More than 30 million Americans have gone without health insurance in the last year. Other high-income nations cover their entire populations for a lot less money than the U.S. already spends. But does a universal health care system help save lives in a pandemic? For answers, William Brangham looks to our northern neighbor Canada and its single-payer system.
Notice: Transcripts are machine and human generated and lightly edited for accuracy. They may contain errors.
Judy Woodruff:
More than 30 million Americans have gone without health insurance during the pandemic.
We recently looked at how several other high-income nations cover their entire populations for a lot less money than we spend. But does a universal health care system help a country respond to a pandemic?
For answers William Brangham, along with producers Jason Kane and Claire Mufson, look to our northern neighbor, Canada, and its single-payer system.
This story is an excerpt from our oncoming — or upcoming "NewsHour" documentary "Critical Care: America vs. the World."
Ruth Castellanos:
I would say, about the seventh day, I woke up with this massive headache, just pain in my skull, my neck, my spine. I never felt anything like it before.
William Brangham:
Ruth Castellanos started feeling sick from the coronavirus last May. Her symptoms kept progressing. And then, one night, at home in Flamborough, Canada, it got worse.
Ruth Castellanos:
I woke up and I couldn't breathe. My husband was sleeping. My dog was sleeping.
I was trying to wake them, but I didn't seem to have strength in my arms. And I thought, 'I'm going to go. This is my time.' And I just looked at my husband one more time. And then I just said, 'OK, I need to just be brave, because this is going to happen.'
Newscaster:
A hundred and fifty-five thousand doses of Pfizer arrived…
William Brangham:
The immediate crisis passed, but her other symptoms didn't. They were so constant, she had to quit her two jobs. Castellanos struggled at first to find a doctor who'd listen and not blame her symptoms on anxiety.
Ruth Castellanos:
I tried to get some food, and it was so much work, I couldn't even get it out of the car.
William Brangham:
She captured her anguish in this video.
Ruth Castellanos:
I'm in so much pain.
William Brangham:
She's now a COVID long-hauler, takes 20 different pills a day, and sees a neurologist, a cardiologist and a pulmonologist.
Ruth Castellanos:
I have an appointment next Thursday.
William Brangham:
While she has to live with this chronic condition, because she lives in Canada, with its taxpayer-funded, universal health care system, at least she doesn't have to worry about getting good care or affording it.
Ruth Castellanos:
That's all part of our universal health care. So I'm not paying any of those bills.
William Brangham:
But does a universal system help more broadly when a pandemic breaks out?
Dr. Danielle Martin:
Welcome back.
William Brangham:
Dr. Danielle Martin is a family doctor And executive vice president at Women's College Hospital in Toronto.
Danielle Martin:
The first and most obvious success of the Canadian health care systems in response to the COVID-19 pandemic is that, if anyone has symptoms of COVID-19, they have been able to access testing free of charge, and, heaven forbid, if you require an ICU stay, if you need to be intubated and ventilated, all of those things are covered under the public system.
William Brangham:
Martin notes that Canada has lost many thousands of people to COVID, and has struggled, in parts, with its response.
Danielle Martin:
This is one of the things about COVID-19. It's exposed in every country the places where you built something strong from the foundations up, and it's also exposed the places where you're running around trying to patch things on in order to make it work.
William Brangham:
Canada is a single-payer system, though, here, each of the 13 provinces and territories control their own system.
Doctor and hospital care is covered, but major gaps exist. One example — most medications outside the hospital aren't covered, but supplemental insurance, which most get through their work, picks up the slack.
During the pandemic, Canada has had much better outcomes than the U.S. Its overall death rate is about three times lower than America's.
Dr. Kieran Moore:
So we have built quite an effective system within Ontario to respond to COVID-19.
William Brangham:
Dr. Kieran Moore is the head of public health for Kingston and the surrounding region in Southern Ontario.
This holiday destination could've easily become a COVID hot spot. But this area of roughly 200,000 people has had only two deaths during the whole pandemic.
Kieran Moore:
That's the benefit of having a universal health care system, because all partners are working together. There's not a private-public separation of responsibility.
Woman:
That's in her period of acquisition, and you said that was a week-and-a-half ago.
William Brangham:
Once a positive case is identified, nurses spring into action.
Man:
Our records indicate that you were exposed on February 14.
William Brangham:
With daily calls, they make sure people are safe, staying home and not spreading the virus
Woman:
All right, so you haven't traveled outside of the province in the last 14 days?
William Brangham:
Public health departments can levy serious penalties if you don't.
Woman:
You can be subject to a fine of $5,000 per day.
Amanda Antoine:
I had only seen what was on the news, and it was all bad, so I was assuming the worst.
William Brangham:
For a patient like Amanda Antoine, who tested positive last year, she got the kind of follow-up care that's often lacking in the U.S.
Amanda Antoine:
I got a call from the public health nurse every day. And if I was having a bad day, it was a couple of times. Any questions that I had, she would find out and get right back to me.
William Brangham:
Canada's system has also largely avoided what we saw in certain parts of America — hospitals being overrun and straining to care for a surge of COVID patients.
Dr. Hannah Wunsch:
We haven't experienced anything like colleagues in places like New York City have experienced or elsewhere in the world where they were hit the hardest.
William Brangham:
Dr. Hannah Wunsch Works in critical care medicine at Sunnybrook Health Sciences in Toronto.
Because hospitals here operate within a coordinated system…
Dr. Michael Scott:
It's been really busy up here.
William Brangham:
… an oversight board, like this one, can shift patients from stressed facilities to those with extra capacity.
Michael Scott:
We have over 50 patients in the hospital, 15 in the unit, 14 ventilated.
William Brangham:
That often didn't happen in places like New York during the early days of the pandemic.
Dr. Hannah Wunsch:
Baseline, U.S. hospitals and health networks are very much competing against each other. And so while many of them have learned to function together over time out of necessity, it's not baked into the system. It's not inherent to the way they function in normal times.
William Brangham:
But Canada's experience also shows the gaps that can occur when a country achieves universal care, but stops there.
Canada has seen many of the same problems we have seen in the U.S. with our fragmented system. The vast majority of Canada's COVID-19 deaths, roughly 70 percent, have occurred in long-term care facilities, most of which aren't a part of the public system. The toll has also been particularly hard on marginalized communities.
Dr. Andrew Boozary:
Really, to me, what COVID has exposed is that the preexisting condition has been chronic neglect.
William Brangham:
Dr. Andrew Boozary teaches public health and also works at a clinic serving people experiencing homelessness
Andrew Boozary:
We can't say that we have a perfect system. We can't say that we have one, when you think about our shortcomings on drug coverage, on access to mental health and supports, to the social supports taking place.
You really can't say that we have completely figured this out. And, really, when you think about the brunt of who has had to be punished by our failure to do so, it's been marginalized communities, racialized populations, and really people living in poverty.
William Brangham:
And then there's the issue of vaccines. If there is anyone in Canada who should be near the top of the list for vaccination, it's 80-year-old breast cancer patient Ruth Ann Wharram.
Her cancer care, she says, has been superb.
Ruth Ann Wharram:
Out of this world, fantastic. I have been so blessed.
William Brangham:
But she, like millions of other older, medically vulnerable Canadians, was still waiting to get a vaccine in late February, when we visited. A complicated negotiation with vaccine manufacturers and a failure to invest in its own drug production and delivery put Canada far behind the U.S.
And, today, only 2 percent of Canada's population has been fully vaccinated, compared to roughly 22 percent of Americans.
C.C. Wharram:
There's your guy.
Ruth Ann Wharram:
That's my doctor.
William Brangham:
But Wharram's son C.C., who's a professor in the U.S., is glad his mother lives in Canada.
C.C. Wharram:
With the death rates in the States compared to what we have had here, I guess I'd rather be waiting for a vaccine than have three times the per capita deaths. That's what we can sort of look at.
William Brangham:
Ruth Ann was confident the vaccine issues would be smoothed out soon. She told us how angry it makes her when she hears politicians in the U.S. demonize her nation's health care system.
Ruth Ann Wharram:
Why wouldn't it make me angry? I have this ability to go to a doctor when I need it, and not just me, but my next-door neighbor who is working at McDonald's on a low-income wage.
Why is the system down in the States so adamant against it? I can't understand that. I just can't understand it.
William Brangham:
We share a common border, but have two very different outlooks.
And as yet another spike of infections hit both countries, with new variants spreading quickly, several Canadian provinces have imposed new restrictions, while, in America, it's largely full steam ahead to reopen.
For the "PBS NewsHour," I'm William Brangham.
Judy Woodruff:
Our full documentary, "Critical Care: America vs. the World," airs on PBS stations starting April 21.
