CMA’s welcome, if belated, change of heart on medicare
Published On Fri Aug 06 2010. Dr. Danielle Martin and Dr. Irfan Dhalla
Every summer, before its annual meeting, the Canadian Medical Association (CMA) publicizes its recommendations for Canada’s health-care system. Over the last few years, the same stale debate has played itself out with clockwork regularity. First, the CMA calls for more privatization. Almost immediately, those who know this would mean inferior care for most Canadians fight back. Then, after a long and occasionally fractious annual meeting, the CMA ultimately makes the sensible decision to back off, at least temporarily, on the privatization issue.
This week, the CMA released its latest prescription. Gone are the calls for private insurance and for-profit delivery. Gone are the illogical defences of queue-jumping. Gone is the innuendo that equity, the key principle that underlies the Canada Health Act, is not a legitimate objective.
Instead, we see an embrace of the principles that underlie medicare, so much so that in a watershed moment, the CMA has rightly called for those principles to be extended to prescription drugs and long-term care.
For those of us who have felt unrepresented by our own national organization, it is revitalizing to read that the CMA has concluded that our health-care system must be improved “in a manner consistent with the spirit and principles that have guided medicare from the beginning.” We applaud the call for “all Canadians [to have] timely access to an appropriate array of medically necessary services across the full continuum of care, independent of their ability to pay.”
Certainly, some of the proposals put forward in the CMA’s document should be debated. Electronic prescribing? Yes, please. A charter to better outline what a patient ought to be able to expect from a doctor or hospital? Great idea. But tax-deductible long-term care insurance? If millions of people actually purchased such insurance, this ill-conceived idea would result in a massive transfer of wealth away from individuals and governments toward insurance companies. Similarly, we and others have concerns about pay-for-performance, and about activity-based hospital funding, which based on experience elsewhere can lead to more harm than benefit.
Also frustrating is the CMA’s assertion that the public health-care system is unsustainable. This is a Chicken Little claim that has been repeated so many times it risks becoming self-fulfilling. The truth is that Canada’s health-care system is less expensive than those of several other wealthy nations. In fact, we spend less public money on the health-care system as a whole than most comparable countries. We are richer than we ever have been. If our government can afford $16 billion for fighter jets, it can certainly afford to pay for a reasonably decent and humane health-care system.
But perhaps even more importantly, the debate over sustainability is a false one. We are going to pay for health care, whether we pay individually or through our taxes. If governments download costs onto citizens in order to make the public system more “sustainable,” we will end up paying more for the same services out of pocket or via private insurance. A few wealthier Canadians would then have better access than the rest of us, and we would be right back where we were before the passage of the Canada Health Act.
What isn’t sustainable is the status quo because Canadians deserve a health-care system that continually gets better. Like everyone who works in the system, doctors are not exempt from the need to change. While doctors play a crucial role in the health-care system, the CMA’s report falls short of recognizing the extent to which we also contribute to our system’s challenges — by ordering too many expensive tests, prescribing medications unnecessarily, contributing to the lack of coordination in the system, and sometimes failing to embrace necessary change when it puts our power or our established ways of doing things at risk.
The CMA’s apparent shift away from privatization, and toward a more constructive dialogue with Canadians about how to improve medicare, will be welcomed by many physicians and our patients. Now that the CMA has recognized that the principles and values of the Canada Health Act provide the most efficient framework for delivering accessible and quality health care, on to the hard work of improving medicare!
Dr. Danielle Martin is chair of Canadian Doctors for Medicare, and Dr. Irfan Dhalla serves on the board of directors.
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