The European OECD says that Canada is heading for serious trouble by refusing to entertain the option of user fees and deductibles. In an analysis of our health care system, the OECD says that Canada’s long wait times and number of patients without doctors is already a symptom of our sickness. The costs of our single-payer health care system are expected to skyrocket with the coming of the “gray tsunami”.

Health care spending in Canada was estimated to be about $183.1 billion in 2009, an increase of $9.5 billion, or 5.5%, since 2008. And the amount we’ve spent on health care in 1997 dollars has increased for every year between 1975 and 2009, more than doubling the per capita spending since the 70′s. Total spending in 2007 was equivalent to 10.1% of our GDP, or 7.8 times what goes to our entire military budget.

OECD recommends that Canada come into line with other countries that utilize health care user fees and privatized services in order to lower our overall burden:

Canada can boost value-for-money in health care. Regulation [Canada Health Act] currently prohibiting private insurance for core services and mixed public-private contracts for doctors should be removed to spur more efficient service delivery and expanded capacity by way of private entry. Pharmaceuticals, home and therapeutic care should be integrated into the core public package. Revenues could be raised and excess demand curbed by implementing some sort of capped patient co-payments and deductibles.

If you think this sounds unreasonable, consider that socialist governments like Portugal have basic user fees for health services. So does Sweden and Denmark and Germany. This is by no means a sudden collapse into a state of deregulated privatization. Ignoring the problem will only force larger government deficits and the slashing and burning of other core services, such as education.

The largest criticism by the OECD is that our health care system is inefficient. The main reason is a lack of competition to maintain cost-effective care, followed by the fact that patients don’t have health care costs quantified. They can go to the doctor as often as they like.

This idea that user fees to see doctors would create a burden on the poor doesn’t wash either. It hasn’t produced a two-tier system in the countries where user fees are employed. Just as one doesn’t run to the insurance company for every paint scratch on their car, a deductible would curtail flagrant abuse of the health care system.

Michael Ignatieff’s constant sniping at the Conservative government has resulted in many sound bites, few of which have any substance. Take the recent comment he made on health care as a perfect example. Canadians would rather see their taxes go toward health care than the construction of prisons or the 65 new F-35 stealth fighters for the military. And that may even be true, but Mr.Ignatieff offers no real solutions to the health care problem.

He agrees with those in the field who say the current system is not sustainable and outlined several specific areas where he says a Liberal government would focus its efforts to strengthen it.

“Sustainable on the present track? No, I think we’re going to have to take action together,” Ignatieff said. “Four years of this Conservative government, we’ve really done nothing substantial on health care.”

Preventing people from using the health-care system in the first place would be a main component of a Liberal government’s plan to alleviate the growing strain on it, Ignatieff said.

“More health, less health care -I just think that’s crucial,” Ignatieff said. “You’ve got to pull some demand out.”

Health prevention and promotion programs, and improving the health of aboriginal people would be part of that initiative. Aboriginal health is an area where “the federal government can and must act,” Ignatieff said, adding that some of the specific problems in that area are “a real shocker.”

What we have here are the makings of an honest discussion on health care: the unsustainable expenditures, the wait times, the doctor shortages, the strain. But what we don’t have is an honest solution being offered by the Liberals.

Improving health care for aboriginals sounds great. If you’re an aboriginal. What does that mean to me, the individual taxpayer who is sick and tired of a health care system that is more costly and more trouble than its worth? I’m sure we’d all like all of our citizens, including aboriginals, to have access to good health care, but singling out that voter demographic is transparent pandering. As it was when he said the same thing about aboriginal education, aboriginal employment, and aboriginal housing.

So how would a Liberal government act to create universal and accessible care that removes the excessive and frivolous use of it? Would he allow the wealthy to pay their own way, so that it would take the strain off of it and free up the supply for the poor? No. That would be too logical:

“I’m a very firm believer that we don’t want user fees,” he told Postmedia News. “We want universal, accessible, free-at-the-point-of-service health care, paid out of general revenue. That’s just bottom line. Otherwise we get two-tiered.”

Really? Does the good Liberal leader really believe this unfounded assertion?

The fact is that European countries like Denmark, Germany, Portugal, and Sweden all have some sort of basic or nominal fee-for-service system that disincentivizes abuse. And Portugal has a socialist government.

Here is the reality of the situation:

The user fee is not a contentious topic in Swedish politics. No one argues for hefty increases in the out-of-pocket payment, and most politicians seem to be satisfied with the present level. More importantly, user fees have not, as many Canadians fear, turned health care into a virtual two-tier system by reducing the public part of the funding. A bottom-line argument in their favour, one that is seldom mentioned, is that they reduce medically less motivated consumption in favour of priority treatments. Without fees, the idea goes, a “luxury” demand would challenge the capacity to satisfy the “true” needs of less articulate citizens. Though they provoke some objections from egalitarian critics, user fees in the Swedish tradition are in fact regarded as an instrument to ensure better health care for weak groups.

It’s rather sad that Michael Ignatieff is using partisan politics to avoid an honest debate about the problems afflicting our Universal health care system. Even worse that he has nothing new to offer to that debate.

Further to the mild tone of optimism in a recent post of mine (with a major reservation), Publius looks to Alberta and describes a dark side:

…
This is not talk of freeing the market for health care – perish the radical thought – but allowing private entities to offer care with public funds. The hope is that by contracting out, the services will be delivered more efficiently, while keeping the provincial governments as paymasters. The latter part is suppose to reassure the electorate in some deeply mystical way. Because the government is paying for it, it will be good and humane. Repeat until numb.

Since this is government-run health care by other means, there is little to cheer about. Its main advantage is circumventing the militant health care unions. Its disadvantage is that, in the Left hands, it can be used to discredit further reforms in the direction of the market. Just regulate privately delivered care in such a way as make it even worse than the purely public system, and wait for the Toronto Star – and its sisters across the Dominion – to denounce it as capitalism run amok…

As I’ve often said in this space, Medicare isn’t a government program, it’s a cult…

…Any sort of health care financing scheme will have to rely on the principle of putting a bit in and using as needed, something akin to insurance. The overwhelmingly majority of Canadians can afford private insurance premiums, if they could not the tax base would not exist to support the current system. Like with food and housing, those who could not afford the premiums would be subsidized. Such a system would have its abuses, as any system does, but it will allow the great majority of Canadians access to health care on their own terms, rather than those of the Minister of Health. It would also ensure that even the poor could get quality health care, since they would be just another customer of the hospital or clinic. While such an approach would be logical, it would challenge the sanctity of government delivered care. The Cult of Medicare is not interested in quality health care, it is interested in preserving state health care…

Cult. Quite. We have ministers, not of health but of cults.

Mark
Ottawa

A ray of reason in our mindlessly ideological health care “debate”:

Tasha Kheiriddin: Private health care comes to…. Saskatchewan

From the cradle of Medicare, hope for health care reform.   The Saskatchewan government announced this week that it will be contracting out dental and knee surgery to a private surgical facility.  While the public purse will foot the bill, the operations will be performed by the Omni Surgery Centre instead of a public hospital.

According to provincial health minister Don McMorris,

“the move will help shorten wait times for some day surgeries and the setting will be more convenient for patients.”

The move will not only save time, but money.  Surgeries done at the Omni Surgery Centre cost less than the same procedures done at a hospital. According to provincial officials, knee surgeries will cost $1,500, $179 or 11 per cent less per procedure. Dental surgeries, at $965, will be cheaper by $76 or seven per cent…

Paying for “one-tier” health care, Part 2

Update thought: As for the current federal government’s even touching on the private funding issue…hah!  Even private provision probably beyond their possibilities given their political pusillanimity (despite the hideously dictatorial habits of a certain prime minister). Ain’t alliteration and assonance awesome? Unless overdone, ça va sans dire.

Mark
Ottawa

Socialized and unionized health care at, er, work.  From Paul at Celestial Junk:

How about cash cow for “insider” scheduling. This is a result of healthcare for the employees, instead of healthcare for the sick…

Not exactly “one-tier” working conditions.

Mark
Ottawa

Yesterday:

Paying for “one-tier” health care

Today the clear answer in a National Post editorial: get rid of that “one-tier”:

…
The CMA has its own list of proposals, which include a reexamination and modernization of the five founding principles of the Health Act, and the creation of a “Charter for Patientcentred Care.”

A better solution, we think, would be simply to bring Canada in line with virtually every other OECD nation, and create a hybrid system that permits private health-funding options in parallel with a publicly-funded universal health system. As others have noted many times, Canada is the only country in the world, outside of Cuba and North Korea, where garden-variety private health insurance for essential health needs is illegal.

It is all well and good that the CMA is critiquing the fine points of Canada’s single-payer health model. But until our politicians tear down its Soviet-style proscription of private options, everything else is palliative care.

As I wrote at Daimnation! in 2005:

…
So once private health insurance for essential services is allowed across Canada (it already is in several provinces, and the Supreme Court decision said it should be allowed in Quebec), then we can have a European-style two-tier system, with the private clinics (hospitals, imaging centres, etc.) existing parallel to the public system as long as they receive no payments from the public system. (A full two-tier system will not be possible if it relies on cash payments–very expensive for major procedures–rather than payments through insurance: see the UK’s BUPA.)…

Remember that even the UK, despite the sainted National Health Service, has always allowed “two-tier” health care via private insurance such as provided by BUPA. Insurance that almost certainly saved my father-in-law’s life when he required rapid major surgery a few years ago.

Update thought: We’re sure making progess in dealing with health care funding, eh?  The CMA itself has backtracked badly.  And there’s been no there there from the currently governing party:

Conservatives kiss health care reform good-bye

Mark
Ottawa

Publius smells a rat in need of, er, salting:

…Then they came for my salt shakers…

Leviathan has gotten cleverer over the centuries. Swords, guns and prisons are crude instruments, ones that cause instant revulsion in civilized men. The gentle threat seems more humane. Yet being less obvious, it is more insidious…

Mark
Ottawa

Maybe, as Spector Vision sees it, the…

CMA speaks with forked tongue

Perusing my morning read, I see that the CMA is out with a new report that is quite critical of our existing health care system. And that the organization is calling “for five major changes to help improve the state of the system, and the health of Canadians.”

How to pay for all this? — you may ask yourself. As a former federal and provincial public servant, I certainly asked that question after reading the Globe article — not to speak of the big, honking headline on the front page of the Star...

…you’d think that the medical profession might have some thoughts to offer Canadians as we make that decision.

Indeed, turning to the CMA report itself, I find that the CMA actually salutes the recent Québec budget:

“Quebec has been the first among the provinces and territories to acknowledge that the current approach to funding health care is neither sustainable in the long term nor fair to future generations…”

One of the favourite dodges of politicians in our country is to say one thing in English and another in French. However, if we can’t count on doctors to give us the straight goods when it comes to health care, on whom can we count?

Earlier, in my province:

The joys of one-tier health care, Ontario style

Mark
Ottawa

Don’t you just love socialized medicine?

Ottawa Hospital turns away sex assault victim
…
A 21-year-old Ottawa woman who had been sexually assaulted was refused immediate treatment at the Ottawa Hospital over the weekend, the Sun has learned.

The woman was taken to the Civic hospital early Sunday [July 4] morning to have a rape kit completed but Ottawa police were told there were no sexual assault nurses available.

The victim was given three options: Lie in a bed until Monday morning when a nurse would be available — but she wouldn’t be able to shower — or go to either Cornwall or Renfrew hospitals.

She ended up being taken to Renfrew [some 100 km, pop. 10,000] to get treatment…

The hospital is going through staffing shortages with their specialized sex assault nurses said Mike Tierney, vice-president of clinical programs.

“We have had some challenges recently in staffing this specialized program and that has resulted in us not always being able to provide service in as a timely manner as we would like,” said Tierney, who declined to comment on the specific incident.

He said the staffing shortage was due to illness and happened about three weeks ago [emphasis added]…

Ah, those beloved “challenges”.  Welcome to the … (your ordinal) world.

Mark
Ottawa

Photo Credit: Christinne Muschi, Reuters

Michael Ignatieff has performed another legendary about-face on the issue of user fees in public health care, mainly to fend off criticism from the Conservative Party that it’s a sign he’s a “tax-and-spend” Liberal. Which is rather unfortunate, because user fees are not only a good idea favoured by rightwing Think Tanks like the Fraser Institute, but used by practically every health system in the world, including those in socialist countries.

Last Thursday, the Liberal leader said he welcomed Quebec’s provincial Liberal budget idea of financing health care through user fees known as “deductibles”, and allowed that the province should be able to advance ideas on their own.

“We have to be open to letting the provinces experiment within the framework of the Canadian law,” Mr.Ignatieff said. “We have to protect universal access to the health system. The government of Quebec knows it.

“I salute the fact it is launching a debate that is important for all Canadians.”

But six days later, the waffling leader had to “clarify” his position on medicare after concerns from within his own caucus that he was sending the wrong message on health care reform.

Yesterday he told media that the Liberals are the “party of medicare” and he is against user fees.

“I am saying no user fees. I want to make it very clear that our party and I personally am a passionate defender of the Canada Health Act and we understand that provinces are facing substantial challenges facing the financing of their health care systems.”

The Globe’s Jane Taber reported one Liberal MP as saying, “If we open the door to user fees we might as well all go home,” though she did not identify the politician.

“Better late than never,” the Liberal MP said. “This has been languishing.”

It’s unfortunate that the Liberals decided to make this into a partisan issue, but perhaps also unfortunate that the Conservatives spotted a source of weakness on this file and attacked them on it. One would think that any ideas of health care reform and innovation to come forth would be welcomed multilaterally.

Wrapping ourselves in some patriotic notion that Canadian medicare is unassailable in its current form is a major mistake. If nothing else is clear about health care, it should be noted that it is the fastest growing liability in government budgets from sea to sea to sea. Creating user fees can reimburse the system for surfeit usage, and create a disincentive of profligate abuse by nose bleeds and dry coughs.