In his 2006 book Differences that Matter: Social Policy and the Working Poor in the United States and Canada, the Canadian sociologist Dan Zuberi examines the experiences of low-wage hotel workers in Seattle, Washington, and Vancouver, British Columbia. His conclusion, unsurprising but powerfully documented, is that the policies and institutions on the Canadian side of the border — comparatively robust public goods and services, national health insurance, higher union density — yield dramatic differences in economic security and mobility for workers.
The COVID-19 crisis has thrown those differences into sharp relief. The point is not that Canada is a beacon of social democracy (it’s not). It is that the United States, with its for-profit health care system, fragmented and miserly welfare state, and inept political class, was so uniquely and manifestly ill-equipped to tackle the crisis that it is now commonly described as a failed state.
The recent experience of Iowa and a similar “heartland” setting north of the border — the Canadian provinces of Manitoba and Saskatchewan (what I’ll call MASK) — dramatize these stark differences.
First, a baseline comparison. The population of Iowa is 3.15 million; the population of MASK is 2.43 million. Although the two provinces are much larger in land area than Iowa, the northern half of Manitoba and Saskatchewan are sparsely populated. About half of MASK’s population lives in cities with over 35,000 people, the biggest of which is Winnipeg, Manitoba at 705,000. Only 28 percent of Iowa’s population reside in cities over 35,000, the largest of which is Des Moines at 210,000.
In terms of demographics, Iowa’s population is 85 percent “white alone (non-Hispanic),” with Hispanics (of any race) making up the next largest share at 6 percent. MASK’s population is 71 percent “European origin,” with “Aboriginal” and “visible minorities” each comprising about 11 percent. The economies of the two locations are broadly similar, with health care, education, and other services predominant.
But when we look at how the pandemic has played out in each setting, these similarities come to a screeching halt (see table below). Iowa’s count of COVID-19 cases through July 21, at 39,793, is almost thirty times higher than the tally in MASK; the reported death total is nearly forty times higher. In Iowa, those rates are 1,263 cases and 25 deaths per 100,000; in MASK, those rates are 53 cases and 1 (just one) death per 100,000. And, lest we follow the logic of Donald Trump or Iowa governor Kim Reynolds and conclude that case counts are just an artifact of extensive testing, consider this: while Iowa has tested a much higher share of its population, the rate testing positive for the virus in Iowa is more than ten times than that in MASK.
How do we account for these startlingly disparate outcomes?
There were only slim differences in the state or provincial responses to the early weeks of the virus. All three places declared states of emergency in mid-March: Iowa on March 17 after recording twenty-three cases, Saskatchewan on March 18 after recording sixteen cases, and Manitoba on March 20 after recording twenty cases. Definitions of essential and nonessential businesses were broadly similar.
COVID-related economic support, coming from the national government on both sides of the border, were comparable as well. In the United States, the CARES Act extended unemployment insurance (UI) to contingent workers and bumped the weekly benefit for all unemployment insurance recipients, through July 25, with an additional $600/week in “Pandemic Unemployment Compensation” (PUC). In Canada, those not qualifying for regular unemployment benefits could apply for a $500 weekly stipend for eighteen (later extended to twenty-four) weeks.
But over time, three important elements of the COVID-19 response set Iowa back compared to its Canadian peers. First, up north, coordination across provinces and between the provinces and the federal government was relatively seamless. There were no important political or partisan differences from jurisdiction to jurisdiction. Even Doug Ford, the buffoonish conservative premier of Ontario, followed the same script and dismissed as “selfish” the scattering of anti-mask protests. In the United States, state-to-state approaches varied widely, and the Trump administration actively undercut the efforts of some states to fight the virus.
Second, the relative generosity of the CARES Act was frustrated in its execution by doubts and dysfunction in the states. Iowa’s unemployment insurance system was disqualify PUC recipients from applying for rental or mortgage assistance), which they felt stood in the way of reopening the economy.
And third, many US states — Iowa among them — let right-wing interests steamroll public health concerns at every stage of the crisis. Iowa was one of only four states never to issue a “shelter in place” order, and its staged reopening was either based on mysterious public health metrics or in open defiance of the available evidence. The governor’s office slapped down local efforts to take a more cautious route — prohibiting Iowa municipalities from requiring face coverings in public spaces, and barring local school boards from starting the upcoming year with remote instruction.
The net result has been a trajectory of COVID-19 cases (new cases recorded each day) that, as of July 21, looked like this:
Even more important than the immediate COVID-19 response were long-standing policy differences between the United States and its northern neighbor.
The starkest is health policy. Canada has a relatively integrated system of national health insurance. The information and fiscal infrastructure of this system facilitated a coordinated and well-targeted public health response. And the foundation of universal coverage meant that citizens of MASK not only received the care they needed when they got sick at essentially no cost, but that they were (and are) more likely to seek medical attention early and unlikely to come into contact with someone who — for lack of insurance or lack of money — has gone undiagnosed.
In Iowa, as elsewhere in the United States, health coverage is uneven and fragmented: 64 percent of the non-elderly are covered by job-based health plans, 21 percent receive Medicaid, 7 percent purchase insurance on their own (including those buying subsidized plans under the Affordable Care Act), and 6 percent are uninsured. Even many of the insured find health security elusive. Nearly a third of those with job-based and other private plans are “underinsured” (their out-of-pocket expenses exceed 10 percent of their income).
Iowa has struggled to find private insurers willing to consistently offer plans in the Affordable Care Act “marketplace,” and the state’s decision to privatize Medicaid has been a disaster for the state budget and patients alike. Reliance on job-based health insurance has meant that many of the unemployed are losing their health insurance just when they need it most. (Through mid-May, nearly 150,000 Iowans had been thrown off their health insurance after being laid off.) And, even without the oft-noted lethal incompetence from the White House, the public health response in the United States — like the larger health system of which it is a part — has been a patchwork chaos.
Canada has a much more rigorous system of occupational safety, with rates of inspection and worker participation that far exceed those of the United States’ Occupational Safety and Health Administration, and its state counterparts. Iowa exemplifies this hyper-pro-business approach. Employers (especially in meat-packing plants) resisted the most basic protections for workers, and state officials and employers actively conspired to downplay the workplace risk of COVID-19. All of this stems from the yawning gap in unionization rates. In MASK, about a third of workers belong to unions (35 percent in Manitoba and 31 percent in Saskatchewan); in Iowa, only 6.3 percent of the labor force are union members, and workers have virtually no say in the safety of their workplaces.
Finally, Canada has a much more generous system of unemployment insurance, with little variation across the provinces. In the United States, unemployment insurance is 67 percent of their lost wages. In Iowa, the same worker’s UI benefits would make up only 34 percent of lost wages.
None of this is to suggest that Canada is a paragon of social democracy. Patterns of using the most recent comparable data, is 13 percent in Canada and 19 percent in the United States; the income share of the top 10 percent is 41 percent in Canada and 45 percent in the United States. Canada has a decent program of paid paternal leave, but — alongside the United States and Japan — is one of only three developed nations that have no national paid sick leave policy. The universality of the national health program, before and during the COVID-19 crisis, does little to address the profound health disparities that Canada’s First Nations face.
The contrast here is not between social democracy in one setting and rapacious neoliberal austerity in another; it is a contrast between the competent execution of social insurance and social policies that are largely universal and national in scope in one setting, and the haphazard and half-hearted execution of willfully fragmented and fragmentary policies on the other.
The Canadian example, in other words, is a low bar. But in the throes of a global pandemic and devastating economic crisis, it’s one the United States can’t even clear.