André Picard, the public health reporter at the Globe and Mail is getting very sensibly realistic–beginning really to see the light?

Canada’s health care system is coming apart at the seams, torn between a desire to uphold a monumental principle and the staggering challenge of delivering on that promise.

Equity – the notion that healthcare should be provided to all without regard to income – is medicare’s defining feature.

But the lofty principle loses its meaning if the care provided is not prompt, high-quality, co-ordinated and affordable…

Other countries with universal health systems – notably those in Europe, which are consistently ranked as the most equitable and cost-effective – have not made Canada’s mistake of confusing equity with sameness.

Rather, European countries have done what Ottawa and the provinces know they need to do: Adopt a model that pragmatically mixes public and private elements both in funding and delivery while staying true to values…

…an oft-illogical patchwork…has left Canadians – and to a large extent policy-makers themselves – perplexed. To wit: Physician visits are covered by medicare but the drugs they prescribe are not – unless the patient is over 65; physicians cannot bill patients but they can refer them to imaging clinics and laboratories that do; private clinics can offer knee surgery but not heart surgery; a citizen cannot jump the queue for care unless they were hurt on the job and they are the responsibility of Worker’s Compensation [there's a whole second tier right there]; homecare nursing is provided by private companies but hospital nursing is not…

Canadian health care is unusual in that the system is bifurcated. There is virtually no private insurance or private delivery in some areas (like physician services – which are 98 per cent public) and in other areas there is virtually no publicly insured or delivered care (like dentistry – which is only five per cent publicly-funded).

By comparison, in European countries, there is almost always a private option for consumers and, at the same time, there is greater public funding and regulation for every aspect of the health system. For example, in France, only 74 per cent of physician services are paid from the public purse and, in Germany, 68 per cent of dental care is covered by public funding.

This approach, generally speaking, has resulted in lower per capita health costs and better outcomes…

First and foremost, we need to throw off the shackles of the Canada Health Act, a well-meaning law that has become an impediment to reform.

The CHA, in its current form, perpetuates a fundamental absurdity of medicare: The universal single-payer model applies only to “medically necessary” physician and hospital services. Focusing on doctors and hospitals made sense in 1960 but not does not in 2010; and leaving the term “medically necessary” undefined suggests that medicare must provide all care to all people – an unrealistic expectation that has driven costs through the roof…

…delivering affordable, timely care in practice is much more important than merely doing so in principle.

Amen.  An earlier glimpse of the light, and the poor realities of our system, by M. Picard is here. As for the reality of the “lofty principle“:

One-tier health care in action: Emergency, schmergency

Update: Liberal M.P. Keith Martin is getting really “radical” (in Canadian terms) and specific–take a look at this. The true key to any meaningful, and affordable for the public, reform is allowing private insurance to be bought for “medically necessary” services that are provided in private facilities. As has always been the case in the UK after the National Health Service, on which our one-tier system was modelled, was created. Take a look at BUPA.

Mark
Ottawa