Readers want no part of two-tier medicine – Opinion/letterss – Readers want no part of two-tier medicine
September 06, 2008

Re:Mixed private-public system best for Canadian patients, Comment, Sept. 3

Dr. Robert Ouellet advances the idea that Canada can develop a European-style health-care system with a public-private blend. This fallacy is promoted by politicians and pundits who are enamored of markets as the solution to our problems. But Canada is not Europe, does not have a European-style social welfare establishment, and is party to a trade treaty with the United States. Once commercial health care becomes a commodity in Canada, U.S. corporations will demand entry under NAFTA and the future of our health-care system will be out of our hands, despite Dr. Ouellet’s soothing rhetoric.

Sure, it is frustrating for physicians to face an unresponsive bureaucracy. But because markets and investors demand constant growth, established commercial clinics and health insurance will seek to expand into other areas. Dr. Ouellet is a manifestation of this – he is using his influence as the president of the Canadian Medical Association to advocate for more commercialization of health care. The conflict of interest is glaring and embarrassing to our profession.

Dr. Randall F. White, Vancouver, B.C.

Canadians have a universal, quality health-care system regardless of their ability to pay, and it has served us very well. We are proud of our health-care system. For Dr. Ouellet’s system, look across the border to what’s happening in the U.S.

Rafat Khan, Mississauga

Dr. Ouellet, part owner of a string of private clinics, takes an altruistic stand, saying his only motive is to ease the burden of people waiting six to nine months for a routine MRI. How can anyone actually believe that?

He states 70 per cent of Canadians have some private insurance. So, what about the other 30 per cent? I would suspect this latter number will grow with the rise in the number of part-time and contract jobs replacing traditional ones. These people will not be able to afford private insurance. And, under a two-tier system, the public system would face less funding and greater demand.

Why do we still listen to doctors whose real motive is profit? Dr. Ouellet talks of rhetoric, fear and misinterpretation as keeping down a private-public system, then goes on to use all three to try to prove his theory.

Is this new president of the CMA speaking for all doctors in Canada? Maybe only 30 per cent.

Glen Kerr, Toronto

Dr. Robert Ouellet expressed surprise at what he describes as Canadians’ fear-based opposition to his plan to turn the country’s cherished medicare system into a for-profit model that will give those willing to pay the ability to skip the waiting lines for select medical services. Fear is a completely rational response. Regardless of Dr. Oullet’s intentions to avoid an American style, two-tiered system, rational human beings gravitate toward the best-paying jobs, and doctors are no different.

I believe Dr. Ouellet when he says he does not want to see the public health-care system weakened or destroyed. But as private insurance companies become more deeply involved in the system and the gap grows between public and private salaries, more and more doctors will slide down that slippery slope toward for-profit medical clinics, leaving our public system understaffed and under-skilled.

I agree the current medical system has its flaws. But I fear a solution that may mean one day having to sell my home to pay for an unexpected medical emergency.

Arthur Malane, Toronto

We completely agree that the health-care debate should not be based on ideology. All experiences, European included, point to the superiority of a publicly funded, financed and delivered health-care system, yet whenever the evidence is presented to health-care profiteers, it is dismissed as ideological rather than debated.

Dr. Ouellet calls for competition among hospitals. The National Health System in the U.K. has shifted to patient-focused funding for some hospitals. The CMA’s British counterpart, the BMA, as reported in the British Medical Association Journal, unanimously passed a motion against expanding patient-based funding for hospitals, asking for more emphasis on collaboration as opposed to competition.

Dr. Ouellet also claims that Canada does not offer value for money in health care. Canada is not, as he said, 30th in the world in terms of results measured by monies invested. This figure is from a widely discredited World Health Organization (WHO) study that ranked Colombia first in fairness of financing and the United Arab Emirates first in responsiveness.

Dr. Ouellet calls for boldness in terms of breaking up the monopoly of funding for doctors and hospitals in Canada. Medicare was and still is the boldest idea around. It is the only way to achieve equal access and ensure a high standard of care.

Linda Silas, President, Canadian Federation of Nurses Unions

Dr. Robert Ouellett is right about one thing – we should indeed be “open-minded” about how best to protect and strengthen our public health-care system.

Our trade agreements and increasing economic and social integration with the U.S. obliterate the fanciful notion – designed to distract – that we can “look to Europe.” This is a familiar and sly gambit of pro-privatization forces in Canada who are desperate to move the debate away from the disaster of U.S. health-care policy and toward European health-care policy. They have correctly recognized that the Canadian public wants nothing to do with U.S. health care.

Ouellett criticizes global hospital funding, but the reality is that the privatized U.S. system adds huge administrative costs for pricing hospital services. Indeed, administrative costs are killing U.S. health care. We can’t afford that (and neither can the U.S.).

“Open-minded” individuals will be able to tell the difference between European fallacy and American fact. So let’s contrast apples with apples, shall we?

Let the “open-minded” debate begin!

Sid Ryan, President, Canadian Union of Public Employees, Ontario

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