Most rich democracies provide citizens universal coverage for medical services—but not in the United States, where tens of millions of people remain without health insurance and costs far exceed spending in any other country.

Some health care advocates and politicians have argued the U.S. should emulate Canada’s “Medicare-for-all” or “single-payer” system, citing the many similarities between the two countries. Yet, few nations other than Canada have systems in which governments serve as the primary insurer for citizens; in many, governments structure a system of private nonprofit insurance.

Joe White

Joe White

Joe White, the Luxenberg Family Professor of Public Policy at Case Western Reserve University, discusses Canada’s experience and its relevance to the U.S. in a new article published in JAMA Internal Medicine. (White was invited to comment on a research article in the same JAMA issue by Canadian health care scholars, which identified ways that Canada’s system could be improved.)

“There is no simple answer to the question of if Canada health care system would work in the U.S.,” said White, the author of Competing Solutions: American Health Care Proposals and International Experience (Brookings Institution, 1995) and many research articles comparing the U.S. health care system to other countries.

The issue has been given new relevance by some Democratic Party candidates in the U.S. campaigning on the idea of creating a “single-payer” health care system with similarities to the country’s northern neighbor.

“Americans should neither reject nor accept some version of Canada’s so-called Medicare-for-all or single-payer system separate from much broader decisions about financing, benefits, and the roles of the national and state governments,” White writes in the article.

Canada’s track record over the past half century is better than America’s in many ways, White notes, especially access to and cost of care. This is especially important because the U.S. and Canadian systems were similar until the 1960s.

While Canada has achieved universal coverage for its citizens for medically necessary physician and hospital services, its current system is not perfect, White writes; for instance, pharmaceutical benefits work through a mix of employer-sponsored insurance and special programs for the poor and the elderly—much like in the U.S.

White spent the first half of 2018 on sabbatical from Case Western Reserve, studying health care systems in Europe, while teaching at Institut d’Etudes Politique in Lyon, France, and serving as a visiting scholar at the Erasmus University School of Health Policy and Management in the Netherlands.

White’s JAMA article also notes:

  • Canada’s system is also more fiscally constrained than systems in other universal-coverage countries that—unlike Canada—have special taxes or social insurance revenue dedicated specifically to health care;
  • Canadian health care financing is also caught in conflict between the national and provincial governments, but these weaknesses are not related to the single-payer approach; and
  • There is little evidence anywhere that some efficiency efforts, such as implementing electronic health records and pay-for-performance systems, have created significant cost savings—therefore, less eager implementation of those ideas in Canada should not be considered a weakness of its health care system.

For more information, contact Daniel Robison at