The Current Situation
Healthcare in North Dakota and South Dakota follows the American model: a mix of employer-provided insurance, individual market plans, Medicare for seniors, Medicaid for some low-income residents, and a significant uninsured population.
By the Numbers:
| North Dakota | South Dakota | Saskatchewan | |
|---|---|---|---|
| Population | ~780,000 | ~880,000 | ~1.2 million |
| Uninsured Rate | ~8% | ~10% | 0% (universal) |
| Healthcare Spending per Capita | ~$12,000 USD | ~$11,500 USD | ~$7,500 CAD |
| Medical Bankruptcy Risk | Present | Present | Essentially None |
| Rural Hospital Closures (2010-2023) | 2 | 4 | 0 |
What Saskatchewan Offers
Saskatchewan's healthcare system, like all Canadian provinces, provides universal coverage for medically necessary services. This means:
- No insurance premiums for basic medical care
- No deductibles or co-pays for physician visits or hospital stays
- No network restrictions—any doctor, any hospital in the province
- No pre-existing condition exclusions
- No lifetime caps on coverage
- No medical bankruptcy—the concept doesn't exist
What's Not Covered:
- Prescription drugs (partial coverage through provincial programs)
- Dental care (except hospital-based)
- Vision care
- Ambulance fees (nominal)
- Private or semi-private hospital rooms
Most Saskatchewanians have supplementary insurance through employers or purchase it individually to cover these gaps. But the catastrophic stuff—cancer treatment, heart surgery, emergency care—is fully covered.
The Transition Question
If the Dakotas joined Saskatchewan, approximately 1.66 million people would gain universal healthcare coverage. This raises practical questions:
Immediate Impacts:
- Health insurance industry jobs would be affected—billing, claims processing, enrollment
- Hospital billing departments would shrink dramatically (single-payer simplifies administration)
- Pharmaceutical pricing would shift to Canadian negotiated rates (generally lower)
- Cross-border care would no longer require international insurance coordination
System Capacity:
- Dakota hospitals and clinics would continue operating but under provincial health authority
- Physician compensation would shift to Canadian fee schedules (generally lower than US, but malpractice costs are also much lower)
- Wait times for elective procedures might increase as utilization rises among formerly uninsured
Rural Healthcare:
This is where integration could genuinely help. Rural healthcare in the Dakotas faces the same challenges as rural Saskatchewan: difficulty recruiting physicians, hospital viability, distance to specialists. A combined system could:
- Coordinate rural physician recruitment across a larger region
- Share telehealth infrastructure
- Establish regional centres of excellence rather than duplicating services
- Pool resources for air ambulance and emergency transport
The Birthplace of Medicare
It's worth noting that universal healthcare in Canada began in Saskatchewan. In 1962, Premier Tommy Douglas introduced the first provincial Medicare program, over fierce opposition from the medical establishment. The "Doctors' Strike" of 1962 lasted 23 days before a compromise was reached.
Saskatchewan's history gives it a particular perspective on healthcare as a public good. Extending that system to the Dakotas would be, in a sense, completing Douglas's vision on a continental scale.
Questions for Discussion
- For Dakotans: What would universal coverage change about your healthcare decisions?
- What concerns would you have about transitioning to a single-payer system?
- How should the transition handle people currently employed in health insurance?
- Could rural healthcare integration justify the broader adoption, even apart from other factors?
This forum explores healthcare integration—the benefits, the challenges, and what universal coverage would mean for prairie families.