While the media focuses on the public spat between Republican presidential front-runner Donald Trump and Fox News, a prominent health care expert says Trump’s praise for single-payer health care systems in Canada and Scotland doesn’t survive an examination of the facts.
During Thursday’s GOP debate, Bret Baier of Fox News opened up a section of questions about Obamacare by asking Trump about his shifting position on health care reform.
“Now, 15 years ago, uncalled yourself a liberal on health care. You were for a single-payer system, a Canadian-style system. Why were you for that then and why aren’t you for it now?” asked Baier.
Trump responded that his opinion back in 2000 related to the situation at the time and does not reflect his position now.
“As far as single payer, it works in Canada. It works incredibly well in Scotland. It could have worked in a different age, which is the age you’re talking about here,” answered Trump, before moving on to discuss his endorsement of allowing health care policies to be purchased across state lines.
Grace-Marie Turner is president of the Galen Institute and battled Obamacare as well as the Clinton health care reform efforts in the 1990s. She says the first thing to remember is that Canada and Scotland have two different systems.
“The Canadian system is a single-payer system. The government is the payer, both the provinces and the federal government for all health care services. In Scotland, it is really socialized medicine, in which the government owns hospitals and employees physicians. So they’re two different systems,” she said.
She also doesn’t buy Trump’s argument that circumstances were that much different 15 years ago, when the GOP front-runner embraced the single-payer approach.
“He’s basically saying that either one of them would have worked better and could have worked in this country in the year 2000, which is relatively recently and I don’t know how much has changed in the sense that we might have been able to have done socialized medicine in the year 2000? I think not,” said Turner.
Regardless of the structure, Turner says the realities in both countries are far from what Trump describes.
“It probably would work very well for him because he would be able to go wherever he wanted and pay for his own care privately. But for individual citizens, that’s not true,” said Turner.
“In either [Canada or Scotland], you face long wait times, unless you can escape and go someplace else for your care. If you are stuck in either one of those systems, in which you need care, you get in the queue and you will wait weeks, sometimes months , sometimes years to get the care that you need,” said Turner.
And she says the waiting game is only getting worse.
“A wonderful think tank in Canada, the Fraser Institute, keeps track of wait times for medical care in the country. In 1993, there was about a nine-week wait for surgery or treatment,” said Turner. Today, it’s 18 weeks on average. So it’s doubled in those 22 years.”
And that’s only for necessary treatment.
“They’re even worse for what we call elective surgeries, like hip, knee or back surgery. That wait? Forty-two weeks or ten months, neurosurgery is 31 weeks,” said Turner.
Turner says life is even more miserable for Canadians unfortunate enough to have their procedure scheduled late in the years.
“If a hospital reaches its budget the first of December, it will close the rest of the year. So if you had a surgery scheduled for the tenth of December, you’re going to have to get back in the queue,” she said.
Turner also points to research from Forbes magazine health care expert Avik Roy, pointing out the contrast in cancer survival between the U.S. and Scotland. The overall five-year survivability numbers show 73.8 of Americans surviving five years or more after their cancer diagnosis, compared to 52.7 percent in Scotland. Double digit differences also exist for specific cancers, including prostate, colon and breast cancers.
Roy has served as a health care adviser to former Gov. Rick Perry, R-Texas, during this campaign. Perry and Trump have taken numerous shots at each other. However, Roy’s numbers on the cancer differential come from a 2008 CONCORD Study.
In his debate answer, Trump also pushed for health insurance policies to be purchased across state lines.
“What I’d like to see is a private system without the artificial lines around every state. I have a big company with thousands and thousands of employees. And if I’m negotiating in New York or in New Jersey or in California, I have like one bidder. Nobody can bid,” said Trump.
“You know why? Because the insurance companies are making a fortune because they have control of the politicians, of course, with the exception of the politicians on this stage. But they have total control of the politicians. They’re making a fortune,” he added.
While endorsing the purchase of policies across state lines, Turner believes that answer suggests Trump doesn’t fully grasp the current system.
“As a large company, he can self-insure his employees. Therefore, he is under a provision of law called ERISA that allows him to operate as one health plan. He doesn’t have to have individual negotiations with individual states,” said Turner.
“He already has, as a major employer, as do tens of thousands or hundreds of thousands of major employers operated exactly the way that he’s describing we should,” said Turner.