie Sanders' health care plan is more ambitious than Canada's. ( AP Photo/Jose Luis Magana)

About a third of Senate Democrats — and most of the party's early presidential contenders — have signed on to Sen. Bernie Sanders' bill to establish a single-payer health care system.

Why it matters

“Single payer" is a catch-all term that means different things to different people. For most people, it just means cutting out private insurance companies, or at least minimizing their role. But the world's single-payer systems are not created equal, and the details — what's covered, how prices are set and how costs are spread across the system — make a huge difference.

Sanders referenced the Canadian system as he introduced his plan, suggesting that if the United States' upstairs neighbor can operate a government-run plan, so should we.

The facts
  • Sanders' plan is actually quite a bit more generous than Canada's — which means it would be more expensive, too.
  • In the U.S., several entities — Medicare, Medicaid and a slew of private insurers — pay for health care. In a pure single-payer system, by contrast, there's just one payer: the government. But in practice, single-payer systems aren't usually that pure.
  • The government accounts for about 70% of Canada's overall health care spending; private insurance and out-of-pocket spending make up the rest.
  • Canada's version of single-payer covers its citizens' hospital care, doctors' visits, mental-health care and diagnostic procedures. It does not cover dental, vision, prescription drugs or home health. Roughly two-thirds of Canadians have private insurance plans to cover those services.
  • Sanders' plan would cover everything, including vision, dental and prescription drugs. It also wouldn't include any cost-sharing from patients, like co-pays or deductibles. Canada doesn't require any cost-sharing for the services its government program covers, although many other single-payer systems do.
  • Because it covers more, Sanders' system would presumably be more expensive than Canada's. But that doesn't necessarily mean it would cost more, overall, than what we have now. Our per-capita health care spending today is more than double Canada's.
  • Still, the more generous a government-run plan is, the more tax revenue it needs to support itself. Taxes would need to go up dramatically to finance Sanders' proposal. And he hasn't said how he would pay for his plan.

Go deeper

Coronavirus dashboard

Illustration: Aïda Amer/Axios

  1. Global: Total confirmed cases as of 4 p.m. ET: 5,463,392 — Total deaths: 344,503 — Total recoveries — 2,195,325Map.
  2. U.S.: Total confirmed cases as of 4 p.m. ET: 1,653,904 — Total deaths: 97,948 — Total recoveries: 366,736 — Total tested: 14,163,915Map.
  3. World: Italy reports lowest number of new cases since February — Ireland reports no new coronavirus deaths on Monday for the first time since March 21 — WHO suspends trial of hydroxychloroquine over safety concerns.
  4. 2020: Trump threatens to move Republican convention from North Carolina — Joe Biden makes first public appearance in two months.
  5. Public health: Officials are urging Americans to wear masks over Memorial Day.
  6. Economy: New York stock exchange to reopen its floor on Tuesday — White House economic adviser Kevin Hassett says it's possible the unemployment rate could still be in double digits by November's election — Charities refocus their efforts to fill gaps left by government.
  7. What should I do? Hydroxychloroquine questions answeredTraveling, asthma, dishes, disinfectants and being contagiousMasks, lending books and self-isolatingExercise, laundry, what counts as soap — Pets, moving and personal healthAnswers about the virus from Axios expertsWhat to know about social distancingHow to minimize your risk.
  8. Other resources: CDC on how to avoid the virus, what to do if you get it, the right mask to wear.

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Updated 2 hours ago - Politics & Policy

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