No time to give up on health care principles

NationalPost.com – Full Comment Canadian politics – Counterpoint: No time to give up on health care principles
Posted: April 10, 2009

A response to:  The biggest hindrance to better health care is our own illusions

Although we agree with Dr. Keith Martin, Member of Parliament from BC, that Canadian health care needs to be improved, there is no evidence to support his assertion that more private competition is the best solution. In fact, Europe has produced much evidence to the contrary.

Governments in Canada spend less on health care than most European countries. Dr. Martin’s comment that Canada spends more on health care than the average European country, although true, is misleading because the private sector in Canada spends more on health care than in many European countries according to the OECD.

Dr. Martin glosses over debates raging in many European countries about the integration of private and public services. For example, in one of France’s national newspapers, three doctors recently pointed out that increased competition in the hospital sector has resulted in exorbitant extra-billing. According to a French official equivalent to our auditor-general, the extra-billing has reached €2 billion (C$3.3 billion) a year. In Paris, it is common to have to pay €500 to €1,000 (C$817 to C$1,634) for cataract surgery, whereas for a hip replacement it’s €3,000 (C$4,902) for the surgeon and another €1,000 (C$1,634) for the anaesthesiologist.  Documents filed by the government of British Columbia during the court case with owners of private for-profit clinics reveal that extra-billing will also be part of Canada’s future if there is increased private-sector involvement in health care.

In Britain, the British Medical Association has been lobbying the government for less, not more competition, and instead for more collaboration in healthcare. A committee of the British House of Commons concluded in 2006 that for-profit surgical centres had not improved capacity and did not offer more efficiency or better “value for money” than the public sector.

We should all be wary of selective comparisons to other countries that are devoid of context. European countries are geographically much smaller than ours, with much greater population densities. Their social safety nets are tightly woven, income taxes are higher and health-care professionals are usually paid significantly less than their Canadian counterparts. Many European doctors are salaried rather than receiving fee for service. Is a lesson we should learn from Europe, then, that we should have higher income taxes and lower pay for doctors?

Dr. Martin also argues that allowing more for-profit health care in Canada would not result in a U.S.-style system: in the United States over 10% of the population is without adequate insurance, medical costs have driven up the rate of personal bankruptcies and produced higher overall costs for the health system. Canadian for-profit health care, specifically dental care and pharmaceuticals, shows numbers comparable to that in the United States. Approximately 10% of Canadians are uninsured or underinsured in these areas. Bankruptcy laws differ in Canada and the United States, but a recent report by the Canadian Health Coalition entitled Life Before Pharmacare documented cases of Canadians facing bankruptcy because of drug costs. Public health-care spending in Canada has remained relatively stable, but for-profit spending is exponentially increasing. 

Furthermore, our politicians would do well to remember that Canada is next door to the United States, not Europe. We have free-trade agreements with the United States that would ensure that the U.S. health-care industry would be a major player in a competitive hospital sector. To suggest that Canada can implement for-profit healthcare markets without involving American corporations is naïve at best and disingenuous at worst.

We all know that Canadian healthcare is far from perfect. Dr. Martin is right to push for change, but we strongly disagree with his prescription. More for-profit health care is not the lesson to draw from Europe. Instead we should learn about European public pharmacare programs, the greater number of doctors and nurses per capita, the greater integration of care across the continuum of care, the better use of many technologies and the focus on the social determinants of health. None of these solutions require further integration of commercial care into our system – many of them require the opposite.

We must also explore made-in-Canada solutions. There have been successful efforts across the country to reduce wait times and lower costs. These need to be replicated on a larger scale.

The evidence in Canada, Europe and the United States shows that it is within the publicly funded not-for-profit health system that Canadians get the best value for money. Let’s stick with evidence-based solutions that will benefit all Canadians, not just those who can afford to pay. 

Linda Silas, President, Canadian Federation of Nurses Unions, Kaaren Neufeld, President Canadian Nurses Association for Nurses for Medicare, and Dr. Danielle Martin, chair, Canadian Doctors for Medicare.

National Post

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