Watch an Expert Teach a Smug U.S. Senator About Canadian Healthcare

From the LA Times

A U.S. politician’s I-don’t-need-no-stinkin’-facts approach to health policy ran smack into some of those troublesome facts Tuesday at a Senate hearing on single-payer healthcare, as it’s practiced in Canada and several other countries.

The countries in question have successful and popular government-sponsored single-payer systems, provide universal coverage and match or outdo the United States on numerous measures of medical outcomes — for far less money than the U.S. spends. To explain this, Sen. Bernie Sanders (I-Vt.) asked seven experts to testify before his subcommittee on primary health and aging.

Those interested in how the U.S. matches up should watch the whole 90-minute session, viewable below. (The official subcommittee hearing record is also available.)

By far the high point of the morning was an exchange between Sen. Richard Burr (R-N.C.) and Danielle Martin, a physician and health policy professor from Toronto. The exchange, in which Martin bats down the myths and misunderstandings about the Canadian system that Burr throws at her, starts at about the 1:00:15 mark.

(The reference to “Premier Williams” is to Newfoundland Premier Danny Williams, whose decision to have a heart valve procedure in Miami, near where he owns a condo, rather than Canada, is widely viewed in Canada as a rich man’s failure to investigate the care available to him closer to home.)

Here’s a lightly edited transcript of the key moments, which start with Burr asking Martin about the observation in her written testimony that wait times for elective surgery in single-payer systems will lengthen as doctors move out of the public system:

BURR: Why are doctors exiting the public system in Canada?

MARTIN: Thank you for your question, Senator. If I didn’t express myself in a way to make myself understood, I apologize. There are no doctors exiting the public system in Canada, and in fact we see a net influx of physicians from the United States into the Canadian system over the last number of years.

What I did say was that the solution to the wait time challenge that we have in Canada — we do have a difficult time with waits for elective medical procedures — does not lie in moving away from our single-payer system toward a multipayer system. And that’s borne out by the experience of Australia. So Australia used to have a single-tier system and did in the 1990s move toward a multiple-payer system where private insurance was permitted. And a very well-known study by Duckett, et al., tracked what took place in terms of wait times in Australia as the multipayer system was put in place.

And what they found was in those areas of Australia where private insurance was being taken up and utilized, waits in the public system became longer.

BURR: What do you say to an elected official who goes to Florida and not the Canadian system to have a heart valve replacement?

MARTIN: It’s actually interesting, because in fact the people who are the pioneers of that particular surgery, which Premier Williams had, and have the best health outcomes in the world for that surgery, are in Toronto, at the Peter Munk Cardiac Center, just down the street from where I work.

So what I say is that sometimes people have a perception, and I believe that actually this is fueled in part by media discourse, that going to where you pay more for something, that that necessarily makes it better, but it’s not actually borne out by the evidence on outcomes from that cardiac surgery or any other.

(The ultimate zinger came at the end of the exchange, when Burr thought he had Martin down for the count about wait times in Canada, and she neatly put the difference between the Canadian and U.S. systems in perspective.)

BURR: On average, how many Canadian patients on a waiting list die each year? Do you know?

MARTIN: I don’t, sir, but I know that there are 45,000 in America who die waiting because they don’t have insurance at all.


  1. Robert Gabriel on March 13, 2014 at 10:53 pm

    ? I did not see any “Smug U.S. Senator”??? Saw Sen Bernie Sanders, who is totally for single payer health care, & several experts attempting to educate other senators. ??????

    • Healthcare-NOW! on March 17, 2014 at 12:15 pm

      Sorry, we changed the video to better reflect the title. The new video above shows the full interaction between Dr. Martin and Sen. Burr. Sorry for the confusion!

  2. Jeff Joseph on March 14, 2014 at 12:17 am

    I’m sure HCN knows Bernie is one of the good guys.

  3. R Kennedy on March 14, 2014 at 1:28 am

    The “zinger” is not in the clip. It’s at the end of the transcript at the bottom of page.

  4. mike russo on March 14, 2014 at 4:35 pm

    I did not see a smug senator but rather a clueless one.
    As far as someone from Canada , who happens to be financially comfortable, coming to America for heart surgery under the supposition the American health system is somehow superior may or may not be true. The point to be made here, is that no matter how superior a medical procedure may be, it is useless if one can not afford to pay the price for such a procedure. One would have to go bankrupt, die or worse.

  5. JB on March 14, 2014 at 5:21 pm

    Sen. Burr is clearly clueless and smug. How could you miss that if you actually watch the video?

  6. John "Hai" Knapp on March 14, 2014 at 11:51 pm

    Bernie gave very valid views. Canadian prime minister is actually a conservative; but backs their single-payer. I think in US I count as a liberal, but would pass as a conservative in Canada. I don’t see myself as a conservative or liberal, just one who wants to do the right thing.
    The answer is truly, HR-676, NOTHING BUT THE SINGLE-PAYER I apologize, there is some upload distortion that occurred; Stops couple times, something like the old groove disc vinyl phonograph records skipping. Borrows melody from “Nothing but the Blood of Jesus.”

  7. Chris Hagel on March 16, 2014 at 12:36 am

    This discussion including physicians and experts advocating single-payer, should have been televised on cable (at least) at the Senate Finance Hearings that first summer after Obama’s first presidential win; instead of that US style fascist farce that banned an open and reasonable description and explaination of single-payer by physicians and experts.
    A more informed citizenry about single-payer would result. However, this is not the desired effect of a government of, by, and for the health insurance industry, big pharma, (and banking-industrial interests, etc. for that matter.)
    Keep them misinformed, uninformed, disorganized etc., that’s their goal.

    I often meet people from all over the world. I briefly discussed health care with this guy from Canada. He said Canadians follow this topic here in the US. He said that they just don’t understand what the big deal we’re making about single-payer. Yes, he said it’s not perfect, but what is, however, in can be modified and improved.

    They would never trade their system for our fragmented, very expensive and wasteful, inhumane non-system of health care. (The fragmented,……… are my words which is true, of course. He basically said ………their health care system for ours.)
    This is the general viewpoint of people from Norway, Sweden, etc.

    • mike russo on March 17, 2014 at 4:09 pm

      the statement by Chris Hagel is well stated. statments like that should be posted on the internet as much as possible. Something that needs to be said and heard should be posted as many times as possible. The internet may be the best place to educate and enlighten people since that is the place that many people of all ages spend most of their time, especialy social media.

  8. Chris Hagel on March 16, 2014 at 7:45 pm

    Yes, he said it’s not perfect, but what is? In any case, it can always be modified and improved.

  9. AW on March 20, 2014 at 11:17 am

    I do not have insurance because I lost my job. After I saw Sen. Burr on C-Span I called his office and asked if he had some plan to allow me to have insurance. His plan is that I should move up north where they just hand out money (according to them). They seem to think that I am a worthless, no-good deadbeat. They think that only the rich bankers who trashed the economy are worthy of health care and not people like me. I used to be a teacher.