By Charles W. Moore
© 1999 By Charles W. Moore
Truth to tell, we already have "two-tiered" health care in Canada. Many of those who can afford it, or have grown desperate sitting on waiting lists for care, or who simply cannot find the treatment they need in this country, head south across the border. The money they spend on services they couldn't find or wait for in Canada helps fuel to the U.S. economy and benefits Canada's GDP not a whit.
Despite these facts, Canadian politicians exhibit phobic hysteria when the dreaded "two-tier health care" buzz-phrase is mentioned. Even Alberta premier Ralph Klein, hardly a poster boy for socialized medicine, recently vowed that "as long as I am premier, there will not be any so-called 'two-tiered' American-style health care in our province."
Blind adherence to the idealized notion of a single, universal health care system is litmus test of Canadianism for some, while America's free-enterprise health care system is contemptuously dismissed as backward and inequitable. However, "free" health care is useless unless you get treated on a timely basis, and the Americans manage to get by without hordes if indigent sick folks dying in the streets.
A Pollara poll last summer indicated that politicians are badly out-of-step with public opinion on health care privatization. Among poll respondents, 73% affirmed that Canadians should have the right to pay for their own health care in private facilities if they can't get "timely access" to treatment through medicare. Only 23% disagreed,
Despite lip service politicos and socialized medicine advocates pay to "maintaining quality health care for ordinary Canadians," a Compas poll found that 41% of Canadians believe that individuals should have the option of choosing private health insurance, and even more interestingly, a greater proportion of respondents earning less than $25,000 a year (47%) were interested in private health insurance than among those earning over $75,000 (39%).
Canadians most satisfied with the health care status quo were those with postgraduate degrees (and commensurate high earning power), underlining my assertion that Canada already has two-tiered health care.
A report released in November by the Halifax-based Atlantic Institute for Market Studies (AIMS), entitled "Operating in the Dark," says it's time for government to relinquish its monopoly on health care and permit private health services and clinics.
"A number of inefficiencies and deficiencies arise out of monopoly behaviour: publicly insured medical services are inefficient, deprive consumers of real choice, and place unsustainable demands on the taxpayer, claims the report. "
AIMS suggests a mix of public and private health care, possibly contracting out some services to private firms and/or giving individuals annual health fund vouchers with which to choose the services they want or need to use.
Predictably, Nova Scotia's Health Minister Jamie Muir responded: "No, we aren't looking at that," without even reading the report, lending credence to its observation that "the operating assumption of the political class seems to be that medicare is the third rail of Canadian politics ('Touch it and you die.')."
Knee-jerk refusal to even consider the case for health care privatization ill-serves Canadians. Perhaps politicians have been deceived by the threadbare truism that Canada's health care system is the "best in the world." It is anything but, according to a recent book by University of Manitoba medical student David Gratzer, entitled "Code Blue: Reviving CanadaŐs Health Care System."
Mr. Gratzer reports that at any given moment, more than 100,000 Canadians are on waiting lists for medical treatment, and that only one in five Canadians diagnosed with cancer get to see an oncologist within the recommended four weeks. Canadians routinely wait 35 to 45 days for radiation therapy, while Americans wait just 10. Canadians' average wait for an MRI scan is nearly half a year (150 days). Americans wait three days.
"Our health care system isnŐt just sick; itŐs killing people," says National CitizensŐ Coalition president Stephen Harper." Canadian politicians can bluster against the bogeyman of "two-tier health care," but all the bluster in the world won't stop what's left of the present system from crumbling around their (and our) ears.
Indeed, the AIMS report argues that "the principle of universality need not suffer under enhanced private-sector participation in publicly-insured medical services. Nor would funding levels necessarily decrease. Rather, the experience in a number of different countries shows that a mix of public and private funding and management can serve the public equally well (if not better) while minimizing (or eliminating) the high costs associated with monopoly government provision."
Canada's health care system cries out for radical overhaul, but standing in the way of doing anything substantive about it are poorly-informed fear of change, mistaken social ideology, and a gaggle of vested and conflicted interests.
No one is advocating a holus-bolus shift to privatized medicine. However, political allergy to even considering whether certain services could not be delivered more cheaply, efficiently, and in a more timely fashion by the private sector amounts to ideological idiocy.
© 1999 Charles W. Moore
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