World has judged universal care lacking, Bliss argues

NationalPost.com – News/Canada
Thursday, Nov. 18, 2010.    Tom Blackwell, National Post

It is time to end universal health-care coverage and focus government-subsidized tax services only on the needy, a prominent social scientist suggests in a provocative new analysis for the C.D. Howe Institute of the health-care system and its growing financial demands.

Michael Bliss, a historian at the University of Toronto, urged that governments do to medicare what they did to the baby bonus and old-age pension more than two decades ago—make it a social program primarily benefiting lower-income Canadians, though still funded by all.

“Why should government continue to pay for the health care of the well-to-do?” he asked in a lecture on Wednesday, a text of which was released Thursday. “Why should the state pay for the banker’s coronary bypass, the retired hockey player’s hip replacement, elbow reconstructions for the ladies who lunch, and so on,” said the academic. “Does the state entitle everyone to all the health care they need, or does it entitle the economically needy to the benefits of modern health care?”

Prof. Bliss acknowledged in an interview he did not have a detailed plan of how to do away with universality. But he suggested it could be achieved through requiring wealthier users to pay for some of their care out of pocket, making health services a taxable benefit for higher-income people, or simply having a separate health tax that exacted more of the revenue from those in the top brackets.

He also argued in the lecture that the burgeoning price tag for health care is a largely unavoidable result of “magnificent” advances in medicine, and that the government’s monopoly on medical services should give way to more competition from the private sector.

The swelling chunk of provincial budgets spent on health care, and the expectation of even higher costs to treat the aging population, is drawing increasing attention lately.

Even the Organization for Economic Co-operation and Development suggested recently that Canada’s existing health system is not sustainable.

But Prof. Bliss’s call to end universality — the notion that all Canadians have equal access to a government service regardless of income — fell flat with some health-policy experts Thursday.

In fact, analysts noted, the wealthy already pay much more than poorer Canadians for health care through the country’s progressive income tax system, where the rate of taxation rises with income levels.

Nadeem Esmail, a research fellow with the conservative Fraser Institute think-tank, recently calculated the approximate sums people contribute to health through their income taxes.

The amounts, based on the proportion of provincial budgets poured into medicare, ranged from $2,300 a year for someone earning $34,000, to $32,000 a year for a person pulling in $230,000.

The way to make health care more affordable is through improving efficiency and competition within the universal public system and opening up a parallel private medical sector to absorb some of the demand, as most European countries do, he said.

“The problems with medicare do not stem from universality,” he said. “The question is how do you deliver universality properly.”

John Sproule, policy director of the Institute for Health Economics in Edmonton, said it could be tricky to force wealthy Canadians to pay for health services when they are already funding medicare heavily through taxes, especially in cases where their ailments were not preventable.

“What if my family has a history of diabetes, what if I have a genetic disorder?” he asked. “What if there is an outbreak of communicable disease in my city? … It gets very complicated around the fairness of asking people to pay.”

Mr. Sproule said the most equitable way to increase the funding of health care would be simply to push up income taxes, but he suggested that there is ample scope to make the system more cost-effective within current budgets.

Prof. Bliss suggested in his lecture that the world had passed judgment on Canada’s single-tier, government-funded health system, unique among industrialized countries in generally not permitting private medicine.

“In the eyes of the world, Cuba and North Korea perhaps excepted, Canadian medicare is not a model.”

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