Many Canadians have blind faith in the health-care system, warts and all, but it would be preferable if it was grounded in knowledge.
Economists say that standard economic models don’t apply to health care, since it exemplifies market failure. And there certainly is no free market at work in European countries that permit private medicine.
For-profit health care has proven to be more expensive, less efficient and less effective than the single-payer, not-for-profit, publicly funded and administered Canadian system.
Why, then, do we have long wait times that cause patients unendurable suffering?
Armed with information, we can ask our governments. We can also buttress blind faith with facts.
Health care is under a microscope and under the gun in a Supreme Court of British Columbia case that will have national ramifications. The Cambie Surgery Centre, among others, is arguing that the constitutional right to life of British Columbians is being violated because they can’t receive timely care in the public system. Physicians must opt out of the public system if they wish to practise privately and Canadians cannot purchase insurance for medically-necessary procedures.
Dr. Brian Day, of Vancouver’s Cambie Surgery Centre, wants this to change. His legal challenge has unleashed horror in many that we are on a slippery slope towards American-style health care.
But Day is trying to reassure us that the sky isn’t falling, that they are merely suggesting a hybrid system akin to those in Europe. So how do hybrid European models stack up?
Britain permits doctors to practise in public and private systems. A privately-insured individual who might wait months for treatment could short-circuit the process, receiving treatment from the same practitioner in the same hospital within days!
Far from freeing up resources, this system provides perverse incentives to doctors to channel patients to their private practices.
Other European countries have a similar mix, but private practitioners face tight government regulation and monitoring. In Holland, agencies monitor the system, described as “managed competition.” The German system is referred to as “manacled competition.”
European plans offer broader coverage but there is a great deal of variation. Some have deductibles and co-payments, others deduct a percentage of wages (15.5 per cent in Germany) from employees and/or employers dedicated to health care, and in others governments negotiate uniform fees with providers.
Cross-national comparisons are fraught with problems since it’s difficult to be certain about equivalence. And unlike Canada, most European countries are small, densely-populated unitary states that can provide care more cheaply. In addition, health care is nested in a set of generous European welfare programs.
In a hybrid system, would Canadian providers accept the tight regulation experienced by their European counterparts or would they look south for role models? Would 14 Canadian governments be willing to undertake the heavy regulatory burden? Administrative costs in the U.S. are three and a half times higher than in Canada.
If health care in Canada is on trial, then this is a good opportunity to have a vigorous debate about it, including a discussion about the battle to change the way we think about it.
Canadian health care is considered the largest unopened oyster in our economy. Many want to crack it open.
For years, proponents of private health care have been frustrated at the stubborn attachment Canadians have to the current system. Advised by global consulting companies on how to advance the case for private medicine, they emphasize the European model because Canadians are terrified about American health care. They deride the outdated public monopoly that offers no choice to patients. And they catalogue deficiencies in the current system repeatedly.
This ongoing campaign has some success because health care is not perfect and does need attention.
So how to address the system’s problems?
First, we need to decide whether reform should take place within the existing framework by asking some tough questions:
- If the framework is sound, why doesn’t the system work as it should?
- Do we get sufficient bang for the billions of bucks we pour into health care?
- Are we so pathetically grateful to have universal health care that is superior to the American model that we dare not demand accountability?
I hope not, but the legal challenges that face us might force our hands. So it’s time we all improved our knowledge of the system, its flaws and strong points. Then bring on the debate!
Doreen Barrie is an adjunct assistant professor in the Political Science Department at the University of Calgary.
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